PREVENTION AND RESPONSE

Article 1. It is widely recognised that conflict, human rights violations, and forced displacement have a substantial negative impact on the physical and mental health of millions of people. This is a serious public health concern, requiring priority action from the emergency onwards to address the consequences of trauma, to prevent personal and collective psychosocial disability and dependency, and to contribute towards preventing future conflicts.

Article 2. It is established that the majority of forcibly displaced populations are women and children. The physical safety, health, psychosocial protection, and healthy development of children must be given priority action. Mental health policies and programmes must be well adapted to the context, be sensitive to the different needs of women, to their culture, must avoid stigmatization and re-victimization. It is recognised that women with special needs must receive due protection and support, whilst a balance must be maintained with the significant needs of other groups.

Article 3. Local regional and international policies and plans should pursue immediate and long-term mental health capacity-building, based on models that respond to the needs of the greatest number of persons affected by conflict, without neglecting those with special needs. Therefore, community-based, psychosocial, phase-specific, cultural and gender-sensitive programmes must be given first priority when establishing or reconstructing mental health care systems. They should bridge in a coherent way emergency response to development. Specialised clinical interventions responding to individual needs are limited. They must be balanced, because they respond to the needs of a few, may possibly become stigmatizing, tackle problems in isolation, are expensive and non-sustainable. In addition to providing treatment mental health professionals should serve as a resource for early detection of people in need of urgent care, for capacity building, on the job support, monitoring, and coordination.

Article 4. In national services, in camps and settings for displaced populations personnel of the primary health care system should be mobilized and be given basic training in mental health, including sensitivity to culture, context, and prejudice. Human resources available within communities affected by conflict, such as camp leaders, staff of national, regional, international, governmental, non-governmental and UN agencies and volunteers must be included in this training. Also, staff of other sectors such as social welfare, education, employment, police and justice, relief project managers and workers, relevant administrators, local press and mass media must receive this training. This should occur in all emergencies, as soon as the peak of the survival crisis starts yielding. Mechanisms must be established enabling these professionals to work together to improve mental health care and psychosocial activities, to develop a well coordinated sustainable, multi-disciplinary, and multi-sectoral mental health response.

Article 5. In the emergency phase, a rapid assessment of initial mental health needs and available resources should be carried out in collaboration with local authorities, professionals and concerned groups to define priorities and to identify: available psychological, social, and economic resources; the severely mentally ill and other vulnerable groups; community and environmental aspects. This will help design and implement adequate programmes.

Article 6. In the long-term phase consolidation, replication, and scaling-up of the most useful programmes should be pursued with the necessary adaptations to the various situations. In the reconstruction phase mental health of refugees and other populations affected by conflict must be included in continuing education of essential personnel and in the curricula of relevant secondary and in university education. This is very important for teachers, social workers, nurses and post-secondary vocational training, midwives, doctors, psychologists, psychiatrists, and other service providers. Efforts must be made to integrate external educational resources into existing local and national systems of education whenever feasible. Establishing parallel systems of education must be avoided they complement the local systems on a temporary basis.

Article 7. Cooperation and partnerships between governments, international, non-governmental organisations, United Nations agencies, the communities affected by conflict and the host communities, scientists, donors, health authorities are essential for good mental health practice, cost-effective and sustainable programmes. Increased information gathering and sharing among agencies must prevent duplication of assessments and programmes. Use of the comparative advantages of agencies should be emphasised to decrease costs, competition, and delays, to limit the risk of re-traumatising the communities concerned, and to accelerate implementation of response.

Article 8. Information on the rights of people, and on the meaning of the psychosocial consequences of violence, should be provided to the populations affected by conflict and to the host communities through ad hoc mass media campaigns and other activities. Access to communications with family and relatives and to family reunion must be facilitated, because these are very effective methods in promoting mental well-being, in reassuring people, especially children. Access to interpretation should be guaranteed when refugees and displaced persons are dealing with authorities, various services, or agencies.

Article 9. For immediate local capacity-building the following summarises the critical activities to pursue in mental health and other social sectors by local and international bodies:

· rapid assessment of mental health needs and available resources;(1)

1. Ref: Orig. English “Rapid Assessment of the Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situations and Available Resources”, Ref:WHO/MNH/MHP/99.4 Rev. 1;

· training of trainers for health, mental health, and other workers involved in protection and assistance, who would multiply knowledge and skills; (2),(3)

2. Ref: WHO/UNHCR Mental Health of Refugees, WHO, 1996;

3. Ref: “WHO Mental Health of Refugees, Displaced and Other Populations Affected by Conflict “ Training the Trainers” Module (Available in English, Russian, French languages)

· in-service training, supervision, support, monitoring, and evaluation;

· workshops providing technical support in the design, planning, monitoring and evaluation of mental health projects;

· mechanisms for coordination of activities;

· awareness and information campaigns;

· creation of mobile mental health teams where appropriate;

· support appropriate existing activities among the community affected by conflict, within national services, NGOs, and UN agencies;

· protection of the local and expatriate personnel working in conflict areas, who are at risk of violence for expressing their opinions, for being neutral, and for being perceived as potential witnesses is critical. Their agencies should provide guidelines and mechanisms to protect and prevent risky behaviour. This should include prevention and care for secondary traumatization and burnout.

Article 10. In situations of prolonged conflict, camp life, displacement, or repatriation, national policies and plans should be elaborated to contribute to the continuity and coherence of achievable goals in psychosocial rehabilitation and to decrease dependency. The participation of the community affected by conflict in the planning and implementation of rehabilitation programmes is essential.