Taking the stigma out of mental health services

While the COVID-19 pandemic has prompted more conversations around mental health, it’s a topic that remains widely misunderstood and highly stigmatized. This can make individuals reluctant to seek out support and create challenges for those delivering mental health services, with some even facing physical risks.

Like all health programs, buy-in from local leaders and context-appropriate sensitization activities are critical in getting communities on board, but additional considerations around language and the delivery of services can help to protect the individual, their families, and program staff from victimization.

Devex asks the experts what more organizations can do to remove the stigma around mental health programming.

Avoid labels

Dena Batrice, director of technical learning and innovation at StrongMinds, an organization that focuses on women’s mental health in sub-Saharan Africa, said language is the most critical element in reducing stigma around mental health. At StrongMinds, teams on the ground describe symptoms in a “culturally competent way” and mental health terminology is avoided.

“When we go into a community, we don't say we're going to talk to you about depression,” Batrice said.

Instead, team members ask people questions about their energy and fatigue levels, and whether they still find joy in common activities such as singing and dancing. Labels are often “ill-fitting” and carry negative affiliations that prevent people from learning more about what they are feeling, Batrice cautioned.

The organization then offers further screening for depression and anxiety through “rapid tests.” With malaria being widespread in rural communities in Uganda, people are familiar with this terminology, and it helps them understand that there is a solution to the symptoms they are experiencing, Batrice said.

Alex Kalatu, a Kenya-based mental health officer at the International Rescue Committee, also emphasized the importance of language in delivering mental health services, particularly in his work in Kakuma refugee camp, where many nationalities are living together.

Stigmatization around certain topics, such as mental health, can be a greater issue among specific groups, Kalatu said. This can then affect caregivers and family members, and the individual. Cultural beliefs, local idioms, and dialects are therefore considered in adapting messaging for sensitization activities.

“We focus a lot on language ... and culture,” Kalatu said. “Especially [with] issues [around] mental health because this is one area where people [lack] understanding.”

Activities are also structured to begin with icebreakers before introducing the topic in a way that facilitates greater acceptance, he added.

Let communities see the benefits

Group therapy sessions are widely used in lower-resource settings and can be particularly effective in contexts where there is a strong emphasis on community.

These sessions are more sustainable as they provide support long after the therapist is gone and the group can hold each other accountable, Batrice said. StrongMinds takes a “very intentional” approach to host these out in the open with group therapy sessions.

This can provoke a lot of opinions in the mental health community, Batrice admitted, but it’s a deliberate decision so that the community can “know who we are and what we’re there for.” Measures are still taken to ensure that these conversations can’t be overheard.

Many communities that the organization works with are very “communal,” and neighbors notice if a woman is not coming out of the house or if her children are not looking well, Batrice said. When that woman then comes out of the house, and her neighbors can see a visible change each week in her health and well-being, they are then less likely to be scared of seeking help for their mental health struggles, she explained.

“It's literally [like] the whole community is watching the transformation … cheering for her success,” Batrice said. “It's really key in that it's a stigma, but it's a different kind of stigma. It's a super positive stigma.”

Buy-in from local leaders does, of course, help get the rest of the community on board. But Batrice’s team doesn’t get hung up on trying to convince those that are not interested and often find that they come around when they see the benefits of improved mental health in their neighboring communities.

Reach communities through local volunteers

Mobilizing local volunteers also helps build trust with communities and reach more people.

In response to the growing need for mental health support services during the COVID-19 pandemic, the Jamaican Red Cross partnered with the Ministry of Health and Wellness to train around 1500 volunteers in psychological first aid, or PFA.

Jason Wynter, an associate professor with the behavioral and social sciences department at Northern Caribbean University, is a psychosocial support team member and trainer of the PFA program with the Jamaican Red Cross. According to Wynter, community members act as “foot soldiers” and play a vital role in raising awareness of mental health issues and gauging the level of stigma that exists around these.

The PFA program is based on a global training toolkit adapted to the Jamaican culture and dialects, Wynter explained. Using the key principles of “look, listen, and link,” it is designed to help volunteers understand the signs that an individual may be struggling with their mental health and advise them where they can get support.

Training activities also prompt volunteers to assess and confront their own misconceptions around mental health. “We then see that knowledge really transfers back to the community level,” he said.

Katua agreed that community members are key. “We call them community gatekeepers [because they help] to align different frontiers in the community group ... [and act as] leaders.” IRC volunteers working across many areas in the camp, from WASH to food distribution, undergo sensitization activities and training to allow them to offer basic psychosocial support.

Other organizations are also providing mental health support alongside wider projects. In Cox’s Bazar, for example, the Bangladesh Red Crescent has integrated psychosocial support into both its WASH and health posts. With psychosocial volunteers joining these house calls to offer emotional support and referrals, the organization has been able to reach more people and broach the subject of mental health alongside more familiar topics.