FOR STRESS AND TRAUMA TREATMENT
Current projects include:
TOWARDS AN INTERNATIONAL TRAUMA AWARENESS DAY
Focus on Trauma Suffering, Trauma Treatments and Post-Traumatic Growth
Almost every day the international community recognizes an issue of significant concern, such as AIDS, disability, poverty, cancer and autism. Many are widely known—for example World AIDS Day on 1 December. There are even days focusing on mountains, toilets and jazz. Yet, surprisingly, there is no International Trauma Awareness Day. This is all the more curious since many of the issues addressed by the existing international days are related to trauma, although that is not explicitly stated.
There may be as many as 500 million people worldwide who suffer from trauma and trauma-based diseases and disorders and yet there is no day in the year when the world stops to consider the insidious individual, and far-reaching social, consequences of stress and trauma. The closest we come to that is World Mental Health Day on 10 October.
GIST-T seeks to increase awareness about trauma and the effective treatments that are now available by setting up a campaign to declare an International Trauma Awareness Day. We will be approaching many stakeholders and liaising with key organisations, including the UN, about the mechanics and logistics of doing so. As a way of supporting those efforts, we are planning on launching a social media campaign to mobilise public support, including on-line petitions, both in the UK and in other countries. We also plan to use our social media profile to disseminate information about the latest developments relating to the causes, symptoms and, crucially, the effective treatments of trauma, as well as to inform the public about how best to help people in the aftermath of an overwhelming event so as to minimize their chances of becoming traumatized. Our aim is that the social media framework supporting International Trauma Aware-ness Day will become a portal for public information about all aspects of trauma.
We believe our message is ultimately very positive. Trauma can be healed. Moreover, we also want to highlight—indeed celebrate—the fact that treatment of trauma can lead to significant personal, and even spiritual, growth. To this end, we hope to produce and publish a companion publication coinciding with the declaration of the International Trauma Awareness Day based on interviews with inspirational people who have managed to overcome trauma in ways that have restored their health and enabled them to live more fully and to connect more deeply with others. This is an important part of our campaign because, although we wish to highlight the devastating effects of unresolved trauma, we also want the message to be hopeful, which we very much believe it to be.
Over the next year we foresee a period of intensive lobbying of governments and UN delegates in favor of a UN resolution creating an International Trauma Awareness Day, perhaps as early as 20 September 2018. This date is significant as it precedes the International Day of Peace on 21 September. By choosing this date, we also wish to highlight the fact that trauma is the root cause of much of the violence and abusive behaviour in the world and therefore treatment of trauma should become an integral part of conflict resolution, civilian protection and peace building efforts. Ultimately, the message we wish to communicate through this campaign is that healing trauma is essential, not only because the health, wellbeing and future of our species depends upon it, but also because it provides us one of the best opportunities to realise our great potential as human beings.
CONFRONTING STRESS AND TRAUMA
An Online Resource Kit for Humanitarian Aid Workers and Peacekeepers
Psychological trauma and trauma–based disorders and diseases affect hundreds of millions of children and adults, and include those who are witnesses, as well as those who are direct victims of traumatic events. A bold guestimate of the prevalence is 500 million PTSD cases, based on a relatively reliable 7% U.S. prevalence rate applied to the total world population of seven billion. This is not an outlandish figure given the rising exposure to traumatic events and circumstances the world is witnessing.
At high risk are field staff involved in humanitarian and peace operations (crisis personnel), and those involved in development activities, especially in conflict and disaster zones1. A 2016 UNHCR study among its professional refugee workers, for example, found that 36% of its staff is at high risk for trauma. Additionally, 47% of their staff experience difficulty sleeping, and 57% report symptoms of sadness, unhappiness, or emptiness.
Psychological trauma is pervasive among humanitarian aid workers and peacekeepers. Surveys indicate that over 70% of aid workers consider the debriefing and support they receive to be insufficient. With such a high rate of distress among staff, it is crucial for organizations to accelerate and expand their psycho-logical resources and services.
