Editor in Chief: Moh. Reza Huwaida Wednesday, October 16th, 2019

Afghanistan’s Silent Mental Health Crisis

Afghanistan’s Silent  Mental Health Crisis

KABUL - “There was no chance of taking her to the hospital, we had to care for the others,” Mirwais told me as we sat in a tent ripped half open by the wind and dust that battered the displaced people’s camp where he lives east of Herat, Afghanistan’s third largest town. “When we crossed the mountain, she had lost her soul.”
Her name was Guldastah. It means “bouquet of flowers” in English. She bloomed no longer than fourteen years.
Twenty-nine-year-old Mirwais – who did not want us to use his real name – is one of many Afghans who have suffered in that country’s four-decades of armed conflict, but his story should resonate with the hundreds of people gathering in Amsterdam today for the International Conference on Mental Health and Psychosocial Support in Crisis Situations. The conference aims to highlight the mental health needs of people in emergency situations.
Mirwais’ traumatic experiences actually began before his sister’s death. In less than two years, the farmer from Faryab province said he lost most of his cattle to drought and had to flee his home more than 20 times due to fighting between the Taliban and Afghan government forces. Guldastah died during one of those escapes.
A few weeks after her death, Mirwais began to experience flashbacks and bouts of anger. “I had headaches and was angry at my family,” he explained. “Especially when it is noisy. If my kids are next to me, I beat them.”
Mirwais told me that beating one’s family is no honorable thing, so he began to seek help.
Afghanistan has been devastated by violence, and it is estimated that half the population experiences depression, anxiety, or post-traumatic stress, which can have a disastrous impact on people’s mental health and the well-being of their relatives and friends. Despite this, the government only spends about US$0.26 per capita on mental health, out of $7spent annually per capita on health services in general.
The World Health Organization says an appropriate mental health system in low-income countries such as Afghanistan would require an investment of $3 to $4 per capita. International donors have invested heavily in health services but focused their attention on physical, rather than mental health .
So, when Mirwais went to see a doctor the first time, he encountered what many Afghans experiencing psychological distress face: instead of being offered psychosocial support, he was told he had a stomach problem. Unsurprisingly, the medication he received did not help .
In April 2019, I travelled to Afghanistan for Human Rights Watch and interviewed 21 people in Kabul, Kandahar and Herat who had experienced psychological distress after direct exposure to conflict-related violence, such as suicide attacks, aerial bombardments, ground fighting, and detonations of unexploded munitions. Thirteen of these people had received little to no psychosocial support from public health services. Nine of them said they did not know that public mental health services existed .
Having again fled his home because of the drought and fighting, Mirwais today has limited access to a psychosocial counsellor provided by a nongovernmental organization in the displaced persons camp where he lives. But for many Afghans, accessing psychosocial support and mental health services remains a daunting task. For women and girls, the barriers stand higher still .
Over the past 15 years, the government has trained roughly 750 psychosocial counselors who can provide basic mental health counseling and facilitate referrals. But less than 10percent of the population is using these services. Those who do use them can suffer abuse, such as forced hospitalizations and treatments .
The health-seeking behavior of Afghans with mental health conditions is influenced by individual, cultural and structural barriers, ranging from poor knowledge about health and available services to poverty, social exclusion, stigma, gender discrimination and the ongoing conflict. But the government can and should do more to provide access to adequate mental health services and ensure that these services are comprehensive and free from coercion. Access to health care does not mean doling out more pills .
To start, the Afghan government should conduct public awareness campaigns to inform people about mental health, reduce stigma and highlight available services. It should instruct health workers to proactively provide referrals to mental health services, with special attention to the needs of women and children, and consider less expensive ways of providing psychosocial services, such as remote counselling through mobile phones .
Afghanistan s international donors, many of whom are gathering in Amsterdam today, should continue their efforts to improve the mental health system through technical assistance and greater support. They should focus on providing medical and psychosocial counsellors with longer trainings, ensure the full inclusion of counselling psychology in university curricula, and encourage the government to deploy and retain more psychosocial counsellors, especially in rural areas .
Everyone from the president to the average person admits that mental health is a problem in the country ,” one Afghan mental health professional told me . “It s shameful that the budget is so low .”
This lack of resources has a clear impact on people like Mirwais, their families and the Afghan public. But it does not absolve the government of its obligation to provide adequate mental health care, especially when international donors are available to help. And help they should .
Access to psychosocial support and mental health services is a basic human right. (HRW )