HEI: Community-based Mental Health Project

Health Equity Initiatives (HEI) is a Kuala Lumpur-based not-for-profit organisation that advances the right to health for marginalised refugee and asylum-seeker communities in Malaysia.

HEI aims to strengthen refugee communities’ right to health through community interventions – at national and regional levels – to increase the agency over their health and lives, to improve the physical and mental health, dignity and well-being of refugees, and to advocate for the laws, policies and programs to recognize and advance the right to health for refugees and asylum seekers.

VCH Workers carrying out support group activities in the community

The community-based mental health program conducts the Community Health Worker Training Program in Mental Health, building the knowledge, skills and attitudes required for volunteer Community Health Workers (CHW) serve their “hard to reach” community members to raise awareness of the relevant mental health issues affecting their communities, and provide psycho-education on culturally appropriate and evidence-based coping strategies.

For refugees whose mental health is at risk, the CHWs make referrals to HEI’s mental health services to gain access to services that include pharmacological treatment, psychological and behavioural interventions, support group, treatment adherence support, day care, physiotherapy, psychosocial interventions (including transportation services) at HEI’s community centre, and in the community. HEI’s multi-disciplinary team of clinical psychologists, consultant psychiatrists, counsellors, psychosocial support service officers, nurses, and medical volunteers provide these interventions in accordance with the Mental Health Services Guidelines. Validation tools and protocols including the identification of those at risk of suicide and/or sexual and gender-based violence (SGBV) in line with professional ethical standards.

HEI’s theoretical framework and empirical model of intervention, one that emphasizes community participation and stakeholder engagement, informs all of its evidence-based advocacy at national, regional and international levels. Additionally, HEI’s technical expertise and experience working on refugee issues has enabled it to build alliances with other stakeholders for multi-sectoral advocacy. HEI’s internship program for medical and psychology students also raises awareness of the access issues to health for marginalized communities with the aim of effecting long-term improvements within the health profession.

HEI has trained 314 CHWs from the Afghan, Syrian, Somali and Sri Lankan communities.

As a primary prevention strategy, the trained CHWs establish mental health promotion outreach modules that meet the particular needs of the communities, such as an alcohol prevention unit was developed for Myanmar adolescents to teach awareness of the harmful effects of alcohol consumption while simultaneously imparting adaptive stress coping strategies.

The services have also expanded to address the needs of the population: HEI set up a support group for the Sri Lankan community to connect with others experiencing similar challenges, share experience, discuss coping skills, and offer encouragement. This activity is especially significant for patients from populations that lack organized community structures and where trust may be weak because of experiences of torture. HEI also provided transportation services for patients to be picked up from HEI’s reliable drivers in response to the increase in the number of patients who expressed that they were unable to turn up for their appointments due to fear of going out during periods of increased risk of arrest and detention.

These programs and outcomes provide the basis for HEI’s advocacy interventions at national and regional levels. HEI’s directors were invited to present its mental health intervention model at the NGO UNHCR consultations in Geneva in 2014. HEI has also made policy interventions at several Ministries and stakeholders on the inter-connected issues of health, law and labour policies and the refugee protection environment in Malaysia.