TRANSCRIPT

Sumaia Binte Islam (Host): Wise men say that mental health is a process rather than a destination.

The goal of a holistic approach to the mental health is to put the patients at the center of the treatment plan so that no one is left behind. How is it different from the traditional approach? Does gender, human crisis, socioeconomic factors and the COVID-19 make an impact on mental health? What is the impact of holistic mental approach on the youth, in detention centers, social workers, refugees, and migrants?

In today’s podcast, we’ll try to find the answers to these questions.

Welcome to Grassroots In Action, where we catch up on grassroots experiences and practice that impact one person, one community at a time. In this podcast, we invite emerging leaders and change makers to share their first hand impact experiences on solution to issues from climate change to public health, impact investment to humanitarian protection and so on, giving insights to impact solution across the globe.

I’m Sumaia from Diinsider Life, your host for today.

Today’s guest is Sarulchana Vireyataveekul, AKA Pam, a senior consultant at Levante International Development, which supports humanitarian interventions and development projects globally. Her focus is on participatory research. She has volunteered and worked for various organizations and NGOs such AIESEC Morocco, Development Innovation Insider, World Bank, and Oxfam. Her experience is in the thematic areas of gender and social inclusion, child protection, mental health and psychological support, and youth empowerment. She holds a bachelor’s degree in Economics from Thammasat University and Lund University, who will talk about holistic mental health, how you can maintain good health while working in the social sector, which can often be quite disheartening.

And Pam, as you already know about the whole topic. So I’ll ask you to walk us through the concept of holistic mental health.


Sarulchana (Pam) Vireyataveekul (Guest): Sure, alright. Thank you so much again for inviting me. And it’s such a pressure because the topic of mental health is a very personal one for me and it’s something that I have been working on at work and that I’m quite passionate about.

So back to the topic of holistic mental health. What this means is that, first of all, we have to understand what holistic means. So holistic means to integrate different elements of things. And when it comes to mental health, traditionally we think of mental health as something that involves professionals such as mental health nurses or psychologists or psychiatrists. But actually these are the people who are towards the end of the mental health care continuum.

When it comes to holistic mental health, we can think about this in terms of the IASC Pyramid Framework. And what this means is that we have to think about, first of all, level one, which is basic services and security. If you think about it, if we don’t have basic services such as dignified, shelter, food and water, then it will be hard for us to think about other things that help us with our mental well being.

And so after this, we have to think also about community and family support, which is level two of the pyramid. As you know, we cannot live alone in the universe. We need people who can support us, such as our family, friends, or other people in the community. So in this level two, we focus on having healthy relationship with people, meaning there’s a space in the community for people to join events that they can gather together, talk to each other, or even have things like peer support group, for example.

And then once you once you accomplish this level, making sure that we have enough support, love, and basic services, then you go on to level three, which is focused on specialized support. And this third layer focuses on support by non specialized people, such as those who were trained in psychological first aid and provision of basic mental health care by primary care workers, such as doctors or nurses, who might not specialize in services of mental health, but they are trained in certain mental health topics.

And then once you reach this level and there are still people who still need specialized mental health services, such as those who have chronic depression or ptsd, post traumatic stress disorder, then you have to think about providing them with specialized services. And what this means is that this is assistance that includes things like psychological therapy, psychiatric support from psychiatrist, or clinical psychologist and this is more focused on people with severe mental health disorders that cannot be taken care of through the other three levels of support that I shared previously.


Sumaia (Host): I think it’s a really effective approach compared to the traditional one that we are more used to. What do you think? Why do you think it’s a more effective and balanced approach?

Pam (Guest): As I mentioned before, I think when you show, when we think about mental health, we would think about, okay, I should probably go see a therapist right away. But we have to stop and think about, do we have these basic foundations like a shelter in place? Do we feel like we have a group of friends we can talk to? Because essentially, actually, when you have a good relationship, you can talk to people about what you go through, have people who can empathize with us, family, who can support us and love us. I think this is the most important part before we start thinking about these specialized services, which oftentimes in developing countries, it’s very hard to access these services.

And even though you can access these, you might not get consistent services or you might not get services that are provided by trained and qualified people. So you are not guaranteed to get high quality services that you feel or you deserve, actually. So, yeah, you have to start thinking about the lower levels first and make sure that these are strong enough before you can go on to more specialized forms.

