How are mental health systems getting stronger in crisis?

May 18, 2023; Unhurry Expert Research Team

Almost all people affected by emergencies will experience psychological distress, which for most people will improve over time. Moreover, among people who have experienced war or another conflict in the previous 10 years, one in five (22%) will have depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia.

According to World Health Organisation, people who suffer from serious mental illnesses are particularly at-risk during emergencies and require access to necessities as well as mental health care.

The organization puts together the problems of mental health faced by individuals during conflict and emergencies, their prevalence, and what systems can be put in place in order to ensure better mental health.

International standards advocate a range of services, from the most basic to clinical care, and state that as part of the medical response, rapid access to mental health care is required for certain, urgent mental health issues.

Emergency situations have proven to be chances to create long-lasting mental health services for everyone who needs them, despite their sad nature and detrimental impacts on mental health.

Types of problems

WHO lists down he types of social and mental health problems that one may go through in any large emergency.

Social problems:

• pre-existing: e.g., poverty and discrimination of marginalized groups;
• emergency-induced: e.g., family separation, lack of safety, loss of livelihoods, disrupted social networks, and low trust and resources; and
• humanitarian response-induced: e.g., overcrowding, lack of privacy, and undermining of community or traditional support.

Mental health problems:

• pre-existing: e.g., mental disorders such as depression, schizophrenia, or harmful use of alcohol.
• emergency-induced: e.g., grief, acute stress reactions, harmful use of alcohol and drugs, and depression and anxiety, including post-traumatic stress disorder; and
• humanitarian response-induced: e.g., anxiety due to a lack of information about food distribution or about how to obtain basic services.

Prevalence

Most people affected by emergencies will experience distress (e.g. feelings of anxiety and sadness, hopelessness, difficulty sleeping, fatigue, irritability or anger and/or aches and pains). This is normal and will for most people improve over time.

However, in a humanitarian crisis, the prevalence of common mental disorders such as depression and anxiety is expected to more than double in a humanitarian crisis.

Mental disorders among conflict-affected population is very high

The burden of mental disorders among conflict-affected populations is extremely high:

According to a WHO review of 129 studies conducted in 39 different countries, one in five people (22%) who have experienced war or other forms of conflict in the past 10 years will suffer from depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia (1).

According to the WHO review, the estimated point prevalence of mental illnesses among populations impacted by armed conflict is 4% for moderate forms of these diseases and 13% for mild types of depression, anxiety, and post-traumatic stress disorder. For severe disorders such schizophrenia, bipolar disorder, severe depression, severe anxiety, and severe post-traumatic stress disorder, the estimated point prevalence is 5%. According to estimates, 1 in 11 (9%) residents of areas that have experienced conflict in the last 10 years may suffer from a moderate to severe mental illness.

Depression is more common in women than in men

In conflict-affected settings, depression and anxiety increase with age. Depression is more common in women than in men.

People who suffer from serious mental problems should have access to both necessities and therapeutic care since they can be particularly vulnerable during and after emergencies. According to a review of the health information system from 90 refugee camps in 15 low- and middle-income countries that was published in 2014, epilepsy/seizures accounted for 41% of visits to the doctor for mental, neurological, and substance use disorders, psychotic disorders accounted for 23%, and moderate to severe cases of depression, anxiety, and post-traumatic stress disorder accounted for 13%.

Effective emergency response

Services at various levels, from basic services to clinical care, are recommended in the interagency mental health and psychosocial support guidelines for an effective response to emergencies that have been endorsed by the WHO. Mental health professionals such as psychiatric nurses, psychologists, or psychiatrists should give or oversee clinical care for mental health.

Community self-help and social support should be strengthened, for instance, building or re-forming community groups, where members collaborate to solve issues and take part in endeavors like providing emergency aid or acquiring new skills while making sure that those who are marginalized and at risk, such as those with mental illnesses, are included.

Psychological first aid offers first-line emotional and practical support by field workers, such as health officials, teachers, or trained volunteers, to persons experiencing acute distress because of a recent tragedy.

Basic clinical mental health care covering priority conditions (e.g., depression, psychotic disorders, epilepsy, alcohol, and substance abuse) should be provided at every healthcare facility by trained and supervised general health staff. 

