NAIROBI, 3 June 2010 (IRIN) - Prolonged conflict in Somalia, especially in and around the capital, Mogadishu, has contributed to an alarming increase in the number of mental health patients, according to health officials.

"There are a number of reasons why we are seeing so many mental health disorders but, in my opinion, the single biggest contributing factor is the conflict," Abdiaziz Mohamed Warsame, the only practising psychiatrist in Mogadishu and professor at Benadir University, told IRIN on 3 June.

"We can blame the consumption of khat [a mild stimulant], lack of employment and abuse of drugs, but all these are symptoms of the conflict."

He said most city residents had been displaced more than a dozen times, with some experiencing horrific violence against themselves, family or friends.

"Very few people can go through this kind of trauma for 20 years and come out unscathed," Warsame said.

Abdirahman Ali Awale, the director and founder of three psychiatric facilities in Mogadishu, known as the Habeb hospitals, said he set up the facilities after "seeing the number of people with mental disorders on our streets was increasing by the day".

He said the three facilities recorded 2,379 patients in 2009. "These numbers reflect those who were brought to us; there are hundreds, maybe even thousands, who are not brought here and are kept by families in their homes," Awale said.

Inadequate facilities

Of the total number treated, more than half, or 1,452, were boys and men.

He said the three Habeb facilities were inadequate to handle the number of people needing help.

"We have people who are sleeping on our floors because we have run out of bed space," Awale said. "We are the only place they can get help for mental disorders."

Most cases at the clinics were of post-traumatic stress disorder (PTSD). "Some have seen entire families wiped out," Awale said. "I recently had a case of young man of 22; he was not talking or moving."

The man's family said he had been in that state for three days. "It turns out he found his missing younger sister with her throat slit and left in a dumpsite," Awale said. "Such an experience will drive anyone over the edge and unfortunately it is all too common in Mogadishu."

Although PTSD was the most common, his patients displayed an array of illnesses such as mood disorders, substance abuse, depression, neurosis and epilepsy.

Challenges

Awale said one of the main problems was lack of awareness among Somalis that mental health problems can be treated successfully.

He said there was a great deal of stigma attached to mental health issues but "most of our patients, if they receive timely and appropriate treatment, will recover".

The continuing violence and poverty were adding to the increasing number of patients, he said.

Abdi Ugas Ali brought his 35-year-old relative to one of the Habeb facilities from the town of Jalalaqsi, 150km north of Mogadishu. He had been sick for more than seven years after witnessing his father's murder, said Ali.

The family tried everything, including traditional means, to cure him. "In the end we did not know what to do so we tied him to a tree to make sure he did hurt himself or others."

A year ago, Ali brought the man to Mogadishu and he was put on medication for schizophrenia, according to Hassan Muse, a clinical officer at the hospital.

Ali said: "He is much better now and can even talk to you coherently, something he has not done in over six years."

The UN World Health Organization (WHO) has been providing psychotropic drugs and improved the quality "of treatment we offer to our patients, but much more is needed", said Awale.

Once treated, patients needed follow-up and rehabilitation. "We don't have social workers or counsellors who can follow up to make sure there is no relapse."

Awale said the mental health facilities in Mogadishu were charging people nominal fees to cover their costs, "but most of our patients cannot afford even that. Our work is more like a Band-aid. Much more help is needed if we are to reach most of those who need our services."