Sumaia (Host): Yes, I think overall these kind of services are also expensive for us. As you mentioned in developing countries, it’s something that people may feel like it’s too expensive for them to attain to all the kind of services. So I think, yeah, that is something important that we need to keep in mind that I think something will benefit us in the longer run.

Pam (Guest): You mention about the price of these access to mental health services because indeed it costs a lot. What this means is that when you try to find where you can access these services, of course you have to go through things like maybe you have to worry about what people think if you see these services and how you’re actually going to find information about them.

While I was a global correspondent with Diinsider, I wrote an article about this tele-mental health platform called Ooca, which is an online mental health services which match you with mental health professional. And you can choose whether you want to talk to a therapist or to a psychiatrist based on the problems that you want to discuss with them about.

So before this, I didn’t know anything about mental health services. But after I got a chance to interview the founder and know more about mental health services, especially online ones during COVID-19, I actually experienced it myself and tried it out and feel like, yes, the price is expensive, but it’s one of the ways which allow me to access mental health care in the most private way and comfortable way during COVID-19 as well, where it’s still difficult to go out and see people. So I think this works well, yeah.

I’m not sure about how services like this will be available in other countries, but thinking about, looking back to COVID-19, this could be something quite beneficial as it will help break barriers on access and also reduce people’s time to travel to see a psychiatrist or a psychologist.

Sumaia (Host): As you mentioned, the COVID-19, I think during the lockdown, a lot of us had to deal with our mental struggles by ourselves. So what do you think then, that COVID-19 overall, how it impacted the mental health? Share some of your experiences with us.

Pam (Guest): Hmm. I think during COVID-19, the biggest problem well the two biggest problems is, first of all, isolation. We humans like to connect, like to socialize, so when there are restrictions where we cannot go out and meet our friends, our colleagues, our family that creates a lot of distress and stress and anxiety, which definitely heightens during this time.

And another problem is that during COVID-19, the economy got hit pretty badly and people were laid off, the unemployment rate increased, and people got lost. Some might even have to redirect their career to something that they might not have thought about or might not be as passionate about. And this is this can be quite worrisome as we need dignified work to all feel good about ourselves. We need our family to support us during difficult times. So definitely COVID affects our mental health critically.

Sumaia (Host): Yes. Pam, as you mentioned, that there were the people who were living away
from their families, especially migrants. From our country (Bangladesh), many laborers go to different countries as migrants. So, migrants and refugees. How how do you think the whole, this whole process, you know, did their experiences how it actually impacts their mental health? And what kind of approach, like holistic you know, this whole holistic approach can actually help them?

Pam (Guest): That’s a very good question. Being a migrant, you have to move and might not just be moving once. It could be several times depending on the situation in your home country, in your home city. And when you have to move, you have to adjust to a new life, to the new community, and you might not have the same kind of family and social support that you had back home.

And this could create a huge problem because, first of all, finding a job is already quite difficult for someone who’s not from the host country. And finding friends and family is, yeah, it’s also difficult. You have to basically find new connections again. So this might cause problems such as the feeling or depression or anxiety about whether or not they can settle in new country, whether or not they will fit, and whether people in the community will accept them. And this could even be worse of people with mental health [problem] because they might not feel comfortable to talk about it because they don’t want to be stigmatized, especially at work and people know that you have mental health issues they might want to hire you under the stigma that this person is not capable to work but that’s not the case.

Sumaia (Host): Pam, as you are saying that, we already know that you work with NGOs who have projects and they have taken initiatives to help such people. Can you share any of the incidents and the stories that you, you know, you were a part of?

Pam (Guest): Sure. Yeah. So mainly I work in projects in Southeast Asia as an evaluator and researcher. And I can tell you that I’ve evaluated many projects and a lot touch on mental health, and I can see the impact of boosting people’s mental health through things like structured
and unstructured psychosocial services, such as providing them with peer group support so they can talk through their problems together with their peers with the facilitator who are trained. And things like psychological first aid, could really help them. Activities such as arts and sports also help boost their mental health as well.

