Community based mental health clinics in Gambia

Aim

Provide counselling and mental health mobile clinics to marginalised and poor rural and urban communities in The Gambia

Team members

1. Alhagie Camara 

Mr Camara is the Executive Director and Founder of www.wayas-gm.org. He is a qualified Counsellor and Psychotherapist and a member of the British Association for Counsellors and Psychotherapist. He has worked with many counselling organisations in the United Kingdom supporting young people and adults. He worked in various settings and with people from diverse backgrounds including Educational settings, in the community and at GP Surgeries offering accessible services and choices to children, young people and adults expressing psychological and mental health challenges.

The therapies he offers range from Person-centred Counselling & Psychotherapy, Humanistic & Integrative Counselling, Cognitive Behavioural Therapy (CBT), Solution – Focused Therapy, Mindfulness, to CATT (Children’s Accelerated Trauma Therapy). He is also a qualified advocate and worked as an independent advocate to empower and enable children and young people to have a voice by providing information, advice, support and advocacy in line with The Advocacy Charter.

Awards:

• 2018 staff award of the year for outstanding performance. Awarded by Nolimits (South).
• 2015 Service to the Community Award. Awarded by West Itchen Community Trust
 • 2018 Certification of appreciation for outstanding performance and leadership. Awarded by Gambia Kaffo Community Interest Company (CIC), England.

2. Maria Chambers

Maria is a teacher, artist and CATT (Children’s Accelerated Trauma Therapy) trainer for ACT international www.actinternational.org formerly www.lunachildren.org. Maria is a trainer and some of her recent work includes training mental healthcare workers in Turkey, UK, Liberia, Jordan and Lebanon to use specific child centred art-based techniques to help young people process and prescript traumatic memories.

Maria is currently the project coordinator for Firefly International www.fireflyinternational.org and established the Fireflys centre for Syrian refugee children in southern Turkey in 2016. Maria is also an education activities coordinator and trainer for Kitabna www.kitabna.org. 

3. Esther Mulders

Esther Mulders is a creative therapist and development anthropologist. She is currently specialising in mental health and psycho-social well-being in the Global South, particularly in post-conflict areas. Esther has experience in working with vulnerable children, young people and women in different cultural contexts. Esther believes that creative, bodily based ways of healing are crucial in working towards better mental health, and social change. Esther’s focus on the body, movement and experience have led her to include yoga in her work. Yoga can be very healing for both body and mind, which is why Esther has used trauma-informed yoga in her work in Belgium, the UK, and Greece.

4. Frederica Taylor

Frederica is a qualified counsellor in Humanistic counselling and Transactional Analysis. She has experience working with clients with a wide variety of issues such as working with Suicide, Eating Disorders, and Domestic Abuse, the Impact of the Internet and Pornography on the Couple and individual and The Nervous System and Trauma.

5. Lucas Karlsen

Lucas is a qualified Counsellor and Psychotherapist and a member of the British Association for Counsellors and Psychotherapist (BACP). Lucas has worked with various counselling organisations in England and worked with young people who have experienced issues such as Sexual Abuse, Anxiety, Trans Gender issues, Porn Addiction, Anger Issues and Domestic Violence.

6. Dr Morro ML Touray is a Health Economist and Health Systems and Policy specialist working for University of Surrey as a Research Fellow in the Surrey Health Economics Centre where he also coordinates Surrey Global Health Research Network (SGHRN). He worked on many high profile health service and clinical trials around the world including in The Gambia. He led a United Nations Development Programme project to establish the National Planning Commission for the Government of The Gambia. He is also a visiting lecturer for University of South Wales. Dr Touray will be advising on all aspects of the implementation of the initiative from design to implementation, monitoring and evaluation. He will most importantly be analysing the costs and consequences of this model of mental health promotion / intervention in low resourced settings like The Gambia and its applicability to similar settings. 

Vision

Our vision is to establish affordable, accessible, effective and efficient counselling and mental health services in marginalised rural and urban communities in The Gambia.

