Traiter la crise invisible de la santé mentale en Afghanistan

Hope is just a phone call away for struggling Afghans

The consequences of war are not always easy to see. In places like Afghanistan, where decades of armed conflict have left many injured, displaced, and hungry, many are facing an unprecedented but unseen mental health crisis.

Unlike physical injuries, stress, anxiety, and depression are not visible to the outside eye. Recent years have been especially challenging for Afghan families, who have faced political upheaval and economic hardship. People are desperate for support but are unable to access the resources they need. Stigmas around mental health have made it especially difficult for Afghans, and stereotypes prevent many from seeking treatment.

Research from the World Health Organization in 2018 found two million Afghans struggling with mental distress, and these numbers are likely much higher today. Still, many suffer in silence. The mental well-being of Afghans has become a pressing concern that demands immediate attention.

Afghanistan does not have enough qualified mental health professionals, such as psychiatrists, psychologists, and counsellors. Additionally, mental health services are concentrated in cities, so many rural communities are underserved. To address these challenges, Action Against Hunger established a mental health hotline, where treatment is provided entirely by phone.

Making mental health services accessible

The hotline service, funded by the UK’s Disasters Emergency Committee (DEC), employs 13 staff members: two receptionists and eleven psychologists. Since it launched in 2022, this unique team has provided mental health expertise during more than 2,060 sessions.

Many calls to the hotline come from remote provinces, such as Ghor, Daykundi, Nangarhar, and Badghis, where people have little access to mental health support. Other calls come from cities like Kabul, Herat, Balkh, and Kandahar.

The hotline is free and offers immediate support to individuals experiencing distress or psychological challenges. All of the hotline professionals are trained in psychosocial and psychological interventions, including emergencies like suicide prevention.

In areas where mental health is rarely talked about, hotline psychologists are among the few who are trusted with stories of trauma. Asef, a hotline psychologist with a background in clinical psychology, sees how mental health issues in Afghanistan are often stigmatized and misunderstood. Traditional cultural norms discourage people from discussing their personal struggles openly, which hinders them from seeking help.

“People facing mental health challenges may be isolated, making accessing appropriate support and treatment even more challenging,” Asef says. “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 share their thoughts and feelings without fear of judgement. Confidentiality is of the utmost importance, and callers are assured that their personal information will not be disclosed to anyone without their consent.

The hotline has established protocols for follow-up calls to check on the well-being of callers and ensure continuity of care. Follow-up sessions help prevent crisis situations and demonstrate a commitment to ongoing support. For people requiring more specialized support, the hotline offers referrals to local mental health professionals or clinics.

Healing broken lives and traumas

About 60% of the callers were women. The rise of gender-based violence, lack of access to healthcare, and barriers to education, employment, and equality mean that women often bear the brunt of Afghanistan’s mental health burden.

“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 more open to sharing their problems and feelings.”

Many men are told from a young age that their mental health challenges are unimportant. In Afghanistan, these men are crushed by the country’s economic crisis, personal trauma, or the inability to feed their families. They feel broken and powerless. Financial instability can be a key contributing factor to mental health challenges, and it often leads to instances of violence and even domestic abuse.

“Most people who call the hotline encounter economic problems,” says Mina, an experienced psychologist. “A 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. Men, when faced with adversity, often suppress anger or pain rather than seeking help.

“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,” says Shahjahan, a hotline psychologist who has conducted more than 80 psychosocial sessions in only two months.

During the first session, Shahjahan found that the man had developed post-traumatic stress disorder, which often resulted in panic attacks. “The man suffered so much that he became intolerant to noises and panicked even at the sound of a hen,” adds Shahjahan. “He could not stand any noises, became violent, and started to beat his wife and children.”

After several sessions, the man achieved real progress and found tools to cope with his mental health challenges. Overcoming his fears was not easy, but there’s no longer violence at home. For Shahjahan, 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 and ensure they feel heard and supported. For teenagers, this validation is incredibly powerful, as it helps them realize that they are not alone in their struggles. Tamana remembers an especially challenging case of a young adolescent girl who faced bullying and sexual violence.

"De retour chez elle, elle ne pouvait rien dire à ses parents ou à sa famille et a passé plusieurs jours enfermée dans sa chambre", raconte Tamana. La jeune fille a découvert qu'elle était enceinte et a trouvé le moyen de faire une fausse couche toute seule.

"Elle vit dans la peur et le silence et n'a pas pu reprendre une vie normale", explique Tamana. "Elle refuse toutes les propositions de fiançailles parce qu'elle craint que son histoire ne soit révélée. En cherchant du soutien, elle a fait le premier pas vers la guérison et s'est libérée des chaînes du silence. J'espère qu'un jour elle retrouvera confiance en elle et construira sa nouvelle vie comme elle l'entend."

Traiter des cas complexes comme ceux-ci est un jour comme les autres pour Tamana, psychologue de la ligne d'assistance téléphonique. Une fois, elle a reçu un appel d'une femme qui est restée au téléphone en pleurant pendant 15 minutes d'affilée.
"J'ai tenu le téléphone et je l'ai accompagnée jusqu'à ce qu'elle puisse parler et partager son chagrin", raconte-t-elle. "Cela fait partie de notre travail, en coulisses.

La crise de la santé mentale en Afghanistan reste une crise urgente et négligée. Dans un pays où les services de santé mentale sont limités et stigmatisés, une ligne d'assistance téléphonique est plus qu'un simple appel pour les personnes en difficulté, c'est une bouée de sauvetage.