Improving Mental Health and Psycho Social Support in the most vulnerable country to natural disasters in the world

In January 2020 it was reported that a woman had committed suicide in Teouma, just outside the capital of Port Vila, Vanuatu. This time the media coverage was brief and factual, unlike the media coverage of the school student who had committed suicide in Santo in October 2018. Since then, many of us in the media have understood our responsibility to cover these issues with consideration of the deceased, his/her bereaving family and friends, as well as with sensitivity to those who may be reading the story and are seeking help themselves.

For a country that has twice been voted the Happiest Country on Earth and for people who were praised for their ‘resilience’ after the horrors of TC Pam in 2015, mental health and suicide is still a contentious topic in Vanuatu. When Vered Amitzi, a Mental Health and Psycho Social Support (MHPSS) specialist at IsraAid, first came to Vanuatu, she says that there was a stigma around the word ‘mental health’, even among healthcare practitioners.

“Many people just assumed that mental health was equal to psychosis – and this meant that person was crazy, or out of control or doing things that they were not aware of. The general consensus was that this person needed to be locked up. There was little-to-no understanding that psychosis is actually treatable,” says Vered.

To demystify any stigmas about mental health, Vered and her team allocated time in their trainings to have an open discussion about mental health. Most recently, IsraAid trained the Vanuatu Emergency Medical Team (EMT) in Psychological First Aid through a DFAT funded program in partnership with Dr. Basil Leodoro. When the whole island of Ambae became displaced after volcanic disruptions in 2018, IsraAid was deployed with the EMT on one of their first missions to Ambae.

Other stakeholders in IsraAid’s trainings have included the Ministry of Health, Ministry of Youth and Sports, Vanuatu College of Nursing Education, ADRA, Red Cross volunteers, police, correctional service officers, teachers, women’s representatives as well as community members such as chiefs, pastors and their wives.

“In the end of the trainings, people understand how treatable mental health really is and that it includes more than just psychosis – there is hierarchy that encompasses a variety of illnesses, disorders and struggles,” says Vered. “For example, bipolar disorder and schizophrenia are illnesses, while depression, anxiety and post-traumatic stress are disorders. And then you have everyday struggles, which aren’t necessarily a disorder, but can pose significant challenges in life.”

IsraAid – an Israeli based humanitarian aid agency specializing in MHPSS

IsraAid first came to Vanuatu after late President Lonsdale appealed for global support in response to TC Pam, a category 5 cyclone, in March 2015. IsraAid, an Israeli-based humanitarian aid agency that responds to emergency crises and engages in international development around the world, immediately responded and dispatched an emergency relief team. After the first team ended its visit, another team returned with psychosocial staff and a water engineer.

For Natalie Silvierlieb, the former country director of IsraAid Vanuatu, it was clear that there was a need to focus on building Mental Health and Psycho Social Support infrastructure. “IsraAid has rolled out psychosocial support in all of our programs internationally and it is one of our core areas of expertise,” says Natalie. “The reason being is that we come from a post-traumatised society and we continue to deal with an ongoing crisis. We have developed various skills of coping and resiliency that has translated into theories and tools for psychosocial support. We then use these Israeli-born practices and adapt it to the local context.”

In their work, IsraAid has recognized that psychological first aid in the first 48 hours after a disaster is crucial to building people’s resilience and mitigating the effects of post traumatic stress and situational depression. Given that Vanuatu has been ranked with the highest natural disaster risk in the world, which includes cyclones, earthquakes, volcanic eruptions, landslides and droughts, it has only been since IsraAid’s presence in Vanuatu that Mental Health and Psycho Social Support has been put in the forefront of disaster preparedness and response planning.

IsraAid’s work to promote MHPSSS was acknowledged by Vanuatu’s Caretaker Minister of Internal Affairs, Andrew Napuat, during the State of Israel-Pacific Leaders’ Summit held on Fiji on the 20 February in 2020. Minister Napuat thanked IsraAid for their contributions in his remarks to Israeli President, Reuven Rivlin.

Working with the Mind Care Unit to develop informed and capable mental health referral chains

Shortly after TC Pam in 2015, IsraAid began working with the Ministry of Health. IsraAid designed the workshops with the Mind Care Unit, the country’s only clinical psychiatric service based in Vila Central Central Hospital, to ensure the long-term sustainability of the project.

