1. IASC Guidelines "A significant gap has been the absence of a multi- sectoral, inter-agency framework that enables coordination, identifies useful practices, flags harmful practices and clarifies how different approaches to mental health and psychosocial support complement one another."

2. Orientation on the IASC Guidelines on Mental health and Psychosocial Support in Emergencies Education Cluster Amanda Melville, occupied Palestinian territory 12 Feb 2009

3. Introductions and agenda Handouts Brochure with matrix Print out of Field Use Version Full Guidelines on CD ROM (explain) True False Exercise Local expertise

4. IASC Task Force: UN and non-UN agencies wrote Guidelines 20.INEE 21.IRC 22.MdM-E 23.Mercy Corps 24.MSF-H 25.Oxfam GB 26.RET 27.SC/UK 28.SC/USA 1.ICVA 2.IFRC 3.Interaction 4.IOM 5.OCHA 6.UNFPA 7.UNHCR 8.UNICEF 9.WFP 10.WHO 11.ACF 12.Am. Red Cross 13.ACT International 14.Action Aid International 11.CARE Austria 12.CCF 13.HealthNet TPO 14.IMC 15.ICMC Ref Group now also has: 29.CARE Int. 30. Ch of Sweden 31. COOPI 32.GP-SI 33.RedR 34.REPSSI 35.TdH 36.UNRWA 37.World Vision

5. Exercise 1: First reaction (1 minute) Reflect on experiences that you had or aware of related to mental health and psychosocial support during and after emergencies. Reflect on the following question. Is there a potential need for applying here internationally endorsed inter-agency mental health and psychosocial support guidelines?

6. Some typical answers to this exercise are Inter-agency guidelines are needed because Need to strengthen coordination and have common comprehensive framework for action Need for guidance on most effective practices and how to avoid doing harm or using ineffective practices Need to bring together diverse actors with strong views in common framework Need guidance on how to prioritise in situations where need is huge and strains existing capacities But: Should be culturally sensitive/adaptable Should take local situation, capacities and resources into account Should cover/not cover/ go beyond PTSD

7. Inclusive framework: mental health and psychosocial support covers both (a)protecting or promoting psychosocial well-being and/or (b) preventing or treating mental disorder. PS MH

8. Diverse needs in midst of emergencies Emergencies erode normally protective supports and increase risks for a range of problems pre-existing social problems E.g. social tensions/divisions emergency-induced social problems E.g. overcrowding in housing, loss of jobs, protection threats, weakening of social support networks pre-existing psychological/psychiatric problems E.g. psychosis, severe alcohol use, depression emergency-induced psychological/psychiatric problems E.g. normal fear (past, present, future), depression, PTSD humanitarian aid-induced problems E.g. conflict between communities, anxiety about lack of information on services

9. Core Principles Human rights and equity Participation Do No Harm Building on available resources and capacities Integrated support systems Multi-layered supports

10. 10 Matrix of Mental Health and Psychosocial Support: All Have Impact on Protecting Well- being 1.Coordination 2.Assessment, monitoring and evaluation 3.Protection and human rights standards 4.Human resources 5.Community mobilisation and support 6.Health services 7.Education 8.Dissemination of information 9.Food security and nutrition 10.Shelter and site planning 11.Water and sanitation

11. 11 Multilayered support Need to ensure support is appropriately divided across layers with good coordination/referral E.g. not overly focused on focused support Many of the professional animosities disappear as soon as one adopts a pyramid model of multi-layered supports with different tasks for different sectors Referral system required but will not work well if not appropriately layered

12. Exercise : Do's and Don’t's for Education Purpose: to learn what the IASC Guidelines recommend regarding Education Fill in the TRUE OR FALSE questionnaire together with somebody in the room who you do not know

13. 13 1.1 Coordination of inter-sectoral MHPSS 1. Coordination

14. Humanitarian Coordinator Health ClusterEducation Cluster Protection Cluster (with Child protection Sub-cluster) MHPSS inter-sectoral coordination subgroup Working groups as Required eg Psychosocial And education MHPSS Technical Support Group Proposed Gaza humanitarian response mental health and psychosocial support (MHPSS) coordination structure MH = mental health; PS = psychosocial MoH, MoE, MoSA

15. 15 2.1 Assessments of MHPSS issues 2.2 Participatory M&E 2. Assessment, monitoring & evaluation Photo courtesy of REUTERS/Finbarr O' Reilly

16. 16 3.1 Human rights framework 3.2 Social protection 3.3 Legal protection 3. Protection & human rights standards Photo courtesy of REUTERS/Finbarr O' Reilly

17. 17 4.1 Local staff & volunteers 4.2 Codes of conduct & ethical guidelines 4. Human resources Photo: Danish Red Cross

18. 18 4.3 Training of aid workers in MHPSS 4.4 MHPSS well-being of staff & volunteers 4. Human resources Photo: Nana Wiedemann, International Federation

19. 19 5.1 Mobilisation, ownership & control 5.2 Community social support 5. Community mobilisation & support Photo: Rita Plotnikova, International Federation

20. 20 5.3 Cultural, spiritual & religious healing practices 5.4 Support for young children & care-givers 5. Community mobilisation & support Photo: Ulrik Norup Jørgensen, Danish Red Cross

21. 21 7.1 Safe & supportive education 7. Education Photo: Patrick Fuller / Internaitonal Federation

22. Promote Safe and Supportive Education Education is a key PS intervention – provides a safe and stable environment & restores a sense of normalcy, dignity and hope. Key Actions: 1.Promote safe learning environments. 2.Make formal and non-formal education supportive and relevant. 3.Strengthen access to education for all. 4.Prepare and encourage educators to support learners’ PS well-being. Indicators: Percent access to formal and non-formal education - girls and boys of different ages. Percent teachers trained in PSP. Teachers refer children with severe MHPS difficulties to specialised services.