Background / current situation

What is the problem being addressed?

The Gambia is one of the smallest but most densely populated countries in Africa (area 11,300km2, population about 2.1 million, average 186 persons per square mile).  Nearly one half of the population (48.4%) lives below the poverty line. The country has recently emerged from a repressive political regime, characterised by gross human rights violations. These socio-economic and political factors exacerbate mental health issues and are associated with inadequacies in the health care system.  Data are scanty, but estimates suggest around 20% of the population are affected by a mental health problem. Drug and alcohol misuse is high amongst the young, especially in urban areas.

Despite being the smallest West African country, Gambians dominate the number of people embarking on irregular and risky migration to Europe through the Mediterranean ocean. Families and survivors of these treacherous journeys suffer from serious psychological and mental health problems. So support to those people cannot be overemphasised.   

The proposed study addresses a serious lack of mental health services in The Gambia and targets a vulnerable group. It will particularly develop a school and community based mental health and emotional well-being intervention for children and young people in response to the rising prevalence of mental disorder among school-age children.  There is currently lack of coordination of care, no referral systems for children experiencing mental health disorders, and only part-time specialist paediatric psychiatric services.   When mental health conditions deteriorate, children often end up out of school and in shackles.  Children and young people affected by mental disorders suffer lasting and wide ranging adverse effects including on their education performance, social interactions, interpersonal skills, self esteem and coping skills going into adulthood.  Hence the associated burden on society is substantial. 

In addition to poor mental health funding, inadequate facilities and lack of trained personnel, most people in The Gambia believe that mental health disorders are associated with evil spirits and do not seek formal care. The hospital is located in the capital city which is literally not accessible to the poor and rural communities for several reasons including poverty. The proposed project focuses on a practical community-based, peer-led intervention with potential to reach large proportions of the population. The intervention will address mental health and emotional wellbeing of children and young people in communities and educational setting. While children and young persons are of particular interest, we will also reach all age groups of the population and serve to improve understanding at the population level.  

Why is this project important in terms of improving the health and/or wellbeing of the relevant populations and healthcare services?

The Gambia’s mental health programme is largely centred on adults. There is only one psychiatric hospital which is for adults. Even in that hospital, there are no trained clinicians, the facility is dilapidated and barely maintained amidst lack of therapeutic interventions.   Hence, this project prioritises children and young people, who will be central to the design and delivery of interventions as agents and beneficiaries. The interventions will focus on support.  This project will be modelled around Gambia’s socio-cultural structures and values to ensure optimal and sustainable impact, and is designed to be implementable with limited resources yet to have maximum reach. 

Strategy to achieve our mission

We intend to establish a sustainable effective, efficient, affordable and accessible services. In this respect, we will use existing government and community structures to promote mental health and provide mental health services. We have signed a Memorandum of Understanding with the Ministry of Basic and Secondary Education and are in the process of developing a Memorandum of Understanding with Ministries of Health and Social Welfare, Justice and Interior. These Ministries will identified core and relevant staff to be trained for sustainable delivery of counselling and mental health intervention services. So there will be three phases subsumeable into two. Phase one will be training of identified staff and phase two will be promotion and service provision.

Phase 1

In this phase, we will work with the respective departments to create / refine appropriate structures and systems required for the delivery of counselling and mental health services at community levels. The identified personnel will thereafter be provided with comprehensive training in line with BACP standards. 

Phase 2

In this phase, we will design mental health promotion strategies with the already trained staff from the ministries. This will also include identification target population centres for maximum outreach and community access strategies. 

As privacy will be fundamental, we will be providing clinical and consultation services in carefully selected community health facilities and schools. These sessions will be opportunities to provide on-the-job training to the trained personnel. 

What will this fund be used for?

All those who will be participating in this project are doing it entirely on voluntary basis. This fund will be strictly used for return travel to and within the Gambia, in-country accommodation and training materials  and expenses. We will also be paying for office accommodation where we will be operating from while in the Gambia.    

This project successfully funded on 13th March 2020