Inter-Agency Standing Committee (IASC) Guidance on Mental Health and Psychosocial Support in Emergency Settings Pau Pérez-Sales pauperez@arrakis.es Psychosocial and Mental Health Advisor. Médicos del Mundo España. IASC Task Force member on behalf of MdM-E / IAVC IASC Task Force on Mental Health and Psychosocial Support in Emergencies

Why inter-agency guidance? Enough consensus on good practices to develop interagency guidance Transcend ideological debates Facilitate addressing of a range of issues (from protecting and improving social well-being to severe mental disorder) Multiple needs in multiple sectors: no humanitarian actor can address needs alone Reduce inappropriate practices Less chaos: facilitate coordinated response on priority issues IASC Task Force on Mental Health and Psychosocial Support in Emergencies

(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. UNFPA, UNHCR, UNICEF, UNHCR, WFP, UNICEF, WHO) Red Cross movement (IFRC and ICRC) 3 large NGO consortia (InterAction, ICVA, SCHR) covering 100s of INGOs. IOM World Bank IASC Task Force on Mental Health and Psychosocial Support in Emergencies

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 HNI-TPO IMC ICMC INEE UN-NGO co-chaired (WHO & InterAction) IASC Task Force on Mental Health and Psychosocial Support in Emergencies

How the Guidelines Were Developed Broad consultative, participatory process Task Force formed by IASC Working Group in 2005 Collaboratively developed content & structure Agencies responsible for drafting different parts of the Guidelines Drew on field experience of leading practitioners Multiple reviews by diverse actors

Target audience authorities, personnel and organizations operating in emergency settings at international, national and local levels. for use by workers of diverse disciplines and sectors: Disaster management Human rights Protection Health Education Shelter Water and sanitation Food security Nutrition Camp management, Community development Mass communication IASC Task Force on Mental Health and Psychosocial Support in Emergencies

Document structure Chapter 1: Pre-amble (6 pages) Chapter 2: Matrix covering 26 minimum response interventions (7 pages) Chapter 3: 26 action sheets (approx. 4 pages each) (total 104 pages) Total: doc of approx 115 pages + matrix poster + CD-ROM IASC Task Force on Mental Health and Psychosocial Support in Emergencies

Core principles Help, but foremost, do no harm Promote human rights and equity Maximize participation Building on available resources and capacities 5. Facilitate multi-layered supports 6. Facilitate integrated support systems IASC Task Force on Mental Health and Psychosocial Support in Emergencies

World Health Organization Key principle: multi-layered responses World Health Organization April 22, 2009 Examples: Mental health care by mental health specialists (psychiatric nurse, psychologist, psychiatrist etc) Specialised services Basic mental health care by PHC doctors Basic emotional and practical support by community workers Focused (person-to-person) non-specialised supports Activating social networks Communal traditional supports Supportive child-friendly spaces Community and family supports Strengthening community and family supports Advocacy for basic services that are safe, socially appropriate and protect dignity Basic services and security Social considerations in basic services and security 9

Multisectoral Guidance Example: The design of sites and shelters often causes distress owing to over-crowding, lack of privacy, and lack of safety at latrines Key Actions: - organize shelters in ways that promote privacy and reduce overcrowding - provide adequate lighting around lockable sanitation facilities

World Health Organization April 22, 2009 Examples of practical do's and don’t's in the IASC Guidelines (see pages 11-13, field guide) Build local capacities, supporting self-help and strengthening the resources already present in affected groups. After trainings on MHPSS provide follow up supervision and monitoring to ensure the interventions are implemented correctly. Do not organise supports that undermine or ignore local responsibilities and capacities. Do not use one-time stand alone trainings or very short trainings without follow-up if preparing people to perform complex psych interventions

World Health Organization 28 March 2017 Matrix of Mental Health and Psychosocial Support: All Have Impact on Protecting MHPS Well-being Coordination Assessment, monitoring and evaluation Human rights standards Human resources Community mobilisation and support(*) Health services Education Dissemination of information Food security and nutrition Shelter and site planning Water and sanitation MHPSS is an inter-sectoral, or mainstreaming concern. You can improve our MHPSS influence by taking A Mental Health & Psychosocial Support Lens across all our programs See Chapter 2 matrix with columns Preparedness 25 minimum responses (see poster) Comprehensive responses 12 12

World Health Organization April 22, 2009 On early recovery Early recovery is about planning for recovery from day one of a crisis IASC Guidelines is mostly about minimum response for emergencies but Chapter 2 (full matrix) contains many suggestions for "comprehensive response"

Examples of ideas for early recovery (see Chap 2 of IASC Guidelines) World Health Organization April 22, 2009 Examples of ideas for early recovery (see Chap 2 of IASC Guidelines) Support safe community reintegration for displaced persons, especially isolated ones Provide the space for victims and survivors to discuss issues of reparation (economic, judicial, symbolic) to be addressed by responsible parties Facilitate recording of historical memory of how the community has dealt with the emergency Strengthen the MHPSS system, including referral mechanisms Strengthen mobilisation of community resources for self-help

Examples of ideas for early recovery (see Chap 2 of IASC Guidelines) World Health Organization April 22, 2009 Examples of ideas for early recovery (see Chap 2 of IASC Guidelines) Organise discussions on helpful and harmful traditional practices Build local organizations' capacities to help parents to provide quality care for young children Develop national plan/policy for mental health Integrate mental health care in PHC Develop community mental health services Follow up on psychosocial support programmes offered in schools Support reliable and accessible systems of accurate dissemination of information, including on returns/resettlement/repatriation

World Health Organization April 22, 2009 For health sector there is no other opportunity for mental health services development/reform than the political aftermath of humanitarian crises Macedonia occupied Palestinian territory Peru Sri Lanka Timor-Lesle . . . among others Positive examples Albania China Indonesia Iraq Jordan Kosovo

Applications of IASC Guidelines World Health Organization April 22, 2009 Applications of IASC Guidelines Some major donors only fund consistent with IASC Guidelines 30,000 copies in print Available in many languages Promoted heavily by agencies Special journal issue of Intervention Increasingly used also in rich countries (Japan, Slovenia) Used for identification of gaps in Philippines Use picture version to mobilize community in Peru Moved people beyond counselling in Kenya Adopted by 4 ministries Gov in Philippines as policy Training in Iran informed by and consistent with IASC Used for planning in Ethiopia Common framework in Myanmar, Lebanon, Jordan and Gaza

World Health Organization April 22, 2009 Final remarks There is a responsability of all (including Donors) to promote and facilitate internationally accepted best practices There is a potential to do harm – Need to work on consensus and tested programms The IASC Guidelines is the point of a hallmark and a consensus standard for best practices at the short and middle term after emergencies

World Health Organization April 22, 2009 Final remarks You can download a copy of the Guidelines in English, French, Spanish, Arab on many web sites, the IASC website among them. You can have a hard copy of the Field Version (not Full Version) at the entrance Thanks

Sphere 2004: minimum standard for mental and social aspects of health World Health Organization April 22, 2009 Sphere 2004: minimum standard for mental and social aspects of health 4 psychological/psychiatric interventions Psychological first aid for people with acute anxiety Care in PHC for urgent psychiatric problems Continue care for people with severe mental illness in previous care Initiate more comprehensive response 8 social interventions Eg restart schooling, give information, community-self help, etc