Supporting children's mental health in crises and conflicts

Season 4, episode 9

Host Saara Chaudry speaks to Dr. Marcia Brophy, one of UNICEF's global mental health and psychosocial advisors, on the impact of conflict on child and adolescent mental health - and the support and services needed. 

Host: Saara Chaudry

Guests: 

Dr. Marcia Brophy, Mental Health and Psychosocial Support (MHPSS) & Innovation Specialist, UNICEF

Producer: Sara Faruqi

Composed and mixed by: Chandra Bulucon

Transcript

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[00:00:12.22] Nowadays we are exposed to all sorts of news about crises and emergencies, war, natural disasters, humanitarian catastrophes. And we have unlimited access to these horrific events from TV, to our phones, to social media often with no filter. Some events capture the public eye more than others and this trickles down to children too. They see things online, they hear from their friends, they observe the adults around them talk about difficult issues, and they have questions, thoughts, and feelings about these things too.

[00:00:49.43] Then there are the children who are the ones in the news. The children impacted by conflict, natural disasters, and other humanitarian crises and they can suffer severe psychological and social consequences. They may be forced to flee their homes, some separated from their parents and caregivers along the way. During conflict, they may endure staggering violence, severe injuries, and even the threat of recruitment into armed groups.

[00:01:21.19] Many are cut off from fundamental services like clean water, health care, and education. And through all this, children often lack access to mental health and psychosocial support with potentially devastating long term effects. UNICEF works with partners and countries around the world to ensure children are getting the support and services they need and deserve.

[00:01:46.12] Hi. I'm your host Saara Chaudry and for this episode of the For Every Child podcast, we will discuss how to talk to children about conflict and UNICEF's work in providing mental health support to children caught in crises.

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[00:02:17.27] Dr. Marcia Brophy is one of UNICEF's global mental health and psychosocial technical advisors. She is trained as a child psychologist and has worked in the field of child and adolescent mental health for 25 years and in humanitarian and emergency settings for more than a decade. Marcia has trained teams and partners on the ground in Syria, Iraq, Jordan, Ukraine, and Bangladesh, to name some. Today she joins us to talk about mental health support.

[00:02:47.36] Hi Marcia. Thank you for joining us. Unfortunately, conflict and war have dominated news headlines recently, especially over the last few weeks, and it is children who are being affected the most by this. Can you tell us what are some of the impacts on the mental health of children who are directly affected by conflict?

[00:03:10.31] Yeah, thank you. During conflict or crisis times, both children and adults can experience extreme stresses and those things could be exposure to vital destruction also loved ones. And it can manifest itself in children through various reactions such as depression, nightmares, difficulty sleeping, it could be aggressive behavior or withdrawing behavior, sadness, and fear, amongst others. But children have different reactions to adverse events in their environments.

[00:03:42.96] It's important to think about how cultural influences the ways that they express their emotions. So in some cultures, for example, it's not appropriate to show strong emotions like crying loudly while in others it is widely accepted. Some of the signs of distress may not be so obvious either for children and youth who are affected by conflict. Some of the signs of distress are also different at different ages and different children will naturally also show different signs of distress.

[00:04:12.12] We're all individually different and beautiful and that means that we have our own reactions to events that we experience. It's also important, I think, to reflect that during times of extreme stress and crisis, children will observe the behaviors of adults around them and the emotions that those adults are showing and they use them as cues to manage their own behavior as well, so in a way like mirroring what they see around them.

[00:04:40.21] So although I can't give you a really simple succinct answer, what I can share is that children and youth experiencing fear and anxiety will show some physical reactions that are common such as headaches, or nausea, dizziness, diarrhea, dumbness. It could be shortness of breath, rapid heartbeat, feeling faint, and sweating, or even shaky. And you asked about the long term consequences or impact that may have, and so one of the obvious things to share here is that the failure to address any of those mental health challenges or psychosocial issues among children affected by conflict can mean that it hampers their emotional and their physical health in the longer term, as well as some of their social development.

[00:05:29.73] So without having the right mental health support and appropriate mechanisms in place, some children may even continue to develop mental health disorders. Some of the figures that the World Health Organization and ourselves show is that during times of conflict, extreme crisis, the children up to the percentage of 22% will go on to develop mental health disorders, which is quite a large number.

[00:05:58.84] And as an organization for Children, what are some ways UNICEF works on mitigating this? What are some solutions and what challenges do we face in providing this support in emergency settings?

[00:06:13.20] Thank you. It's a great question and a really important one. I think it's important to lay out at the broader level first of all UNICEF approach to mental health support. So we really look at it as holistic and a life course approach, which means from birth onwards, and not thinking about any isolated age in particular. We also look from UNICEF's perspective for mental health that it's an issue that's relevant to every sector and that's particularly important during ongoing conflicts or crisis in those emergency humanitarian settings.

[00:06:47.91] So for UNICEF, it would be looking for equitable partnerships with government and civil society partners so that civil society and local partners, whoever they may be, might be a local charity or it could be a parish group, a faith-based organization, to really work with them immediately so that we're delivering both sustainable and socially and culturally appropriate mental health and psychosocial support programs.

[00:07:19.22] Whether it's with government health service providers or it could be a local community group providing training and mentorship immediately so that we are strengthening the capacity if it's needed. Or any local mental health and psychosocial service providers if they exist. Or as I said it could be then if the capacity of the local mental health workforce is low, for whatever reason in that emergency then it's working with the teaching staff, other health workers.

