1. Research and developments in the area of Mental health

2. Rationale World Health Assembly Mental Health Action Plan 2013-2020
Bridging the gap – more than 75% persons with mental health disorders do not have access to the treatment & support they need.
Expansion of the third layer of the intervention pyramid and movement into the 4th layer.
Driven by the Do No Harm Principle
Evidence is very important to support the effectiveness of interventions and to document the training and supervision required to support newly-trained volunteers & staff.
Focus on research and adaptation to RCRC context in the field of MHPSS
The MH action plan recognizes the essential role of mental health in achieving health for all people. It is based on a life-course approach, aims to achieve equity through universal health coverage and stresses the importance of prevention. Four major objectives are set forth: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.
While 14% of the global burden of disease is attributed to MNS disorders, most of the people affected - 75% in many low-income countries - do not have access to the treatment they need.
Research involves partnerships with Governments and with Universities, both for WHO and for the RCRC.

3. Mental Health post-2015
Mental health is a precondition for and an outcome and indicator of sustainable development
Included in SDGs as specfic target under SDG3
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment, and promote mental health and well-being 
Mental health is the leading cause of disability worldwide (1:4)
UN Human Rights Council joint statement signed by 73 countries on Mental Health and Human Rights (March 2016)
World Bank – WHO High level meeting on Mental health – April 2016 (IFRC presented in the IASC RG Co-Chair role)
MHPSS absent from WHS agenda (IASC RG side-event not accepted)
Human rights violations towards people with mental health and psychosocial disabilities are reported in many countries around the world. UN Human Rights Council statement aims to monitor this.

4. Mental Health Gap Action Programme mhGAP
mhGAP Video:
Aims to scale up services for mental, neurological and substance use (MNS) disorders in low and middle income countries.
Decentralise mental health care to the primary healthcare and community level, and away from psychiatric institutions.
Focus on task-shifting – training GPs, Nurses, Case Managers and Community Health Workers to identify, assess and manage MNS disorders. Management includes medication & PSS interventions.
Disorders include: Depression, Psychosis, Bipolar disorder, Epilepsy/ seizures, Developmental disorders, Behavioural disorders, Dementia, Alcohol Use Disorders, Drug Use Disorders, Self-harm/ Suicide, Other, Stress Disorders
Introducing mhGAP into a country is a multi-stakeholder process that fits within the National Mental Health Plans. Low & middle income countries wishing to follow the mhGAP programme conduct a mapping of existing service provision and prevalence of certain disorders. They then select the priority disorders that they wish to focus on within the next strategy period. Most countries choose 5-6 disorders (out of 12) e.g., epilepsy in China, psychosis, depression & bipolar disorders in Syria and Lebanon, suicide & self-harm in India.

5. mhGAP Humanitarian Intervention guide (mhGAP-HUM)
Joint initiative UNHCR & WHO
Emergencies are often a window of opportunity to invest in mental health care and begin the roll out of mhGAP – Philippines, Sri Lanka, Syria, Lebanon, Sierra Leone, Nepal, Ethiopia & Ecuador.
Simple & practical tool to support general health facilities in emergency affected areas to identify, asses & manage MNS conditions.
Priority conditions: acute stress, grief, depression, PTSD, psychosis, epilepsy, intellectual disability, harmful substance use & risk of self harm/ suicide
The mhGAP Humanitarian Intervention Guide contains first-line management recommendations for mental, neurological and substance use conditions for non-specialist health-care providers in humanitarian emergencies where access to specialists and treatment options is limited. It is a simple, practical tool that aims to support general health facilities in areas affected by humanitarian emergencies in assessing and managing acute stress, grief, depression, post-traumatic stress disorder, psychosis, epilepsy, intellectual disability, harmful substance use and risk of suicide.
Again targeting: GPs, Nurses, Case Managers and Community Health Workers.

6. Low-intensity psychological interventions
Emphasis on task-shifting to deliver adapted psychological interventions
Based on cognitive-behavioural therapy, inter-personal therapy and stress management to address (mental) health conditions such as depression, PTSD, anxiety & emotional distress.
Emotional problems are part of cycles of violence, social exclusion, and poverty. They undermine individual and community resilience
Examples include Problem Management Plus (PM+), PM+ for adolescents, Self-help+ (SH+), E-mental health & Parental Skills Training (PST) for caregivers of children with developmental problems & autism.
Companion interventions/ guides to the mhGAP (psychosocial interventions)
Explain the link to mhGAP and the difference. LII aims to support people in L3 of the intervention triangle, but it does not help the access to care for persons with severe mental health disorders. mhGAP was created to plug this gap. Step 1 First offer scalable (low resource intensity) interventions Step 2. If it does not work, “step up” to more intensive care (more resource-intense psychotherapeutic or biomedical interventions) if available
Paradox: introducing scalable psychological interventions does not reduce need for specialists
- It produces more referrals to specialists
- Better use of specialist resources (eg for complex cases)
- It enhances status of mental health in health systems
They are thus not only health problems but implicate protection, social and economic problems and undermine individual and community resilience
Psychological interventions are a promising new direction in terms of efficacy and rank high in research priority setting

