Weanne Estrada:Mental Health Without Borders: How Compassion, Culture, and Community Transform Lives Worldwide

What if everything you thought you knew about autism and
mental health wasn't the full story. Today's conversation might change
the way you see it. Welcome to Why Not Me?
Embracing autism and mental health Worldwide, where real conversations and
lived experiences inspire understanding and hope. I'm Tony Mantor. This
is where understanding begins. If this kind of conversation matters
to you, then follow the show so you don't miss
what comes next. Joining us today is when Estrata. She
is part of the Adventist Development and Relief Agency known
as ADRA, a global organization serving communities in need around
the world. This is not about titles or roles. It's
about lives touched, the challenges faced, and the moments that
don't always get seen. Today we're going beyond the surface
to talk about what it really means to serve and
how those experiences shape the person behind the work.
Thanks for jo joining us today, of.
Course, Now thank you for having me.
I've been looking forward to this getting to talk about
some of my favorite topics.
So thank you for having me.
Oh, it's my pleasure if you would give us a
little background on what you do.
Sure, so I am a mental health specialist at ADRA International.
So ADRA that's the Adventist Development and Relief Agency. We
are the global humanitarian armor the Seventh day Adventist Church,
and we're currently operating in more than one hundred twenty
countries worldwide. We have about one thousand different projects and
they're in the different fields of health, nutrition, water, education,
livelihoods or emergencies, and across all that mental health is
embedded into them. And so what I do as the
mental health specialist is not all are range of different roles.
There's maybe two core ones and one is I help
design and implement our mental health and psychosocial support programs,
and so that involves making sure that these programs follow
international guidelines, that they're delivered effectively and safely for our beneficiaries,
that they're culturally adapted, they're relevant, and they're feasible. And
then the other part of the work that I do
is also I support the staff that we deploy during emergencies.
So there are certain occasions, so when a major humanitarian
crisis might completely overwhelm the capacities of the local country office,
and so what we do in the situations, for example,
last year when Hurricane Melissa hit Jamaica or this year
with a war in the Middle East, is that we
deploy some of our personnel to help out those offices.
And so what I do is, because these staff members
are going to be undergoing, you know, a new culture
and new environment, a very stressful job in these new placements,
I make sure that they're well supported, that they have
the tools in the tool kit to be able to
maintain their resilience during deployment, and that they have intended
supports in place.
So yeah, those are just like internuts.
You've had the opportunity to work in some of the
more challenging environments in the world. Can you give us
a moment that changed the way that you understand mental health?
So yeah, that's a great question. So I grew up
in the Philippines. I actually started out as a nurse there.
When I was younger, I just knew that I wanted
to work in the humanitarian field. And back then it
was because of a very simple reason. I wanted to
travel for work and I wanted to help people. So
I thought, why don't I travel for work well helping people?
And I thought that was what a humanitarian would do.
But then I think one formative experience for me was,
you know, growing up in the Philippines.
Unfortunately, we're exposed to.
A lot of different typhoons hurricane throughout the year, and
so growing up I was keenly aware of the effect
that this had on people, on children, on vulnerable populations,
and so one time I volunteered to help out with
this operation where basically this was during one of the
major typhoons, and they were essentially airlifting people from a
different province who had been affected by the typhoon and
had lost everything.
I'd lost their homes.
There were airlifting them in military airplanes and bringing them
to the capital, Manila, and so my role was to
welcome those people, give them psychological first aid. They had
come in basically wearing the clothes that they had so
that some of them were still wet, and so make
sure that they were warm, they had food, tweet we
would register them and then we would essentially load them
up into cars so that they could be either transported
to Some of them might have had relatives to live
within that area, but then others I don't really know
where they were, you know, shipped off to for lack
of a better word, and so that experience, it made
me think of displacement and what are we doing to
follow up with these needs of these people.
These people we've.
Just just a few days ago, they were safe and
warm in their homes and now they're essentially transplanting different community.
What effect does this have on their mental health? Is
there any sort of follow up available? So I think
that was really formative to me wanting to go into
this word.
When people think about mental health, especially in humanitarian efforts,
most always they will think about trauma.
Most of the time, it's much more than that.
What are some of the things that they're missing when
they think that way.
