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The Center for Victims of Torture (CVT) trains peer counselors to provide mental health services to refugees in Guinea and Sierra Leone. Recent conflicts in those countries produced massive displacement of people in the region. Most refugees survived or witnessed some kind of atrocity, inflicted upon themselves, their families or neighbors—including mutilations, amputations of limbs, forced recruitment of children and adults as soldiers or for forced labor, and horrendous sexual crimes.

With more than 300,000 refugees from Sierra Leone and more than 100,000 refugees from Liberia, staff and resources were far too limited to meet the needs of those who could benefit from mental health services in the refugee camps. As a result, CVT began training of refugees themselves as peer counselors—or Psychosocial Agents (PSAs).

PSAs are chosen from the refugee community itself and provide services back to their community through hands-on training that involves providing actual services and interventions while being supervised by expatriate mental health professionals. CVT wanted to leave a cadre of people who would continue to serve their community regardless of whether CVT was no longer present. Given that the majority of refugees are women and children, CVT sought ways to ensure that women had the opportunity to become PSAs. We have also worked to try to ensure representation of ethnic groups that reflect the composition of the refugee camps in which CVT offers services.

The candidates that are selected participate in an initial period of training that last for five to seven days. This training takes place outside of the refugee camp as a way for the candidates to bond as a team as well as begin learning the basic skills they will be using immediately upon accepting their PSA position.

During this and other training opportunities, PSAs learn how the effects of war and torture have been manifested in individuals, families and communities (including their own self, family and community reflection). Mental health professionals train PSAs in the concept, rationale and need for confidentiality, active listening, offering support, collaborative problem and solution identification, and basic skills in being and using an interpreter (for expatriate staff as well as helping others who may speak another language because many languages may be spoken within one refugee camp. Additional skills include assessment and treatment of trauma victims, as well as follow-up assessments.

This training and supervision model is built around actual service provision and mental health interventions—from referrals, individual casework, to small groups and community-wide activities—in order to teach local staff the skills to become peer-counselors for their communities. The majority of inventions are done in small group therapy which has proven to be an ideal setting for training PSAs. The program blends “western” psychotherapy with local wisdom and understanding about trauma and recovery. This requires finding ways to involve the community in all stages.

There have been 120 PSAs “capacitated” since the beginning of the West African program in 1999. These PSAs, along with the expatriate mental health professionals provided direct service to 5,000 clients (individual counselling and small group therapy). In addition, there have been approximately 20,000 beneficiaries via community sensitization and large group activities.