Mental health in Somalia after decades of humanitarian crises: a qualitative exploration

Abstract

Background Humanitarian crises increase the risk of mental health disorders. 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 a mental illness do not have access to good-quality, affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to understand people’s perceptions, experiences, and behaviour related to mental health. Methods We undertook a qualitative study to explore Somalis’ perceptions and experiences of mental illness. 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 illness to understand care-seeking behaviour and the services available. Results Somalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal health support system exists in the community within clans or family relations. Armed conflict, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental illness is likely greater than is evident. It is perceived that about 10% of people are suffering from mental illness (range < 5–50%) while 95% remain outside of appropriate care. Few people seek care for mental illness, which is highly stigmatized. 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 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 illness and stigma). No tool or programme is available to address these barriers. Conclusion A mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health, 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.