Priorities for future research arising from this overview include understanding why children and adolescents constitute a small proportion of patients in some.
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Mental Health Services for children exposed to armed conflict: MSF experience in DRC, Iraq and occupied Palestinian territory
L
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K. Lokuge1,2, T. Shah2, G. Pintaldi3, K. Thurber1, C. Martınez-Viciana4, M. Cristobal4, L. Palacios4, K. Dear1, E. Banks1
s
tiv
C om m on
de
e
This is routine data collected for
at iv
Precipitating events
programmatic purposes, there is
wellbeing of children and adolescents.
differs between countries however the
adolescents differ between countries.
consequently no control group. Another
Research on mental health interventions
counselling approach in all the
The most common precipitating event
notable limitation is the high default rate.
for conflict-affected children and
programmes is based on principles
was sexual violence in DRC (36.5%),
adolescents has been limited and few
derived from brief trauma-focused
domestic violence in Iraq (17.8%) and
therapy, the current MSF mental health
incarceration or detention in oPt (33%).
re
rC
e at iv
re
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de
un
u ed rm itt
Pe
se :U
iv
re at
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itt ed
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er
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However, a high proportion of children
65.5
25.9
ed
76.7
defaulted before care was complete.
itt
33.8
un d
(47.2%) and adolescents (44.6%) oPt
U
s:
Po st er
00 0
F1
Martínez-Viciana C, Cristobal M, Palacios L,
43
:U
rs
improvement of their complaint.
68.8
rs te
te
e.
Lokuge K, Shah T, Pintaldi G, Thurber K,
Iraq
DRC
female adolescents
Po s
on
DRC, Iraq and oPt, reported
se
Advisor, MSF-OCA, Judith Herrera, Director,
itt ed m
Pe r
se
U .F m
14.6
Table 2 : proportion of children and adolescents that are
female children
om
9.5
10.4
female
C
Publication
e
from care, 99.8%, 98.9% and 81.9% in
adolescents
os
un ed s:
te r ns e ce Li on s C e
iv re
de 36.5
3.7
un
se
s: U
te r
Po s
8
children
Iraq, Musa Hamdan Hamed Hamdan, Health
services for children.
Of children and adolescents discharged
Iraq
Tran, Staff Specialist, Concord Centre for
provide access to mental health
oPt
DRC
%
within the context of efforts to
Short-term outcomes
er m
Po
00 0
facilities
Medical Department, MSF-OCBA and Dr Hang
issues. This research must occur
rC
m
Pe r
presenting in relation to all ages presenting to MH
and Marlene Goodfriend, Mental Health
care early and how to address these
at
ed
itt
rs st e
Table 1 : proportion of children and adolescents
Advisor Iraq, Karla Bil, Health Advisor DRC,
ce ns
proportion significantly varied by country.
project, Hans Stolk, Mental Health Advisor for
programmes, why many leave
Li
during 2012.
mental health care in the DRC, Iraq and oPt
small proportion of patients in some
s
19 years (10%) presented for care. This
%
children and adolescents constitute a
om
occupied Palestinian territory (oPt)
un de
(7.1%) and 1767 adolescents aged 15-
We gratefully acknowledge the teams providing
itt
Pe Po s se .F
m om
rC
rm
Pe
(DRC) and Iraq during 2009–2012, and
Priorities for future research arising from
this overview include understanding why
m
including 1258 children under 15
addressing the mental health needs of children exposed to armed conflict.
C
in Democratic Republic of Congo
Acknowledgements
This illustrates a feasible method for
e
A total of 17,655 individuals of all ages
00 0
arising from the experience of trauma.
at iv
itt
Demographics
mental health services provided by MSF
:U se
behavior and somatization problems.
re
ed
un de
se
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rs :
be effective in reducing symptoms
on s
re
rC
Pe rm
violence.
children and adolescents attending
were anxiety related followed by mood,
adolescents
focus on awareness-raising e.g. sexual
programme monitoring data on all
Brief trauma-focused therapy, appears to
Figure 2: Presenting complaint category for children and
conducts community outreach with a
This is an analysis of routine patient and
complaints in children and adolescents
Li
at iv e
ed itt
targeting children. The DRC programme
Methods
Presenting Complaints
10 00
health outreach activities specifically
treatment approaches outside of conflict settings.
ce n
outcomes in each country.
C
Only oPt has community-based mental
recognizable and have established
10 00
on s
om
un de
provided and their short-term
Many presenting complaints are
The most common presenting
m
rC
Outreach activities
(iii) describe the mental health services
F1
se
Li c
C e iv
re at
ed
are all hospital-based.
underlying events associated with
F1
significant precipitant.
not integrated and the Iraqi programmes
health complaints and precipitating or
itt
conflict is potentially over looked and is a
.F
om
de r
un
(ii) Describe the presenting mental
os te
influencing child mental health needs in
including primary healthcare. In Iraq and oPt, the mental health programmes are
Mental Health, Australia.
The role of increased domestic violence
en se
C
integrated with other health activities,
services
uptake.
10 00
m on s
re
In DRC mental health services are
adolescents presenting to the MSF
contact with children appears to improve
U
en s Li c
C e
at iv
Relationship to other health services
characteristics of children and
health services to groups that come into
Po st er
e.
om
whereas in oPt care is provided by psychologists.
However, information on child mental
s:
F1
are supported by specialist advisers,
(i) describe the demographic
these complaints;
rm
st Po
00 0
Li
s
staff with basic counselling training who
The aims of this analysis were to:
de
Pe
se
s: er
.F
In DRC and Iraq, programmes are run by
m on
re
C
event.
ce
C
at iv
e
understand the mental health exposures
services is variable across contexts.
presenting in each country according to precipitating
Human Resources
component of such evidence is to
The number of children accessing
Figure 1: Proportion of children and adolescents
ns e
om
developing such guidelines; an important
Conclusion
U
10
therapeutic intervention.
evidence base is a vital pre-requisite to
Aims
rm itt
s:
st er
Po
00
Li c
m on s
for their care. Developing an appropriate
and needs of children and adolescents.
ed
Precipitating events in children and
en se .F
The model of mental health care delivery
organisations have adequate guidelines
er m
Limitations
un
U se
10 00
m m on s
Types of Intervention
impacts on the mental health and
re a
Pe
Results (2)
Results
Armed conflict has broad-ranging
rC
rm itt
er s: st Po
Li ce ns
Background
er
ed
U
1.The Australian National University, Canberra; 2.MSF-UK, London; 3.MSF-Operational Centre Amsterdam; 4.MSF-Operational Centre Barcelona Athens
Dear K, Banks E. Mental Health Services for children exposed to armed conflict: MSF experience in DRC, Iraq and occupied Palestinian territory. Paediatrics and International Child Health 2013 Vol. 33 No. 4
