When Deborah was just 12 years old, she was kidnapped and held captive with a group of young girls for two months. By the time she escaped and returned home, the damage was done. Her harrowing ordeal haunted her into her teens and adulthood. Fearing social stigma, she told no one the truth about what had happened, except for her mother and sister. She had been a victim of human trafficking, but she didn’t feel like a survivor. She felt restless, fearful, and depressed. She isolated herself from friends and community. She couldn’t work—she could barely brush her own hair.
And she’s not alone. In Guatemala, more than 25 per cent of the population—3,250,000 people—will suffer from a mental health disorder, like depression, in their lifetimes. Guatemalans are profoundly affected by the violence of wars and armed conflict in their past and the insecurities they face in the present. Widespread psychosocial instability has raised the rates of domestic violence and child abuse syndrome. But cultural stigma and a lack of knowledge surrounding mental health keep people like Deborah silent about their pain. Poverty exacerbates the problem—in 2020, Guatemala’s poverty rate increased to 47 per cent, and the prevalence of family abuse, violence, and suicide cases went up with it.
But there is hope! Deborah received support and professional therapy through a community-based Food for the Hungry mental health project called Problem Management Plus (PM+). She learned how to heal her inner child, practice art therapy, connect with loved ones, start working, and even got married! Now 32, Deborah is living a full life free from shame and supporting other girls and women to do the same.
Small groups provide a safe place for people to share their struggles, problem solve, and learn new ways to boost their mental health.
Deborah’s life, also, was transformed. “I never imagined receiving any kind of support in terms of psychological intervention,” she shares. “I feel accomplished for facing my problem and not hiding it. I am very happy. I feel motivated to support other girls and young women who are going through similar situations. I’d like to see women and men express what is happening to them without fear so that they can get support. I don’t want them to remain silent so suicides can be avoided.”
When Leader Mother Ana first started leading a PM+ group for women like Rosa and Deborah, she had nine years experience leading Cascade Health Groups under her belt. But seeing women learn to solve their own problems helped Ana shift her leadership style. “I used to feel that the moment a mother shared a problem, I needed to give a solution,” she says. “I’ve learned that each person must solve their own problems. I can only support them through sharing ideas.”
"I never imagined receiving any kind of support in terms of psychological intervention... I feel accomplished for facing my problem and not hiding it." —Deborah
PM+ also helped Ana with her own mental health struggles. Her neighbour bullied her and she was losing her 12-year-old son to cell phone gaming. He was failing at school and ignoring his siblings. Ana felt helpless to change the situation. Learning tools to address the emotional stress with her neighbour and lack of communication in her family was revolutionary.
“Now, when I feel stressed, I practice one of the activities we learned in our mental health training,” Ana explains. “I share my worries with my family and friends. I understand the importance of solving problems and how to make an action plan to carry out solutions. If your problems are not solved, you don’t feel peace—you do not have good mental health.”
Why is an international development not-for-profit like FH Canada talking about mental health issues?
FH Canada’s purpose is to end poverty—one community at a time. What does a person’s mental and emotional wellbeing have to do with digging wells, making latrines, building schools, planting gardens, and so on?
Many assume community development is helping families access better houses, better clothes, and clean water. But what happens when the people we serve are too overwhelmed by the cards they’ve been dealt to pick up a hoe or pack a school lunch? A woman like Deborah simply isn’t interested in planting a vegetable garden. Equipping people with practical skills to address their material poverty without addressing their mental health needs will not produce sustainable change in a community.
In Deborah’s words, “Having [my trauma] in mind all the time affected my emotions and physical health.” Our human struggles go deep into the heart and mind.
Stretching exercises like these help our bodies relax and reduce stress.
And don’t we know it! Today, one fifth of Canadians experience moderate to severe depression. According to the Canadian Mental Health Association (CMHA), anxiety, depression, burnout, and stress soared during the pandemic and have not dropped down to pre-pandemic levels. Canadians are stressed to the max about inflation and financial insecurity—we’re afraid of not being able to pay bills, feed our families, or afford housing. Around the world, the unrelenting pressures of material poverty and broken relationships cause mental health to deteriorate into mental illness.
When we ask individuals in our partner communities how their low-income circumstances make them feel, they say things like, “I felt embarrassed because I couldn’t feed my children.” “I was too depressed to try to change our situation.” “I felt powerless.” Shame, isolation, and stress lead to anxiety, depression, and poor choices.
These are markers of personal poverty—mental, emotional, and spiritual pain that prevent people from trying to change their situation. It’s a vicious cycle—poverty drives poor mental health, and poor mental health cripples people from being able to address their poverty.
One PM+ participant, Rosa, said it best when she declared, “Mental health is as important as physical health and economic stability.” You need both!
