David M. Ndetei MBChB (Nrb), DPM (London), MRCPsych. (UK), FRCPsych. (UK), MD (Nrb), DSc (Nrb) Certificate in Psychotherapy (London) Professor of Psychiatry, University of Nairobi (UoN) & Founding Director, Africa Mental Health Foundation (AMHF) & Chair, African Division Royal College of Psychiatrists, UK & World Psychiatric Association (WPA) Zone 14 Representative & Secretary, Division of Psychiatry in Developing Countries, WPA & Chair, Kenya Universities and Colleges Central Placement Service Board, Government of Kenya Website: MENTAL HEALTH NEEDS ASSESSMENT OF SOMALI URBAN REFUGEES IN EASTLEIGH ESTATE IN NAIROBI, KENYA BY

 Prevalence of mental illness and patients’ mental health needs among Somali refugees in Nairobi are scarcely reported.  Particularly vulnerable groups among these refugees are women, children and older people who may have suffered traumatic experiences while escaping their countries and while in the refugee camps.

Methodology 1)Identified and trained high school and College graduates Somali refugees living in Eastleigh, Nairobi 2)Instruments:  Social demographic questionnaire  MINI PLUS  MINI KID 3)Snow balling identification of Somali refugees taking into account confidentiality and sensitivity 4)Both Quantitative and Qualitative (FDG)methods 5)In-depth interviews with Somali Service providers

Results Sample size 1)A total of 242 adult respondents were recruited; age ranging from years, mean age 29.2 years, standard deviation of )A total of 239 youth respondents were recruited: age ranging from years, mean age 5.24 years, standard deviation of 2.91

Psychiatric Disorders by Sex Disorders by Sex - Summarized in Table 1 below

Highlights on Adult Gender Findings  The commonest conditions are highlighted in table 1 below  Note the similarities between the males and females  The only statistically significant difference (p=0.014) between males and females was found in the prevalence of OCD, where a higher proportion of females, that is 30.1% (n=40) met the DSM-IV criteria for OCD than males % (n=18).

Patterns according to Adult Age groups The adult age groups was clustered into three categories: 1) ) )More then 45 These are summarized in table 2 below

Significant Associations between PTSD and other Psychiatric Disorders Among Adults  As indicated in table 3 below, PTSD was significantly associated with: depression (p=0.001), bipolar mood disorder (0.021), OCD (0.012), alcohol abuse (<0.001) and khat use (p=0.004).

Psychiatric disorders according to gender of youth – Summarized in Table 4 below – but note following highlights (a) The only disorders which had significant statistical difference (Fischer exact test) were: - 1)Specific phobia (p=0.001) where a small proportion of boys, 1.7% (2), had the disorder compared to 13.0% (16) girls i.e. more in girls than boys and 2)Social anxiety disorder (p=0.042) where a higher proportion of boys, 6.9% (8), had the disorder compared to girls 1.6% (2) i.e. more in boys than girls.

(b) The proportion of females (69%) who had lifetime suicide risk was more than that of males with the male to female ratio of 1:2.2; giving a significant statistical difference between gender (p=0.044).

Highlights from FGDs with the Refugees and in-depth interviews of the medical providers

1)From the focus group discussion it was found that there were Somali religious and cultural leaders/healers residing in the study area, and therefore refugees had access to culturally appropriate and responsive services.

2)Health professional or mental health service providers trained from western medicine perspective must integrate Somali culture and religion by:  Respecting Somali’s culture and beliefs;  Being open-minded; being up-front about things they do not know and asking questions about a person’s culture and beliefs;  Developing shared expectations;  Allowing more time to support refugees when using interpreters;  Being flexible with appointment times and working with communities to increase mental health literacy and address stigma which have been shown to be effective.

3)The main barrier across the various medical facilities at the study site was lack of basic training in provision of mental health services at primary health care.  Both the refugees and medical workers did not recognize symptoms of common mental disorders;  Hence these mental disorders that are highly prevalent remained undiagnosed and untreated.

4)Other observations:  Medical service providers in this area mainly came from Kenya;  Medical service provision is conducted in Kiswahili and English without considering Somali culture or observing Islamic religion.  This causes barrier for the Somali refugees mainly those without legal status to access medical health services, since they will require an interpreter, who might want to know their legal status.

5)Therefore their ability to access mental health services is limited by fear of getting caught since most have no legal papers, language, economic, stigma/discrimination and culture (religious and traditional) barriers.

6)This study provides important lessons on providing medical services to refugee populations.

CONCLUSIONS

1) Refugees are at high risk of mental health problems as a direct result of the refugee experience and displacement from their homes.

2)In addition, the Somali refugees are adherents of Islam and the Somali culture, which is totally different from the majority of Kenyan experience.

3)This increases the range of experiences that may affect their mental health.

4)The lack of mental health services in the study site further increased the risk of developing more severe forms of mental illnesses due to the absence of early detection and treatment mechanisms.

5)There is need to establish a hierarchy of needs and building from a base of meeting the refugee's physical needs and thereafter to refugees’ psychological needs. The emphasis has been physical with no reference to psychological needs

RECOMMENDATIONS

1) A further anthropological study to understand the barriers and facilitators of mental health access amongst Somali Refugees in Kenya.

2)Identify and engage with the currently available human resources both formal and informal already existing within the Somali Refugees with a view to impart appropriate skills to identify and manage mental health issues using interventions with known efficacy and appropriate for the human resources in line with the WHO Mental Health Treatment Gap – Intervention Guidelines (mhGAP- IG).

3)Established dialogue between the Somali health systems and Kenya health systems.

THANK YOU!!