Mental health services for Syrian conflict survivors: a psychosocial intervention approach

Curfews, military incursions, targeted killing, movement restrictions, arrests, terror acts, humiliation, poverty, and economic condition have affected every single person, right from infants to aged people. Volatility on a daily basis aggravates anxiety and stress - these unfortunate people cease to have any control over their lives (SARC, 2015; PRCS Mental Health Department, 2003; Irwin & Scali, 2010).

The present situation in Syria is devastating, aggravated by memories of past conflicts and the ultimate loss of identity and land. Coping methods attack religious beliefs, cultural traditions, and community lifestyle vigorously. The most prominent impacts of relentless conflict include hopelessness; such situations have a lasting effect on people, their family, and the overall community. Discovering methods for overcoming the ordeal they have experienced is the lone means to a better future, for these people (SARC, 2015; Zimiles, 2009).

Epidemiology of the health/mental health issue

The collective effect of conflict elements deeply affects individual and community psyche. External social and psychological support is an alien concept for the people of Syria. They are not used to voicing their feelings and problems. Only a few dependable psychological, psychosocial and mental health services are available to them, but these services are plagued with several problems, including accessibility, quality, sustainability, and professionalism (Irwin & Scali, 2010).

In keeping with Syria's existing support system and culture, a comprehensive, family-focused psychosocial service intervention is chosen. Family constitutes a source of strength for Syrians, thus being central to their coping; therefore, the best approach to supporting the community would be working through families. "Psycho-social" implies that the intervention combines social and psychological support techniques, understanding that affected persons should be supported and incorporated in social support systems as well. These interventions ensure community empowerment to actively take part in supporting each other by providing them with requisite resources and knowledge. This is a large-scale effort towards capacity building, and thus, the proposal will revolve around SARC's plans for integrating psychosocial services, in accordance with the International Federation of Red Cross and Red Crescent Societies psychosocial policy, via its emergency services, primary healthcare, rehabilitation facilities, volunteers and youth, social welfare and disaster preparedness and response, under the Department of Mental Health's (MHD's) leadership (SARC, 2015; de Savigny and Adam, 2009).

Costs associated with the health/mental health issue

It is difficult to quantify the costs associated with the Syrian Community's psychological issues. The children of Syria have suffered violence in various forms. The most common traumatic events that have been faced by them include: death of one/both parents, family and friends, witnessing or engaging in violent acts, torture, injury (whether transitory or leading to handicap or deformity), separation from parents for some interval of time, severe depravation, poverty, house arrest or curfew, and demolition/shelling of their homes (SARC, 2015; World Health Organization, 2000, 2010).

Social determinants of the health/mental health issue

Children's sentiments and responses to the aforementioned traumatic life events can be enumerated as speech problems, difficulty with concentration, loss of skills recently learnt, learning difficulties, bedwetting, sleep-related issues, guilt, and numerous somatic problems. Children should be able to heal in a safe place, with plenty of emotional support for helping them overcome these issues and continue living a productive, normal life (World Health Organization, 2010; Allotey, Verghis, Alvarez-Castillo & Reidpath, 2012).

Description of the intervention

The SARC Medical and Health Division (MHD) intends to improve child well-being, by setting up Psychosocial Family Centers (PFCs), over a period of six months, among internally displaced communities. The Centers will remain as permanent structures for target communities. The following steps will be undertaken while establishing PFC Network: (SARC, 2015; World Health Organization, 2000)

1. Analysis of target communities will be carried out.

1. Appropriate facilities will be procured for each Center. For facilitating SARC's capacity building, PFC locations will be studied, and wherever possible, PFCs will be constructed within SARC branches, or at least in nearby locations.

1. Interdepartmental collaboration, interaction and harmonization, with regard to shared referral systems, service, and resources will be ensured for maximizing community services and benefit.

1. A large-scale campaign for spreading awareness regarding PFCs among communities will be designed and implemented using the following methods of communication:

0. Brochures conveying all information about PFCs, including their services, locations and psychosocial issues relating particularly to children.

0. Connecting with the populace, and having one-on-one meetings, with affected individuals (community involvement).

0. Contacting and arranging gatherings with local psychosocial service organizations and other relevant groups.

1. Experienced staff will be employed and assigned to all PFCs.

1. A working plan as well as activity schedule will be fixed, for all PFCs.

1. A nation-wide Psychological Support Hotline (PSH) will be instituted.

1. Need Assessment will be completed among all target groups. (SARC, 2015; PRCS, 2003)

Goals and Objectives

1. An overall improved welfare of communities in Syria, and enhanced abilities of people to take care of themselves.

1. Improvements in present social support structures.

1. Enhanced awareness among community members regarding child welfare and psychosocial problems.

1. Improvement in teachers' ability of holistic teaching, by means of awareness and adoption of psychosocial teaching techniques.

1. Improvement in parents' ability towards dealing with children's / family's psychosocial needs.

1. Enhanced community awareness regarding SARC and Red Crescent/Red Cross Movement services, facilities, principles, and International Humanitarian Law (SARC, 2015; PRCS, 2003)

Evidence of effectiveness

MHD is running a program in stress management and psychological support for all of SARC's emergency medical services (EMS) staff, volunteers, other SARC employees, and families. The program was developed for offering support to affected individuals who experience immense stress, on a daily basis, because of operating in regions of unrest and conflict. It also provides critical incident responses within a day or two of events, for providing this group with support (death of coworker, personal injury, traumatic/violent event, or detention). Support is provided on individual, family and group level; the program also offers physical welfare, motivational and social activities for achieving its objective. PFCs will offer room for continuing these services to target communities.

Support Needed & Costs

This initiative requires institution of physical resources via PFC network, thereby necessitating high outlay of capital in its first year. This fact has to be borne in mind by anybody wishing to support the venture financially. Physical centre establishment is imperative here, since a physical space is needed, allotted for the purpose of psychosocial services, wherein both outreach and in-house services can be delivered. As psychosocial and psychological interventions require a large quantity of human resource (trained volunteers, psychologists, and social workers), HR support and investment in quality human resources is needed for success of the intervention. SARC estimates annual program funding at 1-5 million dollars, adding up to 6-9 million dollars for a 6-year period (SARC, 2015; WHO, 2010).