The Mind Care Unit had only been established in 2014 and today their specialized team consists of one trained psychiatrist, Dr. Jimmy Obed, one qualified psychiatric nurse, Norah Simon, and three other nurses, with the Nurse in Charge, Lawrence Hinge holding a certificate in Mental Health Nursing. The Mind Care Unit has the capacity to admit two patients in the unit at a time, sees patients on a daily basis and does a community outreach every Tuesday. They are supported by an Australian volunteer, Dr. Damon Ashworth, who is assigned to assist with the implementation of Vanuatu’s four-year Mental Health and Strategic Policy plan (2016-2020)

To address the reality that most of the 83 islands do not have basic mental health infrastructure, one of IsraAid’s approach is to have an interwoven network that tackles different layers of leadership that includes health care providers, public service providers and community leaders such as chiefs, pastors and their wives.

“We weave in different layers of leadership so that during times of an emergency, people who have been through our training are able to provide the initial psychosocial first aid,” says Natalie. “For example, a wife of a pastor can provide basic exercises and coping mechanisms to support people in her community.”

Natalie explains how they have observed people being stressed out because they are experiencing a drought and have no crops to sell or feed their family. The stress, worry and lack of sleep can form into perpetual migraines and the person will then go into a clinic for treatment. The health worker at the clinic, who is not trained in mental health and psychosocial support, does not realize the migraine is stress induced and prescribes medication.

“This leads to an influx of people overloading an under resourced clinic and getting prescribed medication by overworked staff, who don’t realize the root of the migraine is stress-related,” Natalie says. “This issue could be remedied within their own community through a MHPSS intervention. A pastor’s wife, given her status in the community, has that opportunity to engage and can deliver an intervention to prevent the issue from arising and refer cases as needed. You don’t need to be a fully qualified clinician to provide these kind of initial response interventions.”

IsraAid in collaboration with the Mind Care Unit has trained over 240 people across all six provinces with the outcome of educating and forming networks to develop informed and capable mental health referral chains. This initiative was funded by the World Health Organization and co-facilitated by Vered and Dr Jimmy.

The 5-day training includes raising awareness about MHPSS, undertaking real-life simulations with appropriate culture nuances and the development of a community project. The projects are an opportunity for participants to identify what issues affect their community and provide information about the issue while applying what they learnt from the training. These issues include domestic violence, substance abuse and disability rights.

“Mental Health is For Everybody”

“We are still scraping the surface, there is so much more that needs to be done,” says Natalie. “Mental Health and Psycho Social Support is especially important in a country that is the most vulnerable place on the planet for natural disasters.”

Although IsraAid is still operating in Vanuatu, the MHPSS specialist team is no longer here due to a lack of funding. But before she left, Vered developed a MHPSS curriculum for the Vanuatu College of Nursing Education and trained the teachers to teach the curriculum. She immediately found that people were passionate to know more. “The teacher who has adapted the curriculum into her training has told us how students will voluntarily stay longer to continue the discussions,” says Vered. “They will practice what they have learnt and tell her about it the next day. Participants from our own trainings share the same sentiment – they want to know more about MHPSS and want to share it with others.”

Vanuatu is continuing to make small steps towards progressing MHPSS and recognizing that psychological wellbeing is a fundamental component to good health and the resilience of a disaster-prone country. In October 2019, the Vanuatu Christian Council (VCC) officially launched a “Saekososiel Sapot mo Saekolojikal Fes Eid” Manual to address MHPSS in emergency responses.

Since the suicide of the student in Santo, teachers and principals have been encouraged to take their students’ emotional wellbeing more seriously, while some schools, such as Central School, have introduced guidance counsellors.

Although the Mental Health and Strategic Policy plan is coming to an end this year, the Mind Care Unit is committed to improving mental health in Vanuatu and continues to consistently provide vital services despite being under-staffed and under-resourced. They are also strongly advocating to get Vanuatu’s first Mental Health Bill through legislation since 1964 and if it passes, it will mean greater access to funding and better services.

Natalie Silverlieb, who is now back in Israel, is pleased to see that mental health and psychosocial support is continuing to gain momentum in Vanuatu. “I remember at the start of our trainings, we would have discussions addressing some stigmas and perceptions of mental health, and participants would often say that ‘Mental Health is only for crazy people’,” she reflects. “Then a light bulb would click, and they would become more open, and by the end of the training would say they now understand how important this is and that, ‘Mental Health is for everybody.’”

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