7. PS Centre and Mental Health
Mental health recognized as a global challenge and priority
SOF includes a stronger focus on mental health and the interlinkages with psychosocial support
Expansion on PS tool box through testing and adaptation of low-intensity interventions to RCRC context
Research-based adaptation to RCRC context a key priority for the PS Centre’s work related to mental health

8. IFRC Mental Health Framework
Outlines the RCRC approach to mental health and provides terminology, guidance and inspiration for National Societies, the Secretariat and the PS Centre
A holistic, person-centred, resilience focused approach
Focus on anti-stigma, promotion and prevention, and support and care as three areas of intervention
Cross-cutting themes: research and innovation, advocacy and partnership
Moving forward:
Lessons learned study on Mental Health in the Movement
Testing and adaptation of interventions to RCRC context
Lead by the Secretariat, PS Centre part of the inputting Mental Health working group
The mental health framework is still being finalized at the Secreatariat level but the PS Centre has provided input throughout the process
Explain that it builds largely on WHO concepts and definitions
The Mental Health Framework provides a good, common framework for the RCRC approach to mental health and a starting point building our global capacity in this field.
The information contained within the Framework needs to be operationalised by the National Societies, the IFRC Psychosocial Centre and at the IFRC Secretariat level. We think this could be done through two parallel processes: a “bottom-up” lessons learned study that and would collect experiences on working with mental health in the Movement and a more “top-down” approach where we take some interventions that are developed outside the Movement – for example MhGap, mh-Gap-HUM, and of course the low-intensity interventions – and test and adapt them to the RCRC context.

9. Lessons Learned study on Mental Health
Research and mapping of existing mental health services and programmes provided by National Societies – in non-humanitarian and humanitarian contexts
Research and mapping of existing programmes on mental health promotion and prevention of mental illness implemented by National Societies
Research and mapping of existing anti-stigma and anti-discrimination programmes implemented by National Societies
Even though the MH framework includes examples on what national societies already do in this field, we need to conduct a systematic lessons learned project in this field across the Movement.
At the PS Centre we think that one of the first key steps in moving this forward would be to conduct a lessons learned study focusing on these three areas that links to the priority areas outlined in the MH Framework.
This study is currently not funded but we will seek funding for this for 2017 if the SC is decided to move forward.

10. Low-intensity interventions & the RCRC
CONTEXT project: partnership with Trinity College Dublin and other academic and non-academic partners
Effectiveness of low-intensity interventions implemented by Red Cross volunteers for refugees in Europe
“Caring for Volunteers in Conflict” – a realist evaluation of mental health and psychosocial wellbeing of volunteers in post-conflict situations
Outcomes:
Toolkit for Red Cross volunteers using low-intensity psychological interventions
Toolkit: Caring for Volunteers in Conflict
Time line: Sep 2016-Feb 2020
Two PhDs will working with the PS Centre and IFRC Gva
Outcomes, in addition to peer-reviewed articles, of relevance to the RCRC Movement
Most of the research on mental health of volunteers focused on disaster settings and so does the current toolkit of the PS Centre – focusing on post-conflict settings will provide a lot of new inputs

11. RCRC Research network on MHPSS
Why?
shared platform for knowledge and information sharing and exchange
joint priorities for MHPSS research throughout the RCRC network
strengthening the quality of research partnerships
translation of research findings and evidence into strategic and operational recommendations
new partnership and funding possibilities for research on MHPSS
Who and when?
First meeting June with 24 participants from 18 different NS’es/institutions
Either RCRC practitioners with research experience or academics with RCRC experience
Ear-marked funding from DRC for the first meeting
The idea to establish a more specialized network for RCRC actors involved in research on Mental Health and Psychosocial Support (MHPSS) was conceived at the Movement meeting on Psychological Consequences of Armed Conflicts and Violence in Stockholm in June 2015.
Here it became clear that more research is needed to support and further develop activities and methods to address the psychological effects in these situations.
This realization was included in the pledge from Swedish Red Cross: Addressing Psychological Effects of Armed Conflicts and Violence, which was presented at the 32nd International Conference of the Red Cross and Red Crescent.
The RCRC Research Network on MHPSS will not only focus on research on the psychological effects of armed conflicts and violence, but bring together different research experiences on mental health and psychosocial issues within the Movement.
There are growing institutional experiences with research on MHPSS within the RCRC network but there is a need to facilitate information and knowledge exchange between different actors and to build on existing collaboration and networks.