And a few years ago I worked on a project in Thailand, which help survivors of human trafficking. And this group, as you know, suffers a lot as they had to move from one country to another, and they were exploited, by perpetrators to to work under very unfortunate circumstances, and they were abused. And this is especially worse for children because whatever happens to their childhood sticks with them to adulthood. So what this NGO does is that it helps boost, well strengthen the capacity of social workers and of those who have to work with survivors of human trafficking in shelters in Thailand to help them gain the capacity to talk to the survivors and make sure they’re feeling okay and help them go through processes in courts, which can be quite stressful because they have to face their perpetrators and prove that indeed they have been exploited. They also have to work with lawyers, have to, appear in court, join all of the legal processes, which can be very difficult for them.

In this project they involved multidisciplinary team which also includes a child psychiatrist. The child psychiatrists help train these social workers and case managers on how to detect people who might have mental health problems that will need to be referred to mental health professionals. They also train them on how to provide psychological first aid, how to talk to the survivors.

And this, you can see that it really helps boost their wellbeing. Coz when you first face these kind of problems, you don’t feel like you want to talk to anyone. You will keep to yourself, you became depressed. But if you know that you receive the support, In a way that’s appropriate for you then you’re more likely to open up and start sharing about your story. And this really helps make that case in court more powerful.

Sumaia (Host): And Pam, you mentioned about that, uh, they get exploited. Do you feel that the overall gender dynamics, have any connections to it? Because, you know, the researchers and scholars, they often refer that women are more vulnerable towards such incidents and such crisis. Do you think that the gender dynamics have a connection?

Pam (Guest): Hmm, that’s a good question. I think gender is one of the cross-cutting themes of all these projects, gender, LGBT, marginalized people, elderly, and other groups as well. And definitely gender plays a huge role especially during Covid-19, I think.

Issues like domestic violence, which is not often spoken about and if the wife wants to divorce, some countries don’t allow it. So she’s stuck in a relationship that is very abusive and exploitative, and of course that affects her mental health and affects the way that the children are raised as well by abusive fathers or partners.

And for women in some countries, they’re not allowed to work. They have to rely on income from the fathers and they might be dependent on that to the point where they don’t feel confident to speak up. They might not have financial assets to back them up just in case something happens.

So of course, all these contributes to a lot of stress and depression.

Sumaia (Host): Yeah, this whole gender dynamic part is something that is really, it is actually something that has a connection to our struggles. As a woman, I can always feel that we face different situations, different struggles than a man.

So, I feel like that, yes, there is some, there are situations especially, the whole, sexual harassment and if all these things actually, at the end of the day, make us feel very conscious and make us feel very insecure about our own life, our agency, about capabilities, which makes us feel like maybe we are the one who should be careful.

Maybe we are the one who should be, we should just check ourself from doing things that we really want to do. So I, yeah, I feel that yes, at the end of the day we may feel like heavy burden outside our part. We may feel risk, may start feeling like that, and we are not what we want to become. So, thank you. It’s a huge, it is another conversation that we need to have and we need to encourage as well.

But the point I really wanted to, the question I had… You said that there are in your previous projects, there were social workers that they were trained, but, and as a researcher you may have interacted with a lot of them.

Do you think that even they are, while trying to help the people, they also feel depressed and they sometimes also feel that they are not being heard of.

Pam (Guest): That is a very good question and I’d like to address your comment as well. I like that you use the word agency and sometimes we might feel like we’re helpless and we’re responsible for whatever happens to us, but I think you were speaking about maybe things like toxic masculinity as well, which would be great to touch on.

And in the development conversation these days, we talk a lot about agency because we don’t want to just be the organization that gives help, that provides help and services to, to people who might need them. But we also want to, for them to use their strength. To build their lives as well, and make sure that we hear their voice and that they can create something that they’re proud of that will be sustainable for them. So, yeah, I just wanna touch on these topic for a little bit about agency, inclusiveness, participatory approach, and make sure that the people we are trying to help are strong enough to help themselves and others as well.

And to answer your question about the stress of those who work with vulnerable people. I mean, of course, yes. There’s this thing called secondary traumatization which I’d like to talk about first and then I’ll talk about another problem that the social workers might come across.

