Mental Health in Somaliland

This semester, my working group and I have been collaborating with Fatumo Abdi Abdillahi, and a student panel of “mental health ambassadors” in Somaliland. Before I became a part of this group, I knew very little about Somaliland as a place, and nothing about the mental health of its people.

As an introduction to Somaliland, and the current mental health crisis that exists there, my group was given a comprehensive article Mental Health in Somaliland: a critical situation written by Fatumo and her colleagues (Edna Adan Ismail and Swaran P. Singh). I decided to write my review on this article, because I found that it really helped familiarize me with Somaliland as a place, and the people who live there.

This article seems to serve two purposes:

1 — to introduce global health communities to Somaliland

2 — a call to action to help them in their goal to assist Somaliland in developing mental health services, policies, infrastructure, capacity building for frontline workers, and delivery of mental healthcare that is patient centered and culturally aligned.

The article opens by orienting the reader with where Somaliland is in the world, and what it is — an independent nation on the horn of Africa that gained independence from Somalia after two civil wars that took place in the 80’s and 90’s. The authors make a point to clarify that, despite its current struggles, Somaliland is considered an African success story, as a nation that was able to independently initiate and sustain peace, democratic elections, and that provides sanctuary for people fleeing neighboring areas (Yemen, Syria, Ethiopia, and Somalia).

The reader is then brought through the determinants of the mental health disorders in the region. Meaning — the reason why so many people are struggling with mental disorders is better contextualized. The “why” is closely linked to the aforementioned civil wars, poverty, scarce resources, harsh droughts, and high use of a local amphetamine-based leaf called “khat,” and unemployment. There is also a significant amount of stigma associated with mental health in Somaliland because, culturally, mental health isn’t perceived as being on a spectrum, it’s an “either, or” situation. Either a person is “mad” or they are not. Because of that stigma, people suffering from a range of mental health disorders, as well as the professionals trying to help them, have been treated unfairly at best and abused at worse.

There are 5 mental health departments, all within hospitals, located in principal towns, with very few beds available for in-patient services. There are outpatient services available, but because Somaliland is so rural, it is difficult to assess and maintain contact with patients. This leads to high rates of relapse, and allows illnesses to progress. There is also a general lack of mental health professionals within the facilities that do exist, because of the same cultural stigma that people suffering from mental health issues face. That stigma leads to mental health professionals not being treated with the same respect as other healthcare professionals, as well as few opportunities for growth and career progression.

As a result, a majority of mental health treatment either takes place un unregulated private facilities, or within the home, which is where instances of abuse most often occurs. This abuse may be verbal or emotional, but there have been many instances of physical abuse as well, including patients (including children) being chained for months or years at a time.

The article ends with a section entitled Moving Forward which underlines the ways to address and improve the current situation using an international, multidisciplinary approach, and determining meaningful ways to donate to the nation.

Overall, I think it was a great article that made an incredibly complicated situation accessible to the reader. It was concise, well researched, and is an important starting point for anyone interested in doing work with Somaliland.