Ilya is helping low income and conflict prone communities in East Africa build their resilience towards issues of mental health and psychological trauma
The New Idea
Ilya is helping low income and conflict prone communities in East Africa build their resilience towards issues of mental health and psychological trauma. She does this by repurposing victims of psychological trauma into community-based care givers (para-professionals) that are trained and equipped to handle incidents of trauma whenever they occur at the community level. Through the Global Trauma Project Ilya vision is to effectively mitigate the impacts of psychological trauma on children, families and communities in low-resource areas where mental health supports are lacking.
At the heart of Ilya’s model is the approach she has taken to engage trauma victims to bridge the human resource gap that plagues the mental health sector generally and more severely in resource poor countries. Ilya believes that the most powerful way to support victims of trauma is by empowering them to assist others as they go through their own healing process. GTP therefore approaches community leaders or individuals with leadership potential, who have suffered from any form of psychological trauma and enrols them into a world class professional certification program. The program has been developed by GTP and other partners including the Strathmore Business School Institute of Health Care Management and the Trauma Center at JRI (Boston).
Tied to this new approach is the special focus that GTP places on the impact of complex trauma on children. Young children are especially prone to severe impacts of trauma at the domestic level and in the immediate environments especially schools. In addition, the impact of mental health on children is an area with little to no scientific understanding particularly in conflict prone areas of the world. Ilya believes that this lack of understanding on the impacts of trauma on children and lack of appropriate mental health approaches to deal with the same undermines any efforts to create a world where every child thrives.
By developing a market for mental health services at the community level, Ilya is also unlocking the huge potential for youth employment in this fairly nascent industry of community-based health (at least in resource scarce parts of the world). GTP believes that although it is practically impossible to completely avoid incidents that lead to psychological trauma, it is actually possible to develop the human capacity that can respond to these incidents whenever they occur at the community level. Through this approach she hopes to invert the current model of trauma response from service delivery to building resilience at the community level by having community members trained in trauma response handle any cases whenever they arise.
Ultimately, Ilya hopes to influence public policy by getting community-driven approaches to mental health as critical to the overall public health especially in conflict prone and under-developed countries. This, would be important for the recognition and support necessary to ensure that this role of community-based mental health professionals particularly by governments.
Ilya is addressing the impacts of psychological trauma which are evident at the individual, family, community and society level. At the individual level, psychological trauma leads to mental illness and other forms of disability, including emotional withdrawal, social-economic isolation or discrimination and eventually leads to disempowerment. Mental illness is one of the greatest invisible burdens facing developing societies. It is estimated that mental illness accounts for four of the 10 leading causes of disability worldwide. Psychological trauma and mental illness often lead to broken families with women and children bearing the greatest impact especially in developing countries. Women and children suffer disproportionately from the severe effects of psychological trauma resulting from domestic abuse. They are often ostracised by their families and often end up leading isolated lifestyles. Many of them also suffer economic discrimination which leads to a cycle of poverty and disempowerment. In the absence of proper support systems children who experience trauma in their early years often fail to recover and suffer life-long consequences that are much harder to alter when they are older.
Communities that experience incidents of mass trauma for example war or ethnic violence have a hard time recovering and in some cases never fully recover. Trauma destroys the social fabric that holds people together in addition to disrupting economic and political systems that hold the community together. GTP defines communities in general to include any social group including villages, schools, townships and localities. Mass trauma is often an overlooked subject particularly in school environments and GTP has developed their model to respond specifically to issues of trauma at the school level.
In East Africa and much of the rest of the continent, mental illness and general psychological trauma affects a wide variety of the population although exact numbers are largely unavailable. In Kenya, millions of refugees from neighboring war-torn regions of Rwanda, Ethiopia and more recently the DRC, South Sudan, and Somalia are the most affected population groups particularly those living in isolated refugee camps. Refugess flee into these camps already having experienced different forms of war-related traumas including gender-based violence, rape, fear, loss of family belongings and identity as well as abduction, assault, and even murder. In the camps, there are virtually no functional systems in place to deal with the detrimental effects of trauma, yet refugees are one group for which the effects of trauma and mental illness are better understood. Nevertheless, specific understanding of the impact of trauma on children in this context is not appreciated. If untreated in childhood, trauma-related mental disorders can produce larger amounts of disability and suffering throughout life, exposing children to other social illnesses such as juvenile delinquency, teen pregnancy, school dropout and even drug abuse.