I think that's a great question, and you're absolutely right, Tony.
So one of the biggest misconceptions about mental health, especially
in crisis settings, is that it's only about clinical care.
But in humanitarian context, people are affected at many different levels. So, yes,
there are some people who are experienced severe mental health conditions, right,
and they'll need therapy.
But then many more are dealing with.
Stress disruption, with the loss of routine and the breakdown
of their social systems. So what we do We call
it IMAGEPSS, right, it stands for mental health and psychosocial support.
It's just broader than mental health services. It includes everything
from basic psychological support and community activities to more specialized
care for people experiencing severe distress or mental health conditions.
Because the challenge in this field.
Is that you need to tryaj There's just a wide
range of different needs and not everyone in crisis will
need therapy, but they will all need support of some kind,
and we need to be able to match the intervention
with the need because if we give everybody therapy.
Will overwhelm the specialist services.
If we just give people basic care, then we're leaving
people with more significant needs out of the equation.
And so what we have.
For mental health is we call it the MHPSS pyramid,
and each level of the pyramid provides a different type
of support. So at the most basic level, we have
basic services and security. At the most basic level, people
need safety, right, they need stability, they need access to
essential services because in crisis settings, stress is not just
because of.
The trauma that they have experienced to get to this point.
But it's also by ongoing conditions that they're living in.
Its lack of shelter, food, insecurity, and certainty. And so
for adra one of the basic things we do is
we make sure that we provide food, water, shelter, and
healthcare first. And while those may not be traditionally seen
as mental health interventions, they do have a direct impact
on well being.
So like that's the first.
Level, and then we go to the second level, which
is all about community and family supports. Because crisis often
disrupt social networks. Families may be separated, people's roles are lost,
and so what adro We focus on rebuilding and strengthening
those social systems, So things like reuniting families. May be
building child friendly spaces so that children who have lost
access to like schooling and safe places will have a
safe space to play. Maybe that's making peer support groups
so that women youth can all support each other.
So that's level two, and then level three, now we're
getting to the more focused type of supports.
These are for people who are experiencing more significant distress.
They may be overwhelmed, they will need more structured support,
but they're not necessarily needing psychiatric care at this point.
So at this level we provide psychological first aid. We
teach them problem solving strategies, we teach them how to
manage their stress, and these are often delivered by trained
non specialists. And then lastly, the top level of this pyramid,
sorry for this crash course, is the specialized services that
we provide, and these are for people who are actually
experiencing major depression PTSD psychosis that require clinical intervention.
So at this point, we maybe.
Have clinics, we have mobile clinics, and these clinics provide
psychiatric care, medication management, or they if they're not capable
of doing those, they're at least capable of assessing these
patients and then referring them to a higher level of care.
Just this huge pyramid, recognizing that in these settings you're
not just targeting one level of trauma or one level
of need, but you're targeting this whole layer, intricate, interlayering need.
Now you just brought up psychosis and that deals with
serious mental illness. How do cultural differences shape the way
that that is understood? Because when you get into psychosis
and asignosia, many times that is so misunderstood. So what
is the thought process when you're dealing with different countries
around the world.
Yeah, for sure, culture really plays a huge role in
mental health, and it's not just psychosis, right, And one
thing that I want to bring up is that culture
mental health manifests in many different ways, so cultural adaptation
is absolutely essential in this work.
We can apply just a one size fits all model.
So for example, sometimes when we come into a community,
we need to start with listening and understanding how communities
describe distress, what coping mechanisms already exist, and what support
systems are trusted. And so we first we try to
talk to the leaders in the community and understand who
are the people in the community that people turn to
when they want to talk about mental health.
Where do they want to go?
Is that a health clinic or maybe it's just a
school or community space. And then when we create the interventions,
we want to make sure that we're using very locally
relevant examples like maybe, you know, if we're working in
a more Western context, maybe the stressors that people have
are related to like their jobs or personal issues, but
in these crisis settings, maybe their challenges would go around
accessing water, livelihoods. And so we make sure that the
examples we're using are locally relevant. And then the way
that we deliver support also changes. So in some context,
individual counseling might feel unfamiliar or even uncomfortable, especially if
people are used to more collective ways of coping. So
group based approaches like community support groups might actually be
more effective. But then maybe in some settings they don't
want to spill, you know, their personal problems in front
of the whole group, and so in those settings we
choose to do more individual therapy. And then also we
have to recognize that some communities already have the coping mechanisms.
