Grief and trauma counselling and psycho-social support : Perspectives in a changing society.

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PRESENTED DURING: THE AART OF LIFE INTERNATIONAL TRAUMA CONFERENCE AT THE UNITED STATES INTERNATIONAL UNIVERSITY NAIROBI, KENYA 26 TH – 27 TH AUGUST 2015

Transcript of Grief and trauma counselling and psycho-social support : Perspectives in a changing society.

Grief and trauma counselling and psycho-social support : Perspectives in a changing society DAVID M. NDETEI MBChB (Nrb), DPM (London), MRCPsych. (UK), FRCPsych. (UK), MD (Nrb), DSc (Nrb), Certificate in Psychotherapy (London) Professor of Psychiatry, University of Nairobi (UoN) Founding Director, Africa Mental Health Foundation (AMHF) Faculty and Collaborator, The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA Chair, African Division of the Royal College of Psychiatrists Zone 14 Representative, World Psychiatric Association Website:/ PRESENTED DURING: THE AART OF LIFE INTERNATIONAL TRAUMA CONFERENCE AT THE UNITED STATES INTERNATIONAL UNIVERSITY NAIROBI, KENYA 26 TH 27 TH AUGUST 2015 INTRODUCTION Human beings have lived with the threat of violence, injury and death throughout history. We expect therefore that there are mechanisms available to help us adapt to threats that do not destroy us. When threats are more severe and inescapable, other mechanisms come into play, including dissociation, and aggravated psychiatric conditions Problems linked to trauma are grief and other forms of reactive distress, depressive and anxiety disorders, and post- traumatic stress disorder (PTSD). How does trauma occur? It happened unexpectedly. You were unprepared for it. You felt powerless to prevent it. It happened repeatedly. Someone was intentionally cruel. It happened in childhood. Emotional and psychological trauma can be caused by single- blow, one-time events, such as divorce, a horrible accident, a natural disaster, rape, or a violent attack. Trauma can also stem from ongoing, relentless stress, such as living in a crime-ridden neighbourhood or struggling with cancer. Commonly overlooked causes of emotional and psychological trauma Falls or sports injuries Surgery (especially in the first 3 years of life) The sudden death of someone close A car accident The breakup of a significant relationship A humiliating or deeply disappointing experience The discovery of a life-threatening illness or disabling condition Risk factors that increase occurrence of trauma (Megan et al 2007) GroupIncrease occurrenceDecrease occurrence 1Medical personnel, disaster personnel, fire fighter, police men, military Long exposure during work hours Training improves resilience and self efficacy. 2General populationLack of mental health care services Delayed reporting/ lack of awareness/ stigma/culture (association with spirits) Availability of mental health care services and policies, prompt reporting/increased awareness, treatment options 3General populationHistory of PTSDImproved Psycho-social support 4General populationLack of social supportImproved social support 5Children (Pine and Cohen 2001) Level of exposure & psychopathology Improved Psycho-social support World statistics of trauma (WHO) NoCountryGroupPercentage 1 United statesCivilians7-8 % 2 GeneralWar veterans30% 3 United statesHigh school students 3-6% 4 PakistanWomen refugees 86% 5 UKFemale rape victims 45% 6 Cambodiacivilians3% 7 Across the worldRefugees10% 8 MexicoEarthquake victims 50% Trauma and violent conflict in Africa (contd.) Violent conflict, is perhaps one of the most widespread cause of enduring trauma on the continent In Kenya, my home country, we as a nation have been exposed to trauma as a result of violent conflict from the trauma of World War I and II where many Kenyans were conscripted to fight, one of them being my late father, witnessing and participating in the atrocities of war. Kenyas struggle for independence the Mau Mau war in the 1950s also left its own enduring mark of trauma among the population. In 2005, about 45 years after the end of that war, a student of mine did a study on Mau Mau detention camp survivors, the veterans of that war, and found that a diagnosis of current Post Traumatic Stress Disorder (PTSD) was evident in 65.7% of the 181 survivors who participated in the study. Trauma and violent conflict in Africa After independence Kenya had other various incidences of armed conflict such as the Shifta war in North Eastern Kenya and the not too infrequent tribal clashes. Most recently, the threat of terrorism has constantly been at our doorstep. Since the 1998 bombing of the American Embassy and two years ago, the mass shooting at the Westgate Mall, not to mention the Garissa University attack. Unfortunately such events are not unique to Kenya alone, but can be seen in many other African countries and others around the world. Emotional and