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psychotherapy

Displaced persons camp, North Kivu province <em>Picture: Julien Harneis</em>

Displaced persons camp, North Kivu province Picture: Julien Harneis

Moses Seruwagi
Street News Service

They are men who have lost all pride and self-confidence and who have been left severely traumatised by recent events. At the medical centre in Uganda where they are being treated, they talked candidly about the horrendous crimes carried out against them.

“In the past, I thought that it was only females who were raped but not men,” said John, a 27-year-old refugee from the Democratic Republic of Congo (DRC). “I cannot understand myself today. I feel pain all the time in my anus and bladder. I feel like my bladder is full of water. I do not feel like a man. I do not know whether I will ever have children.”

John is just one of possibly thousands of victims of male rape in Africa, as brutal civil war and tribal conflicts continue unabated.

On 14 January 2009, rebels loyal to the former renegade Congolese general Laurent Nkunda attacked Jomba village in the country’s North Kivu province. There, the militia abducted ten people including six boys and forced them to carry out looting before taking them to a jungle base in Virunga National Park. John was among those captured.

“We were held for nine days,” he said. “The leader of the group asked to have sex with me. I did not understand what he meant. He ordered that I be tied up and then he raped me. The other nine came after him. I passed out. My bottom was covered with blood. All nine days in the bush were like that. It was like that for the others. One of the boys died.”

Nearly two years on from his ordeal, John is one of dozens of male and female rape victims being treated at a trauma counselling centre called the Refugee Law Project (RLP) in the Ugandan capital, Kampala. The survivors come from a number of African nations ridden with conflict, including DRC, Sudan, Somalia, Ethiopia, Eritrea and Burundi.

The RLP was founded ten years ago and is an outreach of the law faculty at Uganda’s main university of Makerere, where staff help rape victims recover from their mental and physical wounds. The centre – situated on a hill in the northern part of the city called Old Kampala, where it is housed in a colonial-style residential building – is unique and not generally known by the Ugandan community.

Salome Atim, the RLP gender official responsible for aiding male rape victims, said that since the beginning of the year they have received about 30 cases of male rape, mostly refugees who have escaped from conflict areas. “These are the ones who are open,” she said. “The others do not speak, and that means there could be very many [victims].”

Many males fear speaking out because they are often branded homosexuals even by doctors and medical workers trying to help them. In other cases, rape victims from Islamic states such as Somalia refuse to talk because revealing what happened can result in them being labelled criminals by wider society.

Atim added that homosexuality, which is taboo in many African societies, compounds the dilemma – but in the Congo, where society is more open, some people feel more able to talk, although only after much counselling.

“People are not used to homosexuality and they do not listen to these people,” she said. “They think anal sex is consensual where they think the victim agreed. They [victims] get further stigmatised because the moment they go to a health centre, they are asked, ‘So you are homosexuals?’ So they do not speak. We help them to open up slowly.”

One of her patients, Pierre, was a student at a school in the Congo city of Bukavu. In 2004, gangs from one of the numerous militia groups trying to exert control of the area attacked his family home and gang raped him, his father and his brother.

“Men in uniform broke into our home. They tied up my father’s legs and arms. They then undressed my brother and told me to have sex with him. I refused,” Pierre said before breaking down in tears as he spoke.

After composing himself, he continued. “They undressed me, held my penis between sticks and repeatedly banged it. One of them held my leg and another held the second leg and they pulled them apart. The rest of the gang then raped me one by one.”

According to Atim, Pierre was suicidal when he arrived at RLP and has since been treated in a psychotherapy clinic.

Ugandan social workers say that male rape has been prevalent as a weapon of war in many conflict zones and also in prison cells, but these crimes are mostly unreported because the focus is on female victims.

John, who covered his face with a cap during the interview, said he now struggles to walk any distance due to unhealed wounds. “When I walk a long distance, blood flows out of my anus. When I eat hard food like cassava I have problems going to the toilet because my rectum gets out when I pass out faeces.”

The names of the interviewees have been changed at their request.