You know, maybe in the more western setting, we think, oh,
journaling is a great way for people to improve their
mental health. But then in other cultural settings, what might
be more effective for them are faith based practices. Maybe
it's storytelling or community rituals. So we want to make
sure that we respect those cultural considerations.
What does recovery look like when you're dealing with places
around the world where resources are almost nonexistent.
Yeah, so this comes into my questions for me, It
comes into my concepts related to resilience, right, and what
it would look like in these settings. Oftentimes, in these settings,
resilience and recovery it isn't this traumatic, heroic thing. It's
not something that we immediately see in humanitarian settings, resilience
and recovery can look very ordinary. Maybe it's apparent finding
a way to comfort their child in a place that
as it feel safe. It could be someone waking up
and continuing daily life even when everything has changed. It
could be a mother that chooses to and I use
this example because it's something that actually.
Happens in real life. Could be a mother.
That decided to eat again after giving birth. And let
me share this example with you is we have this
mobile clinic operating in Yemen, and we have postpart to
mothers that we are affected by conflict and displacement. And
this mother, she had a child who had deformities, She
had a ninia, she had anxiety, she had insomnia, and
when she found out that her fourth baby was going
to be another boy, she wanted a daughter.
She got dispressed and she refused to eat.
And so we had midwife come and talk to her,
visited her several different times, gave her psycho education, helped
her reduce the size of.
The problem in her head. And then after this she
was able.
To recover, to accept that these are her circumstances and
she is able to thrive. So recovery it can look
like a lot of things. It can look like people
deciding to take their medications regularly, but it can also
just look like people taking the first step and asking
for help.
Have you ever had a time when you're working and
you question to yourself is enough being done here? Then
after you assess it, what conclusion did you come up with?
And how did you handle it?
I think the question is the work is never going
to be enough, The need is always going to be great.
And I think.
Especially these days, we have a lot of conflict that
are going to definitely increase the number of people displaced
to have wars. Just twenty twenty four alone, I think
there were about one hundred and twenty four million people
who were displaced. When I think about that number, I
think of another statistic which says that one in every
five people who are displaced to have a mental health condition.
So when we think.
One in five of one hundred and twenty two million,
we're thinking of millions of people who have just a
great need for mental health care. So when I think
of that, it's easy to become discouraged. But I think
what motivates me to really keep going in this field,
I think is the progress that we've seen in how
MHPSS has evolved over time. One of the biggest shifts
I've seen is MHPSS and mental health. Previously, it was
often treated as an add on, something we addressed after
immediate needs like food, shelter, or health. But now we're
seeing a much stronger recognition that mental health is actually
foundational to recovery and not separate from it.
So that gives me hope. But even then, once.
Say, Tony, there's really so much that needs to be
done in this field.
We need to sustain investment.
That includes funding, but that also includes political will and
a broader shift in how we think about supporting people
affected by crisis, because the reality is in many of
the places that we work, people already know what they need,
Communities understand their challenges, they're capable, but they're missing their
resources to actually deliver that support at the scale that's needed.
So it's not always a question of what should we do,
but a question of how do we sustain and expend
and get investment for what we know already works?
Right, how do you build a trust with people that
have every reason not to trust a system or professional.
That's again another great question and This again goes into
topics related to stigma. You know, when stigma is integrated
into the system and people enter a healthcare clinic and
they experience stigma, then it affects the way that they'll
continue to engage with that system. And so what we
do is we make sure that we train staff to
communicate in a respectful, non judgmental way and to avoid
stigmatizing language, because even small interactions can influence whether someone
feels comfortable seeking support. So in many contexts, we make
sure that when our staff speak, they might not necessarily
say mental illness, they don't use words like crazy or
things that phrases that can feel stigmatizing, and tell them
to use language that people already relate to, such as,
you know, maybe stress, worry, feeling overwhelmed, or maybe the
lack of sleep. So it's kind of translating mental health
language into that. And then one of the things we
also do is, again I've alluded to this before, is
making sure that we engage with trusted community actors. This
could be religious leaders, they could be teachers, community health workers.
