Mental Health in Somaliland: a critical situation

Abstract

Somaliland is experiencing an explosion of mental health problems that has received little coverage. The country has experienced devastating civil wars that have resulted in widespread trauma, and the lack of necessary mental health infrastructure is an obstacle to allowing the population to heal and recover. War trauma, poverty, unemployment and widespread substance misuse (khat) have all negatively affected the mental health of its citizens. This report provides an overview of a rapid needs assessment carried out across Somaliland that examined current service provision, gaps in services, and interviews with mental health professionals and caregivers.

Mental health crisis in Somalia: a review and a way forward

“…Since 2009, the self-declared independent Somaliland expanded its mental health services across five main cities: Hargeisa, Berbera, Borama, Gabiley and Burao. In total the bed capacity increased to 250 for a population of 4 million [ 4 , 27 ]. Whereas across the rest of the country, psychiatric units within general hospitals have been established in Puntland (Bosaso) and South Central (Mogadishu, Baidoa and Beledweyne) but the bed ratio remains one of the lowest globally.…”

“…Years of conflict, natural disasters, famine and insecurity, all have contributed to very low scores for most humanitarian indicators, suffering from poor governance, protracted internal conflict, underdevelopment, economic decline, poverty, social and gender inequality, and environmental degradation [ 3 , 4 ]. Despite high mortality caused by civil war and famine, Somalia’s population is growing rapidly due to a high fertility rate (more than six children per woman) and a considerable proportion of people of reproductive age.…”

“…According to a situation analysis by the World Health Organization (WHO) in 2010, Somalia had one of the highest prevalence of mental health problems in the world with one third of Somalis afflicted with some form of psychological disorder [ 3 – 6 ]. However, despite these grim statistics, there is a lack of adequate mental health services in the country with only five low-capacity psychiatric units mostly situated in Somaliland, the relatively stable region [ 3 , 4 ].…”

“…In this regard, the notion of a continuum of mental health issues ranging from mild, moderate, to severe simply did not exist as part of the cultural and linguistic nosology. Beliefs in the causes of mental illness and treatment in the country are predominately metaphysical and spiritual [ 3 , 4 , 9 , 12 ]. Additionally, significant stigma and discrimination in the society conceals mental health issues [ 3 , 13 ].…”

“…Conflict-related trauma, poverty, unemployment and rampant substance abuse in the country has elicited an explosion of mental health problems [ 3 ]. The health care system in Somalia has never developed beyond providing the most basic functions and has negligible capacity to manage monumental challenges from a population health perspective [ 3 , 4 ].…”