The aim of this project is to facilitate the widespread use of the recently completed GIST-T training manual, Confronting Stress and Trauma: A Resource Kit for Personnel Dealing with Violent Conflicts and Natural Disasters2 by adapting it to an e-learning platform and translating it into several languages. GIST-T has found modest funding for the instructional design online of the English version of the training manual, and is now seeking further grants for the Arabic and French versions.
In that online form, this Resource Kit will provide broad access to practical information on stress and trauma symptoms, consequences and therapies, including the three WHO-approved approaches—Psychological First Aid (PFA), Cognitive Behavioural Therapy with a Trauma Focus (CBT-TF), and Eye Movement Desensitization and Reprocessing (EMDR) Therapy. It will offer proven tech-niques of self-care, and clear instructions about when to seek professional help. As such, it will offer support and guidance to crisis personnel who suffer from vicarious traumatic stress—a result of interacting with, or helping, others ex-posed to traumatic experiences—or who have directly experienced an extremely distressing and traumatic event themselves.
This Resource Kit is distinctive. Several organizations offer online courses on stress and trauma topics. However, this modular Resource Kit is more comprehensive in scope, more easily and rapidly scaled up, and designed for more diverse audiences, including humanitarian workers, peacekeepers, scouts, doctors and students. It offers up-to-date scientific and professional information on stress and trauma. And it can be facilitated online by mental health professionals, or it can be used for self-paced learning. The authors created the Resource Kit to provide practical solutions, taking into account the uncertainty and complexity faced by the various target populations.
HEALING TRAUMATIZED YEZIDIS
Bringing Therapies to Victims of Atrocity Crimes
In 2014, Islamic State (IS) terrorists attempted to eradicate the Yezidi people through a deliberate genocidal campaign—of killing, kidnapping, hostage taking, enslavement, sexual exploitation and rape. As IS advanced, many fled to Mount Sinjar, a place of great religious significance to their community. Some 50,000 became trapped before the international community intervened. IS captured an estimated 3,500 women and girls who were sold as ‘sex slaves’ to IS fighters. About 7% managed to escape and return to their communities in the Kurdistan Region of Northern Iraq. Many free Yezidis now live in camps for internally displaced persons in Northern Iraq, fearful of further IS attacks, and too afraid to return to their homes.
The Free Yezidi Foundation (FYF) operates two centers inside the Khange IDP camp—one for women and one for children. FYF’s aims are threefold: restore a sense of normalcy; offer opportunities for learning and new skill acquisition; and, create a safe and nurturing environment.
Despite the trusted care, support and training the FYF centers provide, until recently they offered only very basic stress-reducing activities and Psychological First Aid (PFA). But such modest interventions are generally not sufficient to prevent adverse consequences of untreated trauma—such as PTSD. That requires the application of evidence-based, trauma-focused therapies. This is where GIST-T has provided technical assistance in project design, and helped secure funding from UN Women Trust Fund.
Stabilization interventions and in-depth psychological therapy for survivors are now made available for three groups of survivors: those personally abducted by IS terrorists and who suffered devastating sexual violence; those who fled IS and avoided capture, but know they were targeted for abuse and violence because of their religious identity; and those at risk of developing vicarious trauma through the horrific stories that have been and are being shared.
Existing funding supports two full-time trauma therapists, two interpreters and one driver for a period of two years. Four hundred women and girls annually will receive EMDR individual and group therapy. To sustain these efforts, two significant innovations will be implemented and evaluated: (1) creation of an all-female Yezidi PFA brigade; and, (2) identification and training of Yezidis with an aptitude and disposition to become mental health paraprofessionals. Paraprofessionals will be trained in using simplified trauma therapy protocols using the GIST-T Confronting Stress and Trauma Resource Kit. These two innovations will potentially have significant application elsewhere in Iraq, and beyond.
On behalf of FYF, GIST-T (i) offers support in filling vacancies and reporting, (ii) seeks further funding for the training, evaluation and applied research components, and (iii) raises funds for project extension beyond the two-year funding period of UN Women Trust Fund.
