NIGERIA – October 27 2021 Supporting families by focusing on mental health Text by Elisabeth Schmidt-Hieber In Nigeria, SOS Children's Villages is seeing positive results through a new community health care model. Children’s mental well-being plays a key role in their development, and it is significantly affected by that of their parents and caregivers. Community mental health care models can be integrated into family strengthening programs and train helpers in the community provide mental health support. In Nigeria, SOS Children’s Villages has begun to use the Problem Management + intervention and is seeing positive outcomes. Problem Management + (PM+) is a mental health intervention that targets people aged 16 or older who are affected by adversity and are experiencing some level of distress. PM+ aims to decrease early symptoms of mental health issues such as depression and anxiety when there is not yet a need to see a specialist. Certified trainers train helpers in the community to use PM+. Helpers are frontline workers who directly work with families. Since June 2021, 25 members of SOS Children’s Villages staff in Nigeria have been trained as PM+ helpers. “For adult members of families within our family strengthening program, the PM+ intervention is quite useful to ensure psychological issues do not deteriorate into full-scale mental health issues, which can lead to the caregiver’s inability to provide adequate care and protection for the children as well as to child-family separation,” says Oluwole Amosu, Program Development Advisor at SOS Children’s Villages in Nigeria. Problem Management + develops over five weekly sessions and supports people through the use of evidence-based techniques such as problem-solving, stress management and accessing social support. The trained helpers guide program participants through the sessions so that they find out for themselves what the source of their emotional and practical issues is. The focus is then on what the clients themselves can do and change. According to Amosu, “PM+ allows clients to identify their problems. We guide them to identify what options they have. This way, they come up with solutions within their circle of influence and control. We enable them to get out of their problems themselves and to take the lead to create change.” Stigma, shame and cultural beliefs that attribute mental health issues to spiritual causes remain a major barrier to addressing mental health issues. Community models which do not require families to seek the help of a psychologist can help reduce stigma. Program Development Advisor-Gender at SOS Children’s Villages in Nigeria, Nandi Dakum, observes that language barriers and a general lack of awareness of the importance of mental well-being also pose challenges. “You do not have to go and see a specialist; instead, the trained helpers in the community provide the non-specialized service. This is a huge step for us to make the intervention accessible, use it widely in family strengthening programs and extend it to other people in the community who are not part of our programs,” says Dakum. “After the community awareness session, clients usually come with basic knowledge on what the PM+ intervention is about and are open to going through particular issues,” adds Nandi Dakum. Due to the COVID-19 pandemic, meeting and training helpers in person was not often possible. In some situations, PM+ intervention sessions were held virtually, while remote training of certified PM+ helpers and trainers also proved to be effective in spreading the service. In 2020, mental health and psychosocial support experts of SOS Children’s Villages adapted Problem Management +, originally developed by the World Health Organization (WHO), for remote use in collaboration with the International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support and the New School for Social Research (NSSR) in New York City. As a result of the collaboration, helpers were trained in Belgium, Burundi, Ethiopia, Greece, Italy, Nigeria, Rwanda, Somalia, Somaliland, South Africa, Sweden, Uganda and the United States. The training of helpers comprised a wide range of learning modalities, including lectures, demonstrations, role play and group discussions using tools such as Zoom, Mural, Google Drive and WhatsApp. Role-play activities during Zoom meetings, for example, allowed participants to practice and receive live feedback on their newly gained skills. In Nigeria, it has only been several months since PM+ became part of family strengthening programs, but responses and increased reach indicate positive outcomes for families’ well-being, the care and protection of children and efforts to keep families together. “Almost everywhere in the world, people focus more on their physical health than on their mental health. It should be an imperative that in family strengthening we focus just as much on mental health and psychosocial support,” concludes Oluwole Amosu.