KENYA – November 24 2021 Strengthening family care through mental health support Text by Anne Kahura; Photos by Jakob Fuhr As a trained counselor, Josephine works with families to strengthen their capacity to care for their children and youth. As a trained community development counselor at SOS Children's Villages in Kenya, Josephine Rombo integrates mental health services in her work to improve the quality of life and well-being of children and families in need. In this interview, she talks about what her work looks like in practice. Why did you decide to do social work? I got into social work because of the influence of my family's background. My mother was a social worker with the government, while my sister was doing something with the university, and I often helped her with practical work. This brought me in close contact with people, and I learned about humanity and the different journeys people take in their lives. I became very interested in this line of work, and I felt it was very satisfying to impact someone's life. What are some of the needs of the families you work with within the family strengthening program? At the program level, we look after the most disadvantaged families in low-income communities. The family composition is usually a caregiver and children under and over 18 years. In addition to livelihood and material needs, the families face many challenges. For example, there are advocacy issues where we empower the family to advocate for their children's rights. We sensitize them on things that may look normal and acceptable in a community but are against children's rights, like asking children to participate in income-generating activities. We educate caregivers to approach government offices for essential services. There has been a barrier because caregivers feel the administration is not a go-zone for them. They are behind with documents such as birth certificates and registration into the national health scheme. Without some of these documents, you will not be able to get into school or employment or get government services such as the national identity card. We have interventions for children. We teach them financial literacy, and we build their self-esteem. We encourage them to be vocal about their issues and report cases of abuse. This has worked very well for family strengthening. The agenda for young people is tough because there are so many of them and the opportunities are not available. That is why we encourage parents to ensure their children finish school. We have adult education for those who have dropped out early to enable them to complete their education. Youth employability, entrepreneurship, mentorship and general life skills training are key things we do with youths here. We also have educational support for families. This helps children who are willing to go back to school but are disadvantaged because of vulnerability at home. What are the mental health needs for these families? Mental health is a priority for all the families we have recruited; it is just that it has not been documented that way. We look more at the physical presentation when they first come in because that is what catches our eye: physically malnourished, looking unwell. But it is more than that. Once I open a file, I look past the economic situation, past the presentations and ask the caregiver what they have gone through. This way I know where they are. There is a lot of loss and grief in these families. They have lost spouses, some have lost body parts, there is so much loss. Men walk away from families to start new families, and it hurts the women so much. There is depression, anxiety, family problems and behavioral issues that I deal with. How do you handle these mental health issues? Mental health has been forgotten. Caregivers do not have the time to address it, and young people struggle to accept they need help. I tell them that if they acknowledge that they need help, the healing process can begin. But if we wait too long, it becomes a case of no return. Addressing mental illness is especially important for young people because there is so much expected of them from their impoverished families. Once they are 18, they have no business being in the house. They must go out and bring something home. So you find our youth at construction sites; they are the ones that lift concrete and carry bricks. They do heavy-duty work or sell coffee or clothes, trying not to be idle. As a result, we have young people committing suicide or having suicidal thoughts. Others try to fill a void in them through drug abuse and crime. They feel there is no reason to live, so better to live on the edge. After all, no one cares whether they are there or not. Talking about young people, we visited a 19-year-old named Wairegi* and he spoke about his difficult childhood. Tell us about your work with him. Work started with him when he was 13 years old. He had very low self-esteem because he thought he looked smaller than the average person. We had the first talk and then went through the session of accepting ourselves. I asked him to join the family strengthening youth group so I could mentor and keep a close eye on him. We spent more time talking, and I discovered that he was very depressed. The depression was hurting him deeply and he was not letting go of past events of his childhood. When we broke it down, it came to many punishments—what he called violence and rejection from his father towards him. The thing is that he loved his father so much and he was looking for that father figure to create the bond between father and son. He pursued it, and the more he tried to cling to the father, the more his father verbally and physically assaulted him. The mother opted to leave the relationship and have some peace. It worked out for her, but for Wairegi, it left him injured and with a void that his father had left. It took many therapy sessions to get him to open up, then more sessions with his mother as I tried to understand what had happened. The mother felt that she could not protect her son because she loved this man. The relationship between mother and son was strained, and they were not on talking terms. He blamed his mother for what happened to him, and he felt alone. Slowly we started what we call a disclosure session, which is most important to children. The counselor helps the caregiver take responsibility for their hurtful actions. The weight comes off the child, and they begin to understand why it is the way it is and it helps to heal them. With this young man and his mother, I am there for them and it does not matter what time of day or night. I encourage them to send me a message. We can talk. That has helped release a lot of pent-up anger and anxiety. We can do a lot of online consultation besides the physical meetings. One of the greatest things she said was: "I have my child back, and we talk—we really talk." We need to educate children that they cannot choose their parents—they are who they are. We can forgive and try to work towards a better future together. The lesson learned is that when we become parents as well, hopefully, we will not repeat the same mistakes. What motivates you to do this work? The small victories and the small positive changes in the lives of children, young people and their families keep me going. *Name changed for privacy reasons.