Mental Health in Complex Emergencies and Refugee Settings: The case of Syria Tahilia J. Rebello, PhD Columbia Global Mental Health Program WHO Collaborating Center for Research and Capacity Building in Global Mental Health New York, USA WHO Department of Mental Health and Substance Abuse Geneva, Switzerland

Framing questions 1.Why should mental health care be a priority? 2.What are the mental health concerns? 3.What are the challenges? 4.What are effective strategies and resources? 5.How is the Global Mental Health Program contributing? 2

1.Why should mental health care be a priority? Stressors and trauma are experienced at all stages of displacement Substantial impact on functioning and disability High comorbidity and bidirectional relationship with physical illnesses Long-term, generational ramifications Undermines integration, adaptation, and socioeconomic recovery Core human right and falls under UNHCR’s mandate as a “protection activity” 3

2. What are the mental health concerns of refugees? Enhanced rates of: Depression Anxiety Disorders Post-Traumatic Stress Disorder (PTSD) Prolonged Grief Disorder Adjustment Disorders Substance Use Disorders Suicidal ideation and self-harm behaviors 4 Portrait of a young Syrian refugee taken in her mobile home in the Za’atari refugee camp in Jordan, UNHCR, 2013

3. What are the challenges to providing care in complex emergencies and refugee settings? Need for effective Mental Health and Psychosocial Services (MHPSS) Lack of resources Lack of strong assessment of needs, and monitoring and evaluation of interventions Ongoing stressors and trauma Lack of coordinated, multi-sectoral response 5

4. What are effective strategies and resources for providing mental health care in complex emergencies and refugee settings? Coordination Assessment and monitoring Early intervention Engagement of pre-existing health resources / structures Training and education Cultural competence Ethics and community participation Addressing mental health needs of health professionals Outcomes assessment research 6

Operational Guidance Mental Health & Psychosocial Support (MHPSS) Programming for Refugee Operations Assessing mental health and psychosocial needs and resources: Toolkit for humanitarian settings mhGAP Humanitarian Intervention Guide Inter-Agency Standing Committee Guidelines Intervention Pyramid 7 Toolkits and Resources to guide implementation of mental health programs

5. How is the Global Mental Health Program contributing? WHO’s Psychological First Aid Guide for Field Workers Capacity Building and Dissemination of Interpersonal Psychotherapy for Syrian Displaced Persons in Lebanon Collaborating with the International Rescue Committee to build data collection infrastructure and clinical capacity 8