This document summarizes the establishment and operations of the first dedicated mental health outpatient department (OPD) in Borama, Somaliland. The OPD was launched in May 2011 as part of the Amoud Mental Health Project, with financial support from THET and academic assistance from King's College London. It provides free psychiatric services and has treated over 500 clients annually. The OPD also conducts community outreach and trains medical students and staff. Its success led to the construction of a mental health ward and expansion of mental healthcare in Borama and the region.

1. Mental Health OPD
Dr. Jibril Handuleh, MBBS
Amoud University teaching hospital
Al-Hayat medical center

2. Background
• Borama had no
dedicated mental
health service before
May 2011.
• Mental health OPD
started service on May
3rd
2011 with three days
Saturdays, Wednesdays
and Thursdays.

3. Mental health OPD
• It was a part of mental
health project Amoud
mental health project
supported financially by the
Tropical health and
education trust (THET).
• Academic assistance was
offered by Institute of
psychiatry - King’s College
London in partnership with
Amoud University.

4. • It was a pilot phase of 6
months to introduce
mental health service in
Borama. By December
2011, it met all of its
target goals.
• It is run by one of the
doctors in the hospital
and a nurse.

5. Benefits of the OPD service
• Within a year it led to
the construction of
mental health ward in
Borama hospital.
• Borama population got
access to mental health
care both in hospital
and in the community
setting.
• Our OPD is free of
charge for clients.

6. • Students of Amoud University got bed side
teaching site on Psychiatry as a part of their
undergraduate training.
• Social workers referred cases to the service.
• School children and maternal mental health
service is offered. The first in the country.
• Regular follow ups and talking therapy
sessions for clients.

7. • The OPD serves not only clients in Borama but
also have patients from Ethiopia and Djibouti.
• The number of cases of the OPD Service for a
year is over 500 clients.
• The OPD service also offers patient leaflets.
• Room is equipped enough to do physical
exam.
• We have good documentation system.

8. Scope of work- The first of its kind
in Somali context
• Mental health disorders
• Neurological service including epilepsy ,
movement disorders etc. Some consultation
liaison work with hospitals and clinicians
particularly on neurosis.
• Childhood behavioral disorders
• School teen mental health service
• Perinatal psychiatry service

9. • Forensic support for Borama prison- King’s
College London Forensic psychiatrists
• Counseling service on Khat
• Community Psychiatry support for social
workers/traditional workers
• student mentoring on mental health in the
OPD.

10. Partnerships
• Amoud University
• King’s health partners
• Peace-ware Somaliland
• Somali Swedish Research Association
• Borama community

11. Mental health disorders-
Borama 2011 community reach
out

12. Presentations
• Case presentations were done in different
conferences on mental health locally and
internationally.
• Examples include
• The annual institute of psychiatry academic meeting
on behavioral psychiatry in January 2012 as
international case presentation. Post cast can be
downloaded at
http://dl.dropbox.com/u/21419522/SW_somalia_edit2.m
• Annual CME session at Al-Hayat in December 2011.

13. Future plans
• Dedicated childhood behavioral and
adolescent clinic in partnership with KTSP.
• Khat Clinic
• Psychotherapy service
• Training for primary care physicians and
nurses in the region on mental health using
the WHO MH Gap. MMH was done last year.
• These activities are planned in next few
months.

14. Example of our success
• These two sisters and
their healthy caretaker
brother came to the
OPD service in October
2011.
• They had schizophrenia
and no care for them
for 17 years being
chained at a hut in
Fardolaguxidh, midway
between Borama and
Djibouti.

15. • The two sisters were brought in by women
who saw them for assessment.
• Volunteer women rented home for them and
offered costs for medications.
• OPD service supported with follow ups and
consultations to the supporting brother and
social workers.
• The message reached so far places and so
many other patients received care.

16. • Patients are doing well, fully integrated into
community.
• They cook food, eat well and communicate
well.
• Social workers and their relatives support
them with life.
• OPD service offer one a month follow up.

17. ACKNOWLEGEMENT
• Amoud University schools of health sciences
• Al-Hayat Hospital
• King’s Health Partners
• Tropical Health and Educational Trust (THET)
• Peace-ware Somaliland