1. Inter-Agency Standing Committee (IASC) Guidance on Mental Health and Psychosocial Support in Emergency Settings
Mark van Ommeren
Mental Health and Substance Abuse
MSD/WHO, Geneva
28 November 2006
Public Health Pre-Deployment Training
Chavannes de Bogis, Switzerland

2. ASSISTANCE IN COMPLEX EMERGENCIES (eg DARFUR)
I BELIEVE THERE IS ENOUGH CONSENSUS FOR SITUATIONS INVOLVING

3. ASSISTANCE IN NATURAL DISASTERS
I BELIEVE THERE IS ENOUGH CONSENSUS FOR SITUATIONS INVOLVING

4. Consistent with
Principles and strategies for public mental health action during and after emergencies (WHO, 2003)
Ç SOURCES THAT REPRESENT THE PRINCIPLES OUTLINED IN THIS PRESENTATION
MANY OF YOU WILL HAVE SEEN THIS DOC
WIDELY DISSEMINATED THROUGHOUT THE WORLD
USED WIDELY BY MANY AGENCIES
TRANSLATED IN MOST UN LANGAUGES
WIDELY USED IN SRI LANKA AND Indonesia
USED FOR MOH MH POLICY ALREADY BEFORE THE TSUNAMI
USED FOR GOV MOH PLANSIN SRI LANKA AND INDONESIA

5. Consistent with
Sphere Handbook (2004): First-time inclusion of a mental and social aspects of health standard Covers: 8 social interventions 4 psychological/psychiatric interventions
BIBLE OF HUMANITARIAN AID BY NGOS
WATSAN, HEALTH, FOOD, SHELTER
FIRST TIME ^MENTAL HEALTH STANDARD IN SPHERE
CONTENT OF MENTAL HEALTH STANDARD BASED ON WHO(2003)
OUR FIELD IS COMING TO CONSENSUS, BUT STILL A LOT OF PRACTICE OUT THERE.

6. Mental health and psychosocial support covers . . .
any type of local or outside support that
aims to
(a) protect or promote psychosocial well-being
and/or
(b) prevent or treat mental disorder.

7. Diverse needs in midst of emergencies
pre-existing social problems
E.g. marginalized groups
disaster-induced social problems
E.g. destruction of protective community's structures
pre-existing mental disorders
E.g. chronic psychosis
disaster-induced distress and disorder
E.g. normal fear (past, present, future), mood and anxiety disorders (incl. PTSD)
humanitarian aid-induced problems
E.g. undermining of traditional supports

8. Summary Table of Generic WHO Projections
This slide is about patterns, not about absolute numbers

9. Why inter-agency guidance?
Enough consensus on good practices
Transcend ideological debates and dogma
Reduce inappropriate practices
Less chaos: facilitate coordinated response on priority issues

10. Controversies (of the past?)
Dogma (e.g. 'trauma' vs 'no trauma', 'psychosocial' vs 'mental health')
Duplicate assessments
Parachuting foreign clinicians
Exclusive focus on intra-psychic processes, clinical interventions
Training without proper follow-up supervision

11. Controversies (of the past?) (cont'd)
Ignoring/over-focus on PTSD or pre-existing severe mental illness
Neglecting people's participation
Neglecting informing affected populations
Neglecting social action
Ignoring psychosocial factors in education, health, nutrition, watsan and shelter programming

12. Controversial? VULNERABLE TO BIASED AGENDAS
ARE PEOPLE QIALIFIED TO HELP?

13. IASC Task Force Guidance
Forthcoming Dec 2006
Modelled after IASC HIV/AIDS & GBV guidance
Focus on minimum response
Focus on practical actions
Matrix outlining key interventions / supports
Short action sheets on each key intervention written by experts of those agencies specialized in the topic

14. (see UN General Assembly Resolution 48/57)
Inter-Agency Standing Committee (IASC) Committee of heads of large humanitarian agencies responsible for global humanitarian policy
(see UN General Assembly Resolution 48/57)
10 UN agencies (e.g. OCHA, UNFPA, UNHCR, UNICEF,, WFP, UNICEF, WHO)
Red Cross movement (IFRC and ICRC)
3 large NGO consortia (InterAction, ICVA, SCHR) covering 100s of INGOs.
IOM
World Bank

15. IASC Task Force: 27 agencies - 1 year mandate
IRC
MdM-E
Mercy Corps
MSF-H
Oxfam GB
RET
SC-UK
SC-USA
IASC bodies
ICVA
IFRC
Interaction
IOM
OCHA
UNFPA
UNHCR
UNICEF
WFP
WHO
Individual INGOs:
ACF
Am. Red Cross
Action Aid Int.
CARE Austria
CCF
HealthNet-TPO
IMC
ICMC
INEE
UN-NGO co-chaired (WHO & InterAction)

16. Not a cookbook! Local situation analyses are essential
To determine what specific actions are priority in the local context
To avoid social/cultural inappropriate action.
These guidelines do NOT give implementation details but rather a list of summary actions.