Psychological interventions (e.g., problem-solving interventions, group interpersonal therapy, interventions based on the principles of cognitive-behavioral therapy) for people impaired by prolonged distress should be offered by specialists or by trained and supervised community workers in the health and social sector.

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

Links and referral mechanisms need to be established between mental health specialists, general health-care providers, community-based support, and other services (e.g., schools, social services and emergency relief services such as those providing food, water and housing/shelter).

Looking forward: emergencies can build better mental health systems

Mental health is crucial to the overall social and economic recovery of individuals, societies, and countries after emergencies. WHO points out a few examples where they have developed systems during emergencies that have helped in building better mental health, which otherwise would not have been initiated.

If attempts are made to turn the short-term rise in attention to mental health issues paired with a surge of help into momentum for long-term service development during every crisis, global progress on mental health reform will happen more swiftly. Many nations have taken advantage of crisis events to improve their mental health infrastructure afterward.

Mental health programs in Syra, Sri Lanka, and the Philippines

Despite — or perhaps because of — the difficulties brought on by the ongoing conflict, mental health treatments, and psychosocial assistance are now more accessible than ever in the Syrian Arab Republic. In more than 12 Syrian cities located in governorates that have been badly affected by the conflict, mental health, and psychosocial assistance are now provided in primary and secondary health and social care facilities, through community and women’s centers, and through school-based initiatives. In contrast, prior to the conflict, mental health services were mostly offered in mental hospitals in Aleppo and Damascus.

Mental health was a top concern in Sri Lanka in the immediate aftermath of the tsunami in 2004. This resulted in a WHO-supported reform of the mental health system that addressed the lack of mental health-related human resources, such as distinct cadres of committed mental health workers. Due to this, 20 of the country’s 27 districts now have infrastructure for mental health care, as opposed to only 10 prior to the tsunami.

Only two facilities offered basic mental health care when Typhoon Haiyan destroyed the Philippines in 2013, and there weren’t enough people available to support those in need. The WHO and its allies encouraged the government to significantly expand its mental health services. As a result, all general healthcare facilities in the Philippines’ impacted region now employ personnel who have received training in the treatment of mental illnesses.

National catastrophe programs must include mental health

National catastrophe preparedness programs must include mental health as well. For countries in the Caribbean sub-region of the Americas to be able to adequately provide mental health and psychosocial care to persons in need following hurricanes and other natural disasters, WHO and the Pan-American Health Organisation are supporting those countries.

There is a lack of access to high-quality, reasonably priced mental health care in many humanitarian and war situations. Public health emergencies like COVID-19, which tend to disrupt services and elevate requirements even more, can further limit this access.

WHO response

WHO is the lead agency in providing technical advice on mental health in emergency situations. In 2022 WHO is operational on mental health in a range of countries and territories affected by large-scale emergencies such as Afghanistan, Bangladesh, Ethiopia, Iraq, Jordan, Lebanon, Libya, Nigeria, South Sudan, the Syrian Arab Republic, Turkey, Ukraine, the West Bank and Gaza Strip and Yemen.

WHO co-chairs the IASC Reference Group on Mental Health and Psychosocial Support (MHPSS)in Emergency Settings which provides advice and support to organizations working in emergencies and to country-level MHPSS technical working groups in more than 50 countries affected by emergencies.

The Organization works globally to ensure that the humanitarian mental health response is both coordinated and effective and that following humanitarian emergencies, all efforts are made to build/rebuild mental health services for the long-term.  

WHO’s advice and tools are used by most large international humanitarian organizations active in mental health. WHO and partners have published a range of practical tools and guidelines to meet the mental health needs of people affected by emergencies.

Source: www.who.int

Reference: New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis

Help is here:

Name of the Organisation: Vandrevala Foundation

Vandrevala Foundation is a non-profit that partners with organizations to help communities thrive by providing education and healthcare. Vandrevala Foundation launched a mental health helpline in India in 2009 to offer free psychological counselling and crisis mediation to anyone who is experiencing distress due to depression, trauma, mood disorders, chronic illness, and relationship conflict.

Website:  http://www.vandrevalafoundation.com

Contact: Email: info@vandrevalafoundation.com

Telephone: +91 9999 666 555