PARAPROFESSIONALS IN ACTION CONTRE LA FAIM (ACF)
Testing Simplified EMDR- and CBT-Based Group Approaches
Many large INGOs understand the importance of addressing mental health concerns of the large populations they serve. So does ACF. But a constraint they face is shortage or lack of trained and certified mental health professionals. GIST-T believes that one solution is to extend carefully defined skills sets to paraprofessionals by training them in very specific and evidence-based therapeutic group protocols, applied under close supervision.
In cooperation with Action against Hunger (ACF), the University of Worcester and two pioneer-psychologists from the Middle East, GIST-T proposes to research the efficacy of these protocols in four distinctly different settings: Iraqi Kurdistan, Central African Republic and two other countries. This study will test the hypothesis that group protocols can be safely administered by trained paraprofessionals who are provided training, ongoing supervision and monitoring. Furthermore, as the research study will be done in different countries and continents, it will look into the issue of cultural adaptability and efficacy.
The aim of the comparative study is to explore the efficacy and cost-effectiveness of two short-term group protocols based in the two WHO-approved trauma therapies, Cognitive Behavioural Therapy with a Trauma Focus (CBT-TF) and Eye Movement Desensitization and Reprocessing Therapy (EMDR).
Action against Hunger was founded in France in 1979, and has since grown into an organization with five global headquarters, projects in over 45 countries with over 6,500 field staff assisting almost 15 million people. ACF is recognized as one of the leading organizations in the fight against hunger worldwide, saving lives through prevention, detection and treatment of malnutrition, in particular during and following natural disasters and conflicts. ACF also knows through its extensive experience that when parents are depressed, in an enduring state of shock or have very little time, their children run a high risk of growing up less healthy and might be having greater difficulty in recovering from an episode of acute malnutrition—which is why their programmes include a mental health component, providing psychosocial and psychological support.
ACF field staff already involved in psychosocial support will conduct the study that will include groups of adults and youth drawn from ACF project beneficiary populations suffering from trauma symptoms. The University of Worcester will provide guidance in the research design, implementation and data collection. Ethical clearance has already been secured. The results of the study will contribute to the growing body of evidence that group protocols can be safely administered by trained paraprofessionals provided with sufficient training, ongoing supervision and monitoring.
GIST-T is brokering technical and financial support for this applied research project.
LISTENING AND RESPONDING
Exploring Staff Trauma Experiences and Organizational Responsibilities
As a systematic way to begin a dialogue on stress and trauma with humanitarian organizations, GIST-T began testing a ‘listening exercise’ using structured questionnaires and interviews with the staff of Mediators Beyond Borders (MBB). Applying the lessons learnt from this exercise, a similar pilot will be conducted with staff of Nonviolent Peaceforce (NP), first in Mindanao, Philippines, thereafter in Northern Iraq and possibly South Sudan.
The overall results will be used to streamline a more general technique for initiating an informed engagement with Geneva-based humanitarian agencies. These exercises will help agencies consider how best to meet the evolving Duty of Care standards. Twenty agencies have been selected out of a list of 350. The aim is to explore both staff members’ and the organizations’ experiences with staff mental health issues, and the effectiveness of staff welfare processes already in place. All respondents will have voluntarily agreed to participate.
The listening exercise will be followed by a dialogue about possibilities for organizational capacity building, staff training or individual/group therapy. Any subsequent training will be based on the Confronting Stress and Trauma Resource Kit (or, whenever appropriate, the already-established EMDR trainings for professionals).
GIST-T will seek funding, organizational interest and contracts.
USE OF PARAPROFESSIONALS AND SIMPLIFIED PROTOCOLS
Review Conference on the State of the Art
The future of accelerated, large-scale trauma healing depends on the greater acceptance and use of paraprofessionals and simplified protocols. For that reason, GIST-T is keen to promote applied research into the use of paraprofessionals and simplified protocols within the context of specific field projects. Innovations based on CBT-TF and EMDR are ongoing and include group therapies, and early interventions aimed at preventing PTSD. Their wider use, however, is conditional upon satisfactory research evidence of effectiveness and appropriateness.