17. Collaborative, multisectoral approach
No single organization or community is expected to be able to conduct all actions covered in the guidance.

18. Role of mental health professionals?
Use their position for advocacy with other sectors to ensure that key risk factors for impaired mental health and psychosocial well-being are being addressed across sectors.
Supervision in implementing aspects of guidance on clinical/interpersonal forms of psychological/psychiatric support

19. Document structure Chapter 1: Pre-amble (6 pages)
Chapter 2: Matrix covering 25 minimum response interventions
(7 pages)
Chapter 3: 25 action sheets (approx.
4 pages each) (total 104 pages)
Total: doc of approx 115 pages + matrix poster + CD-ROM

20. See handout
What could be WHO and recommended Health Cluster activities in emergencies are highlighted in blue
Core interventions include
Coordination and assessment
Training health professionals in basic support
Care and protection of people with severe disorders (e.g. esp. if in institutions)

21. Coordination is Key
The guidelines emphasize the importance of multi-sectoral coordinated action and community involvement.
Too often split coordination groups
One action sheet on intersectoral coordination:
Each Action Sheet includes links to related Action Sheets for related actions
Matrix to be used as coordination tool

22. Several 'firsts'
First guidance to cover MH support from to bottom of 'pyramid' in emergencies (E)
First guidance on mental health coordination in E
First guidance on sub abuse in E
First guidance on 'self-care' materials in E
First (?) guidance on interface with healers
Matrix provides model on how to work on mental health with agencies outside health sector

23. Early successes
Mostly positive reviews (150+ reviewers from academia, IASC bodies, UN, INGOs, HQ & field-based colleagues, major professional associations, small NGOs, from all continents)
Drawing in not only English but also French and Spanish speaking colleagues
Early implementation already happening
Matrix used as a coordination tool (Java)
Core tool for training of all Am Red Cross staff in Asia
Tool for international Red Cross/Crescent consultants
It has become the de facto framework of various agencies

24. Early successes (cont'd)
Spontaneous translations (Hindi, Bahasa, Tamil, Sinhala, Arabic)
Spontaneous NGO review workshop in Sri Lanka (positive review!)
Spontaneous regional workshops in W-Africa
Used for needs assessment in Jaffna
Used for attention to custodial hospitals in Lebanon and Jaffna
Radically improved relationships and collaboration among agencies at HQ-level

25. Agenda setting
Now increasingly accepted by agencies outside health sector
Health sector does have a legitimate leadership role
Custodial hospital on the agenda in emergencies
Severe mental disorders on the agenda in emergencies
Sub abuse on the agenda (somewhat) in emergencies
Now increasingly accepted by health sector
Social approaches are not all 'smoke'
Sharing coordination has many advantages
Value of participatory approaches/ community mobilization

26. Where is the evidence?
Much more evidence needed for psychological interventions in real word emergency settings
→ Challenge: deciding on outcome measure
Much evidence from qualitative social science (anthropology, sociology) in support of Sphere social interventions in real word emergency settings (Batniji et al 2006)
→ Challenge: collecting quantitative evidence for social interventions

27. Post-emergency: address long-term increase in mental disorders
Formal health sector response:
update MH policy and legislation
develop sustainable community mental health (MH) services
organize MH care in primary health care

28. Self-care for staff after critical incident exposure
Before: Enhance resilience (improve work and living environment, stress management)
After: 100% of people: access to psychological first aid + useful self-care materials
Single session psychological debriefing is ineffective
If not able to function or if suffering intolerable, immediate referral to mental health professional trained in managing of acute problem (few %)
100% systematic follow-up (1-3 months)

29. Key messages Be aware of own and other's dogma
Use the increasing expert consensus / inter-agency consensus on what is good mental health and psychosocial support
Consider using forthcoming IASC guidance
Strive towards integrated, multi-sectoral response
Think about long-term clinical and health system development needs
Take care of yourself