So, secondary traumatization, meaning that when you work with people who were traumatized and you hear stories about how they were exploited, how they were abused, and you’re a very empathetic person, you’ll feel so much for them to the point where you might start to feel depressed after you hear these stories multiple times. So, you have to not only care for others as a part of your job, but also have to care about your own mental health as well because you cannot help others if you are not well enough to do so. So, yeah, always take care of yourself. Put on your own life jacket before you can help others.

The second thing is that, during, especially during covid 19, social workers and anyone who works with vulnerable populations might experience increasing work burden because not only do they have to provide regular service, they have to provide things like covid support as well, which might increase their workload. The way they work might become more difficult. Trying to reach the population who are in remote places might be more cumbersome because the covid restrictions.

So these overburdening on their work could create a lot of stress for them.

There is this new, well, not so new actually, but it’s becoming more talked about now. It’s an initiative by the WHO and ILO. There’s a policy brief and a guideline which talk about how we can take care of our mental health at work and they provide a really good framework to think about how we can address this, how to prevent mental health problems and how to protect and promote our mental health. Things like providing training for mental health workers and even to the individuals, awareness of mental health problems, and how to seek help and providing support with people who have mental health working conditions, making sure that those with mental health problems can still find jobs. And those who experience mental health problems at work can still continue to work or take rest and make sure that they come back and receive the support they need.

So, I think this is a very interesting initiative. Since we spend a lot of our time at work, this will be very much, um, needed nowadays.

Sumaia (Host): Thank you Pam. Thank you so much for sharing your experiences and your knowledge about this topic. And thank you so much for giving us your time.

But before we end the conversation, I want to ask you. What is that one thing that you do to maintain your mental health?

Pam (Guest): Oh wow. I love this question because for me it’s not just the one thing. So I’ll cheat a little bit. I’ve been seeing a therapist and I was recommended that I should exercise at least 30 minutes, three times a day. And I’ve been doing that and I feel so much better about myself and my mental health.

But also aside from that, having really good physical health, you also should have a good support system as well. And I’m someone who doesn’t like to burden people. I feel like if I talk about my feelings or if I ask them for help, I’m burdening them. But then what my therapist recommends to me is that she wants me to ask myself that, ‘if your friend were to have any problem, would you have done the same for them? Would you console them? Would you be there for them?’ Makes me feel so much better that we are human beings, we all need support, and it’s okay to talk about your feelings with others.

So, yeah, exercise and good support. And also if you’re invited to parties, just go. It’s good for mental health.

Sumaia (Host): Yes. And it’s really important, especially for introverts. I think we constantly shy from any kind of social gatherings. I must to feel like that staying at home is the best relaxation for me. But sometimes it’s not about being, grab a table at your own house and not, and feeling like, being shying away from gatherings.

When you talk to new people, you get new perspectives of life. Something that..

Pam (Guest): Exactly!

Sumaia (Host): I must say, I got from you. And that, I think is really important in our life to gain new perspectives of life, which actually helps a lot to deal with your limited understanding of life. We can actually sometimes temper our growth.

Pam (Guest): Likewise. And I learned about you as well. I really enjoyed this conversation. You’re absolutely wonderful.

I’d like to ask you as well. How do you take care of your mental health? What’s the one most important thing for you?

Sumaia (Host): As an introvert it’s really difficult for me because whenever I go outside, I constantly feel like, I need to go home. I just need to go home. It’s just an introvert thing where you constantly feel like you need to go home.

And as I said something recently, I think one of my biggest help is literature and movies and even a podcast, actually. That’s one of the reasons why I am also interested in… When Diinsider presented me with this opportunity, I was also interested to work with them because this is where people can actually share. As I said, that perspectives are important.

Pam (Guest): For people listening to the this podcast, our message is that you are not alone and keep being hopeful for another day of at least five minutes of happiness in you.

Sumaia (Host): Yes. That’s the, I think that should be our message. That you are not alone. You need to exercise. If you feel bad, you need to get up and exercise and talk to your friends, even if you feel like that you’ll be bothering them, you are not, coz they, at the end of the day, wish your best. So they are the one you should go talk to. And even if it’s five minutes, give it a try. It’s worth it.

Thank you Pam! Again, thank you for giving us your time.

Pam (Guest): Thank you!

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