1. Psychosocial Support in the IFRC
APDC

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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

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

10. Matching needs

11. 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).

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. An example: Type of Information Including 5. Organizational capacitiesü
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

19. More references for conducting assessment

20. 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)

21. 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

22. 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)

23. 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

24. Thank you