Mental health and psychosocial support in emergencies Dr Fahmy Hanna, Co-Chair – Inter Agency Standing Committee Reference Group on MHPSS in emergencies. Technical Officer- Mental Health and Substance Abuse WHO- Geneva www.who.int
What do you think? ⚫ Should internationally endorsed inter-agency mental health and psychosocial support guidelines apply to your country? 2 |
Some typical answers from other workshops "Yes, but . . ." ⚫ Should be culturally sensitive/adaptable ⚫ Should take local situation and resources into account ⚫ Should cover/not cover/ go beyond traumatic stress responses ⚫ Should cover staff welfare ⚫ Should warn about harmful interventions ⚫ Should discuss coordination 3 |
Key global policies and resources Sphere (2011), IASC (2007, 2010) 4 |
Needs are diverse ⚫ Pre-existing problems – Social problems – Psychological (incl. psychiatric) problems ⚫ Emergency-induced problems – Social problems – Psychological (incl. psychiatric) problems • Psychological problems may involve realistic appraisal (no mental disorder) or distortions (possible mental disorder) ⚫ Humanitarian aid-induced problems – Social problems – Psychological (incl. psychiatric) problems 5 |
Impact of Disasters on Prevalence of Mental Disorders: (expected medians across countries & level of adversity exposure) BEFORE DISASTER: AFTER DISASTER: 12-month prevalence 12-month prevalence Severe disorder 2-3% 3-4% (e.g., psychosis, severe depression, severely disabling form of anxiety disorder) Mild or moderate mental disorder 10% 15% - 20% (e.g., mild and moderate forms of (usually reduces over time) depression and anxiety disorders) "Normal" stress reactions (no No estimate Large percentage disorder) (usually reduces over time) Source: van Ommeren et al. BMJ; 330:1160-1; 2005, 6 | http://www.bmj.com/content/330/7501/1160/suppl/DC1
Traditional usage of the term psychosocial support varies with sector ⚫ Health sector staff: non-biological interventions for people with mental disorder (eg CBT) ⚫ Protection, social & community services: any non- clinical support for any person with/ without disorder (eg child friendly spaces) Lack of common language confusion 7 |
Launch of the IASC Guidelines at the United Nations in New York, 2007 • a multi-sectoral, inter-agency (UN-NGO) framework • that enables coordination, • that identifies useful practices, • that flags harmful practices • that clarifies how different approaches to mental health and psychosocial support complement one another. 8 |
IASC Guidelines: Inclusive framework: mental health and psychosocial support covers both Composite definition • protecting or promoting psychosocial well-being and/or MH PS preventing or treating mental disorder. • 9 |
Underlying Core Principles IASC Guidelines Human rights and equity of all affected persons Participation of local affected population Do no harm Building on available resources and capacities Integrated support systems Multi-layered supports – Intervention pyramid.
Intervention pyramid (Adapted from IASC 2007) Examples: Clinical mental health care (whether by PHC staff or by mental health professionals) Clinical services Basic emotional and practical support to selected individuals or families Focused psychosocial supports Activating social networks Supportive child-friendly Community and family supports Strengthening community and spaces family supports Advocacy for good Basic services and security humanitarian practice: Social considerations in basic services that are basic services and security safe, socially appropriate and that protect dignity 11 |
IASC Secretariat Global level Country level Health Protection Co-Chairs WHO Education MHPSS CCCM & IFRC coordination Nutrition groups: IASC Disability (IDP, refugee & TT migrant settings) IASC Gender Sphere 2018 MHPSS RG Zika manual members Expanded membership in 2017 48 full members │ 9 Observers │ 4 Donor organisations
ACTION BY THE HEALTH SYSTEM 13 |
Sphere Handbook mental health standard: 9 key actions 1. Coordinate mental health and psychosocial support across sectors 14 |
Reaching agreement on model for coordinating Mental Health and Psychosocial Support (MHPSS) Humanitarian Coordinator / Government leader Inter-sector Coordination Group Protection sector Education and other Health sector (with Child protection sectors Sub-sector) MHPSS Cross-sector Technical Working Group (with focal points in each of the sectors and with accountability in sectors, with MHPSS activities as relevant in Appeal chapters under health, protection and education, rather than in a separate Appeal chapter)
Sphere Handbook mental health standard: 9 key actions 2. Ensure interventions are developed on the basis of identified needs and resources. 16 |
Desk reviews during emergencies 17 |
Sphere Handbook mental health standard: 9 key actions 3. Enable community members including marginalized people to strengthen community self-help and social support 4. Ensure that community workers, including volunteers, as well as staff at health services offer psychological first aid to people in acute distress after exposure to extreme stressors 18 |
What is PFA? ⚫ Humane, supportive and practical assistance to fellow human beings who recently suffered exposure to serious stressors, and involves: – Non-intrusive, practical care and support – Assessing needs and concerns – Helping people to address basic needs (food, water) – Listening, but not pressuring people to talk – Comforting people and helping them to feel calm – Helping people connect to information, services and social supports – Protecting people from further harm 19 |
What PFA is NOT? ⚫ It is NOT something only professionals can do ⚫ It is NOT professional counselling ⚫ It is NOT “ psychological debriefing ” – No detailed discussion of the distressing event ⚫ It is NOT asking people to analyze what happened or put time and events in order ⚫ Although PFA involves being available to listen to people ’ s stories, it is NOT pressuring people to tell you their feelings or reactions to an event 20 |
Sphere Handbook mental health standard: 9 key actions 5. Ensure that there is at least one staff member at every health facility who manages diverse, severe mental health problems in adults and children. 21 |
Sphere Handbook mental health standard: 9 key actions 6. Make psychological interventions available when possible for people impaired by prolonged distress 22 |
Sphere Handbook mental health standard: 9 key actions 7. Address the safety, basic needs and rights of people with mental health problems in institutions. 8. Minimize harm related to alcohol and drugs 23 |
Sphere Handbook mental health standard: 9 key actions 9. As part of early recovery, initiate plans to develop a sustainable community mental health system. ⚫ Afghanistan ⚫ Kosovo ⚫ Burundi ⚫ Somalia ⚫ Indonesia ⚫ Sri Lanka ⚫ Iraq ⚫ Timor-Leste ⚫ Jordan ⚫ West Bank and Gaza Strip 24 |
Lisbon- May 18 th , 2017
GOAL: Reduce suffering and improved mental health and psychosocial well-being Lisbon- May 18 th , 2017
Lisbon- May 18 th , 2017
In conclusion ⚫ Clear guidelines and technical instruments are available ⚫ The response can be largely delivered by non-specialised workers ⚫ Emergencies can be used as opportunities for mental health system reform 28 |
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