Starting Right: A Psychological Toolbox for Somaliland Adolescents in Schools
Located in the horn of Africa, Somaliland is an unrecognized self-declared de-facto nation with a population estimate of 3.5 million. Hargeisa is the largest city and it serves as the capital of Somaliland. Islam is the dominant religion and most people in Somaliland speak Somali, Arabic, and English language. Since 1800s, Somaliland has been a distinct region with its own culture and language. The region was a British protectorate until 1960 when it gained independence for 5 days and joined Somalia under an Italian rule and this led to a protracted conflict and political instability. Somaliland has witness political instability amidst slow paced socioeconomic trajectory. Access to healthcare, education, employment opportunities, and other public amenities remain constrained. Particularly, for the youthful population, the stress of living in a resource limited environment, the lack of shared socioeconomic opportunities, and intergenerational trauma from over 20 years of conflict may predispose them to adverse mental health outcomes and maladaptive coping mechanisms. Hence, the development and deployment of culturally sensitive mental health programs cannot be overemphasized. Therefore, it is a pleasure to work with Fatumo Osman (Ph.D.) towards designing a tailored innovative mental health awareness campaign and interventions for youth in Somaliland. Currently, the focus of the intervention is targeted towards adolescents in schools. Below is a timeline of some key events that may potentially impact on the mental health outcomes of adolescents in Somaliland.
Inventory of Somaliland Mental Health Stigma
Our group held about five virtual meetings with Fatumo to discuss salient issues concerning how mental health is conceptualized among youth in Somaliland. An analysis of transcripts based on a qualitative interview session between the project lead (Fatumo) and a sample of youth (youth advisory board) reveals that, mental health is perceived predominantly as a dichotomous construct. Thus, a person’s behavior is either “normal” or “abnormal”. Questions such as “What is mental health?”, elicited responses such as “being free from stress”, “not being anxious”, “being able to function effectively in your community”, “not being a burden to the society or others”, and “being someone like us”. For me these responses reveal how the youth advisory board perceived mental health as a positive outcome and hence anything devoid of that is considered as a deviation. Mental health problems were conceptualized from a deficit and disability model by the youth. They indicated that persons with mental health problems exhibit “poor coping mechanism”, “violent behaviors”, “poor grooming” and “an unstable emotional response to stress”.
Majority of the youth advisory board believed that mental health problems manifest in/as somatic symptoms at various parts of the body as shown in Figure 3. Furthermore, they perceived mental health problems to affect individuals irrespective of their sociodemographic background. Persons with mental health problems are stigmatized and discriminated against due to the misconception about mental health among the population in Somaliland. This can impede their search for healthcare providers and may further worsen their conditions. Previous studies conducted in Somaliland found physical and psychological abuse to be associated with elevated risk for depression particularly among older girls than boys. Fortunately, mental health is considered as a preventable and treatable condition when the society, family, and religious leaders offer the needed support to the most vulnerable members in their community.
Healthcare Systems Mapping in Somaliland
Despite the limited number of healthcare facilities in Somaliland, it appears that the few facilities that exist are geographically clustered in specific regions. There are only two psychiatric doctors and less than 100 psychiatric nurses in Somaliland. This implies that most people with mental health problems may experience difficulties in accessing healthcare facilities and healthcare providers. We hope interventions like ours among many others may help to reduce the burden of care and bridge the mental health delivery gap in Somaliland.
As part of efforts to ensure the sustainability of this project, the existing relationship between Amoud University’s Department of Research and Community Services, the Ministry of Health Development, and the project lead would be strengthen. This would help galvanize local support and existing structure towards deploying mental health awareness and intervention to adolescents in schools. Currently, most healthcare interventions in Somaliland are generic in nature without specific focus on adolescents mental health. This is largely due to the budgetary constraints and human resources needed to offer mental health services. Hence, adolescents experiencing diverse forms of mental health problems may resort to social support systems and religious coping strategies which are well documented protective factors to mental health in Somaliland. Also, there are traditional healers who offer psychological support services to people struggling with mental illness in Somaliland. Due to the unregulated nature of the activities of traditional healers in Somaliland and the difficulty in identifying those who are “competent” it is difficult to rely on their services.
Non-Profit Organizations such as Action AID, Save The Children, and THET have over the years provided health assistance to youth in Somaliland. However, these efforts were not specifically designed to address mental health issues that may be confronting the youthful population.
In addition to providing general medical services, hospitals in Somaliland have made significant efforts to incorporate mental health services into their protocols.
Also, religion and culture have been described as the twin pillars in Somaliland. Mental health problems such as depression are often perceived as resulting from lack of devotion to Islam and hence some studies have found religious leaders such as the Imams to be helpful in providing basic psychological counseling to Muslims who experience emotional distress in Somaliland.
This current project attempts to fill in the gap by working with local partners and leveraging on existing structures to deploy culturally sensitive mental health awareness campaign and interventions to adolescents in schools.
Interviews with Youth Advisory Board
Although, we have not interacted with members of the youth advisory board directly, themes from a recent interview transcript between the project lead and the youth advisory suggested they possess as strong sense of resilience. Most of them understood what it means to have a sound mental health versus experiencing psychological distress symptoms. So far, these youth advisory board members are excited to serve as ambassadors to promote mental health awareness among their peers in Somaliland. Since, this is budding project, it also serves as a learning curve for scaling up this project to a larger youthful population in future.
It is exciting to see efforts by young adults such as Asma Dhamac who have dedicated their resource to offer psycho-education to youth in Somaliland in their native language. Youth-led projects like these are sings of hope as these media campaigns reach a wider audience and break any potential communication barrier.
At the moment were are working to develop a mental health awareness campaign for adolescent in Somaliland. This campaign would involve activities that are underpinned by psychological theories of learning, social baseline theory, and play therapy to address depressive symptoms, trauma, and stress resulting from well document risk factors in Somaliland. We hope to deploy these activities during school break periods when the students have free periods for extracurricular activities. We hope to create awareness of mental health symptoms, risk factors, protective factor, and resources available to those at risk. Student would be educated on how mental health problems manifest in school settings and its impact on their academic performance. Additionally, we would focus on incorporating games, story telling, and role playing into these activities. These are proposals and our ideas are still evolving. We hope to come up with a well crafted and culturally tailored intervention as the final product.