Other groups that face temporary displacement, whether due to ethnic violence or domestic abuse suffer the same effects of trauma though their plight is often considered “temporary,” compared to that of international refugees. As a result, these latter groups face even greater challenges in their journey to recovery. Studies have also confirmed that incidents of mass transfer such as movement of refugees across boarder often lead to mass trauma for hosting countries due to the spiking of pressure on social-economic fabric of the host society. Rural-urban migration which has led to a rapid increase number of street children and those growing up in informal settlements is a major contributing factor to mass trauma. Often exposed to poverty, violence, forced labor, and the sex trade from a very young age, and without the protection of family or other social supports, street children suffer from chronic trauma which is often left unattended to leading to life-long disability.
Mental health, as a subset of the broader global health sector, is largely understudied and under-resourced and in much of the developing world support systems are virtually non-existent. In Kenya, traumas of the 2007-2008 election violence are yet to be addressed or dealt with in an adequate manner as thousands of IDPs languish in resettlement camps. Similarly, the aftermath of terrorist attack at Westgate shopping mall exposed the country’s lack of understanding on the issue of trauma and mental illness and lack thereof of proper support systems to respond to such incidents. All these factors have a negative influence on the mental health of the population, especially if other factors, like family support, medical treatment, and mental health care, are largely unavailable.
Reasons for a lack of treatment options and psycho-emotional support include a shortage of adequately trained and supported mental health staff for high-need areas, and a historic lack of attention to mental disorders. Existing services are often not affordable and even if they are, may not be culturally appropriate. There are very few professionals or agencies offering supervision, consultation or training in the areas of complex trauma, as well as a lack of existing support systems to make referral support such as for domestic violence, suicidal clients/ psychiatric emergencies, community-based mental health providers. Although trauma has extensive impact at the individual, community and society levels existing support systems are inadequate to cope with the numbers and issues that arise at the community level. Additionally, there continues to be inadequate understanding of the importance of mental health within the healthcare system at large, as well as a lack of funds and stigma around mental illness.
GTP operates through a four-pronged strategy: capacity and systems building, clinical services, research and job development. Capacity and system building forms the core part of the GTP strategy as it works to plug the existing gap of mental health support by repurposing trauma victims into community-based care givers or para-professionals. GTP has developed a rigorous supplemental training program for existing mental health professionals to bring them up to speed with global standards of mental health support. These professionals then go on to train community based leaders who are preselected to become certified para-professionals offering support at the community level. Through a pilot program in Western Kenya, Ilya is currently scaling this part of the model to other regions of East Africa that are prone to conflict hence plagued by chronic mass trauma. GTP also provides direct clinical services to high-need, marginalized populations particularly in the areas of gender-based violence, child abuse and war trauma.
The focus on capacity building is informed by the understanding that current “western” approaches to mental health are largely in-applicable for developing regions of the world. Global mental health field is largely driven by North America and European approaches which has led to significant inadequacies in the development of the sector locally. In addition, current efforts to train community based health care providers have largely failed to address the need for mental health para-professionals due to their costly nature and specialized approach. GTP integrates various aspects of therapeutic care into their model including music, dance, art, theatre which ensures that community based practitioners are able to sustain themselves through other income generating activities without depending on a fee-based serviced delivery method which often hinders access to support in low income communities.
GTP also conducts much needed research in the field of mental health and trauma issues in East-Africa, focusing on culturally-sensitive community based approach as the most feasible and effective treatment method for the region. The research aids in developing culturally-appropriate, evidence-based guidelines for trauma treatment for the most affected communities. To achieve this, Ilya aims to create a global network of mental health partners to engage professionals, academic researchers, and para-professionals in knowledge sharing in the field of mental health and trauma. The Global Mental Health Ambassadors program is specifically developed to fulfil this objective.
Partnerships are core part of Ilya’s strategy to bring her solution to scale. She has already developed a partnership with USAID which enabled her to raise $750,000 for launching the program in Southern Sudan and the commitment for an additional 3-4 million USD over the next 3 years.
In 2013, the GTP launched an initial pilot in Kenya working with a total of 10 teams from 7 different counties. The pilot focused on capacity building for mental health professionals who are already in the field who then acted as disseminators of GTP’s TICE framework. The pilot also provided Ilya with critical learnings about the model which she is now applying to the programs in Somalia and Southern Sudan. In Ethiopia, GTP has partnered with the Posterity Psychological and Training Center to further develop the TICE framework and adapt it to local context.
