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MENTAL HEALTH IN EMERGENCIES: WEBINAR NOTES AND REFERENCES

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The webinar had the following panel of experts:

Marcio Gagliato, MHPSS Specialist, Libya (chair), Fahmy Hanna, Technical Officer, WHO from the Ukraine frontline, Orest Suvalo, coordinator of community based mental health services development, Mental Health for Ukraine project, Ukraine, Karla Alvear-Veintimilla, Mental Health and Psychosocial Support Specialist, International Medical Corps, Venezuela and Ann Willhoite, MHPSS Specialist, UNICEF, South Africa).

The webinar covered a range of themes related to the topic of mental health in emergency settings including a list of the most common mental health issues in emergencies, advice for civil society organisations, the role of governments, lessons learned, gender-based violence, and addressing the mental health of migrants who are often undocumented.

Fahmy Hanna of WHO outlined key issues in emergencies and conflict settings (see this blog for a longer summary) including the importance of good coordination. According to Dr Fahmy Hanna, psychological distress like anxiety, stress and sleep deprivation is quite common in emergency situations. He ended by highlighting the importance of ensuring sustained mental health support to people in institutions as they are often forgotten in acute situations. Ann Willhoite of UNICEF presented a timely and useful MHPSS minimum service package to help prioritise action under emergencies and encouraged its use by a wide range of stakeholders including governments, international agencies and civil society. She explained multi-sectoral response is key and listed some benefits of using the MHPSS minimum service package. The package supports humanitarians to coordinate and collaborate, plan and make decisions, implement and allocate.  

In Ukraine, destroyed infrastructure and unsafe health facilities are just some of the many obstacles people face. According to Orest Suvalo, Mental health for Ukraine project, lack of integrated services and technical knowledge of mental health, along with a lack of local services are other challenges.

In emergencies, the risk of Gender-Based Violence (GBV) is heightened, according to Karla Alvear-Veintimilla of International Medical Corps (IMC). She highlighted the importance of training staff on the different types of violence that people experience in order to provide appropriate support. She emphasised it is key to be able to refer cases when needed as each situation will require a specific kind of treatment. 

In response to a question on what advice WHO would give those working on mental health in emergencies, Fahmy Hanna explained the importance of avoiding duplicated services, integration across sectors, e.g. mental health and nutrition. He also stressed the importance of using the knowledge and tools already available to us such as the MHPSS minimum service package described by Ann Willhoite.

Karla Alvear-Veintimilla discussed her experience with undocumented migrants in Venezuela and the importance of ensuring that those lacking a legal status have access to services. Mental health disorders such as depression, anxiety and traumatic stress are higher among migrant populations and the lack of access can make things worse

The advice from Orest Sufalo was for civil society organisations to assert themselves and ensure they work alongside, at the same level as decision-makers because often they are not involved in decision-making about mental health service provision

Ann Willhoite mentioned the importance of mental health staff care and self-care which should be a collaboration between the staff and the organisation. She mentioned the MHPSS minimum service package has guidelines on this as well: https://www.unicef.org/ukraine/en 

Fahmy Hanna mentioned the need to build on existing structures. To work not only with the ministry of health but also with the ministry of education and the presidential office, for example. To make sure facilities are included in evaluations of what services are available; working with mayors’ offices to make sure the MHPSS technical group working to deliver mental health services is received, supported and endorsed by local government. The role of international actors should be advising the government, for example, see the MHPSS minimum service package

Karla Alvear-Veintimilla made an interesting point about how this connection with local government can be difficult if not impossible as often agencies don’t wish to work with the government due to political differences – which is the case in Venezuela. It’s a difficulty that must be addressed constantly so that the government understands the benefits of providing mental health services (for local populations and for migrants) and how to build this infrastructure. In her experience, the best results have come out of showing the government the long-term benefits of their support. This needs to be done continuously and consistently as it works in the long term. If done only once, it doesn’t work.

To ensure that mental health strategies and legislation can be incorporated Fahmy Hanna suggested the following Inter-Agency mental health guidance for preparedness for Disaster Risk Reductoin (DRR); the WHO Comprehensive Mental Health Action Plan 2013-2030 and the WHO 2020 Mental Health Atlas.

Tweet-size quotes:

“To deliver the best mental health programmes in emergencies you need to integrate the population you are working with and address their needs with them, not without them.” – Karla Alvear-Veintimilla, Mental Health and Psychosocial Support Specialist, International Medical Corps, Venezuela.

“To deliver the best mental health programmes in emergencies you need to be collaborative, transparent and evidence-based.” – Orest Suvalo, Coordinator of community based mental health services development, Mental health for Ukraine project, Ukraine.

“To deliver the best mental health programmes in emergencies you need to treat mental health and psychosocial support as a human right, not as a luxury because people during emergencies are people: they need more than food to survive.” – Fahmy Hanna (Technical Officer, Mental Health & Substance Abuse, WHO, currently in Ukraine

“To deliver the best mental health programmes in emergencies you need to be genuine. It’s very important that you are genuine and that it’s a human-centred approach. Not only technical but profoundly human.” – Marcio Gagliato, MHPSS Specialist, Libya 

Useful links shared during the session:

UNICEF’s response to the Ukraine Crisis: https://www.unicef.org/ukraine/en

The Inter-Agency MHPSS Reference Group on MHPSS support in emergency settings: https://interagencystandingcommittee.org/iasc-reference-group-on-mental-health-and-psychosocial-support-in-emergency-settings

The Inter-Agency MHPSS Reference Group’s information on the Ukraine response:https://internationalmedicalcorps.org/emergency-response/war-in-ukraine/

The WHO’s guidelines on MHPSS responses: https://www.who.int/activities/ensuring-a-coordinated-and-effective-mental-health-response-in-emergencies

The IMC programme on MHPSS in emergencies https://internationalmedicalcorps.org/program/mental-health-psychosocial-support/

www.mhpssmsp.org