Boosting mental health in Thailand's refugee camps

San Lin is a mother of two, living in Thailand’s Umpiem Refugee Camp, 12 kilometres from the Myanmar border. Her daughter has severe autism, and her son suffers from polio. She’s stressed and worried about her children, and she suffers from insomnia as a result. 

Thailand currently hosts over 90,000 refugees across nine refugee camps along the Thai-Myanmar border. Many refugees – who mainly consist of Karen, Karenni and Burmese ethnicities – have lived in these camps since the mid-1980s after fleeing conflict between ethnic armed groups and the Myanmar military. 

Like San Lin, many refugees are faced with daily stress-inducing factors that inevitably compound and impact their mental health. Furthermore, with widespread misconceptions and a general lack of knowledge about mental health issues, only 2 per cent of camp residents have registered to seek Mental Health and Psychosocial Support (MHPSS) services this year. 

In response, UNHCR, the UN Refugee Agency via its implementing partner, Humanity & Inclusion, launched a new dedicated programme on MHPSS. The programme objectives are to raise awareness and strengthen community support – allowing camp residents to not only have a better understanding of mental health but also be empowered by strategies to cope.

Recently, San Lin was visited by Do Nu Ei, 25, a new camp-based mental-health staff. She is part of the eleven newly trained MHPSS refugee staff across Thailand’s five refugee camps. Do Nu Ei was selected based on her educational background and her aptitude in working with people with disabilities.  She listened attentively to San Lin’s troubles, provided her counsel, and ended the session by teaching her some deep breathing techniques to manage her anxiety. For San Lin, regular home visits by the Humanity & Inclusion staff offer her “comfort and encouragement”.

Home visits aren’t the only activities arranged by staff like Do Nu Ei. They also organize regular workshops for camp residents to increase their awareness of mental health issues, learn how to alleviate them and methods to help members of their own community. 

Tami Lu, 23, the camp-based mental-health staff in Mae La Camp – Thailand’s largest refugee camp – recently organized a workshop for ten participants. Participants in these workshops are selected based on a mental health assessment conducted by the Humanity & Inclusion team. 

Even before enrolling into the MHPSS programme, Tami Lu used to provide an attentive ear to his neighbours and siblings to relieve stress. Now, his skills serve the community at large. 

During his workshop in Mae La, he began the session by asking participants how much they knew about mental health. They knew very little. 

To allow them to understand, Tami Lu draws on their daily experiences as examples. “For instance, we start with a situation and dissect their thinking, feeling and reaction – including physical reaction,” he explains. “The objective is to get participants aware that mental health illnesses can trigger bodily reactions such as pain or insomnia. The consequence is physical, but the cause is mental.”

Physical activities are also used to better explain how mental health illnesses arise. During one of their stress management sessions, Do Nu Ei asked participants in the Umpiem workshop to stand on one leg while holding a book in one hand. She gradually gives the participants more books and items to hold. Once unable to take the load, all the items would eventually drop to the floor.

“Afterwards, I restart the same exercise, telling participants that they can ask for help from someone else,” said Do Nu Ei. “When they receive support, they realize they can stand on one foot for longer or carry more items. The purpose of this analogy is for them to understand that negative thinking is like a pile of books. If they are already in a fragile position and carry on, the stress accumulates, and you may collapse with time. Whereas if you ask for help, someone can take the load off your hands – literally and figuratively.” 

“In the past, when I was overwhelmed by negative feelings, I sometimes stayed home not doing anything, not moving, not eating and not sleeping,” said a young female refugee who took part in the activity. “By joining the workshop, I understand these coping mechanisms are toxic but also other people feel the same way as I do. We learned that we can support each other.”

Art therapy workshops are conducted as well to help camp residents channel their energy and frustrations. Creating art, as many studies have found, can be highly therapeutic. The act of drawing, painting and other forms of creativity can significantly reduce cortisol or “stress hormone” levels. 

Do Nu Ei had Umpiem camp residents create “hapa-zome” – or leaf-dye art. Participants were handed blank tote bags and taped flowers and leaves on top. Then, they smashed the flowers and leaves onto the fabric with a hammer, transferring their natural pigment into the cloth. To further let loose, they were encouraged to yell “troubles, go away” while smashing their bags. With easily found tools and materials, participants were empowered to both manage their stress and create art. 

Considering the challenges and stressors that refugees in the camps face daily, community-based psychosocial support is essential. The strategies that Tami Lu and Do Nu Ei are simple, but they empower refugees – providing them with the tools and knowledge to manage and improve their own mental well-being, as well as being able to help their fellow community members in need. 

By the end of the home visit, San Lin’s breath slowed and she felt more appeased. “The breathing exercise helps me control my thoughts,” she says. “When I overthink, cannot sleep and feel anxious, I do the exercise and it helps me calm down, reduce my heartbeat, and relieves anxiety”.