23. 23 8.1 Information to population on emergency, relief efforts & legal rights 8.2 Information on positive coping methods 8. Dissemination of information Photo courtesy of REUTERS/Eduard Kornienko

24. 24 Specialised services Focused, non-specialised supports Social and psychological considerations in basic services and security Community and family supports

25. Examples in Education sector Social and psychological considerations in basic services and security Advocating for schools to be protected during conflict Rescheduling exams or gradually returning to formal curriculum Community and family supports Training teachers to provide PS support in classrooms Facilitating peer support among teachers Establishing child friendly spaces Parents discussion groups or involvement of parents in supportive Focused,non-specialised supports Strengthening school counselling Structured group sessions for children (e.g. by NGOs) Referral of children or families to social services Support groups for teachers Specialised services Referral to clinical mental health services

26. 26 Specialised services Focused, non-specialised supports Social and psychological considerations in basic services and security Community and family supports What %?

27. Beyond education: Social and Psychological Considerations in Basic Services and Security All members of the community have responsibility to ensure there is a suitable environment for psychosocial development. These activities help to establish a suitable environment to protect and promote psychosocial healing and well-being. Usually these programmes are conducted by other organisations or under an existing sector Psychosocial and mental health programmes should advocate for ensuring these basic needs are met cooperate with sectoral programmes to ensure that are implemented in a way that supports psychosocial development and healing

28. Level 1: Social and Psychological Considerations in Basic Services and Security Document impact of lack of services and security on MHPS wellbeing and use this for advocacy For children, advocate for the protection of children from violence, abuse and exploitation, the promotion of family unity, re-establishing safe and supportive education Advocate for delivery of humanitarian assistance in a manner that promotes well-being Work to promote ways of delivering aid that promote self-reliance and dignity Facilitate community involvement in decision-making and assistance Disseminate essential information to affected populations on situation and emergency response

29. Level 2: Community and Family Supports Support play, art, recreational and sporting activities Provide structured groups activities for expression and the development of life skills and coping mechanisms Support children and youth friendly spaces/environments Promote meaningful opportunities to participate in rebuilding society Provide information on positive coping mechanisms Activities that facilitate the inclusion of isolated individuals (orphans, widows, widowers, elderly people, people with severe mental disorders or disabilities or those without their families) into social networks;

30. Level 2 (cont’d) Strengthening the family: Provide culturally appropriate guidance on how parents and family members can help children Support parents and families to cope with their own difficulties Support and facilitate the establishment of parent groups/committees Early childhood stimulation (with nutrition) Informal family visits for caregivers in need of extra support Support family access to basic services

31. Level 2 (cont’d) Strengthening community supports: Helping caregivers and educators to better cope and to support children Strengthen community based supports for adult caregivers Strengthen child-to-child or youth support Resumption of cultural and spiritual activities, including appropriate grieving rituals Strengthening social networks teacher training on psychosocial care and support Group discussions on how the community may help at-risk groups identified in the assessment as needing protection and support

32. Level 3: Focused Supports For people who are: struggling to cope within their existing care network Not progressing in terms of their development Unable to function as well as their peers In need of activities that address their psychosocial needs more directly

33. Level 3 (cont’d) Focused psychosocial support activities require trained and experienced staff Activities may include: Case management Family visits Psychological first aid Support groups Structured play activities Psychosocial hotlines Non-clinical family or individual counselling (e.g. school counselling)

34. Level 4: Specialized Services Traditional specialized healing (e.g. cleansing and purification rituals) Clinical social work or psychological treatment Psychotherapy Drug or alcohol treatment Specialised mental health care

35. Examples of how the guidelines have been used Used for identification of gaps in Myanmar Use picture version to mobilize community in Peru Influenced a lot of PS programming in Jordan Limit harmful practive in Kenya (widespread “trauma counselling”) Adopted by 4 ministries Gov in Philippines as policy Training in Iran informed by and consistent with IASC Some donors only fund consistent with IASC Guidelines Highlight importance of engaging with unusual sectors on MHPSS How could the Guidelines be used in Gaza?

36. Key messages IASC Guidelines provide a common framework and language to communicate and coordinate with one other during large crises There is substantial technical know how on how to meaningfully reduce suffering and this involves different types of complimentary supports Using them effectively must be an ongoing process involving multiple humanitarian actors

37. Mapping MHPSS in education using guideline matrix Complete matrix