psychological Shock, denial, or disbelief Anger, irritability, mood swings Guilt, shame, self-blame Feeling sad or hopeless Confusion, difficulty concentrating Anxiety and fear Withdrawing from others Feeling disconnected or numb Symptoms of trauma Physical Insomnia or nightmares Being startled easily Racing heartbeat Aches and pains Fatigue Difficulty concentrating Edginess and agitation Muscle tension Symptoms of trauma (Contd.) TRAUMA RELATED WORK TRAUMA RELATED WORK In my work, I have been involved in various efforts for trauma interventions following armed conflict and violence such as: The development and execution the Psychotrauma Programme (module) for the Rwanda Genocide ( ) Development of a training programme for political refugees in Dadaab Camp in North Eastern Province Development of a training programme for counsellors following the terrorist bombing of the American Embassy in Nairobi in 1998 Training and providing counselling and psychiatric services to survivors of the 1998 bombing of the American Embassy, the 2007/08 post- election violence and even more recently, the students of Garissa University. AFRICA MENTAL HEALTH FOUNDATION (AMHF) Founded in 2004 to break away from silos of individual institutions (public and private) and different professions in order to bring them together under one roof. AMHF brings together the widest possible spectrum of professionals with something to contribute to mental health solutions and enhanced mental health wellbeing These include: psychiatrists, clinical and counselling psychologists, social scientists, economists, human rights activists and people living with mental disorders all supported by a group of research staff experienced in research management, proposal writing, grant management, communication etc. TRAUMA RESEARCH BY AMHF AMHF has over the years conducted studies on trauma such as: The psychological effects of the Nairobi US embassy bomb blast on pregnant women and their children. A mental health needs assessment of Somali urban refugees in Eastleigh estate in Nairobi, Kenya. Traumatic grief in Kenyan bereaved parents following the Kyanguli School fire tragedy Traumatic experiences of Kenyan secondary school students TRAUMA: EVIDENCE FROM RESEARCH IN KENYA I will now take a few moments to share with you some of the findings of the studies we have done and what these results tell us about trauma interventions and what we should be looking to. As I have limited time, I will only give the overview of the conduct of the studies and the results. Detailed information and data is available through the various published papers. However, all proper scientific process and ethical considerations were followed in the conduct of each study. THE PSYCHOLOGICAL EFFECTS OF THE NAIROBI US EMBASSY BOMB BLAST ON PREGNANT WOMEN AND THEIR CHILDREN We carried out a descriptive study in pregnant women who were affected by the bomb blast occurring in Nairobi, Kenya on August 7, 1998 and their babies who were in utero at the time of the blast and contrasted the results to a control sample of similar pregnant women who had no history of trauma Both quantitative and qualitative data was collected using their medical records and a socio-demographic questionnaire, the Impact of Event Scale Revised (IES-R) (6), the Childhood Personality Scale (CPS) (7) and Focus Group Discussions. SIGNIFICANT RESULTS: The psychological effects of the disastrous event on exposed women, as assessed by the IES-R, were severe. There were significant improvements after three years in hyperarousal and re- experiencing subscales, but the average score on IES-R was still higher than 29 for the three subscales combined, suggesting that most of the study group was still suffering from clinical PTSD, although they reported they had found counseling helpful. The scores on all CPS subscales were significantly higher in children of the study group than in controls. Despite the perceived benefits of interventions limited effects on the intensity of PTSD were demonstrated in exposed mothers three years after the event, which emphasizes the need to evaluate psychological interventions for trauma victims with a view to making them more effective and culturally appropriate. THE PSYCHOLOGICAL EFFECTS OF THE NAIROBI US EMBASSY BOMB BLAST ON PREGNANT WOMEN AND THEIR CHILDREN (contd.) The purpose of this study was to highlight the prevalence of mental illness among Somali refugees in Nairobi and their ability to access mental health services. The tools used were the Mini International Neuro- psychiatric Interview (MINI plus and MINI kid) which were translated into Somali language. A MENTAL HEALTH NEEDS ASSESSMENT OF SOMALI URBAN REFUGEES IN EASTLEIGH ESTATE IN NAIROBI, KENYA SIGNIFICANT RESULTS: PTSD was significantly associated with: depression (p=0.001), bipolar mood disorder (0.021), OCD (0.012), alcohol abuse (