GIST-T is aware of promising recent developments as reported by Drs. Nacho Jarero, Elan Shapiro and others. Further studies are ongoing. GIST-T, in cooperation with EMDR Advanced Training and Distance Learning (ATDL), is working to convene a Conference on Early EMDR-based Interventions, including the role of paraprofessionals, bringing together the principal researchers, mental health leadership, and other stakeholders. The aim is to curate the field-based results so far, provide training to professionals, encourage further research, and offer policy guidance. The Summit Conference, to be held in Boston in April 2018, will also be open as an educational event for therapists/practitioners with an interest in these field innovations. Meanwhile, GIST-T (in dialogue with Derek Farrell and Mark Nickerson) will advocate and pursue possibilities for applications in project settings with adequate evaluative research components.
TACKLING PHANTOM LIMB PAIN (PLP)
Promoting EMDR to Organizations Dealing with PLP
Millions of people worldwide suffer from phantom limb pain, which is a debilitating and psychologically disturbing condition. Causes of limb loss range from wounds of war (landmines, infected bullets) to medical conditions (diabetes) to torture and accidents. Conventional treatment modalities for amputees are many, including various types of pain medication as well as non-medical treatments (e.g., acupuncture, massage, biofeedback, imagery, etc.).
EMDR’s Adaptive Information Processing Model (AIP) posits that PLP is the result of unprocessed memories of the event (together with its physical sensation) that necessitated the amputation. This is a different paradigm than those underlying conventional treatments. EMDR Therapy offers an effective PLP treatment, namely one that targets and reprocesses the traumatic memories associated with limb damage. Success (defined as complete or substantial reduction of experienced pain) was on average obtained with 80% of the cases after 2 to 9 sessions.
GIST-T seeks to promote and broker arrangements that connect victims of PLP (mainly through their special interest organizations) with licensed providers of EMDR therapy (mainly through their professional associations). While the evidence cited earlier is very promising, only six case studies have been published. More field research using randomly controlled trials would provide a stronger evidence base, and for that reason, GIST-T is also interested in identifying interested researchers to connect them with organizations representing victims. Finally, GIST-T is keen to bring together EMDR trainers with organizations (of nurses, doctors, physical therapists and others) that are potentially interested in building up their own capacity in the area of PLP reduction.
SCOUTS GAINING PSYCHOSOCIAL SKILLS
Echo-Trainings for the World Organization of the Scout Movement
In seeking to help prepare young people for the challenges of life, the Scout Movement has done a unique and outstanding job in developing substantial ‘tool boxes’ of practical skills and supportive advice that have proved to be valuable for millions of youth—both boys and girls. Today, when increasing numbers of young people are faced in their own lives with crises and catastrophes that are not only physically devastating, but also emotionally and psychologically damaging, it is wholly appropriate to add practical emergency preparedness skills to their training.
The World Organization of the Scout Movement (WOSM) is organized in 166 member countries, with recognized national Scout organizations, and over 40 million participants. Already a quarter of WOSM members is involved in activities, trainings and responses to natural disasters and crises, and the leadership of WOSM is now engaged in introducing a broad programme of ‘Humanitarian Action’ worldwide.
GIST-T, in collaboration with WOSM, plans to design and deliver a three-day Training of Trainers (TOT) in (i) Self-Care for Stress and Trauma and (ii) in Psychological First Aid (PFA), and in so doing initiate a series of echo-trainings at national levels.
• This first TOT will be held first in Switzerland for senior trainers from 20-25 national Scouting organizations, who in turn will develop their own plan of training appropriate for their national situation. The TOT would be conducted initially in two languages (French and English). The initial list of 17 selected countries is shown here3.
• By focusing on Self-Care training, the scouts will gain a greater understanding of their own reactions to stressful and sometimes traumatic experiences, and know how to respond, or if necessary when to seek help from professionals.
• PFA training for scouts would be specifically targeted at their needs and capabilities, so they can better respond in crisis situations where they may be called on to help—as has already happened in Haiti, Nepal, India and Bangladesh, to name only a few. Proof of mastery of these two topics would earn scouts merit badges.
• Following the initial TOT, GIST-T would help to identify suitable and interested therapists, counselors and trainers to accompany the national-level implementation, and support quality control and evaluation in each of the programme countries. To this end, GIST-T is in the process of establishing a database of qualified PFA trainers and mental health professionals.
