VIEWPOINT: Tackling mental health problems in a crisis

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Wednesday, 19 September 2007 00:00 GMT
The United Nations has launched a set of guidelines to help aid agencies minimise mental health problems among survivors of disasters and conflicts. ActionAid&${esc.hash}39;s Dr Unnikrishnan, who helped develop the guidelines, outlines the new approach.

Armed conflict, war and natural disasters can cause significant psychological and social suffering. Research shows that after an emergency there will be a 5 to 10 percent increase in the number of people with mild or moderate mental health problems.

In actual numbers, this means that every year millions of people are affected emotionally and that their ability to function efficiently is compromised.

Whilst the psychosocial impacts of emergencies may be acute in the short term, they can also undermine the long-term mental health and psychosocial well-being of those affected. Humanitarian workers note that such impacts may threaten peace, human rights and development, yet broken minds and wrecked social ties are often ignored or tackled incoherently.

With human rights and equality as its cornerstones, the new "Inter-Agency Standing Committee (IASC) guidelines on mental health and psychosocial support in emergency settings" stress the need for high quality care to address the psychosocial and social problems that often accompany disasters.

Key principles include human rights and equality, participation of the affected communities, building on available resources and capacities, providing integrated support systems and a multi-layered intervention ranging from basic services and community support to specialised care.

According to Dr Ala Alwan, Assistant Director-General for Health Action in Crises at the World Health Organisation: "These new IASC guidelines are a significant step towards providing better care and support to people in disaster and conflict-affected areas worldwide."

In future, one of the priorities in emergencies will therefore be to protect and improve people&${esc.hash}39;s mental health and psychosocial well-being. Observations from the tsunami, hurricane Katrina and the conflicts in Afghanistan, Darfur and Colombia buttress this point.

Women and children are particularly vulnerable in emergency situations. Loss of family members, traumatic experiences, displacement and constant terror can rewrite their life stories. Still worse can be the situation of people with other limitations. Those who are physically challenged (&${esc.hash}39;disabled&${esc.hash}39;) by birth or due to landmines can face even greater disadvantage. Poverty, insecurity, uncertainties and other social factors complicate the plight of the conflict and disaster-affected people. Nightmares too are one of the many challenges for the survivors of disasters and conflicts.

Even the way in which humanitarian aid is provided can have a substantial impact. Several agencies repeatedly asking the same set of questions can be traumatic. Further, different constituencies have been responding to psychosocial issues in emergencies in various ways, often compromising the quality and effectiveness of interventions.

The guidelines should make a valuable contribution to putting this particular house in order. By calling for better co-operation amongst agencies and government, maximizing the influence of the intervention and, most importantly, putting people at the centre of community interventions, the guidelines lay out the essential first steps in protecting and promoting people&${esc.hash}39;s mental health and psychosocial well-being. They identify useful practices, flag potentially harmful ones, and clarify how different approaches complement one another.

Dealing with the mind is not just a clinical challenge. It is not just the business of psychiatrists and psychologists. Initiatives to protect and heal the wounded, build trust and confidence and bolster resilience need to be an integral part of all humanitarian responses. ActionAid&${esc.hash}39;s ongoing psychosocial programmes in tsunami and earthquake situations show that a community based approach by engaging local people, especially women and children, can accelerate the recovery process.

The IASC was established in 1992 in response to the U.N. General Assembly Resolution 46/182, which called for better coordination of humanitarian assistance. The IASC task force to develop the guidelines was set up in 2005. Numerous consultations at various levels, including with the affected communities, strengthened this process.

Dr Unnikrishnan leads ActionAid International&${esc.hash}39;s psychosocial work.

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