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Decades of armed conflicts have negatively contributed to every aspect of Afghan people’s life, resulting in extensive displacement, loss of employment, and disruption of agriculture.
While the physical scars of war are evident, the impact on mental health remains invisible. The country’s history of violence, displacement, and social upheaval has left a significant portion of its population grappling with mental health challenges. Since 2021, people’s mental well-being has been significantly impacted by political changes and economic hardship, leading to increased levels of stress, anxiety, depression, and a sense of uncertainty about the future. With limited resources and stigma surrounding mental health issues, addressing the mental well-being of Afghans has become a pressing concern that demands immediate attention. Moreover, the country lacks adequate mental health professionals, including psychiatrists, psychologists, and counsellors, with mental health services concentrated in urban areas, leaving rural communities underserved.
In 2022, Action Against Hunger launched a unique hotline service with a team of psychosocial experts. Today, the hotline employs 13 staff, including two receptionists and eleven psychologists, who have delivered more than 2069 sessions since its opening in June 2022*. Many calls to the hotline come from remote provinces, such as Ghor, Daykundi, Nangarhar, and Badghis, where people need access to such services. As for urban areas, most calls come from Kabul, Herat, Balkh, and Kandahar. The hotline is free of charge and offers immediate support to individuals experiencing distress or psychological challenges. Callers can speak to the team of mental health professionals trained in psychosocial and psychological interventions, including problem-solving, online counselling skills, and mental health and psychosocial support services in emergencies, including suicide risk mitigation.
Hotline psychologists are among the few witnesses to the stories of individuals who have experienced traumas or difficult situations. For Asef, a hotline psychologist with a background in clinical psychology, mental health issues in Afghanistan are often stigmatised and misunderstood. Traditional cultural norms discourage discussing personal struggles openly, which hinders individuals from seeking help. “As a result, individuals facing mental health challenges may be isolated, making accessing appropriate support and treatment even more challenging. That is why it is crucial that the hotline is open to everybody, men and women, and online counselling makes things much easier. People feel more comfortable sharing their hardship over the phone without seeing our faces”.
The anonymity of the hotline allows callers to feel safe and comfortable sharing their thoughts and feelings without fear of judgement or stigma. Confidentiality is paramount, assuring callers that their personal information will not be disclosed to anyone without their consent. “Misconceptions surrounding mental health perpetuate the belief that psychological distress is a sign of weakness or moral failing,” says Tamana, hotline psychologist. “The hotline gives women a kind of freedom and a safe space where they are keener to share their problems and emotions.” Bas Bibi, the hotline psychologist from the female team, points out that the hotline system is very beneficial, especially for people who live in rural areas and do not have access to counsellors where they live.
The hotline has established protocols for follow-up calls to check on the well-being of callers and ensure continuity of care. These follow-up sessions help prevent crisis situations and demonstrate a commitment to ongoing support. For individuals requiring more specialised support, the hotline can offer referrals to local mental health professionals or clinics.
Women and children, in particular, bear the brunt of the mental health burden. The rise in gender-based violence and the lack of access to education and healthcare have further exacerbated their vulnerability to mental health challenges. Whereas men, crushed by the economic situation, personal trauma, or the inability to feed their families, feel broken and powerless. For Mina, an experienced psychologist, the main reason for the problems and violence is the financial situation. “Most people who call the hotline encounter economic problems. The poor financial situation is the cause of most family problems and violence, especially when women are silenced and have no right to express their opinion. If we ask a man – how do you cope with anger? Often you will hear the answer – I beat my wife”.
Societal expectations and traditional gender norms often influence how men express and cope with anger. It is common to believe that expressing vulnerability or seeking mental health support is a sign of weakness, leading men to suppress emotions like anger rather than seeking help. Shah Jahan has been working as a hotline psychologist for two months. For such a short period, he conducted more than 80 psychosocial sessions. “One day, I received a call from a man who was terrified and had no one to talk to. I learned that his brother was tortured to death, and he had to leave the village out of fear.” During the first session, Shah Jahan found that the man has developed panic attacks and post-traumatic stress disorder. “The man suffered so much that he became intolerant to noises and panicked even at the sound of a hen. He could not stand any noises, became violent, and started to beat his wife and children”. After several sessions with Shah Jahan, the man overcame his fears and brought peace to his home. For Shah Jahan, this is another small victory in his daily work.
Mental health counsellors are trained to listen with empathy and understanding. They validate the callers’ feelings, ensuring they feel heard and supported. For adolescents, this validation is incredibly powerful, as it helps them realise that they are not alone in their struggles. Some brave adolescent girls and boys find the strength to call a mental health hotline.
Tamana was following a challenging and sensitive case of a young girl who was a victim of bullying and sexual violence. It was a very complex case of ruthless revenge because of a minor conflict at school. “Back home, she could not say anything to her parents or relatives and spent several days locked in her room. A bit later, she discovered she was pregnant.” The girl discovered that lifting heavy objects can trigger a miscarriage, something she finally did on her own. “She lives in fear and silence and has been unable to return to normal life. She refuses all engagement proposals because she fears her story will be revealed”, explains Tamana. “By reaching out for support, she took the first step towards healing and breaking free from the chains of silence. I hope one day she will regain her faith in herself and build her new life the way she wants”. Another day, Tamana received a call from a woman who stayed on the call crying for 15 minutes. “I held the phone and was there for her until she could speak and share her grief. This is part of our work, behind the scenes”.
The mental health needs in Afghanistan remain an urgent and overlooked crisis. Therefore, a mental health hotline can be a lifeline for individuals grappling with psychosocial problems in a country where mental health services are limited and stigmatised. It is crucial to maintain this unique support that plays an important role in improving the mental well-being of Afghan people**.
ACF Mental Health Hotline is financed by the generous support of the Disasters Emergency Committee (DEC). All interviews with the hotline team were conducted in June 2023.
* Data covers the period between June 2022 – June 2023.
** Besides the mental health hotline, Action Against Hunger’s MHPSS program provides in-person MHPSS services to girls and women through Women Friendly Spaces. As well as women can benefit from our services in MHPSS corners and baby-friendly spaces at Therapeutic Feeding Units (TFUs), where they can access optimal care practices, psycho-stimulation sessions, and in-person psychosocial support.
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