Further developments could include designing and conducting webinars for subsequent TOTs in the five official WOSM languages (Russian, Spanish, French, Arabic, and English), and the preparation of a tailored-made online course.
PSYCHOSOCIAL NEEDS ASSESSMENT MISSION TO MARAWI, PHILIPPINES
Demonstrating EMDR Approaches in a Setting of Violent Extremism
On 23 May 2017, affiliated militants of the Islamic State (IS)—including the Maute and Abu Sayyaf Salafi jihadist groups—launched an attack on the Philippine government security forces in the city of Marawi, Mindanao, occupying several buildings and taking control of key areas. Three months later the conflict is still ongoing, with an estimated toll of casualties reaching more than 75 government troops and at least 44 civilians.
At the suggestion of colleagues at the World Bank, a needs assessment mission is fielded (as soon as conditions allow) to take stock of the impact of the terrorist and military activities in Marawi on the civilian and military population, with special attention to its psychological impact on individuals, families, and local communities.
The purpose of the mission is two-fold: first, to gauge the emergency needs and identify immediate opportunities to provide stress and trauma care for those in greatest need, including IDPs and humanitarian workers with primary or vicarious trauma; and second, to explore the feasibility, appropriateness and acceptability of developing a specific project that would address these needs.
The intention is to undertake a project that would use Eye Movement Desensitization and Reprocessing (EMDR). Though less known that the widely applied Cognitive Behavioral Therapy (CBT), EMDR has some inherent advantages in humanitarian field settings and violent conflict contexts. As such, this project is also intended to serve as a demonstration of the effectiveness of EMDR.
GIST-T is coordinating the fielding of this mission, in dialogue with several other actors, including the World Bank, Nonviolent Peaceforce Philippines, EMDR Philippines and, possibly, the Philippines Psychiatric Association. Mission funding has been secured and some funding of emergency phase activities is in hand.
CARING FOR THE CARERS
Workshops for Grenfell Tower Disaster Support Organizations
The Grenfell Tower fire, in June 2017, caused at least 80 deaths and over 70 injuries, and left more than 1,000 people homeless. The fire occurred at the 24-storey Grenfell Tower block of public housing apartments in North Kensington, London. Individuals and community groups and organizations in the surrounding area, and from across London, rallied to organize speedy help for the hundreds of victims. Temporary shelter was provided in local churches, mosques, and a sports hall, and donations of money, food, water, clothes and toys were received in enormous quantities. Local organizations were flooded by volunteers, wanting to assist regular staff to coordinate assistance and distribute relief supplies. The relief effort involved hundreds of people working round the clock for several weeks. While the action of firefighters, ambulance crews and police responding to the disaster was universally praised, the immediate support organized by the local council was wholly inadequate, and undoubtedly compounded the anguish and misery of the surviving victims.
Having talked to several local organizations by telephone, GIST-T has offered to hold short workshops tailored to the needs of staff and volunteers. Held in collaboration with local groups, these workshops—‘Caring for the Carers’, and ‘Psychological First Aid’—will be informal, flexible and cutting edge, with opportunities for participants to both listen and talk. A maximum of 15 participants can be accepted for each 2½-hour workshop. The local mosque, about 10 minutes’ walk from Grenfell, has already agreed to host these workshops in either October or November 2017. This mosque had itself over 100 volunteers working on assistance to Grenfell survivors for several weeks, and the leadership readily acknowledges the need for psychosocial support to be offered to staff and volunteers. Other local groups will be invited to join.
‘Caring for the Carers’ Workshop: this will help participants understand the basic principles of psychological trauma, with specific consideration to self-care. Participants will learn and practice simple and effective self-care techniques with a view to not only being able to use these techniques themselves, but also to teach others about them.
‘Psychological First Aid (PFA)’ Workshop: participants will learn the key features of psychological trauma and how this affects individuals, families and the community. The core principles of PFA will be discussed and participants will learn how to interact with people impacted by the effects of trauma. They will consider what interventions are more helpful than others in post-trauma situations.
