|Mental Health in Emergencies (WHO - OMS, 2003, 7 p.)|
Informed by a range of documents by acknowledged experts on guidelines, principles and projects, the Department of Mental Health and Substance Dependence draws attention to the following general principles:
1. Preparation before the emergency.
National preparation plans should be made before occurrence of emergencies and should involve: (a) development of a system of co-ordination with specification of focal persons responsible within each relevant agency, (b) design of detailed plans to prepare for an adequate social and mental health response, and (c) training of relevant personnel in indicated social and psychological interventions.
Return of refugees from West Timor. Photo courtesy of UNHCR/M. Kobayashi
Interventions should be preceded by careful planning and broad assessment of the local context (i.e, setting, culture, history and nature of problems, local perceptions of distress and illness, ways of coping, community resources, etc). The Department encourages in emergency settings a qualitative assessment of context with a quantitative assessment of disability or daily functioning. When assessment uncovers a broad range of needs that will unlikely be met, assessment reports should specify urgency of needs, local resources and potential external resources.
Interventions should involve consultation and collaboration with other governmental and nongovernmental organizations (NGOs) working in the area. Continuous involvement preferably of the government or, otherwise, local NGOs is essential to ensure sustainability. A multitude of agencies operating independently without co-ordination causes wastage of valuable resources. If possible, staff, including management staff, should be hired from the local community.
4. Integration into primary health care.
Led by the health sector, mental health interventions should be carried out within general primary health care (PHC) and should maximise care by families and active use of resources within the community. Clinical on-the-job training and thorough supervision and support of PHC-workers by mental health specialists is an essential component for successful integration of mental health care into PHC.
5. Access to services for all.
Setting up separate, vertical mental health services for special populations is discouraged. As far as possible, access to services should be for the whole community and preferably not be restricted to subpopulations identified on the basis of exposure to certain stressors. Nevertheless, it may be important to conduct outreach awareness programmes to ensure the treatment of vulnerable or minority groups within PHC.
6. Training and supervision.
Training and supervision activities should be by mental health specialists - or under their guidance - for a substantial amount of time to ensure lasting effects of training and responsible care. Short one-week or two-week skills training without thorough follow-up supervision is not advised.
7. Long-term perspective.
In the aftermath of a population's exposure to severe stressors, it is preferable to focus on medium-and long-term development of community-based and primary mental health care services and social interventions rather than to focus on the immediate, short-term relief of psychological distress during the acute phase of an emergency. Unfortunately, impetus and funding for mental health programmes is highest during or immediate after acute emergencies, but such programmes is much more effectively implemented over a protracted time during the following years. It is necessary to increase donor awareness on this issue.
8. Monitoring indicators.
Rather than as an afterthought, activities should be monitored and evaluated through indicators that need to be determined, if possible, before starting the activity.