Improving Access to Mental Health Care and Psychosocial Support within a Fragile Context: A Case Study from Afghanistan

While American service men and women are being treated for war related traumas, let us not forget the effects of war on civilians…

From the PLos Absract 

• After the fall of the Taliban, the rebuilding of the Afghan health care system, from scratch, provided opportunities to integrate mental health into basic health services through the use of funds that became available during this complex humanitarian emergency.
• Practice-oriented mental health trainings for general health workers and ongoing clinical supervision in the basic health care system led to substantially increased demand for and access to basic mental health care services.
• Treatment of mental disorders within the health care system needs to be accompanied by a community-based approach that focuses on psychosocial problems.
• Addressing service delivery needs in a fragile state has to be accompanied by capacity building and policy development in order to foster structural changes within the health care system.

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Looking to the Future

The experience in Nangarhar shows that, even within a fragile and resource poor context, it is possible to develop integrated services for mental health and psychosocial support, to rapidly cover an area of more than a million people. It is important to use funds available during a humanitarian emergency to pursue lasting improvements in the health care system [28]. There is an urgent need to develop a system of routine outcome measuring tools that includes both symptom reduction and improvement of social functioning. It is challenging to develop context-specific and low-cost outcome measures, but recent evidence for child psychosocial programmes in post conflict areas demonstrates that it can be done [29]. People with a limited background in mental health care can deliver integrated services, once their tasks are integrated within a system of care that includes focused, competency-based trainings, regular supervision, and refresher training [30]. It is important to strengthen the psychosocial elements of treatment within the health care system, and to ensure that the social context in which the symptoms occur and are maintained, are considered in the treatment plans of health care providers. The most recent version of the BPHS includes the addition of psychosocial counsellors at the district hospitals and comprehensive health centres. Preliminary evidence on the effectiveness of adding psychosocial counselling in primary health care settings in Afghanistan is encouraging [31] Apart from health system–based interventions, the authors have learned the importance of addressing psychosocial problems through activities outside the formal health care sector to strengthen self-help and foster resilience.

Related articles

• Community and health system approaches improves mental health in Afghanistan (eurekalert.org)
• Community and health system approaches improves mental health in Afghanistan (medicalxpress.com)
• Providing psychosocial assessment and support for migrants: A critical urge (icmhd.wordpress.com)
• Combatting Mental Illness Stigma in Society (psychcentral.com)
• Adolescent Suicide Prompts Look at Mental Health System: Ontario, Canada (jeanettebartha.wordpress.com)

• PTSD outcomes improve as US Army adds behavioral health screening to primary care (EurekAlert)