1-We chose to focus initially on crisis personnel within organizations, rather than on the traumatized popu-lations they serve. Crisis personnel’s regular exposure to traumatic events and circumstances puts them at high risk for depression, anxiety and PTSD. And they are more easily reached. Increasing their resilience and addressing their trauma symptoms early on enables them to continue performing their much-needed duties. Thereafter, other priority populations, like women and children in conflict or disaster zones, will be included.
2-This up-to-date manual was developed by a consortium comprising the UN Institute for Training and Research (UNITAR), the University of Worcester (UW) in the UK, NGO Forum for Health, and EMDR Europe.
3-Bosnia and Herzegovina, Congo (Democratic Republic), Dominican Republic, Greece, Iceland, Indonesia, Japan, Lebanon, Malaysia, Nepal, Philippines, Rwanda, Saudi Arabia, Sudan, Sweden, Tunisia, Turkey.
Future project opportunities include:
RAPID TRAUMA MAPPING
Using Mobile Telephone Technology to Gauge Prevalence
Most countries have never undertaken a nationwide PTSD/trauma prevalence survey, which requires costly and time-consuming research. Lack of prevalence data is one reason why trauma remains unrecognized, undiagnosed and untreated: you cannot manage what you cannot measure.
This is where the ubiquitous mobile telephone technology may come to the rescue. If it is possible to communicate with very large numbers of people (‘social monitors’) within a country through an SMS-based programme, asking one or more specific questions, then the very large number of respondents easily com-pensates for the lower quality or accuracy of responses.
This is precisely what UNICEF has done, initially in Uganda and Kenya, and now elsewhere. Recently it sent a carefully phrased question to three million social monitors about their experience with violence against children. Those who responded ‘yes’ can again be contacted with one or more follow-up questions. UNICEF has rolled out such free and open programmes, called U-Report, in over 50 developing countries to interact with social monitors (or U-Reporters) on a whole range of issues.
Results are then tabulated and shared with the respondents, but at the same time they are shared with government offices, politicians, newspapers, and TV and radio programmes. Suddenly the voice of ‘nobody’ becomes the voice influencing national discourse—real power to the people. This method is ‘quick, cheap and ballpark’ rather than ‘very time-consuming, expensive and accurate’. It helps to raise the profile of an issue.
GIST-T seeks resources to develop, validate and apply one or more appropriate methodologies to assess the magnitude of the trauma problem in countries. This type of study lends itself well for one or more PhD students to conduct. Initial validation of methodology, using statistical analysis and scientific study, will first be undertaken in a developed country setting, with already well-established and accurate data on trauma and PTSD. The next phase will be to develop one key question (for example: “Have you seen or experienced any mental trauma in the past 3 or 6 months?”, &/or “Have you experienced chronic sleeplessness?” &/or “Do you want some help in dealing with this?”), the answer to which would be the best proxy indicator for PTSD or trauma (and then more questions, asked sequentially). This phase requires a deep understanding of the phenomenon of trauma in the cultural setting where it occurs and the language in which it is expressed. Information on available treatments would be shared, targeted at those who gave a positive response.
A breakthrough in this area of measurement of PTSD/trauma could dramatically help in getting trauma onto national and global agendas and become a driving force in demanding improved mental health services. Repeat surveys could easily be carried out over time, and more targeted in-depth surveys could then fol-low to serve as baselines.
ONLINE TRAUMA COURSES FOR MEDICAL PERSONNEL
Working in Partnership with Professional Associations
Despite the enormous worldwide prevalence of trauma and trauma-based diseases and disorders, it remains largely hidden—unrecognized, undiagnosed and untreated—especially in the developing world. Many traumatized people initially seek out medical care for physical ailments (for example, chronic pain or addiction) that may actually be rooted in earlier psychological trauma. For this reason, physicians and other medical personnel are in a unique position to help recognize, diagnose, intervene, and support those who have experienced psychological trauma. But they need the necessary knowledge and skills to do so.
Medical personnel all over the world are organized through professional associations, many of which run courses aimed at updating knowledge and skills. However, as far as GIST-T knows, none focus on trauma detection, or specifically on non-pharmacological approaches to treatment, or the two WHO-approved, evi-dence-based trauma therapies.