Because then if trusted individuals model supportive language and then
they can encourage help seeking, that can shift attitudes much
more effectively than outside messaging and loan. And so we
engage these trusted community leaders to speak openly about mental health.
And then we also really tap people with lived experience.
When people hear stories that are responsibly and respectfully shared
related to.
Mental health, stigma often decreases.
And so we also just normalize these conversations. We deliver
support in a group setting, like in a parenting group,
youth group, or community activity becomes normalized. We tell people
that whatever they're experiencing, there's stress, their responses to these
abnormal experiences, they are normal and they're safe to talk about.
And that's how we address self stigma and maybe distressing
the system as well.
Okay, my next question is in two parts. When you
step back and you look at your work, what gives
you the most hope right now? And on the flip side,
what still keeps you up at night.
Let me think about that for a second. What gives
me hope?
I think I briefly spoke about it. I think it's
the shift that I'm starting to see in how people
understand mental health. Again, for a long time, it's been
treated as something secondary, something you address after everything else,
but more and more, I'm seeing people recognize that mental
health is foundational and it's not separate from things like education, livelihoods,
or recovery, and it allows all of those things to work.
And so when I see that shift from mental health
being seen as an afterthought to now being seen as
a multiplier to all these different interventions, to all these
different approaches, it makes me feel hopeful because it means
that we're starting to understand people more holistically, not just
in terms of what they need, but in terms of
what helps them move forward.
What keeps me awake at night.
What really disheartens me sometimes is how people view refugees
and a lot of these people that we serve. I
think there's so many misconceptions that they are just people
who are passive recipients of aid, and I think that
makes people view them as people who just suck resources
or people who, you know, it kind of dehumanizes them.
And so when I hear Tory about that about these
populations that we serve that are incredibly resourceful, who are
capable or very resilient, it disheartens me a little bit
because these people are people with so much resilience. We've
overcome so much and are trying to just recover.
And use the tools that they have to live a
normal life, the normal lives that we're living.
And so I really stay up at night thinking of
ways to help people care about these populations and see
them as human.
Okay, so, now, how do people find more about what
you're doing?
Yeah, So, if people who are interested in what we do,
especially at ADRA, you can go to our.
Website that's ADRA dot org.
That's ADRA dot org, and you can learn more about
our different programs there. There's also what tab up top
on the website that says ways to give or ways
to help. I believe, and so if you are so
inclined to do so, please feel fee too click that tab.
Okay, for the person listening right now who wants to
help but doesn't know how, what's the first step that
they have to take?
I think it's really just awareness.
I did a study once on how we can make
people more attune to the needs of refugees and to
their mental health, and it really starts with contact. So
I would encourage people there are refugees in your communities,
there are people with mental health conditions who might be
your neighbors, who might be your coworkers, and so I
encourage you to talk to them, get to know them,
get to know their needs, get to know their stories.
What they've been through.
I've had the opportunity in my life to speak with
refugees who have traveled from their original countries, crossed oceans.
To get to where they are today and just hearing.
Their stories of bravery and how they're now readjusting, but
also just hearing about their normal lives and what they
were back in their home countries, of whether they were
a doctor, a business professional, or a student, and it
just like humanizes these people in my eyes. So I think,
really the first step is awareness and getting to know
your neighbor and seeing them as human, I think is
a great first step.
What is one story that kind of sticks with you
and not because it was tragic, but because it reveals
something very important?
Yeah, so this story is it does start out a
little tragic.
So I had the opportunity.
Of interviewing some refugees who had been displaced, they had
traveled to Greece, and these were because they were members
of the LGBT community, and they came from countries where
being part of that community was a death sentence. So
this particular person, he was a refugee, and his story
was that he was kicked out of his village because
he was gay. And then when he tried to return
back to his village, and this is quite tragic, he
returned to his house being burnt by the villagers with
his family inside the house, and he found out that
because there was a misconception in that community that being
gay can be infectious, they decided to kill his whole family.
And so he escaped and he, you know, he made
it through food, and then he wrote on a dinghy
on a boat and.
Made his way to Athens.
But then he met a donor there who spoke to
him about how do you want to move forward from here?
