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Post-Traumatic Stress Disorder (PTSD) Among East African

Zahra Abdalla

Dr. Wheeler

584-Community Health

April 19, 2015


According to Healthy People 2020 1 in every 17 people American adults have mental illness.

Mental illness is the leading cause of disability and it is the 11 leading cause of death in the

United States. Every year 42.5 American suffer from mental illness, 30 thousand of the 42.5

million who have mental illness commit suicide each year. Even though the exact cause of most

mental problem is unknown, in the research/medical world it is believed that mental problem is

cause by biological (heredity), psychological, and environmental factors (war, trauma), or

situational/ socio-economical such as poverty, joblessness and HIV/AIDs (The Mental Health

and Poverty Project, 2010; IRIN,2014 ; Mtonga, 1994). However, in the cultural and religious

perspective

According to CDC our healthcare system has establish strong system in term of

screening, diagnosis and treatment of mental illness. However, we still have long way to go in

the area of mental health prevention to help and teach our community to maintain emotional,

psychological and social well-being. Mental health problem is a public health concern in the

United State, but mostly in the East African immigrant community. The goal of this paper is to

address the impact of mental health problem such as Post-Traumatic Stress Disorder (PTSD)

Among East African community in Minnesota. Also examine how having access to culturally

competent mental health service and increase awareness and literacy of mental health and

receiving a treatment improves the lives of East African individuals with Post-Traumatic Stress

Disorder.


VMOSA (Vision, Mission, Objectives, Strategies, and Action Plans

VISION: Many East African refugee in Minnesota experienced war trauma and as a result of

that they carry many mental health problem such as Post Traumatic Stress Disorder (PTSD). The

vision of this program is to increase mental health literacy among East African community and

create awareness to reduce stigma related to mental health.

Mission: The mission of this program is to decrease stigma relate to PTSD within the East

African Community through education and promote healthy environment to support those with

PTSD and their people.

Objectives:

1. By 2017, mental health literacy among East African community in Minnesota will be

increased.

2. By 2018 beliefs associated with mental health stigma and treatment will be increased

at least 55% of the East African community.

3. By 2018 the rate of individuals who seek mental health service will be increased by

40%.

Strategies: In order to reach the design objectives for the PTSD mental health program the

following strategies will be reached:


An implementation team consist of six people will be put together, to ensure the progress of the

strategies plan and to make sure objectives of the program is met. The first objective states

increasing mental health literacy among East African community. In order to reached this goal a

community health worker who is familiar with this community will go out to the community and

conduct survey to test people’s literacy about mental health. The community health work will go

to the gathering places such as Mosques, adult day care, child care to discuss mental health

especially PTSD once done with the survey. Community health worker will conduct a focus

group to help people understand the sign and symptoms associated with PTSD and increase

individual’s knowledge about different treatment that is available. Also a to decrease stigma

associated with mental health in the East African community, there will be collaboration between

community stakeholders for example religious and community leaders to increase awareness

about mental health such as PTSD. Since East African community listens to the word of their

religious and/or community leaders it would be good strategy to trained the community leaders

on the topic of mental health. For example, if both community and religious leaders state mental

health is not something to be ashamed, then hopefully people will be open to discussing mental

health concerns within their family, community and their health professional such as doctors.

The third objectives is to increase the numbers of people who will seek mental health services.

Locating a mental health services that is will be culturally sensitive when serving East African

community. It is important that East African community knows their belief and culture is valued

when seeking a treatment to improve their mental health, because it takes a lot of courage to get

to that stages.


Action Plan: To address the mental health concerns in the East African community it is

essential to create awareness and educated the community. Also a collaboration with religious

and community leaders, mental health professional, primary care doctors, local and state

agencies, and other organization who serve this community will need to take place.


What will be done Who is/are responsible

When will it Completed by

How much will it cost and what resources is needed?

Who should know about?

A culturally/religiously mental health survey and discussions and topic for PTSD pamphlet will be design

Community Health worker , internship, Volunteers & program director

By December, 2017

2 community health workers, 2 volunteers & 2 internships. Community health hourly paid= $15.87/ for 10 hours a week. Volunteers and internships assistance (2 hours a day.printing the material $200Internship and volunteer 1 meal a day total meal/day = $100

Funders, program committee, local agency, government and East African community

A meeting with the community and religious leaders will be establish to ensure the survey questions and the discussion topics for PTSD is culturally and religiously appropriate.

Community health worker, Internships & volunteers

By December, 2017

Total travel mileage for internships, volunteers and community health workers= $60 Light meal for the meeting = $300/week

Community leaders, local media, and the East African community living in Minnesota

Administer the survey in Mosques, adult day care, child care and other community gathering, create awareness using media such as radio,& local TV.

Internships & volunteers .

