Psychosocial Support in the IFRC APDC

Definitions “Any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent mental disorder” (IASC Guidelines for Mental Health and Psychosocial Support) “Psychosocial support is a process of facilitating resilience within individuals, families and communities. Through respecting the independence, dignity and coping mechanisms of individuals and communities, psychosocial support promotes the restoration of social cohesion and infrastructure” (IRFC Psychosocial Framework) Background notes: "Psychosocial support is an approach to victims of violence or natural disasters to foster resilience of both communities and individuals. It aims at easing resumption of normalcy and to prevent pathological consequences of potentially traumatic situations". The term ‘psychosocial’ refers to the close relationship between the individual and the collective aspects of any social entity. They mutually influence each other. The ‘psychological’ effects are caused by a range of experiences that affect the emotions, behaviour, thoughts, memory and learning capacity of an individual. To a large extent, the psychological effects depend on the way in which these events are perceived and given meaning by the individual.  Social effects are the shared experiences of disruptive events that affect the relations between people – not only as a result of the events but also of death, separation and sense of loss. It also includes an economic and political dimension, since many people suffer multiple consequences of, for example, disasters or armed conflicts. The mid 1990s saw a growing dissatisfaction with the traditional trauma-focused mental health interventions that were being implemented in the aftermath of disasters and conflicts. There was a growing realisation that conceptualising the suffering caused by natural catastrophes and conflicts primarily in terms of Post-Traumatic Stress Disorder (PTSD) or associated mental disorders was a hindrance to providing adequate support.  Along with the critiques of the trauma approach, the mid 1990s saw the articulation of many alternative approaches to psychosocial intervention, which acknowledged people’s capacity for resilience and aimed primarily to enhance and support this. Experience shows that accidents and disasters do not necessarily produce huge numbers of people with acute psychiatric disturbances. While some individuals do require treatment of psychological disorders, the majority of affected people have a need for information and have practical, social, emotional and psychological needs.  This more generalised support will enable them to better access the material and social resources they seek. In November 2004 the centre changed its name to the Reference Centre for Psychosocial Support, thereby underlining the community-based character of the interventions.

What is psychosocial support? Psychosocial support refers to actions that address psychological and social needs of individuals, families and communities. Psychosocial support can be delivered in specific programmes or be integrated within other activities. The IFRC approach to psychosocial support is: A community based approach to facilitate the resilience of the affected population. A means of maintaining health and well-being of staff and volunteers.

Why provide psychosocial support? Mobilizing early and adequate psychosocial support can prevent distress and suffering from developing into something more severe. Psychosocial support helps people affected by crises to recover.

Factors affecting the psychosocial impact of crisis events Characteristics of the event Natural versus man-made Intentionality Degree of preventability Scope of impact Suffering Degree of expectedness Duration of the event Crisis/post-crisis environment Weather Time of day Accessibility to area Amount of physical destruction Number of deaths Number of child deaths

Factors affecting the psychosocial impact of crisis events Individual characteristics Age - stage of life Mental health Social support systems Disabilities Social economic status Religion Disaster history Previous traumatic experiences Family and community resources Nature of relationship between children and caregivers Active social networks Community cohesion Religious system and rites Economic/educational opportunities

Psychosocial impact of crisis events Positive aspects Reinforcing social fabric Cohesion Altruism, helping each other Empathy and understanding Positive meaning making Resilience Responsibility Preventing new disasters Increased preparedness Health improvement Negative aspects Fragmentation of human bonds Conflict Individualism Psychic numbing, denial Erosion of sense of community Vulnerability No sense of responsibility No plans for the future Hyper vigilance, overreactions Health deterioration Dr. Atle Dyregrov

How do we provide PSS? Promote sense of safety • Calm anxiety and decrease physiological arousal • Increase self- and collective efficacy • Encourage social support and bonding • Instill hope and sense of positive future Stevan E. Hobfoll

How do we provide psychosocial support? Intervention pyramid for mental health and psychosocial support in emergencies

Matching needs

IFRC PSS resources Psychosocial Interventions – a handbook Community Based Psychosocial Support. The Children’s Resilience Programme. Caring for Volunteers – a toolkit. Emergency Response Unit PSS. Lay counselling. Psychosocial Life Skills (pending).

