Download Guidelines - Palestine Journal

Mental health and
psychosocial support in
emergencies: emerging
consensus?
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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Preliminaries
 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 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 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?
 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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Controversies
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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
Consensus
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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)
Recent consensus on good practices
IASC Guidelines
(2007)
consistent with WHO
(2003), and with:
Sphere Handbook
standard on
mental and social
aspects of health
(2004, 3 pages)
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Importance 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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Specialised
services
Focused,
non-specialised supports
Community and family supports
Social considerations in
basic services and security
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Multilayered 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 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.
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