Youth in Honduras are struggling with mental health issues like depression, anxiety, and Post Traumatic Stress Disorder, derived from domestic and street violence, as well as the absence of parents and caregivers who may be seasonal or temporary workers in other countries, according to the World Health Organization (WHO). The family members and teachers who interact with struggling youth lack training to confront these mental health issues, and face a limited public mental health system to support or help youth navigate difficult topics. Many youth experience recurring domestic violence, against them, or their parents at home.
These children need a support system, but regions like Honduras have a shortage of providers and mental health professionals trained to assist someone experiencing a crisis of depression or anxiety related to violence. A 2020 WHO assessment of the Honduran health system showed that only 1.8% of their total health budget was slated for mental health, and 88% of that was designated to fund psychiatric hospitals, with only 12% to other services, which mainly consist of family councils working to address the intrafamily violence problems.
To combat this problem, Dr. Ali Hurtado, Professor at UMD’s School of Public Health, and Extension Specialist, has launched a program to help youth to access a healthier mental state. Through his efforts, school teachers can now participate in Mental Health First Aid (MHFA) and other evidence-based training programs for adults to help identify risk factors and provide support for families and youth who are experiencing domestic or other forms of violence.
SPH partnered with the University of Maryland Extension in this effort, as well as the Organization for Community Health Outreach (OHCO), a Baltimore- based program that provides medical outreach to Honduras, to bring prevention programs adapted for the Honduran public school system.
“We’ve adapted the curriculum to include the limited information available about mental health in Honduras. There is a high rate of violence in the community—not just gang warfare, but domestic violence.” said Dr. Alexander Chan, Extension Mental Health Specialist who traveled to Honduras with Hurtado to implement the training program in early 2024. “We know there are adverse experiences happening, so if we can identify the gaps in protective factors, that will allow us to provide solid advice and programming for the schools who can then do something to increase those protective factors.”
The effort, funded by a three-year Grand Challenges grant awarded by the University of Maryland, aims to train the teachers to identify behavioral changes in the youth they work with, and provides tools to help them intervene and connect youth to local support. The MHFA curriculum teaches participants to notice behaviors that are out-of-character, like dropping grades or sudden changes in attitudes or interests; and then to intervene with empathetic interjections and approaches that allow the teachers to bring up difficult subjects to students or anyone potentially experiencing a mental problem.
“This is a project about understanding the context and understanding the issues and resources within the community,” said Hurtado. “It’s a program that helps you increase awareness and learn how to connect with resources.”
Because a mental health network is negligible in the country, those complaints are mainly handled by hospital staff. Empowering teachers and family to recognize potential risk factors and behavioral changes may have other future implications, like helping ease the overwhelming burden on the medical community, Chan said.
“It’s really the nurses that are the frontlines for this type of work, but only five percent of their continuing education is dedicated to mental health,” said Chan. “I think the more prevention we can provide, the more likely we are to reduce the present and future strain on the medical community.”
The program includes ongoing technical assistance to the Honduran teachers who participated in the original training, in the form of online meetings, and these calls have expanded to include other teachers who have expressed an interest in participating and learning the MHFA framework. With the pilot program underway, Hurtado’s team will evaluate its effectiveness through surveys and case studies, determining what changes are further needed to tailor the program to Latino communities. They will then focus on the youth themselves.
“We’ve done programming for the adults, offering solutions for teachers and families, but we want to know from the youth what they’re going through so that we can continue working with the schools and parents to develop programming for the youth,” Chan said.
“There’s a lot of layers to the things that are happening there and we have to be aware of all of those pieces to make the biggest impact,” Hurtado said.
And that impact, he says, extends to benefitting Maryland communities as well. “These transnational families are living and working here, in Maryland,” said Hurtado. “So the state of Maryland benefits from these adapted programs as well.”
“We’ve already done two or three classes in Spanish here in Maryland. Just a couple of weeks ago, I did a training for recent immigrants who are just arriving now, essentially with nothing,” Chan said. “So it’s having a local impact on our accessibility here in Maryland. It’s adding not just to our international mission, but because of our preparations and adaptations, we have the tools to serve our communities here too.”
by Laura Wormuth : Momentum Magazine Summer 2024