Through its partnership model, GTP has managed to raise $200,000 to provide mental health training and support in South Sudan. Through this partnership, GTP is providing capacity building for organizations working in the mental health space in the country thus filling a critical capacity gap which would otherwise be filled throug external consultants. An additional $3-4 million has also been committed to continue implementing the current program in the two conflict prone countries of Somali and Southern Sudan.
Considering the scale of the mental health challenge in the region, there is little doubt that GTP will, in partnership with others, have remarkable impact on the lives of poor victims of mass trauma. This is especially so in countries such as South Sudan, Somalia and Rwanda which are barely rising up from a dark past of ethnic and political violence. Sudan and Somalia in particular are societies that are experiencing complex trauma and stress — both from conflict and violence related to conflict as well as there is also cattle raid conflict, high rates of domestic violence and family violence, an extremely militarized society, numerous natural disasters and a looming famine. Most of the society requires support for individual, social and community healing
About a year ago, Ilya quit her job to focus full time on developing GTP into a full fledge organization based in Nairobi. She has since recruited a team drawn from the USA, Ethiopia, Europe, and Kenya who include staff, volunteers and pro-bono partners. Ilya Yacevich has been working in the field of trauma treatment for nearly 20 years and has worked with some of the top leaders in the field across the U.S, India and East Africa. She has developed her idea for the Global Trauma Project over the last ten years gathering inputs from collaborative partners including the Trauma Center at Boston-based JRI, the Strathmore Business School Nairobi, Posterity Psychological Therapy and Training Center, Family & Children’s Service, Head Start, Addis Ababa University, Center for Victims of Torture, Heshima Kenya as well as two Ashoka Fellow organizations Refuge Point (Sasha) and Africa Yoga Project (Paige Ellenson). Through her work Ilya identified a widening gap in the current western-led global mental health field and began working on a solution that led her to the idea for building community – based support system to create what she perceives as “trauma-resilient communities.”
Ilya grew up in a middle class neighbourhood in a small town in Iowa, USA. As a child, she experienced significant amount of emotional/ verbal/ physical abuse, neglect and domestic violence which left her and her siblings severely traumatized. Ilya recalls feeling scared, shameful, and utterly alone and at age 9, she decided that would spend her life working to ensure that other children did not have to go through the kinds of experiences she was having. That same year she began volunteering at a home for children with disabilities. Due to domestic abuse and poor socialization, Ilya grew up with very few friends, was mistrustful, guarded, and insecure. She however developed an empathetic understanding for others who had also experienced pain, violence and abuse. At the age of 16 she got a job at a child care program for at-risk children in foster care or whose mothers were in shelter for domestic violence and who suffered from the impacts of molestation, physical abuse, neglect and complex trauma.
In addition to working with special needs children Ilya spent most of her free time in the local theatre where she found a sense of respite and comfort. There she felt nurtured, inspired, protected, and surrounded by people who believed in her which helped her build her confidence and self-esteem and she was able to direct her first professional play with an all child cast at age 13. From an early age, Ilya wondered about the experiences of other people in their homes.“When people go through very painful things, how do they keep living? How do they end up ok, and able to feel joy and happiness and to keep going on to have a fulfilling life?” She wondered about people all over the world, and what they could teach her about learning to feel joy and peace. Although no one in her community had travelled widely wondered, Ilya found herself wondering, “What about people in China, in Ethiopia, and India? How do they do it? How do those kids go through it and still find a life with happiness and love?” Therefore the driving question for is always the same, “What enables people to get through trauma, and heal, and flourish and thrive?”
Equally important to Ilya is the belief that every person has unique gifts to share, and that it is our responsibility to discover our special gifts and to have the strength to share them with others. She also believes that we all have things to learn and therefore need the openness and humility to acknowledge what we do not know, as well as the willingness to learn all that we can from others. Nevertheless, Ilya admits that her greatest challenge in her life, both personally and professionally, has been learning how to connect with and trust others.
Through her own healing journey Ilya found a lot of strength in working with children which helped her come to terms with her own childhood experiences. She also realized that children that are going through abuse, violence, parental death and abandonment need the same protection, nurturance, and love regardless of where they are. From her own experiences, Ilya knows that people can experience trauma anywhere, whether they live in a pretty house in a safe neighbourhood in the United States or Kenya, or a war zone in Congo. Working in the field of trauma support, Ilya encountered numerous examples of why the traditional development-led approach to trauma and mental health support has failed to work. She eventually decided to do something herself and quit her job while working in Nairobi to launch GTP.