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Mental health and psychosocial support in emergencies: emerging

consensus?

Mental health and psychosocial support in emergencies: emerging

consensus? By

Mark van Ommeren, Dep. of Mental Health and Substance Abuse, WHO GenevaPresentation at Siege and Mental Health Conference. Gaza City 27 Oct 2008

By Mark van Ommeren, Dep. of Mental Health and Substance Abuse, WHO Geneva

Presentation at Siege and Mental Health Conference. Gaza City 27 Oct 2008

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PreliminariesPreliminaries

Gaza - Ramallah

This presentation: story about emerging consensus

This presentation is consistent with – IASC (2007) Guidelines on Mental Health and Psychosocial Support– Sphere Standard (2004) on Mental & Social Aspects of Health– WHO (2003) Mental health in Emergencies recommendations

(all available in Arabic)

Local expertise

A technical presentation in the midst of a humanitarian tragedy: The value of witnessing

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On dogma in our fieldOn dogma in our field

Pre-scientific stage in evaluating real world interventions in face of massive needs → chaos & fights

Recognizing our assumptions, beliefs and dogma

Dogma = firmly held beliefs (by individual/group) that are resistant to other perspectives without self-awareness about this resistance

Perhaps we all have assumptions, beliefs and some dogma based on our deeply-held professional and personal beliefs

We all differ in our dogma & are challenged in taking the perspective of others

Great emotionality about terminology (‘trauma’ ‘mental health’ ‘psychosocial’ ‘debriefing’ ‘PTSD’)

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Diverse needs in midst of emergenciesDiverse needs in midst of emergencies

pre-existing social problems – E.g. Large inequities in access to services, marginalization of groups

emergency-induced social problems – E.g. family separations, loss of jobs

pre-existing psychological/psychiatric problems– E.g. psychosis, severe alcohol use

emergency-induced psychological/psychiatric problems– E.g. normal fear (past, present, future), depression

humanitarian aid-induced problems– E.g. anxiety about lack of information on food distributions,

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How common are mental disorders in humanitarian situations?

How common are mental disorders in humanitarian situations?

Epidemiology ideally would give answer

Many studies have been done in last 15 years

Yet: the validity of current data are too easily contested

Fair assumption that rates are elevated in crisis affected countries compared to what they would have been if the same state had been stable

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ControversiesControversies

• Medicalization of distress• Lack of participatory approaches• Focus on one type of problem only (PTSD)• Undermining dignity by the way aid is delivered• Interventions that have no evidence• Training without follow-up• Terminology (e.g. 'psychosocial' 'mental health')• Universal vs cultural relevant symptoms and

interventions

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ConsensusConsensus

• Widespread distress in populations

in mental disorders (mostly depression and anxiety disorders)

• Need to protect and care for those with pre-existing severe mental illness

• Making mental health care available (inside health care sector)

• Value of social supports/interventions (outside health care sector)

• Value of offering basic psychological support (inside/outside health care sector)

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IASC Guidelines(2007)

consistent with WHO (2003), and with:

Sphere Handbook standard on mental and social aspects of health(2004, 3 pages)

IASC Guidelines(2007)

consistent with WHO (2003), and with:

Sphere Handbook standard on mental and social aspects of health(2004, 3 pages)

Recent consensus on good practices

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Importance of an Inclusive FrameworkImportance of an Inclusive Framework

‘Mental health and psychosocial support’ means both

(a) protecting or promoting psychosocial well-being and

(b) preventing or treating mental disorder.

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Specialisedservices

Focused,non-specialised supports

Social considerations in basic services and security

Community and family supports

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Multilayered supportMultilayered support

Need to ensure support is appropriately divided across layers with good coordination/referral

• E.g. not focused only at clinical level (e.g. Bosnia) or at social level (e.g. Uganda)

Many of the professional animosities disappear as soon as one adopts a public health pyramid model of multi-layered supports with different tasks for different sectors

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Key messagesKey messages

There is increasing consensus on what is good mental health and psychosocial support

There is substantial technical know-how on how to meaningfully reduce suffering

Partnership involving international organization should start with building on local resources and expertise

MH & PS practitioners are key to witness and support those who suffer.