And his story was that he decided, I want to
be able to help other people. I want to be
able to help refugees in this area find shelter. I
want to be able to give them language lessons. I
want to be able to help them find gainful employment.
And so this man was able to take the pain
from his experiences and transform it into a wag to
help other people.
So I believe that that story really stuck with me.
But also I think another story that goes to your
second question of.
You know what, something that was revealing.
I remember asking one of these refugees once I asked them,
you know what, what is your hope from here now
that you've received the supports?
What do you want to be?
And I came in asking that question expecting something lofty like, oh,
I want to change the world. Oh I want to
be able to become a doctor, and things like that,
and the person's response was, well, I want to go
home eventually, maybe I want to find work.
It was just a very simple.
Answer that made me realize that I think I was
being part of the narrative that refugee should be able
to rationalize their existence and the help that we give
them by becoming someone extraordinary, when in reality, they don't
owe us that right. They can be just like us
and they have normal aspirations just like us. And placing
that expectation on them, I think is a shift in
perspective that I needed to change.
And so, yeah, that was revealing to me.
Okay, so one last question is how do you define
dignity and mental health care, especially in the places where
people tend to feel forgotten.
Yeah, so again I think this also goes back to
the concepts of resilience. So resilience has four pillars, and
these four pillars are social competence, problem solving, autonomy, and hope.
So if a person as all four of those things,
and they will have resilience.
And I think your question of dignity goes to the
third one, and that is giving people autonomy or a
sense of agency, the feeling that they have control over
their life, even in constrained environments. And so we see
that in a lot of small but important ways, when
people make decisions about their daily lives, when they contribute
to their households, when they problem solve, when they decide
how to manage their limited resources.
So they're able to do that on their own.
But I think for us, for people who are trying
to help, we need to remember that when we design programs,
we need to restore a sense of agency and make
sure that these people whose control is often stripped from them,
have a voice in the interventions that we create. So
supporting resilience means creating opportunities for people to make choices
and have a voice, and that can be as simple
as involving them in program design, or as practacle as
giving people options in how they access services. We're not
just giving them, hey, this is what we want you
to do, but we give them voice. Maybe we even
have seen refugee communities where the people, the refugees in
the communities, they're actually given roles where they're the ones
who provide.
Training to people.
Maybe they were teachers in the past, and so we
give them opportunities to teach at these camps, and so
giving them this sense of purpose, giving them the sense
of agency is a big way to give them some
dignity that they might have lost in the journey to
put them to get here.
Okay, so in closing, what would you like people the
listeners to know that you think is important that they
hear from you.
My message for listeners, I think.
Is to really reconsider how we think about people who
are going through different circumstances. We often see refugees displaced
individuals in ways that are very one dimensional, like they're
just recipients of aid, But they're actually people who are
incredibly resourceful, who are problems solving every day, who are
supporting each other, who are actively trying to rebuild them lives.
So I think when we start looking at people that
way that ship is really critical not just for dignity
but also for effectiveness. And I wanted, actually Tony to
quote when preparing to speak to you this podcast, I
listen to your song that I believe like this podcast
title was based on lyrics song of why Not Me?
And I know that those lyrics that you have and
that song you had specifically dedicated it to the autism community.
But while I was listening to it, I couldn't help
but think that you could have also just written this
song about refugee communities as well, because when you talk
about mountains that have to be climb or like motions
that need to be crossed, these are literally and figuratively
the things that refugees have to overcome, right They need
to get to the other side of the mountain. They
literally have to cross oceans so they can see that
the dream that they have and realize and get away
from the dangers that they have and experience the you know,
reach the goals that they have for themselves.
So I think looking at.
You know, refugees from that perspective as people who are
overcomerce rather than as people who are victims.
I hope that's what listeners take away.
Yeah, nice, I really appreciate you taking the time to
join us.
Thank you so much for having me. I appreciate you
and the work that you're doing.
Oh it's my pleasure. Thanks again.
A sincere thank you to our guests for sharing their
journey with us today. We appreciate their honesty, courage, and
willingness to open their heart in hopes of helping others.
If today's conversation helped you see the world a little differently,
then we've accomplished exactly what we set out to do.
Until next time, keep believing, keep learning, and most importantly,
keep asking yourself, why not me?