IFRC Reference Centre for PSS Established in 1993 to support National societies and the IFRC secretariat to promote psychosocial wellbeing of staff, volunteers and beneficiaries. www.ifrc.org/psychosocial

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings a set of minimum multi-sectoral responses to protect and improve people’s mental health and psychosocial well-being in the midst of an emergency To be achieved through coordinated effort from various agencies

Core Principles 1. Human rights and equity 2. Participation 3. Do no harm 4. Building on available resources and capacities 5. Integrated support systems 6. Multi-layered supports

Matrix of Interventions Emergency Preparedness Minimum Response Comprehensive Response Coordination Assessment, monitoring and evaluation Protection and human rights standards Human resources Community mobilization and support Health services Education Dissemination of information Food security and nutrition Shelter and site planning Water and sanitation Common functions across domains Core mental health and psychosocial support domains Social considerations in sectoral domains

An example: Type of Information Including 1. Relevant demographics ü Size of (sub - )population and contextual information ü Mortality and threats of mortality ü Access to basic physical needs ( eg . Food, shelter, water and sanitation, health care) and education ü Human rights violations and protective frameworks ü Social, political, religious and economic structures and dynamics ü Changes in livelihood activities and daily community life ü Basic ethnographic information on cultural resources, norms, roles and attitudes

An example: Type of Information Including 2. Experience of the ü Local people’s experiences of the emergency (perceptions of events and their importance, perceived causes, expected consequences) emergency 3. Mental health and ü Signs of psychological and social distress, including behavioral and emotions problems psychosocial problems ü Signs of impaired daily functioning ü Disruption of social solidarity and support mechanisms ü Information on people with severe mental disorders 4. Existing sources of ü Ways in which people help themselves and others psychosocial well - being and ü Ways in which the population may previously have dealt with adversity mental health ü Types of social support and sources of community solidarity

An example: Type of Information Including 5. Organizational capacities ü Structure, locations, staffing and resources for mental health care in the health sector and the impact of the emergency on services and activities ü Structure, locations, staffing and resources of psychosocial support programs in education and social services and the impact of the emergency on services ü Mapping psychosocial skills of community actors ü Mapping of potential partners and the extent and quality/content of previous MHPSS training ü Mapping of emergency MHPSS programs 6. Programming needs and ü Recommendations by stakeholders opportunities ü Extent to which key actions outlines in IASC guidelines are implemented ü Functionality of referral systems between and within health and other social, education, community and religious sectors

More references for conducting assessment

How to obtain these information? Qualitative Methods: Key Informant Interviews Who is where, when, doing what (4Ws) in mental health and psychosocial support: Summary of manual with activity codes Checklist for site visits at institutions in humanitarian settings Checklist for integrating mental health in primary health care (PHC) in humanitarian settings Participatory assessment (with general community members/ community leaders/ people who are severely affected)

Participatory Assessment 1. Free listing (problems + descriptions) 2. List of mental health psychosocial problems 3. Ranking/ Voting 4. Top 3 (or whatever problems that you can manage) priority problems 5. Their impact on daily functioning and coping

How to obtain these information? Quantitative Methods: validated scales and questionnaire in the local communities IASC’s Multi cluster/sector Initial Rapid Assessment (MIRA; IASC, 2012) Humanitarian Emergency Setting Perceived Needs Scale (HESPER; WHO, 2011)

MHPSS operational challenges Lack of awareness of mental health and psychosocial well-being among community leaders When conducting quantitative needs assessments: Translations of scales. Enough sample size. Training of interviewers/ translators. Human resources: lack of qualified local MH/PSS specialists, staff, volunteers. Local staff/volunteers overwhelmed or traumatised. High levels of stress cause psycho-somatic effects - as a result health facilities may be overloaded. Tracing services not always available. Monitoring and evaluation – developing measurable indicators

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