Global Mental Health Inside Stories: Dr. Wais Aria, Kabul, Afghanistan

picTabishWaisAriaThis is the third post in the Global Mental Health Inside Stories. In this series I want to collect and spread information/ideas from people active in mental health from all over the world and specially from low resource settings or fragile countries.
I hope this series contributes to more insight in the challenges and wishes from people active in these settings and adds to a more bottom up movement in global mental health.
Dr. Wais Aria’s answers on 10 interview questions are as follows:

Work location and some background information:
picLogoTabishOfficialI’m the Executive Director of Tabish Organization in Kabul, Afghanistan. Tabish was established by a group of intellectual Afghans thoughtful about their country in 2007 to offer services to their extent to the needy country people, particularly women’s, children, disables and other traumatized people
I have a medical and psychosocial background for five years, but I’m currently working in the field of mental health.

Brief country profile:
Afghanistan is an Islamic country, with a population of around 35 million people. It is a landlocked country bordered by Pakistan in the south and the east, Iran in the west, Turkmenistan, Uzbekistan and Tajikistan in the north, and China in the far northeast.
Three decades of war made Afghanistan one of the world’s most dangerous and traumatized countries, including the largest producer of refugees and asylum seekers. While the international community tries to help rebuild war-torn Afghanistan, terrorist groups are actively involved in a nationwide Taliban-led insurgency, which includes hundreds of assassinations and suicide attacks.
picTabishCountryMapAbout 42% of the population of the country lives below the international poverty line which means living on less than U.S. $1.25 a day and about a little over 70% of the population is still illiterate. According to the Human Development Index, Afghanistan is the 15th least developed country in the world. The average life expectancy was estimated in 2012 to be 49.72 years (information from wikipedia)
Mental Health figures: Epidemiological surveys in Afghanistan found high rates of self-reported symptoms of depression, anxiety, and post-traumatic stress, particularly among women and girls. Findings, for instance, in a 2002 survey were: symptoms of depression 67.7% of respondents, symptoms of anxiety in 72.2%, and post-traumatic stress disorder (PTSD) in 42%.
There is no reliable data on the prevalence of severe mental health problems in Afghanistan, but, in general, it is estimated that the prevalence of severe mental disorder may rise 50% after emergencies.(information from a Plos article 2012).

Overview of work activities:
Currently I’m active in the NGO called Tabish, Social health Education organization (TSHEO). This is one of the organizations in Afghanistan active in the field of mental health.
Our services include psychotherapy for children in prison, psychosocial services for survivors of GBV (gender based violence), community based primary education, community mobilization and empowerment, group counseling in IDP (internal displaced persons) camp, CBT (cognitive behavioral therapy) with political and armed conflict children, emergency mobile services for victimized of trauma and capacity building for other organization in the field of mental health and psychosocial support.
picTabishboysThe Tabish approach is compatible with the public mental health model used in the Inter Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings. As the Guidelines state, “people are affected in different ways and require different kinds of supports. A key to organizing … psychosocial support is to develop a layered system of complementary support that meets the needs of different groups.”
Within Tabish this is organized as follows:
Level 1: Environment building and providing basic services. Tabish coordinates with partners and other local organizations, conducts orientations and psycho-education for families, communities, and front-line workers aimed at identifying and referring those needing services, and establishes social support groups (youth, parents, women, etc).
Level 2: Reinforcing community and family support. Tabish provides training, supervision and mentoring to build the capacity of community members and frontline workers to undertake screening and provide effective short-term support to individuals and families needing basic emotional support.
Level 3: Non-specialized community based support. Through teams of Community and Classroom-Based Psychosocial Workers and Psychosocial Counselors, Tabish provides services for more vulnerable individuals and families through targeted interventions including: screening/assessment of those needing counseling, therapeutic group work, individual, family and group counseling, structured group interventions (e.g. class-room based intervention for vulnerable children; self-help groups for recovering addicts etc.)
Level 4: Specialized services. Tabish conducts in-depth assessments and establishes a referral mechanism for those in need of specialized mental health/psychiatric care.

The main challenges personally in work/study/life:
Within my personal live, the main challenges are the lack of professional education in the field of mental health (like a diploma, or other degree), security, and other social problems.

The main challenges for the organization(s)/colleagues/clients:
picTabishbannerLack of international advisers for refresh trainings and other capacity building.
A culture in which people find it difficult to accept counseling.
A shortage of funding.
Not able to participate enough in international workshops and conferences, etc.

The main challenges for the country regarding mental health care:
Lack of national and international expertise. Lack of knowledge in the people regarding the importance of mental health. ‘Low culture’, especially regarding the position of women; they are sometimes not allowed to use mental health support.

What should be changed in mental health care on a local or national level:
More advocacy, more capacity building regarding mental health in the community. Raising awareness.

What is the right direction for the global mental health movements:
To be honest at this very moment the big global organizations like the UN and the WHO are not very useful for us. I prefer other, mostly smaller organizations, like for instance an organization from Sweden with whom we are currently cooperating.
picTabishgirls

What can ICT, mhealth and e-learning contribute to mental health care:
Yes, this could be an option, but in my country Afghanistan many people are still illiterate. In the mean time the people are poor and don’t have access to ICT yet. That’s why local awareness is much better.

Other links and contact information:
Tabish website
Tabish on Facebook
Wais Aria on Facebook
mail address Tabish: Tabish_organization@yahoo.com
mail address Wais Aria: aria_popal@hotmail.com
Skype: wais.aria1
Post box: Kabul Afghanistan 5661

With many thanks to Wias Aria!
Roos Korste, psychologist, international trainer and blogger.

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