Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women.

Background: The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists. Purpose: To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD). Methods: 83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy. Results: PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment. Conclusion: In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.

The Need for Trauma Therapy for Victims of Man-Made Trauma Compared to Those of Natural Disaster, a Survey of Health Professionals.

INTRODUCTION: Trauma Aid UK (previously HAP UK & Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28th November 2013. Since then, 3 groups of mental health trainees attending part 1 of 3 parts EMDR training. In total, 86 clinicians were trained. Also, in June 2016, the first part of a three-part EMDR training in Nepal was completed following the Nepal Earthquake in 2015. The purpose of this study is to assess, analyse and understand the needs of Syrian refugees, who have being experiencing man made trauma since 2011, with Nepalese people who were exposed to the earthquake on 25/4/2015, in their needs for trauma services, training and provision as assessed by mental health professionals working with both groups of people. SUBJECTS AND METHODS: A survey was conducted at the beginning of each of the above-mentioned training courses. Participants were asked to consent to participate in the study and, if they did, they were given the 'The Need for Trauma-based Services' quantitative and qualitative questionnaire, or its Arabic translation. 63 Syrian participants of the Istanbul and Gaziantep EMDR training were compared with 37 Nepalese participants who also completed the survey. RESULTS: The results analysis of these surveys showed significantly higher PTSD prevalence in the man-made trauma of the Syrian conflict compared with the prevalence following the natural Earthquake in Nepal. 52% of the Syrian mental health professionals surveyed suggested that PTSD is the major mental health problem in their country, compared to only 6% of the Nepalese mental health professionals. Both the Syrian (33%) and Nepalese (27%) health professionals surveyed felt that they were only able to meet around a third of their clients' needs. They felt that training in EMDR in their mother-tongue would help increase their meeting of these needs. Other suggestions of service provisions and innovations were made in order to meet more of the needs of their trauma survivors. CONCLUSIONS: This study highlighted a high need for trauma mental health services of the Syrian refugees as reported by mental health professionals working in the neighbouring countries. The important difference of these needs from those of the Nepalese people confirms that man-made trauma can cause much greater mental health disturbance and a higher level of needs. Recommendations for training and service development for Syrian refugees were made.

The Syrian Refugees' Need for Trauma-Based Services, a Survey of Mental Health Professionals.

BACKGROUND: Trauma Aid UK (previously HAP UK &Ireland) conducted three EMDR trainings in Turkey: the first was in Istanbul on 28thNovember 2013. AIM: The purpose of this study is to assess the needs of the Syrian Refugees for trauma services training and provision as assesses by mental health professionals who work with them. SUBJECTS AND METHODS: Amongst the 62 participants of two Istanbul EMDR trainings organised by HAP, 53% were Syrian. We felt it is a unique opportunity to assess the needs of Syrian refugees they are working with. We asked all the participants who are all mental health professionals to complete an Arabic translation of 'The Need for Trauma-based Services Questionnaire' in these trainings. The rest of the participants on the course were from Iraq (18%), Jordan (16%), Egypt (7%) and others from Palestine, Sudan & Libya (6%). All participants completed questionnaires. RESULTS: The results of comparing the needs reported by Syrian mental health professionals showed higher prevalence of PTSD seen by the Syrian mental health professionals (72% compared with 56% in the clients seen by the rest of participants). Also, the Syrian mental health professionals could only meet 34% (SD=17.1) of the needs of their client who suffer from PTSD. The unmet need for trauma therapy was reported as 100% by these professionals. CONCLUSIONS: This study highlighted the high need for trauma mental health services of the Syrian refugees as reported by mental health professionals working in the neighbouring countries. The needs of the Syrian refugees, arriving to the UK because of the very difficult situations, these refugees are coming from, may be met with EMDR therapy. EMDR can be used to help these refugees to be a productive part of the British society.

Comparision of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey.

BACKGROUND: There is little research evidence as to whether general adult psychiatry or old age psychiatry should look after old people with enduring mental illness. AIMS: To compare the extent to which general adult and old age psychiatric services meet the needs of older people with enduring mental illness. METHOD: A total of 74 elderly patients with functional psychiatric disorders were identified by reviewing the notes of patients over the age of 60 living in a defined inner urban catchment area. Data were collected on the morbidity and needs of the sample. Needs were assessed using the Elderly Psychiatric Needs Schedule (EPNS). RESULTS: The participants in contact with old age psychiatry had significantly fewer unmet needs compared with those in contact with general adult psychiatry (2.8 v. 5.6, t = 2.2, P<0.03). Total needs were not significantly different between those managed by old age and general adult services (8.0 v. 6.5 respectively, t = 1.2, P = 0.2). CONCLUSIONS: This study found that old age psychiatry services were better placed to meet the needs of elderly people with mental illness. This finding supports the need for a separate old age psychiatry service.

Psychiatry, homeless patients and welfare reforms: historical links and chains.

The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors' opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.

Nothing new under the sun: post-traumatic stress disorders in the ancient world.

Herodotus' account of the Athenian spear carrier Epizelus' psychogenic mutism following the Marathon Wars is usually cited as the first documented account of post-traumatic stress disorders in historical literature. This paper describes much earlier accounts of post combat disorders that were recorded as occurring in Mesopotamia (present day Iraq) during the Assyrian dynasty (1300-609 BC). The descriptions in this paper include many symptoms of what we would now identify in current diagnostic classification systems as post-traumatic stress disorders; including flashbacks, sleep disturbance and low mood. The Mesopotamians explain the disorder in terms of spirit affliction; the spirit of those enemies whom the patient had killed during battle causing the symptoms.

The need for a category of 'religious and spiritual problems' in ICD-11.

The World Health Organization's International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders is currently working on the development of ICD-11 (World Health Organization, 2007). A more responsive ICD coding system should incorporate recent work which suggests that the religious and spiritual domain is important for a comprehensive, culturally sensitive diagnosis and management plan (e.g. Sims, 1992, 2004; Koenig et al, 2008). A 'religious or spiritual problems' category, similar to that in DSM-IV (American Psychiatric Association, 1994), should be included in ICD-11.