By December, 2017

Total travel mileage for internships and volunteers= $40/wk. Light meal /week = $300/week $5 gift cards for those who participants the survey.Printing the consent forms= $200

East African population living in Minnesota

Create a resource & referral for those who want to seek mental health service: Assist with

Community health worker

By December, 2018

Transportation rides and interpreters are paid by health insurance card. Community

East African community, health insurance (transportation), agency that provides


Application of the Cognitive Behavioral Theory Model

PTSD can be chronic if not treated and can affect individual quality of life. PTSD occurs

when individual goes through an event that is marked by clear cognitive, behavioral, and

physiologic changes (Clark & Ehlers, 2004; Ehlers & Clark, 2000; Foa & Kozak, 1986).

Cognitive Behavioral Theory Model will be used to help East African individual with PTSD to

become aware of mental health treatment such as to Cognitive behavior therapy develop a

behavioral and cognitive intervention for East African individuals with PTSD. Cognitive

Behavioral theory focus on individual’s how perceptions influence their emotional, and

behavioral (Beck Institute, n.d,). Cognitive Behavioral Therapy (CBT) has been found to help

those with PTSD take charge of their cycles of their thoughts. Cognitive Behavioral Therapy is

based on a cognitive behavior theory, and it is a useful treatment to help individuals with mental

health change their thoughts and beliefs about their condition (PTSD) and adapt more healthy

behavior. (NIMH, 2015, Beck, et al., 2008 & Mayo Clinic, 2013).

Hopefully the end goal to referred people to Cognitive Behavior Therapy is to help East African

individuals identify thoughts and emotion that are associated with PTSD. So the individuals are

able to learned new skills to cope with PTSD. To create a focus group to address cognitive

thought so individual are able to discuss negative thoughts associated with their mental health.

Also to ensure mental health professionals are culturally competent in order to identify thoughts

(negative cognitive thinking) associated with mental health (PTSD) in East African culture. East

African individuals with PTSD would benefit from Cognitive Behavioral Therapy because they

are able to understand certain triggers for PTSD such as a death of family death. Also going

through the treatment individual with PTSD will be able to understand their thoughts associated

with PTSD and ways to control instead of avoiding.


Cognitive Behavioral Theory Model for Post-Traumatic Stress Disorder (PTSD)

Literature review

Number of refugees and internally displaced persons who are in need of protection for today is

estimated about 51.2 million (UNHCR, 2013). It is estimated that more than 6000,000 refugees

settle make their home in the United States (Refugee Health .org, 2010). Refugees are people

who are displaced and fled their home country due a conflict of war. The violence of war has

touched almost every part of the world (Toole & Waldman, 1993), and contribute the increased

Whenever I go out in the community, in the public area I feel anxious. Every time I get a phone from back home I worry constantly

Emotional :feeling, mood and emotion

Cognitive : Belief, thoughts

Before I came to this country I have witnessed my daughter get

Physiological:

Behavior Action and

BehaviorI like being alone, I rather be alone than have someone judging me all the time.

Cognitive Behavioral

If I have mental health problem I am worthless and I am not useful in my


numbers of refugees in the world. Before settling to country like the United States refugees left

behind their familiar environment, possessions,

Refugee are vulnerable population and are often experience many traumatic events for example

they witness their loved one, friends, neighbors get murder, observed violent acts for instance,

their daughter or mother get raped (Refugee Health .org ,2010). Due the exposure to many

different traumatic events refugees become vulnerable mental health problem as well ((Lipson,

1993).The more common mental health diagnoses associated with refugee populations include

post-traumatic stress disorder (PTSD) (Lipson, 1993).

Cultural Background and mental health

In developing countries mental health service is not the government first priority (Abdulmalik

and Kola et., al., 2013.There was no functioning government in East Africa for last 25 years, one

in three Somalis has mental problem and not until recently a few mental health facilities has been

establish (WHO, 2011). In order to address the impact of mental health problem and to create

awareness, it is essential to understand the barriers such as values and belief relate to mental

health within East African community. East African (Somali) refugees are the fast growing

refugee entering the United State, between 2003 and 2007 more than 40,000 enter the U.S

fleeing their homeland country Jefferys (2006). It is estimated about 77,000 Somalis living in

Minnesota. Somalis arrive other states, they come to Minnesota because sense of community

belonging (culture, food, culturally appropriate markets) Arriving Ministries (2012).


Cultural belief about mental health among cultures varies (Unite For Sight. (2015), and

so when treating people with mental health problem it critical to understand individual and

cultural background, (Nieuwsma, Pepper and Maack et al.,2011).

Mental health stigma is deeply rooted in the Somali culture, mainly because it is due lack of

awareness, education, and social acceptance. In the East African (Somali) community, if

someone has a Mental illness, he/she is categorized as “a mad person.” Being mad, is associated

with having been possessed by an evil spirit and demon/, cursed and that person with mental

health problem is punished by God (ALLAH). Also within the culture the mentally ill

individuals are look down by the society as someone who done something very wrong and

therefore are shunned, isolated and sometimes beaten.