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bacplogoBy Stuart Crawford

The British Association for Counselling and Psychotherapy (BACP) has renewed calls that there should be a trained counsellor in every Scottish school. The BACP has over 1,500 members in Scotland (35,000 across the UK), who work across the private, public and voluntary sectors.

Counselling and psychotherapy cover a range of “talking” therapies, and offer an alternative route to tackle some problems that might otherwise be countered by prescription medicines, including antidepressants. These talking therapies can help people with problems as diverse as bereavement, relationships, educational problems as well as anxiety and depression.

Usually delivered in a safe, confidential environment by therapeutically trained practitioners, therapies allow people to talk through sometimes painful, confusing and uncomfortable issues with someone who can help improve things.

This, sadly, also includes young people. In 2004, over 55,000 Scottish children were identified as suffering with mental health problems – roughly 8 per cent of the age group population. One can only wonder at how many more might remain unidentified, or who do not seek or have access to the appropriate help. Current provision throughout the country is patchy at best.

Successive Scottish governments have been aware of this, and have attempted to tackle the problem of mental ill health in young people. In 2005, the then Labour–Lib Dem Scottish executive produced the report The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care, which called for the provision of confidential, accessible, and non-stigmatising counselling support for all young people by 2015.

Despite this commitment, there has been little movement towards this target during succeeding administrations and there is still no Scottish national strategy for its implementation.

Evidence does show that school-based counselling is associated with improvement in a range of problems that young people might face – for example family issues, eating disorders, bullying and anger management.

Recognising this, both Wales and Northern Ireland have their own national strategies in place for school-based counselling. Both provide ringfenced funding for the provision of these services in every secondary school in their countries. Indeed, such counselling services that have been implemented in Wales have helped thousands of children and young people and are associated with improved attendance and greater confidence in school.

But not yet in Scotland. It may be, of course, that the idea has fallen victim to politics north of the border. The pledge to place a counsellor in every school in Scotland was made in 2005 by the Labour–Lib Dem coalition. The SNP has formed the administration in Holyrood since 2007, and possibly it has slipped down the priority list as the party seeks to implement its own policies.

However, what can possibly be more important for the country, as it movees towards an independence referendum, than the wellbeing of its young people? They are the future of Scotland.

Accordingly, the BACP is once again voicing its recommendation that all Scots children and young people should have access to professional, qualified counselling services at school. There should also be alternative provision within community settings for those who prefer not to access the service at school.

The BACP fully understands the fact that such facilities would have to be authorised and implemented at local authority level, but is keen that the Scottish government should put a fair wind behind it.

That’s not really a lot to ask, is it?

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By Stuart Crawford

The Scottish Government has just announced its performance targets for access to mental health services in the NHS. These HEAT targets (the acronym stands for “health improvement, efficiency, access and treatment”) reflect the government’s priorities for the health services in Scotland and are set for all aspects of healthcare delivery.

The aim is to deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013; and 18 weeks referral to treatment for psychological therapies from December 2014.

The rationale is that timely access to healthcare is a key measure of quality and that applies equally in respect of access to mental health services. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the impact on other aspects of their development such as their education, so improving their wider social development outcomes.

The intention is to agree a target of 18 weeks referral to treatment for specialist CAMHS services from December 2014 for inclusion in HEAT next year. Psychological therapies have an important role in helping people with mental health problems, who should have access to effective treatment, both physical and psychological. It is generally accepted that these therapies can have demonstrable benefit in reducing distress, symptoms, risk of harm to self or others, health related quality of life and return to work.

The announcement has been given a qualified welcome by the British Association for Counselling and Psychotherapy (BACP), the leading professional body for counselling and psychotherapy in the UK, which has over 1,500 members in Scotland. Members are employed in a range of services and work with people who have wide ranging needs such as relationship problems, addiction, stress and bereavement through to mental health problems such as depression and anxiety.

Its welcome is qualified because BACP has concerns that the new target refers only to a narrow range of psychological therapies for specific diagnosed conditions. Therefore, an unintended consequence of the HEAT target is its potential to draw funding away from services offering a range of therapies. BACP is committed to patient care as the centrepiece of mental health service design, and is therefore strongly encouraging the Government to widen its view of the mental health and wellbeing needs of the population and the therapies that meet these needs.

