October 2015 - by Boniface Duku - I am a South Sudanese working for HealthNet in Wau County, Western Bahr El Ghazal State. We work to strengthen health systems in the country, community governance, empowering communities to take charge of their own lives and development needs using Resource Mapping and Mobilization approaches and community based mental health and psychosocial support interventions. In this regard mental health and psychosocial support is an integral part of HealthNet’s projects. Over the years of my engagement in provision of mental health and psychosocial support intervention in the south Sudan, I have come to believe that communities themselves play a key role in the prevention of mental illness and helping those who are suffering from mental health issues. We encourage communities to focus on restoring the broken social connectedness, loss of trust and dysfunctional community systems to be able to increase their resilience and empower them to respond to the psychosocial needs in their community, at the early stages before they often become more severe.
On 10 October 2015 World Mental Health Day was celebrated worldwide with this year’s theme ‘Dignity in Mental Health’. This day is about making sense of, raising awareness for and advocating for improved services for all people living with mental illness. The newest country in the world, South Sudan attained its independence in 2011 after two decades of political violence that drifted through the country resulting in millions of lives lost, people displaced and people witnessing and experiencing horrible things. The traumatic experiences from the previous conflict have not been dealt with at all, while the fighting already continued when a new conflict broke out in 2013. As a result, the South Sudanese people are yet again going through the same cycle of violence and trauma: loss of lives, displacement and horror repeat itself again and again.
Reflecting on this, the vast majority of the people in South Sudan are still displaced both within and outside of the country, they are living in United Nations Protection of Civilian camps (PoCs), internally displaced person camps & settlements, and in Refugee camps in the neighbouring countries; Kenya, Uganda and Ethiopia. Life in the PoCs has become very difficult due to overcrowding and outbreak of diseases such as cholera. During the rainy season the camps quickly turned into swamps, adding to the struggles of the already scattered minds and psychologically distressed people.
Dignity in mental health: what does this mean to me as a south Sudanese citizen? As I mentioned, South Sudan has been engulfed in war since 1955. Peace returned in the 2005 and then independence came in 2011. I was happy and hopeful that it was time to rebuild the destroyed community support systems and infrastructure to respond to the mental health and the development needs of the people in the country. The health systems are stretched and overwhelmed. The government is faced with other competing priorities, making the scattered minds of the people invisible, let alone focusing on the easily recognizable severely mentally ill people, this is a non-issue. To this end, access to mental health services in South Sudan presents a big challenge. People with severe mental illness are either thrown into prisons, chained in dark rooms or under trees, as this is the only known and understood remedy to control their violent behaviours. This undermines the movement to reduce the discrimination and stigma that comes with illness.
The dignity of people with mental illness is not respected in South Sudan; I cannot precisely tell statistics of people living with mental health problems in the south Sudan because these statistics are lacking and difficult to comprehend given the context of south Sudan and other pressing priorities which have degraded the prioritization of mental health services and research in the country. I continue to see people with mental health problems and epilepsy who suffer without any treatment. They are ill-treated within communities, often physically, sexually, and emotionally abused and more often than not, neglected or rejected entirely within the communities and in prisons simply because they are mentally ill. A 12 year old child I spoke to said, “I was rejected at school when the teachers discovered I have epilepsy; pupils called me all sorts of names…” The right to be treated with dignity is not there.
Despite the contextual challenge, some little progress for recognition of mental health as an issue had been made in South Sudan. Over the last two years HealthNet within the Dutch Consortium Rehabilitation (DCR) as well as under the Dutch Joint Response for South Sudan (SSJR) has been advocating with the government for improved access and availability of services. In addition HealthNet/DCR co-coordinates monthly mental health platform meetings in Juba to bring key actors together to push the mental health agenda in the country. I am happy that, through the work of the mental health and psychosocial support platform, things are starting to move and mental health is placed onto the national agenda. The establishment of a directorate of mental health within the Ministry of Health and the appointment of one of the only two psychiatrists in the country as the Mental Health Directorate signifies a positive move in this regard.
At the community level where we work, communities are organized, sensitized and trained in early identification of symptoms of mental illness and participation in activities that enhances psychosocial wellbeing of individuals, families and communities. These activities have helped to build community social support systems around individuals presenting with symptoms of mental illness. More national non-governmental organizations and international agencies are working together to bring hope to the people. I am hopeful that everlasting peace will return to the country so that we can start to rebuild our broken hearts and allow for complete healing of the wounds so we can then continue with the rehabilitation of the destroyed infrastructure. This is what all the South Sudanese people want. I say no to war and yes to peace and development for my people.