Mental Health Consultant - Dadaab Refugee camp

[Admin]

Dadaab is the world’s largest refugee complex and is situated in Kenya’s North Eastern province approximately 80 kilometres from the border with Somalia. The three refugee camps in Dadaab namely, Ifo, Hagadera and Dagahaley, continue to receive a significant number of new arrivals (on average around 2,000 per week) and mostly from Somalia. As of 17 October 2011, the overall population in the Dadaab camps stood at 463,795 persons and a total of 152,987 have been registered since the beginning of 2011. This number is significant given the fact that the three camps were originally established to accommodate 90,000 refugees (30,000 per camp) in the early 1990s.

The resources and infrastructure of the camps have been stretched beyond their capacity and the quality and quantity of service delivery heavily compromised. The influx and the resultant population increase has also led to environmental degradation, insecurity and hostility from the host community. In effect, the Dadaab operation consists of two situations running side by side; the long term protracted refugee caseload on the one hand and the emergency operation (influx of new arrivals) on the other – both of which offer a mountain of challenges.

Each camp has clinic based mental health services, some mental health outreach activities and counseling and other services for particular target groups such as SGBV survivors, affected children and torture survivors. Funding allocated to mental health by the agencies working in Dadaab is small compared to the overall need.

Justification Within the camps a range of socio-cultural factors hamper the delivery of mental health services. Refugees with mental health problems are often stigmatized, discriminated and socially isolated. The burden of care is left to families who occasionally resort to restraining with chains and often resort to traditional healers in preference to medical services. A mental health assessment carried out by Handicap International in 2010 found that 44% of persons with a mental health problem who were interviewed have been chained at least once, while 19% were chained at the time of the interview. Half of those in chains had been chained for at least one to more than five consecutive years. There is a relationship between mental ill-health and substance use as 17% of persons interviewed reported misuse of khat. The main treatment sought by people was Koranic (92%) and medical (87%); mixed interventions were common. However, health agencies are approached only when the condition is chronic and deterioration is extreme. The Handicap International report recommended the establishment of integrated community based mental health services to complement the existing facility based services.

In 2010 a Mental Health Working Group was convened by UNHCR with active participation by agencies working in mental health and psychosocial support in Dadaab. Outputs of the working group to date include a matrix of agency activities in MHSSP, a referral mechanism for camp mental health referrals, pilot project on family support associations, joint trainings and a draft proposal for support and supervision for mental health service providers. Though much progress has been made significant challenges remain and the MHWG is seeking a consultant to assist in developing a mental health and psychosocial support strategy for the Dadaab camps.

Overall Objective 1. Develop a comprehensive multisectoral strategy including associated costs to address the main mental health and psychosocial problems found in the camps addressing both the long term refugees and the ongoing refugee influx

Specific Objectives 1. Assess and document the range and scope of mental health services at family, community and facility level and the extent to which they address the main mental health and psychosocial support needs of the refugees 2. With reference to the WHO Mental Health Gap Action Programme guide Make recommendations on interventions to improve the range, quality and coverage of mental health services including the required staffing levels and appropriate supervision and support systems for staff; emphasis should be on building local capacities, supporting self-help, strengthening the existing resources and using appropriate local cultural practices 3. With reference to the IASC Guidelines on Mental Health and Psychosocial Support in Emergencies make recommendations to improve social support and mental health response for new arrivals and to enhance intersectoral collaboration on mental health in the three camps 4. Assess potential for linking with other agencies such as UNICEF (psychosocial support for children) and WHO Somalia (sharing approaches and strategies, training tools and other resources).

Methodology Information will be collected from a variety of sources. The methodology will be participatory and involve key stakeholders including affected community members, service providers and opinion leaders.
a. Review of existing information Health information system data of common mental health presentations, agency reports and assessments, Ministry of Health policies and strategies; reports and assessments relating to mental health in Somalia, Dadaab and Kenya (with due attention to other countries of origin such as Ethiopia and Sudan); review of assessment tools b. Key informant interviews with agencies working in various aspects of mental health; community leaders representing the different refugee groups, religious leaders, traditional healers, service providers, teachers.
c. Interviews with families and caregivers of those with mental health problems and persons living with mental health problems (including substance use predominantly khat but alcohol is also problematic is some groups) and newly arrived d. Facility and service assessment using standardized assessment tool, observation, review of registers and collection of secondary data Tasks of the Consultant 1. Conduct literature review and review of existing information documenting interventions and their reasons for success or failure; review and document relevant aspects of current mental health polices and strategies in Kenya 2. Develop assessment tools including various key informant interview tools, facility and service assessment data 3. Meet with agencies at Nairobi level such as UNHCR, UNICEF, WHO Somalia, Ministry of Health and psychiatric hospital
4. Conduct interviews with key informants including agency staff (Handicap International, Centre for Victims of Torture, Save the Children UK, International Rescue Committee, Medecins Sans Frontieres, Lutheran World Federation, CARE, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)); meet with mental health service providers, families/caregivers of those with mental health problems, police, traditional healers, community leaders. 5. Conduct visits to facilities and services to assess range and coverage of the mental health services in the three camps including to mental health outpatient clinics, family support centre pilot in Dagahaley, Ifo Day Support centre, inpatients departments, GBV services, registration site, services for orphans and vulnerable children, referral facility in Nairobi
6. Assess agency resources allocated to mental health and psychosocial support 7. Conduct a multi-stakeholder workshop with the aim of developing a strategy to guide agencies working in MHSSP to address identified gaps in services and improve range, coverage, quality and effectiveness of services 8. Write report with key findings recommendations and costed draft mental health strategy

Outputs: 1. Literature review 2. Qualitative and quantitative assessment tools (facility based checklist, key informant interview guides ) 3. Final report with key findings and recommendations (including separate workshop report) and draft strategy to guide UNHCR and partners in improving mental health and psychosocial services

Timeline Day 1-5: Literature review and development of assessment tools Day 6-7: Travel Days 8-9: Meetings in Nairobi Day 10: Travel to Dadaab Day 10 to Day 29: Conduct Assessment Day 30 to 31: Workshop Day 32-33: Travel to Nairobi and Debrief in Nairobi Day 34: Travel Day 35 to 40: Write report

Consultant Profile 1. Mental health background (psychiatrist, psychiatric nurse or senior mental health professional) 2. Extensive experience in assessing, planning, monitoring and evaluating mental health and psychosocial support programmes in resource limited settings. Experience with refugees or other conflict affected settings highly advantageous 3. Understanding of Somali socio-cultural and community dynamics highly desirable 4. Strong communication and facilitation skills 5. Proficiency in English essential; Somali language skills highly desirable

Kindly submit P 11 / detailed CV to HQPHN@UNHCR.ORG