Public Health Approaches to Mental Health During Emergencies

Introduction

Health emergencies, natural and environmental disasters, armed conflicts, and migration events can cause significant suffering for affected populations. The psychological and social impacts of these emergencies can be severe both in the short and long term, potentially threatening peace, human rights, and development. Thus, protecting and improving mental health and psychosocial well-being is a priority during emergencies. Collaboration is essential among humanitarian aid providers, including government agencies, non-governmental organizations, and civil society groups engaged in Mental Health and Psychosocial Support (MHPSS) to achieve this goal.

What Are the Different Types of Problems in Emergencies?

In any large emergency, there are different types of social and mental health issues:

Social Problems:

• Pre-existing: Examples include poverty and discrimination against marginalized groups.

• Emergency-Induced: Examples include family separation, lack of safety, loss of livelihoods, disrupted social networks, and reduced trust and resources.

• Humanitarian Response-Induced: Examples include overcrowding, lack of privacy, and weakening of community or traditional support systems.

Mental Health Problems:

• Pre-existing: Examples include mental disorders such as depression, schizophrenia, or harmful use of alcohol.

• Emergency-Induced: Examples include grief, acute stress reactions, harmful use of alcohol and drugs, depression, anxiety, and post-traumatic stress disorder.

• Humanitarian Response-Induced: Examples include anxiety due to less information about food distribution or how to access basic services.

What Is the Prevalence of Mental Health Problems in Emergencies?

Most people affected by emergencies experience distress, such as anxiety, sadness, hopelessness, trouble sleeping, fatigue, irritability, anger, and physical aches and pains. These reactions are normal and usually improve over time. In a humanitarian crisis, common mental disorders like depression and anxiety are expected to more than double.

The prevalence of mental disorders among conflict-affected populations is very high. According to a WHO review of 129 studies in 39 countries, one in five people (22 percent) who have experienced war or conflict in the past ten years will suffer from depression, panic attacks, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, or schizophrenia.

The WHO review also found that at any given time, about 13 percent of people in conflict-affected populations have mild forms of depression, anxiety, and PTSD. In comparison, four percent have moderate forms of these disorders. The estimated occurrence rate for severe disorders (such as schizophrenia, severe depression, bipolar disorder, severe anxiety, and severe PTSD) is 5 percent. It is assumed that one in 11 people (nine percent) living in conflict-affected areas in the past ten years will develop a moderate or severe mental disorder.

In conflict-affected areas, depression and anxiety increase with age, and depression is more common in women than in men. Individuals with severe mental disorders are especially vulnerable during and after emergencies and need access to basic needs and clinical care. A 2014 analysis of health records from 90 refugee camps across 15 low- and middle-income countries found that 41 percent of healthcare visits for mental, neurological, and substance use disorders were for epilepsy or seizures, 23 percent for psychotic disorders, and 13 percent for moderate to severe depression, anxiety, or PTSD.

What Does Who Recommend for an Effective Emergency Response?

The WHO-endorsed interagency guidelines for mental health and psychosocial support in emergencies suggest various services, from fundamental support to clinical treatment. Clinical mental health care should be administered or overseen by specialists like psychiatric nurses, psychologists, or psychiatrists.

• Strengthening community self-help and social support is essential. This can involve creating or re-establishing community groups where members work together to solve problems and participate in activities like emergency relief or learning new skills. It is important to include vulnerable and marginalized individuals, including those with mental disorders, in these efforts.

• Psychological first aid should be available to offer initial emotional and practical support to people in acute distress from a recent event. Field workers, such as healthcare professionals, educators, or qualified volunteers, can offer this service.

• Basic clinical mental health care for priority conditions (such as depression, psychotic disorders, epilepsy, and substance abuse) should be provided at each healthcare facility by trained and supervised general health staff.

• Specialists or trained and supervised community workers should offer psychological interventions, such as problem-solving therapy, group interpersonal therapy, and cognitive-behavioral therapy, for people dealing with prolonged distress.

• Protecting and promoting the rights of individuals with critical mental health conditions and psychosocial disabilities is crucial in humanitarian emergencies. This includes visiting, monitoring, and supporting people in psychiatric facilities and residential homes.

• Establishing links and referral mechanisms between mental health specialists, general healthcare providers, community-based support, and other services (such as schools, social services, and emergency relief services) is essential for comprehensive care.

How Does Who Provide Support for Mental Health Problems in Emergencies?

WHO is the leading agency providing technical advice on mental health in emergencies. In 2022, WHO will be active in several countries and territories affected by large-scale emergencies, including Bangladesh, Ethiopia, Iraq, Afghanistan, Jordan, Lebanon, Libya, Nigeria, South Sudan, Ukraine, Turkey, the Gaza Strip, the West Bank, and Yemen.

WHO co-chairs the IASC Reference Group on Mental Health and Psychosocial Support (MHPSS) in Emergency Settings, offering guidance and support to organizations working in emergencies and country-level MHPSS technical working groups in over 50 countries.

WHO works globally to ensure that humanitarian mental health responses are coordinated and effective. It also focuses on building or rebuilding mental health services for the long term after emergencies. Major international humanitarian organizations involved in mental health use WHO's advice and tools. WHO and its partners have published practical tools and guidelines to address the mental health requirements of people affected by emergencies.

What Is Paho's (Pan American Health Organisation) Role in Providing Mental Health Support During Emergencies?

PAHOprovides expert guidance on mental health and psychosocial support during emergencies. They assess mental health systems, evaluate the MHPSS situation, and identify available human resources such as community agents and specialized personnel.

PAHO also works to identify local regulatory bodies for MHPSS and coordinates with stakeholders to ensure a unified response involving affected communities. As part of emergency plans, PAHO assures the delivery of Psychological First Aid (PFA) and other health interventions and develops proposals for ongoing mental health and psychosocial care during and after emergencies.

Lastly, PAHO analyzes the impact on health resources and other response teams, suggesting management alternatives and self-care plans.

Conclusion

Addressing mental health during emergencies is vital to alleviate suffering and aid recovery in affected communities. Crises' profound and lasting psychological impacts highlight the importance of coordinated efforts among humanitarian agencies, governments, and civil society groups. By following WHO guidelines and utilizing resources such as Psychological First Aid (PFA), PAHO and other stakeholders play a crucial role in providing comprehensive support and care. Continued investment in mental health infrastructure and services is key to strengthening resilience and promoting well-being in communities navigating difficult circumstances.