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Bridging the gap in mental health and
psychosocial services in low resource
settings: a case study in Sudan
Shahla Eltayeb, Yvonne Sliep & Orso Muneghina
Sudan has endured the longest civil war in Africa,
with ongoing con£ict since 1983. As a result, it has
one of the largest internally displaced populations
on the continent.The gap in care for mental health
in Sudan islarge, therefore, most ofthe peoplea¡ected
do not have access to the treatment they need (World
Helath Organization, 2009). Mental health facili-
ties in current day Sudan are few and concentrated
in urban centres, where they are di⁄cult to access
and lack adequately trained professionals who are,
in particular, lacking training for trauma related
disorders. The objectives of this intervention were
to bridge the gap in mental health psychosocial sup-
port services in Sudan by setting up a community
based, nongovernmental trauma mental health
centre providing free mental health services, in
addition to mental health professional capacity
building.This paperaddressesdi⁄culties and oppor-
tunities in providing mental health and psychosocial
support in country torn by warand political embargo.
Furthermore, it includes how to incorporate cultural
adaption encompassing Afro/Arab cultures with a
focus on gender and political sensitive approaches
in introducing psychosocial support and specialised
trauma services.
Keywords: capacity building, mental
health and psychosocial support, narrative
theatre, trauma counselling, war a¡ected
communities
Introduction
Background and context
Mental disorders are a source of substantial
disability worldwide, with this burden likely
to be greater in countries a¡ected by mass
con£ict (World Health Organization
(WHO), 2013). Depression alone accounts
for 4.3% of the global burden of disease
and is among the largest single cause of dis-
ability worldwide (11% of all years lived with
disability globally), particularly for women.
The economic consequences of these health
losses are equally large; a recent study esti-
mated that the cumulative global impact of
mental disorders in terms of lost economic
output will amount to US$ 16.3 million
between 2011 and 2030 (WHO, 2013).
Resources and skills in developing countries
are limited, requiring careful consideration
in determining service priorities, while
direct clinical services can only reach a small
percentage of the population (Mannan
et al., 2013). Alternatively, community based
mental health services can provide accessi-
ble, equitable and e¡ective care at low costs,
thereby avoiding the harm created by insti-
tutionalising patients in large mental hospi-
tals (Patel et al., 2016; Qureshi, Al-Habeeb,
& Koenig, 2013).
Health systems worldwide have not yet ade-
quately responded to the burden of mental
disorders, therefore, the gap between the
need for treatment and its provision is large
all over the world. Between 76% and 85%
of people with severe mental disorders
receive no treatment for their disorders in
low or middle income countries, and further
compounding problems are the poor quality
of care and stigma for those receiving treat-
ment (Ali, & Agyapong, 2016; WHO, 2013).
This gap in mental health provision and
quality of care is even worse in Sudan
whereby the country has experienced dec-
ades of internal con£ict that makes it di⁄cult
Field report
Eltayeb et al.
151