Blog 3: Child and Adolescent Global Mental Health.

When designing a mental health intervention for adolescents, Rachit retold the story of when he worked on a project for the StrongMinds company in Uganda. He claimed that the client was worried about two particular things for the adolescents: absenteeism and drop-outs. In Uganda, about 21% of adolescents school-age were reported to have depressive symptoms. First, they asked the adolescents to draw a picture of the relationships in their house (i.e., several students drew their father outside the house while their mother and their siblings were drawn inside the house, omitting family members from the drawings, etc). I consider that this exercise could be helpful when designing a teacher intervention for the Navajo community; perhaps by expressing themselves through drawing, the Navajo children and adolescents could inform the teachers of their inner struggles and pains, as they navigate life and the consequences of a dominant regime that once colonized the indigenous lands. Additionally, the issue with the Ugandan children that arose was that they were intimidated by possibly being punished and did not initially give honest responses when tested with the PHQ9; this is also an issue that needs to be considered and paid attention to when considering the mental health of Navajo youth — how trusting and safe would they actually feel with their current teachers in order to give honest answers if they were tested on such a scale. Eventually, in the Uganda case, all students favored what turned out to be group therapy sessions, revealing their value. Additionally, there was a stark difference between what the teachers thought were the problems of the adolescents, and what were their real problems. This is also something to consider in the Navajo case. There is also a lot of shame and stigma regarding seeking therapy services. For this particular program that Richat shared about, the challenges included the lack of tools for psychoeducation, parental component, integrity with school curriculum, short attention span, mobilization, time allocation, trust and confidentiality, etc. They really struggled with the icebreakers with the Ugandan adolescents as they were initially very quiet; they didn't want to share their challenges with the people that they knew. What helped was to create imaginary stories of different adolescents and their challenges, and ask these adolescents what advice would they give them. By polishing the stories down to 8 narratives everyone could relate to, that helped the adolescents engage a lot more. The bead exercise where they were asked “why did you choose this bead?” also worked extremely well and helped students open up a lot more, which could also be implemented when attempting to bond the Navajo students and teachers. Rachit also mentions the importance of observation. When answering the question of how Rachit was able to “enter” the community, he explained that it was very important to create the sense that he is one of them as he was participating in all the same exercises and sharing personal things about himself as well; solely asking the students to share themselves did not work. They did not have a lot of resistance from the students' caretakers because unfortunately, Richat explained that they “do not care” once their children are out of the house in the morning.

An important point was that Rachit was designing the assessment tool with the help of the audience; that way understanding the behaviors, practices, and attitudes of the target community. Richat advises starting “very small”. He also describes the importance of the relationships with pharmacies, where people go for medication of physical symptoms when pharmacists admit that those are most likely psychological issues. Also, an interesting finding was that in Jordan between 40–60% of people turn to their family as the first point of contact during times of distress; thus, the importance of the PFA trained non-specialists. The power of storytelling helps connect people with one another. Richat explains that the role of the designer is to bring people from the unknown to the known through conflicts, to bring down the existing barriers that prevent people from going to that space.