Islam Md Manirul, Siyad Abdiwali Ahmed, Malik Sk Md Mamunur Rahman
World Health Organization Country Office, Mogadishu, Somalia.
World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt.
Trop Med Health. 2024 Sep 9;52(1):58. doi: 10.1186/s41182-024-00618-z.
Humanitarian crises increase the risk of mental health problems. Somalia has been affected by conflict, insecurity, and economic turmoil for over three decades, as well as climatic shocks. However, 80-90% of Somalis who have mental health problems do not have access to good-quality, and affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to have a holistic understanding of mental health problems and care in relation to people's perceptions, experiences, and behaviour related to mental health.
We undertook a qualitative study to explore Somalis' perceptions and experiences of mental health problems. We conducted three key informant interviews, two in-depth interviews, nine focus group discussions, 12 observations in private and public health facilities and more than 12 informal discussions. We used case vignettes translated into Somali during our discussion. We also studied three cases with experience of mental health problems to understand care-seeking behaviour and the experiences with services available.
Somalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal support system exists in the community within clans or family relations. Armed conflict often among clans, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental problems is likely greater than is evident. It is perceived that about 95% of people suffering from mental illness remain outside of appropriate care. Few people seek care for mental health problems because they are not aware of it and because it is highly stigmatized and neglected. Those who do seek care usually go to traditional healers because of culture and cost. Resources for mental health care are grossly inadequate with a limited and often poorly trained workforce. At least two levels of barrier to mental health care exist, at the individual/family level (e.g. poor awareness of mental health and stigma) and service provider level (e.g. lack of staff and limited ability to diagnose, treat, or refer persons with mental health problems and stigma). No tool or evidence-based programme is available to address these barriers.
A qualitative data-driven mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health problems, there is also a need for a tool to raise awareness about mental health and the importance of mental health care among both the public and health workers.
人道主义危机增加了出现心理健康问题的风险。索马里受冲突、不安全和经济动荡影响已达三十多年，还遭受气候冲击。然而，80%至90%有心理健康问题的索马里人无法获得优质且负担得起的心理健康护理。为制定一项基于证据、有效、公平且人道的心理健康计划，我们需要全面了解心理健康问题以及与人们对心理健康的认知、经历和行为相关的护理情况。
我们开展了一项定性研究，以探究索马里人对心理健康问题的认知和经历。我们进行了三次关键信息人访谈、两次深度访谈、九次焦点小组讨论、在公共和私人卫生设施进行了12次观察以及12次以上非正式讨论。在讨论过程中，我们使用了翻译成索马里语的病例 vignettes。我们还研究了三个有心理健康问题经历的案例，以了解寻求护理行为以及现有服务的体验。
索马里正从传统的游牧放牧生活方式向定居生活方式转变。在氏族或家庭关系构成的社区中存在强大的非正式支持系统。氏族间经常发生的武装冲突、自然灾害和恰特草的使用是影响心理健康的三个主要因素。心理问题的患病率可能高于明显可见的情况。据认为，约95%患有精神疾病的人未得到适当护理。很少有人因心理健康问题寻求护理，原因是他们对此不了解，且心理健康问题极具污名化且被忽视。那些确实寻求护理的人通常因文化和成本因素而去找传统治疗师。心理健康护理资源严重不足，工作人员有限且往往培训不足。心理健康护理至少存在两个层面的障碍，在个人/家庭层面（例如对心理健康的认识不足和污名化）以及服务提供者层面（例如工作人员短缺以及诊断、治疗或转诊有心理健康问题者的能力有限和污名化）。没有工具或基于证据的计划可解决这些障碍。
需要一个定性数据驱动的心理健康计划来解决所有这些问题，同时需要更多训练有素的心理健康专业人员。鉴于心理健康问题存在污名化，还需要一种工具来提高公众和卫生工作者对心理健康及其护理重要性的认识。
