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Table 5 Mental health activities in Hagadera, Musasa, and Nakivale refugee camps from 2009 to 2018

From: Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)

Hagadera, Kenya

Context: Hagadera refugee camp in northeastern Kenya was established in 1992 for Somali refugees. From the onset, mental health services were integrated within the primary health care services delivered by an NGO. Initially, mental health services were concentrated in the camp’s main health center but starting in 2011, satellite mental health clinics were opened in three additional health posts.

Staffing: One psychiatric nurse worked in the camp starting in 2010 and was supported by a team of six trained refugee mental health workers who were actively supervised by the psychiatric nurse. Case identifications and home follow-up visits were conducted by general community health workers.

Training and supervision: Brief mental health trainings were organized annually for health staff. Five-day basic mental health trainings were also organized for mental health workers with the mhGAP-HIG in 2013 and 2018. Clinical supervision was organized by the psychiatric nurse. During weekly trainings for community health workers, mental health was a regular topic.

Community engagement: Every month there were an average of 12 community engagement activities, including meetings with community leaders, youth groups, teachers, religious leaders, and family members of people with severe mental health issues in different parts of the camp.

Intersectoral collaboration: There were close relationships with organizations across sectors including gender-based violence, child protection, and social work, with clear referral pathways. Starting in 2013, a mental health technical working group for all regional camps met regularly.

Musasa, Burundi

Context: Musasa refugee camp in northern Burundi was established in 2005. Medical services were provided by an NGO. Until 2009, a specialized NGO provided additional mental health services. After 2009, these were integrated within primary health care services.

Staffing: One nurse was trained in mental health but did not have a formal mental health diploma. There was also one psychologist attached to the clinic. Until 2011, there was a community outreach team of psychosocial volunteers which was discontinued due to budget cuts.

Training and supervision: From 2009 to 2011, a specialized NGO provided a series of mental health trainings for health and protection services staff and refugee volunteers. Health staff were supervised by a physician from the provincial health department.

Community engagement: Until 2012, there were monthly community meetings around mental health, and counselors organized recreational activities for youth and conducted home visits for people with severe mental disorders. These decreased over time due to staff attrition and lack of training for new staff.

Intersectoral collaboration: There were no formal coordination meetings around mental health.

Nakivale, Uganda

Context: Nakivale refugee settlement in southwestern Uganda was established in 1958. The settlement is 80 km2, with refugees scattered over dozens of “villages.” From 2009 to 2018, one NGO organized health services in seven health facilities.

Staffing: From 2009 to 2014, there was one psychiatric nurse, and from 2015 to 2019, there were two psychiatric nurses.

Training and supervision: In 2017, a mhGAP training of trainers was conducted, followed by a training for primary health care workers. In 2018, a mhGAP training for primary health care workers was conducted. Until 2015, a psychiatric clinical officer from the regional hospital did monthly supervision.

Community engagement: A total of 385 community health workers received trained on mental health in 2018.

Intersectoral collaboration: After 2017, an NGO started providing psychosocial services and a mental health coordination group was established.

  1. NGO, non-governmental organization; mhGAP, Mental Health Gap Action Programme; HIG, Humanitarian Intervention Guide