Treatments

It has been shown that people with PTSD disorder benefit from treatment such as medication

(antidepressants, anti-anxiety, & Prazosin), Psychoeducational, Self-help and Support Groups,

cognitive behavioral therapy (Smith and Segal, 2015, Meichenbaum, 1994, Neuner, et al., 2004,

Najavits, 1998, & Monson et al.,2006). Before seeking treatment, it is essential that level of

mental health literacy in community is improved so that individual are able to recognize the sign

and symptoms of mental health (JORM, 2000, & Corrigan, Patrick, 2004). With the East African

community improving mental health literacy is important because the stigma toward to mental

health is general built in their own culture? It is essential individuals with PTSD overcome

stigma and seek help they need. The purpose of this mental health intervention is to educate

people about mental health, but also to connect individuals with mental health to treatment

and/or resource to those who are willing to seek treatment. Since mental health is a taboo in East


African community, many people do not seek treatment and are not aware of different types of

treatment for PTSD.

Program: Mental Health Program for East African refugees with _PTSD Logic Model

Situation: Post Traumatic Stress Disorder (PTSD) is mental health problem for East African

refugees who experienced the tragedy of war. These refugees witness the horrific violence

associated with war: their loved one killed, tortured, and sexual violence. PTSD occurs couple

month after the person goes through traumatic event. Person exposed PTSD is most likely to

develop feeling of fear, guilt, and anxiety, and without a treatment those feeling will not go away

(Mayo Clinic, 2015, PTSD.Ne.gov, 2007). In the East African community stigma associated with

mental health is overwhelmingly high. Unfortunately, since the East African culture associate

mental illness with negativity, a person with mental health problem such as PTSD will not only

isolates him/herself, but will also reluctant to seek treatment. It is important this community has

access to culturally competent mental health services. To address the concern with PTSD in the

East African community, it is critical to increase mental health literacy, and decreased stigma

associated with mental health. Also to create awareness about mental health (PTSD) by forming

partnerships with community leaders, local, state agencies, and mental health professional that

provides mental health resource.


Inputs

Outputs

Outcomes -- Impact

Activities Participation Short Medium Long

➔ Time ➔ Money (grants)➔ trained

community health workers

volunteers &

-apply for grant -conduct meeting with community leaders-Facilitate community discussion- Develop curriculumdevelop support groups.-Culturally competent mental health resource will be develop.-Education will be provided for mental professional to

-East African community w/PTSD-community -

East African community w/PTSD-community leaders-

-provide individuals in the community information about mental health.- a group discussion will be created to help people start thinking about mental health. -The community members with PTSD will be to begin to talk each other about mental health.

-Community leaders are able to discuss mental health with the community.East African community will become aware of Mental health: PTSD.-Mental health professionals will learn common words used in the East African community to understand

East African individuals with PTSD have increased mental health literacy.-Individuals are able to address feeling of isolation from their own culture.Individuals are able gained insight of PTSD and seek mental health service treatment.


Assumptions: We assume mental health program for PTSD is needed in the East African community. We assume there will be effective participation from the community leader, and community itself. We assume the targeted community will be open to education and discussion associated with mental health: PTSD. We assume there are not culturally competent mental health services for East African community. Finally we assume we will have enough fund to implement the program.

External Factors: Lack of funding and policy to support the program. Not having access to transportation and ensuring health insurance will cover the rides to and from medical appointment.

Mental health is taboo in the East African community and individual who has PTSD are

reluctant to seek help due negative cultural influences (stigma). And so the idea of this program

is to bring positive changes and help create awareness by engaging the community engagement.

The best approach to decrease mental health stigma within the community is to have the


community discuss mental health as every topic. For example, collaborating with the community

leaders talk to discuss mental health problem during religious gathering, community meeting,

and in the mosques is a good strategy plan to create acceptance for those who are diagnosed with

mental health illness. Also to help people understand the severity of mental health there will be

ongoing discussion in community health fairs and local community media.

Limitations of your approach to this community health issue (1/2 page).

Although United States is a head treating and preventing infectious and/or chronic disease it

seems identifying culturally competent mental health that address the cultural belief, and barrier

is lacking behind (Refugee Health .org. (2010). There isn’t any research that is done in the East

African community with mental health, so it will be difficult to know which approach works

best. Also a further research study is needed to understand the impact of PTSD in the Somali

community. It will be difficult finding resource for such as mental health professional that is

culturally competence in Minnesota. According to (Tol et al., 2014), finding availability for

mental health resources can be challenging, and so some limitation to this mental health program

is finding a mental health resource. To assist the East African (Somali) community utilize mental

health service is beneficial, but it will be difficult task working around a tradition that is carry

over many generation: the stigmatization associated with mental health. In order to implement

an effective mental health care that is culturally competent; it is important to understand East

African Community cultural beliefs and their perception is linked to mental health.


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