So, in 2022, FH Canada partnered with FH Guatemala to fund PM+ groups in Acul. Located in the Central and Western Highlands, Acul is an Indigenous-dominated area with the most extreme combinations of systemic poverty, illiteracy, and inequality in the hemisphere. It also has high rates of food insecurity and malnutrition.
"From small changes come big changes—every problem has a solution." - Rosa
FH Guatemala saw that people living in Acul are at greater risk of developing mental health disorders because of these poverty-related stressors. PM+ addressed their situation by giving them control over their lives—their emotions, relationships, and practical, poverty-related problems. It also filled a gap in Guatemala’s health care system—less than one per cent of public health funding goes toward mental health supports, and those supports are extremely difficult to access.
FH facilitators in Acul invited Cascade Health Group leaders and members to join. The women who said yes were screened for symptoms of common mental health problems like anxiety and depression and evaluated on psychological stress, personally identified problems, and impaired functioning. Leader Mothers in the community were trained to facilitate the groups and assess each woman’s progress. Participants like Deborah were referred to professional therapists who helped them heal from severe trauma. Other participants, like Rosa, received the learning and support they needed in their group meetings.
"Mental health is as important as physical health and economic stability!" —Rosa
Rosa fled violence during Guatemala’s civil war and settled in Acul. She married a widower who already had two children, then they had five more—talk about stress! As an “outsider”, Rosa was never really accepted into the community. One grandson and five of her children still live at home, and struggle to find work. As the cost of the "basic basket" increased over the past few years, so did Rosa’s anxiety about finances. Her strained relationships with her daughters deepened her sadness, and she didn’t know how to change their unhealthy patterns of communication. “Mothers in the community knew very little about mental health,” Rosa explains.
But her PM+ group changed all that. They openly discussed mental health topics and learned stress management techniques like deep breathing, stretching, the importance of listening, identifying stressors and solutions, and more. Stigma around mental health issues began to change.
“Now, women help each other to brainstorm possible solutions when you have a problem. This has come to help the community a lot in improving their emotional quality of life,” Rosa says. “I feel empowered by what I’ve learned.” As Rosa applied her newfound knowledge to repair her relationships with her daughters, three of them stepped out and got jobs selling traditional blouses, housecleaning, and taking care of a store. Through the program, FH addressed families’ mental health needs which, in turn, supported those families to address their own financial needs.
Group leaders help women practice sharing their emotions with visual icons, often an easier way to get sensitive conversations going.
Deborah’s life, also, was transformed. “I never imagined receiving any kind of support in terms of psychological intervention,” she shares. “I feel accomplished for facing my problem and not hiding it. I am very happy. I feel motivated to support other girls and young women who are going through similar situations. I’d like to see women and men express what is happening to them without fear so that they can get support. I don’t want them to remain silent so suicides can be avoided.”
When Leader Mother Ana first started leading a PM+ group for women like Rosa and Deborah, she had nine years experience leading Cascade Health Groups under her belt. But seeing women learn to solve their own problems helped Ana shift her leadership style. “I used to feel that the moment a mother shared a problem, I needed to give a solution,” she says. “I’ve learned that each person must solve their own problems. I can only support them through sharing ideas.”
PM+ also helped Ana with her own mental health struggles. Her neighbour bullied her and she was losing her 12-year-old son to cell phone gaming. He was failing at school and ignoring his siblings. Ana felt helpless to change the situation. Learning tools to address the emotional stress with her neighbour and lack of communication in her family was revolutionary.
“Now, when I feel stressed, I practice one of the activities we learned in our mental health training,” Ana explains. “I share my worries with my family and friends. I understand the importance of solving problems and how to make an action plan to carry out solutions. If your problems are not solved, you don’t feel peace—you do not have good mental health.”
Mothers in Acul invest in a brighter future by taking time to review Problem Management Plus lessons with their children.
Participating in PM+ groups increased women’s functioning so they could do daily activities, again, like cook dinner, help children with homework, weed the garden. It empowered them to be the mothers, wives, friends, and leaders they want to be. One participant commented, “Before, when problems came, I stopped eating, I didn’t sleep well, or sometimes I didn’t want to go out. Now, after participating in this project, this no longer happens to me.”
In Canada, one in three people will be affected by a mental illness during their lifetime. It’s something we have in common with the people in Guatemala (and everywhere) who we’re trying to help get out of poverty. It turns out, at the heart of it, we’re not that different. We all experience the poverty of poor mental health from time to time, regardless of the state of our material wealth.
So, why is FH Canada talking about mental health? Because it matters to you and it matters to them—it matters to all of us.
As Rosa said, “Mental health is as important as physical health and economic stability...people [should] seek professional help, just as a doctor is sought when a person is physically ill.”
Interested in walking with with communities like Acul as they overcome mental, emotional, and socio-economic poverty?