Shane Buckeridge, BACP Lead Advisor for Scotland, said: “It is admirable to see that the Scottish Government has developed a target for access to mental health services. It is estimated that at any one time there are some 850,000 Scottish people with mental health problems, and until now it has been a postcode lottery in terms of what is available, leading to a huge disparity in service provision across Scotland.

“The new target makes health boards accountable, and will hopefully ensure that all patients have access to the services they need in a timely manner. However, BACP is concerned that existing services which are excluded from the narrow range of acceptable therapies within the target, may find themselves under threat. These services are often used by GPs to help people with multiple issues which do not fit the referral criteria for current secondary care mental health services.”

BACP points out that many users report wanting choice about what is most appropriate to their needs. The research evidence also suggests that no one approach in this field will be effective with all patients. The Association is therefore continuing to urge the Government to incorporate choice into the new targets to make mental health service provision accessible for all.

<em>Picture: Chris Breikss</em>

Picture: Chris Breikss

By Allan Laing
Ecstasy is showing promising signs of success as a treatment for post-traumatic stress disorder.

Clinical trials in California and Switzerland suggest that the beneficial effect of the substance, regarded as the original designer drug, continue for years after treatment.

Now medical scientists are looking to expand their pilot study in the hope that ecstasy – also known as MDMA (methylenedioxymethamphetamine) – could be more easily approved as a prescription medicine in the US. Much of the testing so far has been carried out on American veterans suffering from PTSD.

The results of the human tests, unveiled at a conference last week in San Jose, California, and published in the science journal Nature, are described as “encouraging” with most sufferers involved in the study showing lasting improvements.

Dr Michael Mithoefer, the South Carolina psychiatrist who led the study, said: “The results were very promising and there were no safety problems or serious adverse events but we need to replicate this.”

The US study was the first in America to look at the therapeutic effects of ecstasy on PTSD. The 20 patients, mostly women, had been resistant to psychotherapy and standard PTSD drugs. They were given MDMA during a series of sessions. Two months later, only 15% of those who took ecstasy were still suffering from PTSD, whereas 85% of another group who received a placebo did.
In long-term follow-ups, averaging more than three years after the initial treatment, most of the patients who took MDMA were still free of PTSD.

In a second study, carried out by psychiatrists in Biberest, Switzerland, the results showed an improvement in some patients but it was not “statistically significant”. Experts suspect that this was because of cultural differences between the two test groups.
Now they want to expand their research in other countries, both to make sure the drug works in different cultural contexts and to make the approval as a prescription medicine more likely. The group is seeking approval to conduct experiments in Canada, Israel, Jordan and Spain.

PTSD can develop after traumatic experiences such as sexual abuse or witnessing extreme violence. Patients can suffer from frightening flashbacks and nightmares.

Ecstasy, a so-called psychedelic drug, releases neurotransmitters such as serotonin to the brain and, according to the researchers, could help to decrease fear and defensiveness during treatment.

The controversial drug was used during psycho therapy in the 1970s but, with the rise in its misuse in the rave scene of the 1980s and 1990s, it was classified as dangerous drug and made illegal. Only relatively recently have scientists been allowed to experiment with it.

Ecstasy is a Class A drug in the UK. It is estimated that there have been as many as 60 deaths, most of them young people, connected to the substance in Britain, most notably 18-year-old Leah Betts from Essex in 1995.

The research findings received a cautious welcome from anti-drug groups in Scotland.

A spokeswoman for the Scottish Drugs Forum, the non-government agency which helps coordinates drugs policy, said: “Post traumatic stress disorder rising from damaging experiences as a child or as an adult – including while servicing in the Armed Forces – is strongly associated with the development of drug and alcohol problems.

“And the combination of PTSD-type mental health conditions mixed with drug and alcohol problems can be very difficult to treat safely and effectively.

“Therefore, further research to identify drugs which could be offered by health services to prevent drug and alcohol dependency developing in traumatised people – and also to more effectively deal with people who have already slipped through the net – would be a very welcome step forward.”