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Mental Health Work in Humanitarian Crises

Milfred Perkins

WASHINGTON, Jun 15 2011 (IPS) - When the devastating ‘Boxing Day’ tsunami hit Sri Lanka in December 2004, claiming over 35,000 lives and rendering 1.5 million people homeless, the World Health Organization (WHO) was confronted by a second disaster soon after it arrived to begin relief efforts in early January.

For a population of nearly 20 million people, Sri Lanka was home to just 19 specialised psychiatrists – every single one of them concentrated in the capital city of Colombo.

Faced with thousands of decimated families, scores of orphans, countless refugees and other severely traumatised people, the WHO had to work quickly to prevent another crisis – one of lingering health problems caused by prolonged mental distress – from unfolding in the tsunami-wrecked island.

“We grabbed the opportunity and asked ourselves what we could do with local workers,” Shekhar Saxena, program manager of the department of mental health and substance abuse at the WHO told a gathering of health professionals at the Global Health Council Conference that opened in Washington D.C. Monday.

“We knew that community healthcare and social workers were just as well-placed – if not more so – to meet the needs of traumatised people during moments of crisis, so we seized the moment to start building local capacity,” he said.

While tackling the mental health issue in post-tsunami Sri Lanka, the WHO asked the question that not many humanitarian agencies stop to ask in the immediate aftermath of a disaster: ‘What do we want to see ten years from now?’

“Now, in 2011, Sri Lanka has mental health facilities in 20 of its 25 districts,” Saxena said at a panel aimed at addressing mental health needs in humanitarian settings Tuesday. “This, in a place where there is a lot of stigma and a lot of resistance, is no small achievement,” he said.

Saxena added that myths surrounding the provision of mental healthcare in humanitarian post-disaster or conflict settings – including the mistaken belief that community health workers and local general practitioners cannot be mobilised and trained to do the work of highly-qualified specialists – often prevents interventions that could avert protracted mental health-related problems.

“Members of the local community can be trained in very short time periods to provide curative and preventative treatments for everything from bi-polar disorder to schizophrenia while in the field,” Saxena argued.

Dispatches from the Field

The Global Health Council’s week-long conference, ‘Securing a Healthier Future in a Changing World’, was convened to address the challenges of rapidly changing global demographics, and pose the question: ‘What will the population look like in twenty years?’

Plaguing nearly 450 million people worldwide, mental illnesses account for 14 percent of the global disease burden, and well over 30 percent of all non-communicable diseases (NCDs), according to the WHO.

Yet, the John Hopkins Bloomberg School of Public Health reported in 2009 that the overwhelming majority of mental health patients – as many as 75 percent in developing countries – receive little to no treatment.

This figure climbs even higher in conflict or disaster zones, where the rush of search-and-rescue missions or emergency interventions often dwarfs the invisible plague of mental illness.

“We believe that governments and aid workers need to fully integrate the WHO Inter Agency Standing Committee (IASC)’s guidelines on mental health and psychosocial support in emergency settings into all aspects of humanitarian missions – including in the provision of sanitation, shelter and nutrition,” Inka Weissbecker, the global mental health and psychosocial advisor of the International Medical Corps (IMC), said at the panel on Tuesday.

“There is so much that can be achieved through effective psychological first aid,” she said, adding that effective interventions in medical health must flow vertically from the bottom up, with local, grassroots practices and practitioners informing the actions of aid workers and, ultimately, the decisions of policy- makers.

“While the work done in the moment is absolutely crucial, what is equally important is what comes after that,” Weissbecker warned, noting the tendency for mental health crises to be buried under the rubble of homes and corpses – generally resurfacing only after aid-workers have petered out and the resource pool is shallow.

“After the tsunami in Japan, one of the worst things for people was the lack of quiet houses in which to mourn the dead,” Weissbecker said. “IMC helped people to create these spaces.”

Experts believe that hearing community voices is of the utmost importance during times of emergency.

“We need to build evidence-based research and systems based on what works for whom,” said Judith Bass, assistant professor at the John Hopkins Bloomberg School of Public Health.

“Rather than randomised control trials, we need strong systems in place that can monitor the needs of the population, and involve them in their own recovery,” Bass said, adding that existing practices, data and populations must also be employed in addressing mental health in times of crisis.

Describing a joint project between IMC and the Japan-based non-profit Peace Boat, Weissbecker noted that community members in the Miyagi prefecture were mobilised after the quake to clear rubble and remove sludge. This partnership with locals had the double benefit of avoiding the cost of migrant workers from Tokyo, while simultaneously fostering a sense of solidarity in the community.

“In moments like this it is really important for people to feel a solid sense of purpose,” Weissbecker concluded.