1 |1 | 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

2 |2 | 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

3 |3 | 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’)

4 |4 | 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,

5 |5 | 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

6 |6 | Controversies 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

7 |7 | Consensus 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)

8 |8 | 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

9 |9 | 9 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.

10 | 10 Specialised services Focused, non-specialised supports Social considerations in basic services and security Community and family supports

11 | 11 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

12 | 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.