Where Do We Turn for Psychiatric Help When There Are No Resources?

Unless you have received treatment for a mental illness, you may not understand the structure of care within the US. Although mental healthcare in the US is far from perfect, it far exceeds that of undeveloped countries. For example, if you develop a serious mental illness such as schizophrenia, you are likely to have a number of available options for your care. You may see a psychotherapist, a psychologist or a psychiatrist. If you are unable to function or are considered a threat to yourself or others, you will likely be hospitalized in a psychiatric unit. You might need residential care. A team of professionals will become your network of care. The structure of US mental health treatment also includes support groups and crisis hot lines. It is relatively easy to get education on mental health topics in the US.

Now contrast the services that are available in the US with the lack of services in undeveloped countries. For example, the Nebbi District in Uganda, Africa has been undeveloped for 60 years and has recently experienced a 20-year civil war. This war has been particularly brutal. In addition to men, many children and women were abducted or killed. Boys, some as young as four, were forced to become child soldiers and perform acts of terror and violence. Females were victims of sexual assault, some of them becoming child brides for the soldiers. PTSD, Post Traumatic Stress Disorder, is the number one mental health problem in this area. A review of research made mention of lack of mental health services such that a severely mentally ill person was chained to a tree in order to reduce risk of harm to them and others.

To intervene in Nebbi is to establish mental health services for survivors of war. In a war-torn country, infrastructures are weakened or destroyed. There are few mental health counselors and there is one psychiatrist for every 1.3 million people in Uganda. The local hospital is understaffed and probably lacks sufficient training in psychology and lack psychiatric medication. As in the example of a schizophrenic, where do you intervene to get help?

Trauma Rehabilitation After War and Conflict, by Erin Martz offers a framework for intervention as developed by another researcher, Olweean. Some of the interventions he proposes are brief therapy for individuals; creating peer-run volunteer support groups; crisis phone lines and drop-in centers; triage of needs and assessment of available community resources; stress management education; training of counselors and para-professionals; general education about trauma and psychological health; and the development of library/resource centers. These interventions provide a protective membrane as a first step towards a more stable infrastructure.

If you are struggling with mental health issues of any kind in the US, there is help for you. It is a sad reality that others are not so fortunate. I am grateful for the advanced care available in our society.

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