Community-based mental health sessions are giving hope to people in Myanmar who have faced years of conflict and displacement and who are still rebuilding following the damage caused by a category five cyclone that hit parts of the country in mid-May.
“Patients often say to me that our sessions give them hope for the future,” says Phyo Zin* a mental health counsellor educator. “They feel calmer, more positive and better equipped to face the future with our support.”
Cyclone Mocha, with winds of up to 280 kilometres/hour, ripped through Rakhine state and the northwest of Myanmar on 14 May. People in these areas are already incredibly vulnerable. Most of them live in bamboo houses and there are around 6 million people in Rakhine who rely on humanitarian assistance. Over 26,500 internally displaced people live in camps in the area; a large number are Rohingya, who have a high number of mental health conditions due to years of persecution and severe restrictions on their freedom of movement.
MSF counsellor educators and community-based health workers provide ongoing support to patients in villages, health clinics, and displaced people’s camps. Services include psychological education and counselling to help enhance understanding and coping skills for patients (and their caregivers) experiencing a wide range of mental health concerns. These range from depression and anxiety to psychosis, and even thoughts or acts of suicide when people feel completely hopeless.
“Working with patients and their caregivers in the environment where they live helps us provide support and counselling that touches patients’ lives at the most critical of moments,” says Sara Chesters, MSF mental health activity manager. “Our patients struggle with displacement resulting from ethnic or religious conflicts, sexual assault, and the mental health issues that can evolve from acutely stressful situations where basic resources and healthcare are hard to find and access.”
“We help treat their symptoms and work with them to provide the tools and resources to not just survive but to learn to thrive in the most challenging of circumstances,” says Chesters.
Working with patients and their caregivers in the environment where they live helps us provide support and counselling that touches patients’ lives at the most critical of moments.Sara Chesters, MSF mental health activity manager
Mental health support is a core part of MSF’s medical work in Rakhine state, but following the recent cyclone, the team have adapted the way they work to improve the care they provide to affected communities. Instead of a formal, individual approach, which is treatment focused, our teams are currently working on building relationships and allowing people the space to talk.
In the aftermath of the storm, mental health counsellors and community health workers were out every day, accompanying the medical teams to MSF clinics and displaced people’s camps in Rakhine state. Supporting people in their own communities creates a safe space for people to talk. Our teams run small, informal sessions with a focus on listening to support people through difficult times.
“We usually go to monasteries or local villages and hold group sessions,” says Ei Ngoon Phyo, MSF mental health counsellor educator. “The main message is to tell patients that they are not alone. We try to encourage people that their hopes and dreams can come alive again.”
Ei Ngoon Phyo can empathise greatly with patients; she also lost her family home to Cyclone Mocha and had to wait several terrifying days until she managed to confirm that all family members were safe. Returning to her village, she found widespread destruction of trees and houses.
“A coconut tree cut my house in half, it was completely destroyed, and we are seeing a lot of patients who also lost their houses and their businesses,” says Phyo. “There are many patients who need mental health support.”
“After the storm, I met patients who needed psychological first aid and I tried to support them as much as I could,” she continues. “Speaking to the patients was a healing experience for me; encouraging them to think in a certain way, helped me to do so, too.”
Following Cyclone Mocha, humanitarian organisations struggled to scale up their activities to meet the new needs. Barriers such as limited access to patients remain, and this has affected our ability to deliver mental health counselling to those who need it.
Our teams are seeing high numbers of requests for mental health support following Cyclone Mocha.
“We have found that there are huge needs in the community but we are struggling to reach many patients who need support,” says Myat Kyaw*, MSF mental health supervisor.
Our teams have seen high demand for mental health support, particularly over the last few months, but without more access to patients, high numbers of people are missing out. It is essential that humanitarian organisations can reach and deliver care to communities and be allowed to scale up as necessary.
*names of some of our staff changed to protect their identity.