Browsing by Author "Hjelmeland, Heidi"

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Cultural responses towards the aftermath of suicide among the Acholi in northern Uganda
(International Journal of Social Psychiatry, 2018-07-02) Mugisha, James; Muyinda, Herbert; Hjelmeland, Heidi; Kinyanda, Eugene; Vancampfort, Davy; Knizek, Birthe Loa
Suicide is a public health problem in Uganda among indigenous societies, and different societies manage its aftermath differently. Aim: To explore how the Acholi in Northern Uganda manage the aftermath of suicide. Methods: We conducted a qualitative study in Gulu district, a post-conflict area in Northern Uganda. We conducted a total of four focus group discussions (FGDs) and 12 key informant (KI) interviews. KI interviews were conducted with community leaders, while the FGDs were conducted with members of the general population. We analysed the data by means of Grounded Theory. Results: Our findings indicate that rituals form a large part in managing suicide among the Acholi. Study communities practised distancing (symbolically and physically) as a way of dealing with the threat of suicide. Conclusion: Distancing was organized into two broad themes: affect regulation and securing future generations. It is recommended that public health interventions should utilize cultural institutions in the prevention of suicide.
Meaning-making and health
(Health Behavior and Environmental Health. Springer, 2024-08-19) Knizek, Birthe Loa; Hagen, Julia; Hjelmeland, Heidi; Mugisha, James
During the last decades, meaning-making has come into focus as a valuable resource for health. Through life, a person might face different challenges such as bereavement, loss of abilities, and unemployment, among others, and the ability to cope with these is decisive for the person’s health and well-being. Making-meaning is a way of coping with difficult situations and can enhance a healing process of the biopsychosocial individual. As nobody lives in a vacuum, meaning-making is dependent on the cultural, social, and relationship context of a person and is an ever-ongoing process as both the individual, the context, and the interaction with the environment are constantly changing. This chapter discusses different models of meaning-making and provides examples of how they work in suicidality, illness, and loss. On this background, the chapter presents a new way of approaching individuals in difficult situations: the power threat meaning framework (PTMF). PTMF was developed as an alternative to diagnostic and medicalized thinking to provide a more contextual understanding of various challenges, emotional distress, and unusual or troubling behavior. The PTMF also offers practical guidance, which is presented briefly.
A patchwork of good intentions: a critical look at different perspectives regarding ethics-based mental health care in under-resourced settings
(Foundation of Ethics-Based Practices : Springer Nature, 2022-01-01) Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene; Hjelmeland, Heidi
Currently, there is an overall focus on mental health as a global health priority in the United Nations (Sustainable developmental Goals), World Health Organization (WHO), and Global Mental Health (movement and study field). As “mental disorder” is constructed as universal, the consequence is that the focus is on the treatment gap as a result of the huge inequalities regarding access to mental health care and treatment (Mills and Fernando, Disability and the Global South 1:188–202, 2014). UN’s Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (UN Human Rights Council, https://reliefweb.int/sites/reliefweb.int/files/resources/G1707604.pdf, 2017) urges the promotion of mental health for all ages in all settings as a general human right. In the historical basis for Global Mental Health, we find efforts to improve mental health for people living in under-resourced settings. According to mainstream, this means that the Global South should get better access to staff trained after standards and evidence-based treatment from the Global North. Critics rebut this approach since evidence-based practices developed in a Western setting transferred to different contexts might have unethical consequences, due to the ruling idea of a universal human, by pathologizing individuals rather than their sociopolitical-economic conditions. Attempts have been made to bypass or solve the discussion on the possibility of combining culture and the notion of a universal human which is implicit in Western evidence-based practice. Human rights and ethics-based practices are the ideals of all approaches, but all seem to have unforeseen consequences that go against these ideals. In this chapter, we take a critical look at different perspectives and the debate around ethics-based practice in mental health care in under-resourced settings.
“When you are alone you have a narrow mind, but when you are with others you think broader into the other aspects”. A qualitative study on the role of sense of belonging and mattering in attempted suicide in Uganda
(International Journal of Qualitative Studies on Health and Well-being, 2024-11-02) Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene; Hagen, Julia; Hjelmeland, Heidi
Introduction: Suicide is globally a severe problem with an estimated 700.000 deaths annually. Six of the 10 countries with the highest suicide rates worldwide are in Africa, though, reliable statistics are scarce. Method: In this qualitative interview study in Uganda, we analysed the stories of 16 people admitted to hospital following a serious suicide attempt. We focussed especially on each person’s decision process towards their resolution to attempt suicide. Findings: Despite the huge heterogeneity of the narratives, we could identify problems regarding the sense of belonging and mattering in all the stories. Both the sense of belonging and mattering have been related to suicidal behaviour in earlier theories, but they were never studied together or under consideration of the influence of this specific cultural context. We found that the participants’ sense of belonging and mattering to a large degree was influenced by their traditional communalistic context with a worldview where the line between the natural and spiritual world was blurry. Conclusion: This kind of knowledge could be a valuable source for health professionals in their treatment of suicidal persons; it could direct their approach to the core of each person’s relational problems and meaning-making, which is crucial for their decisions with regard to suicide.