Previous research found high levels of trauma-related difficulties amongst the conflict-affected population in Northern Uganda. There is international evidence that psychological therapy can reduce depression, one of the effects of traumatic experiences, but there is very limited literature regarding the experiences of trauma counselling in Sub-Saharan Africa.
British Academy and Leverhulme-funded research investigated the experiences of service users and providers of trauma centres established by Peter Alderman Foundation (http://www.petercaldermanfoundation.org). It also examined their implications for mental health policy and legislation. We carried out in-depth interviews with 10 women and 10 men survivors of human rights abuses who attended trauma centres in Kitgum and Gulu. We also interviewed 15 key informants in Kitgum, Gulu and Kampala including counsellors, ministers, cultural leaders and mental health professionals.
Men and women survivors had suffered torture including burning and bomb attacks and sexual violence, as well as other horrific conflict-related experiences during abduction by Alice Lakwena in 1986-1987 and the Lord’s Resistance Army led by Joseph Kony. Many were forced to commit and witness atrocities, including the brutal killing of loved ones. Most related understandable traumatic effects, including severe depression and suicidal feelings leading to isolation and loneliness, anger, nightmares, flashbacks and low self-esteem. Survivor’s accessed medication at the services and counselling that varied in length and quality. Antidepressants, sleeping tablets and antipsychotic medication were frequently prescribed. Those survivors we spoke to lacked knowledge and understanding about the purpose of the medication given. However, trauma services served to restore hope in survivors, which was extremely valued. Service providers felt the treatments provided tackled depression, increased empowerment and social engagement. Service provider’s described anger as a frequent traumatic effect, with alcohol use and domestic violence common. The study revealed a lack of professional skills and expertise for the effective delivery of trauma counselling and mental health legislation was not properly implemented due to a lack of infrastructure.
Survivors voiced there was a limit to the benefits that could be achieved from the trauma services, without using a holistic approach. We argue there is a need for the state to ensure reparation and/or justice for the atrocities witnessed by and perpetrated against survivors. This could include the provision of compensation, or restoration of their land and property stolen from them during the conflict, which would help meet social needs and reduce feelings of shame and anger.
We also made the following recommendations for further development and implementation by experts in Uganda:
- Access to trauma services for survivors should be increased in rural areas and the town, especially by extending services to those who are suicidal and abuse alcohol.
- Increase outreach to communities and train and increase the capacity of village health professionals at community health centres to assess the health needs of those with trauma difficulties, provide counselling, and be made fully aware of referral procedures.
- Community outreach mental health provision should be integrated into primary health care services in rural settings for those who cannot afford transport. Mobile clinics and therapeutic support groups would give more regular mental health provision.
- Countrywide sensitization through radio and local media, particularly targeting families of survivors, will increase knowledge of vulnerable groups with trauma-related problems.
- Education should be provided in schools to ensure the population understands the traumatic impact and importance of reconciliation and relevant policy and legislation which protects those in the community with mental health problems.
- There needs to be support for professional organisations seeking to register, and in the monitoring of all professionals providing trauma counselling. Regular provision of support and supervision structures would help tackle ‘compassion fatigue’ and ensure optimal confidential counselling for survivors.
- The new mental health legislation must be fully implemented and its’ effectiveness evaluated. This requires the inclusion of anti-discrimination provisions with penalties for those who abuse people with mental health problems, and adverse consequences in law for those who violate the legislation. The legislation should clearly define the roles of professionals and service providers who deliver services including trauma counselling.
Link to the Primary Paper
Liebling, H., Davidson, L., Akello, G. F., & Ochola, G. (2016). The experiences of survivors and trauma counselling service providers in northern Uganda: Implications for mental health policy and legislation. International Journal of Law and Psychiatry. Advance online publication. DOI: 10.1016/ijlp.2016.06.12
We are grateful to the survivors and service providers in Uganda that we interviewed. The research was carried out together with Dr Laura Davidson, Barrister, in conjunction with Gladys Faddy Canogura and Geoffrey Ochola, Kitgum Women’s Peace Initiative. We thank Peter C. Alderman Foundation and Dr Eugene Kinyanda, Consultant Psychiatrist for their support. We also give thanks to our driver Mr Frank Maka.
Dr Helen Liebling is a Senior Lecturer-Practitioner in Clinical Psychology at Coventry University. Helen has carried out research with survivors of conflict and post-conflict sexual violence and torture in Africa and refugees in the UK since 1998. Helen’s book publications include ‘Ugandan Women War Survivors’ (Liebling-Kalifani, 2009) and ‘Justice and Health Provision for Survivors of Sexual Violence’ (Liebling & Baker, 2010). Follow Helen on Twitter or view her Curriculum Vitae.
Helen can be contacted at E-mail: Helen.Liebling@coventry.ac.uk
Gladys can be contacted at E-mail: firstname.lastname@example.org