Improving mental health in refugee camps in Thailand – Thailand

In a new UNHCR programme, trained refugee volunteers protect and promote the mental health and psychosocial well-being of camp residents. By Morgane Roussel-Hemery San Lin is a mother of two and lives in Umpiem refugee

In a new UNHCR programme, trained refugee volunteers protect and promote the mental health and psychosocial well-being of camp residents.

By Morgane Roussel-Hemery

San Lin is a mother of two and lives in Umpiem refugee camp in Thailand, 12 kilometers from the border with Myanmar. Her daughter has severe autism and her son has poliomyelitis. She is stressed and worried about her children, which leads her to suffer from insomnia.

Thailand currently hosts more than 90,000 refugees in nine refugee camps along the Thailand-Myanmar border. Many refugees – mainly ethnic Karen, Karenni and Burmese – have lived in these camps since the mid-1980s after fleeing conflict between ethnic armed groups and the Myanmar military.

Like San Lin, many refugees face daily stressors that compound and inevitably impact their mental health. Additionally, with widespread misconceptions and a general lack of knowledge about mental health issues, only 2% of camp residents registered to seek mental health and psychosocial support (MHPSS) services this year.

In response, UNHCR, the UN Refugee Agency, through its implementing partner, Humanity & Inclusion, has launched a new program dedicated to MHPSS. The goals of the program are to raise awareness and build community support – enabling camp residents to not only have a better understanding of mental health, but also be empowered with strategies for coping.

Recently, San Lin received a visit from Do Nu Ei, 25, a new mental health worker based in the camp. She is one of eleven newly trained MHPSS refugee staff in Thailand’s five refugee camps. Do Nu Ei was selected based on her training and ability to work with people with disabilities. She listened carefully to San Lin’s issues, offered her advice, and ended the session by teaching her some deep breathing techniques to manage her anxiety. For San Lin, regular home visits from Humanity & Inclusion staff offer her “comfort and encouragement”.

Home visits aren’t the only activities organized by employees like Do Nu Ei. They also hold regular workshops for camp residents to raise awareness of mental health issues, how to relieve them, and methods to help members of their own community.

Tami Lu, 23, mental health staff at Mae La Camp – Thailand’s largest refugee camp – recently held a workshop for ten participants. Participants in these workshops are selected based on a mental health assessment conducted by the Humanity & Inclusion team.

Even before enrolling in the MHPSS program, Tami Lu listened to her neighbors and siblings for stress relief. Today, his skills are at the service of the community as a whole.

At his workshop in Mae La, he started the session by asking participants what they knew about mental health. They knew very little.

To help them understand, Tami Lu draws on their daily experiences as examples. “For example, we start with a situation and dissect their thinking, feelings and reactions – including the physical reaction,” he explains. “The aim is to make participants aware of the fact that mental illnesses can trigger bodily reactions such as pain or insomnia. The consequence is physical, but the cause is mental.

Physical activities are also used to better explain how mental illnesses arise. During one of their stress management sessions, Do Nu Ei asked Umpiem workshop participants to stand on one leg while holding a book in one hand. She gradually gives participants more books and objects to hold. Once unable to support the load, all objects would eventually fall to the ground.

“Afterwards, I repeat the same exercise, telling the participants that they can ask someone else for help,” Do Nu Ei said. “When they get help, they find they can stand on one foot longer or carry more things. The purpose of this analogy is to make them understand that negative thinking is like a pile of books. If they are already in a shaky position and continue, the stress builds up and you are likely to crumble over time. Whereas if you ask for help, someone can relieve you – literally and figuratively.

“In the past, when I was overwhelmed by negative feelings, I sometimes stayed at home without doing anything, without moving, without eating and without sleeping,” said a young refugee who participated in the activity. “Joining the workshop, I understand that these coping mechanisms are toxic, but other people also feel the same as me. We learned that we can support each other.

Art therapy workshops are also held to help camp residents channel their energy and frustrations. Creating art, as numerous studies have shown, can be highly therapeutic. Drawing, painting, and other forms of creativity can dramatically lower cortisol or “stress hormone” levels.

Do Nu Ei asked the residents of the Umpiem camp to create “hapa-zome” – or leaf-dyeing art. Attendees were given blank tote bags and flowers and leaves taped to the tops. Then they crushed the flowers and leaves onto the fabric with a hammer, transferring their natural pigment into the fabric. To loosen up further, they were encouraged to shout “trouble, go” while smashing their bags. With easy-to-find tools and materials, participants were able to both manage stress and create art.

Given the challenges and stressors that refugees in camps face on a daily basis, community-based psychosocial support is essential. Tami Lu and Do Nu Ei’s strategies are simple, yet they empower refugees – providing them with the tools and knowledge to manage and improve their own mental well-being, while also being able to help other members of the community in need.

At the end of the home visit, San Lin’s breathing slowed down and she felt more peaceful. “The breathing exercise helps me control my thoughts,” she says. “When I’m overthinking, can’t sleep and feel anxious, I do the exercise and it helps calm me down, lower my heart rate and relieve anxiety.”