[00:07:54.44] As I said, it could be including midwives and nurses in that. It could be other social work or social welfare child protection colleagues, could be part of that, and other community providers. So again, it doesn't necessarily always have to be professionalized workforce. Local community providers are incredibly important and significant in us providing the most appropriate support, including mental health support but also support the children and caregivers in emergency.

[00:08:25.90] The practical examples would be things like setting up safe spaces that provide a regular structured activities to help children and adolescents. Really develop skills to deal with the crisis to help problem solve, to help regulate their own emotions, and help maintain or form new relationships, so that could be through peer to peer groups or recreational activities.

[00:08:50.55] While we create those safe spaces for children and adolescents, it also allows the parents, the caregivers a moment of calmness and reprieve from themselves so that maybe they can go off to a separate space, have a cup of tea, sit together and talk quietly as parents sharing their own experiences and sharing their own experiences with the psychosocial or mental health support that's there to help facilitate that.

[00:09:17.14] So us having that safe space for recreational activities, children and young people supports the young people but it also helpfully gives a moment of space and calmness to the parents as well to allow them to regroup as it were, or even maybe it might be to go and have their own tears and their own sadness and they don't feel guilty because they're not doing it directly maybe in front of their children.

[00:09:44.14] So we try to offer that safe space to everyone, which brings me back I guess to an earlier point of that life course approach that we take in terms of our mental health services. It's not just the five-year-olds or the 10-year-olds, but we're really thinking about that full age range including the caregivers or parents.

[00:10:03.01] How can parents, caregivers, schools, or teachers have those conversations with children to help them cope and understand the crises around the world? And what are some tools and approaches that work or help with this?

[00:10:19.96] I think the first thing I'd like to share is whoever it is, whether it's a parent, a caregiver, a teacher at school, when we're asked those difficult questions maybe, I think it's OK to remember that I might not have all the answers to every question that I'm going to be asked, whether it's at school or by my own children. If you have an older group of children, for example, it's an opportunity to be able to use that to look up answers together. And you're using it as a way to build that conversation quite naturally because you're both looking up the information at the same time.

[00:10:58.37] So I think that the young person or the child already begins to build that sense of confidence to be able to ask any questions. No question's off the table, which is important to not have them just having it in their mind and worrying about it even more, and not having the confidence to come forward to ask any questions.

[00:11:18.71] Children often take their emotional cues from the significant adults in their lives. So how we respond to the crisis is really important. So again, for parents, caregivers, teachers, how you're managing your own emotions, are you managing them really well? Are you remaining calm?

[00:11:36.78] It's not saying, don't ever cry in front of your children if you're the parent but just really being mindful of that you're avoiding commenting on rumors or speculating about the situation in front of your children, that you are demonstrating how to be compassionate, sensitive, you're being respectful of the context potentially, the privacy of the affected children and families in that crisis or emergency that you are talking about. I think my next top approach or tip continues along the same vein as it were, it's about continuing to enable an open communication about the situation.

[00:12:19.98] So letting your children know that it is normal to feel upset, fearful, sadness, or anger, when these crises or emergencies are taking place and encouraging them to talk to you about how they're feeling, expressing their emotions, listening carefully to what they're saying and feeling so really being present. Some young people or children may not find it very easy to express themselves with words, just by allowing that space, being present, being reassuring means that they know that space is open that they can come back to it at any point.

[00:12:58.33] Also really important to focus on the helpers in a situation, to try to focus on some positive aspects even in the most horrific emergency situations. So important to let our children know about who the people are who are helping each other out with acts of courage or kindness. Try to find those positive youth stories about first responders or those frontline practitioners who are assisting people or other young people that are calling out for peace.

[00:13:31.24] There's a sense of doing something no matter how small can often bring a lot of comfort into children and adolescents' lives. And it might be even encouraging your child to participate in taking a positive action themselves, it could be drawing a poster, it could be participating in a local fundraiser. Just that sense of doing something no matter how small can really feel immensely positive way for your child to get their sense in the world.

[00:14:02.37] One last question for you, having worked in emergency settings for so long, what is it about this job that keeps you going?

[00:14:10.50] It's such a privilege and pride and respect that I have for local communities, including children and adolescents in some of the contexts that I've worked in, that finding those moments of playfulness and humor is still there. And I can think of so many times when there has been a moment of laughter that's just broken that tension and it could be over something silly and it could be with a local team that I've been working with and we've been working out really intensely with families who are left with nothing.

[00:14:46.05] But sharing a joke over a cup of tea and knowing that you can still or are capable to have a joke and share that common sense of humor. And that spirit of humanity I think is incredibly powerful for me and keeps me motivated. I have such respect for my local practitioners that I've been able to support and mentor or supervise or even for some of them to train and their enthusiasm and engagement and motivation to support their local communities gives me the strength and energy to carry on knowing that we're passing on really practical skills and tools that will help them maintain their own mental health as well as support the mental health of their local communities.

[00:15:46.19] That's incredibly important because it's sustainable, it's not about me as an international helicoptering in, so to speak, being there for a week or two and then leaving again. It's actually about building up a workforce that's sustainable and has the capacity to work really well. But I've also learned an incredible lot from having those opportunities with different cultures, different communities, different backgrounds of how we adapt.

[00:16:13.97] The way we think and the way we learn is quite important. But I think in those safe spaces for children seeing those moments, when they're running around and laughter and playing are the things that keep me glowing inside, shall we say. Like yeah, this is exactly the reason I need to do this job, it's to allow children a safe space to be children. That's the most important thing.

[00:16:39.95] That was Dr. Marcia Brophy speaking to us from London. Thank you for listening.

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