GIST-T plans to promote a series of online webinars and courses, aimed at doctors, nurses and other medical personnel, on the assessment, diagnosis and treatment of acute and chronic trauma symptoms. Also included in these courses will be simple self-care techniques for traumatized patients, and how to implement early intervention protocols, and where to refer patients for further trauma care.
Additionally, doctors, nurses and other medical personnel working in conflict and disaster zones can use self-care techniques for themselves, as they too are at high-risk for stress and trauma, either as a direct result of experiencing a traumatic event or being a witness to one. Such self-care is important and will allow them to continue their much-needed humanitarian work caring for others. The basis for these courses will be the recently completed Confronting Stress and Trauma Resource Kit.
Training medical personnel to recognize the signs and symptoms of trauma, and to intervene appropriately, can ultimately result in hundreds of thousands of patients worldwide getting the care they need and deserve.
HEALING TRAUMA IN GROUPS
Training Paraprofessionals in Sri Lanka
Northern Sri Lanka, a mostly Tamil region, was wracked by a brutal civil war for 26 years. Eight years after the conflict ended in 2009, it remains one of the trauma ‘hot spots’ of the world. Rates of suicide, substance abuse and sexual violence have soared. Fourteen percent of Tamils suffer from PTSD. An estimated 315,000 need mental health services, particularly specialized trauma treatment. But access is hampered by the rural setting in which most Tamils live, and by a lack of mental health professionals trained in trauma treatment techniques who can serve them.
EMDR Therapy, one of the two WHO-approved trauma therapies, has a trusted history in Sri Lanka. Since 2005, 30 Sri Lankan mental health professionals have been fully trained in EMDR Therapy, and have used it successfully to treat many soldiers and victims of the 2004 tsunami. Moreover, given the enormous need, there are still not enough trauma-informed mental health professionals in the country, let alone in rural communities. And it takes years of specialized training and the proper credentials to become fully trained.
Properly trained paraprofessionals can effectively fill the treatment shortfall. The largest psychiatry trial conducted in the developing world, the MANAS intervention, convincingly demonstrated that trained lay health counselors could play a crucial role in helping to deliver effective care for depression and anxiety in resource-poor communities in India4.
GIST-T seeks support for a pilot project to train, supervise and evaluate 100 Northern Sri Lankan paraprofessionals in the use of a simplified EMDR group therapy protocol. The Confronting Stress and Trauma Resource Kit, with its online and face-to-face components, would form the basis for comprehensive training.
Once trained, paraprofessionals would work in pairs to provide 10 group sessions annually, with 30 Tamil participants per session (50 facilitator pairs x 10 sessions per pair per year x 30 participants per group). Over a three-year period, 45,000 trauma-affected Tamils would receive the care they need to help alleviate their trauma symptoms.
INCORPORATING TRAUMA EXPERTISE IN RAPID RESPONSE ACTION
Strengthening the UN’s Standby Capacity
The Protection Standby Capacity Project (ProCap)—an inter-agency initiative created in 2005 in collaboration with the Norwegian Refugee Council (NRC)—seeks to build capacity of relevant actors to enhance the humanitarian protection response. Protection Capacity Advisers support the strategic and operational humanitarian protection response for IDPs and other vulnerable populations.
ProCap deploys senior personnel with proven protection expertise to field, regional and global operations and trains mid-level protection staff from Standby Partners and UN Agencies. ProCap Advisers are an inter-agency resource deployed to the Humanitarian Coordinator, UN agencies, and integrated missions. ProCap Advisers work in humanitarian emergencies caused either by disaster or conflict, in the immediate aftermath or at a later stage, and to protracted or neglected crises. ProCap can also respond in transitional contexts.
GIST-T seeks to identify experienced EMDR therapists with a public health background and expertise in rapid needs assessments, and to nominate them for addition to PROCAP’s standing roster of experts.
4-Effectiveness of an intervention led by lay health counselors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomized controlled trial. Lancet. 2010 Dec 18;376(9758):2086-95. E-pub 2010 Dec 13. https://www.ncbi.nlm.nih.gov/pubmed/21159375