The Nakivale Camp Mental Health Project : building local competency for psychological assistance to traumatised refugees

Abstract

Little is known about the usefulness of psychiatric concepts and psychotherapeutic approaches for refugees who have experienced severe traumatic events and continue to live in stressful and potentially dangerous conditions in refugee settlements. The central goal of the Nakivale Camp Mental Health Project is to establish the usefulness of shortterm treatment approaches when applied by local paramedical personnel in a disaster region. In a randomized controlled clinical trial, the efficacy of Narrative Exposure Therapy (NET) vis-à-vis Supportive Counselling has been tested, when applied by trained paramedical personnel from within the same refugee community. Here we demonstrate the feasibility of such an approach and detail the methods and strategy for it. The project also included an epidemiological survey to ascertain the prevalence of PTSD among refugee adolescents and adults alike. Consistent with other investigations, the demographic survey revealed a high prevalence of chronic PTSD ranging from 31.1% in the Rwandan to 47% in the Somali population; even though traumatic events had on average taken place more than 9 and 11 years earlier in each case respectively. Diagnostic validity was assured using expert clinical interviews. The significant social and work-related dysfunction, a disabling consequence of PTSD, does not only impact on the life of the affected individual. Communities where a significant percentage of members are psychologically affected by past human rights violations, atrocities and war, are held back in their recovery process at many levels. Therefore mental health programmes with workable guidelines on how to treat posttraumatic symptoms, based on solid scientific research with proven effectiveness and feasibility, in particular cultural settings, must become a humanitarian priority.