Presentation on theme: "Inter-Agency Standing Committee (IASC) Guidance on Mental Health and Psychosocial Support in Emergency Settings Mark van Ommeren Mental Health and Substance."— Presentation transcript:
1Inter-Agency Standing Committee (IASC) Guidance on Mental Health and Psychosocial Support in Emergency SettingsMark van OmmerenMental Health and Substance AbuseMSD/WHO, Geneva28 November 2006Public Health Pre-Deployment TrainingChavannes de Bogis, Switzerland
2ASSISTANCE IN COMPLEX EMERGENCIES (eg DARFUR) I BELIEVE THERE IS ENOUGH CONSENSUS FOR SITUATIONS INVOLVING
3ASSISTANCE IN NATURAL DISASTERS I BELIEVE THERE IS ENOUGH CONSENSUS FOR SITUATIONS INVOLVING
4Consistent withPrinciples and strategies for public mental health action during and after emergencies (WHO, 2003)Ç SOURCES THAT REPRESENT THE PRINCIPLES OUTLINED IN THIS PRESENTATIONMANY OF YOU WILL HAVE SEEN THIS DOCWIDELY DISSEMINATED THROUGHOUT THE WORLDUSED WIDELY BY MANY AGENCIESTRANSLATED IN MOST UN LANGAUGESWIDELY USED IN SRI LANKA AND IndonesiaUSED FOR MOH MH POLICY ALREADY BEFORE THE TSUNAMIUSED FOR GOV MOH PLANSIN SRI LANKA AND INDONESIA
5Consistent withSphere Handbook (2004): First-time inclusion of a mental and social aspects of health standard Covers: 8 social interventions 4 psychological/psychiatric interventionsBIBLE OF HUMANITARIAN AID BY NGOSWATSAN, HEALTH, FOOD, SHELTERFIRST TIME ^MENTAL HEALTH STANDARD IN SPHERECONTENT OF MENTAL HEALTH STANDARD BASED ON WHO(2003)OUR FIELD IS COMING TO CONSENSUS, BUT STILL A LOT OF PRACTICE OUT THERE.
6Mental health and psychosocial support covers . . . any type of local or outside support thataims to(a) protect or promote psychosocial well-beingand/or(b) prevent or treat mental disorder.
7Diverse needs in midst of emergencies pre-existing social problemsE.g. marginalized groupsdisaster-induced social problemsE.g. destruction of protective community's structurespre-existing mental disordersE.g. chronic psychosisdisaster-induced distress and disorderE.g. normal fear (past, present, future), mood and anxiety disorders (incl. PTSD)humanitarian aid-induced problemsE.g. undermining of traditional supports
8Summary Table of Generic WHO Projections This slide is about patterns, not about absolute numbers
9Why inter-agency guidance? Enough consensus on good practicesTranscend ideological debates and dogmaReduce inappropriate practicesLess chaos: facilitate coordinated response on priority issues
10Controversies (of the past?) Dogma (e.g. 'trauma' vs 'no trauma', 'psychosocial' vs 'mental health')Duplicate assessmentsParachuting foreign cliniciansExclusive focus on intra-psychic processes, clinical interventionsTraining without proper follow-up supervision
11Controversies (of the past?) (cont'd) Ignoring/over-focus on PTSD or pre-existing severe mental illnessNeglecting people's participationNeglecting informing affected populationsNeglecting social actionIgnoring psychosocial factors in education, health, nutrition, watsan and shelter programming
12Controversial? VULNERABLE TO BIASED AGENDAS ARE PEOPLE QIALIFIED TO HELP?
13IASC Task Force Guidance Forthcoming Dec 2006Modelled after IASC HIV/AIDS & GBV guidanceFocus on minimum responseFocus on practical actionsMatrix outlining key interventions / supportsShort 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.IOMWorld Bank
15IASC Task Force: 27 agencies - 1 year mandate IRCMdM-EMercy CorpsMSF-HOxfam GBRETSC-UKSC-USAIASC bodiesICVAIFRCInteractionIOMOCHAUNFPAUNHCRUNICEFWFPWHOIndividual INGOs:ACFAm. Red CrossAction Aid Int.CARE AustriaCCFHealthNet-TPOIMCICMCINEEUN-NGO co-chaired (WHO & InterAction)
16Not a cookbook! Local situation analyses are essential To determine what specific actions are priority in the local contextTo avoid social/cultural inappropriate action.These guidelines do NOT give implementation details but rather a list of summary actions.
17Collaborative, multisectoral approach No single organization or community is expected to be able to conduct all actions covered in the guidance.
18Role 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
20See handoutWhat could be WHO and recommended Health Cluster activities in emergencies are highlighted in blueCore interventions includeCoordination and assessmentTraining health professionals in basic supportCare and protection of people with severe disorders (e.g. esp. if in institutions)
21Coordination is KeyThe guidelines emphasize the importance of multi-sectoral coordinated action and community involvement.Too often split coordination groupsOne action sheet on intersectoral coordination:Each Action Sheet includes links to related Action Sheets for related actionsMatrix to be used as coordination tool
22Several 'firsts'First guidance to cover MH support from to bottom of 'pyramid' in emergencies (E)First guidance on mental health coordination in EFirst guidance on sub abuse in EFirst guidance on 'self-care' materials in EFirst (?) guidance on interface with healersMatrix provides model on how to work on mental health with agencies outside health sector
23Early successesMostly 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 colleaguesEarly implementation already happeningMatrix used as a coordination tool (Java)Core tool for training of all Am Red Cross staff in AsiaTool for international Red Cross/Crescent consultantsIt has become the de facto framework of various agencies
24Early successes (cont'd) Spontaneous translations (Hindi, Bahasa, Tamil, Sinhala, Arabic)Spontaneous NGO review workshop in Sri Lanka (positive review!)Spontaneous regional workshops in W-AfricaUsed for needs assessment in JaffnaUsed for attention to custodial hospitals in Lebanon and JaffnaRadically improved relationships and collaboration among agencies at HQ-level
25Agenda settingNow increasingly accepted by agencies outside health sectorHealth sector does have a legitimate leadership roleCustodial hospital on the agenda in emergenciesSevere mental disorders on the agenda in emergenciesSub abuse on the agenda (somewhat) in emergenciesNow increasingly accepted by health sectorSocial approaches are not all 'smoke'Sharing coordination has many advantagesValue of participatory approaches/ community mobilization
26Where is the evidence?Much more evidence needed for psychological interventions in real word emergency settings→ Challenge: deciding on outcome measureMuch 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
27Post-emergency: address long-term increase in mental disorders Formal health sector response:update MH policy and legislationdevelop sustainable community mental health (MH) servicesorganize MH care in primary health care
28Self-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 materialsSingle session psychological debriefing is ineffectiveIf 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)
29Key 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 supportConsider using forthcoming IASC guidanceStrive towards integrated, multi-sectoral responseThink about long-term clinical and health system development needsTake care of yourself