The Nakivale Camp Mental Health Project: building local competency for psychological assistance to traumatised refugees

Little is known about the usefulness of psychiatric concepts and psychotherapeutic approaches for refugees who have experienced severe traumatic events and continue to live in stressful and potentially dangerous conditions in refugee settlements. The central goal of the Nakivale Camp Mental Health Project is to establish the usefulness of short-term treatment approaches when applied by local paramedical personnel in a disaster region. In a randomized controlled clinical trial, the efficacy of Narrative Exposure Therapy (NET) vis-à-vis Supportive Counselling has been tested, when applied by trained paramedical personnel from within the same refugee community. Here we demonstrate the feasibility of such an approach and detail the methods and strategy for it. The project also included an epidemiological survey to ascertain the prevalence of PTSD among refugee adolescents and adults alike. Consistent with other investigations, the demographic survey revealed a high prevalence of chronic PTSD ranging from 31.1% in the Rwandan to 47% in the Somali population; even though traumatic events had on average taken place more than 9 and 11 years earlier in each case respectively. Diagnostic validity was assured using expert clinical interviews. The significant social and work-related dysfunction, a disabling consequence of PTSD, does not only impact on the life of the affected individual. Communities where a significant percentage of members, are psychologically affected by past human rights violations, atrocities and war, are held back in their recovery process at many levels. Therefore mental health programmes with workable guidelines on how to treat posttraumatic symptoms, based on solid scientific research with proven effectiveness and feasibility, in particular cultural settings, must become a humanitarian priority. (PsycINFO Database Record (c) 2006 APA, all rights reserved) (from the journal abstract)

[1]  E. Foa,et al.  A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. , 2009, Journal of consulting and clinical psychology.

[2]  T. Elbert,et al.  A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. , 2004, Journal of consulting and clinical psychology.

[3]  Thomas Elbert,et al.  Traumatic events and symptoms of post-traumatic stress disorder amongst Sudanese nationals, refugees and Ugandans in the West Nile. , 2004, African health sciences.

[4]  Victor Igreja,et al.  Testimony method to ameliorate post-traumatic stress symptoms , 2004, British Journal of Psychiatry.

[5]  W. Beardslee,et al.  Testimonial Psychotherapy for Adolescent Refugees: a Case Series , 2004, Transcultural psychiatry.

[6]  R. Ray,et al.  Psychological Treatments for Posttraumatic Stress Disorder: Recommendations for the Clinician Based on a Review of the Literature , 2004, Journal of psychiatric practice.

[7]  R. McNally,et al.  Progress and controversy in the study of posttraumatic stress disorder. , 2003, Annual review of psychology.

[8]  T. Elbert,et al.  Psychological trauma: Burnt into memory , 2002, Nature.

[9]  M. Ommeren,et al.  Lifetime events and posttraumatic stress disorder in 4 postconflict settings. , 2001, JAMA.

[10]  D. Summerfield.  The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category , 2001, BMJ : British Medical Journal.

[11]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[12]  M. Massagli,et al.  Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. , 1999, JAMA.

[13]  R. Gibbons,et al.  Testimony psychotherapy in Bosnian refugees: a pilot study. , 1998, The American journal of psychiatry.

[14]  G. Veer.  Counselling and therapy with refugees and victims of trauma , 1998 .

[15]  D. Summerfield.  Legacy of war: beyond “trauma” to the social fabric , 1997, The Lancet.

[16]  D. Somasundaram,et al.  War Trauma in a Civilian Population , 1994, British Journal of Psychiatry.

[17]  K. Donelan,et al.  The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps. , 1993, JAMA.

[18]  J. Davidson,et al.  Validity and Reliability of the DSM-III Criteria for Posttraumatic Stress Disorder: Experience with a Structured Interview , 1989, The Journal of nervous and mental disease.

[19]  H. Adler.  THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY , 1936 .

[20]  Thomas Elbert,et al.  PTSD and the "building block" effect of psychological trauma among West Nile Africans , 2003 .

[21]  T. Elbert,et al.  Erzähl' um dein Leben - Traumatherapie bei Opfern von Gewalt und Terror in Krisenregionen , 2003 .

[22]  T. Elbert,et al.  A Narrative Exposure Treatment as intervention in a Macedonia's refugee camp: a case report , 2002 .

[23]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[24]  A. Cienfuegos,et al.  The testimony of political repression as a therapeutic instrument. , 1983, The American journal of orthopsychiatry.

[25]  L. Covi,et al.  The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. , 1974, Behavioral science.