During Sierra Leone’s civil war from 1991 to 2002, 150,000 people were killed, 200,000 women were raped, and hundreds of thousands of people were displace. According to the World Health Organization, when the war ended the nation of four million had only one psychiatrist and two trained psychiatric nurses. Many rebuilding efforts focused on repairing war-torn areas; few focused on the nation’s mental health in the wake of so much suffering.
This scenario is disturbingly common: Mental health—especially in developing nations—is, at best, an afterthought. In addition to a lack of knowledge and understanding about normal reactions to crisis, stigmatization of more severe mental health issues means that those who could greatly benefit from treatment and support often end up ostracized, abused, or ignored.
Disasters can magnify existing challenges. Consider the case of a mother who loses a child to famine, one who still has a living baby. The woman is likely to be malnourished and depressed herself. With low energy, she may not interact with the baby, and that lack of interaction may interfere with the baby’s cognitive development.
Disasters not only produce physical trauma. They also may induce a variety of mental reactions. Anxiety, anger, fear, panic, guilt, and depression are all common reactions, even among otherwise healthy individuals. For those already in a delicate balance, the experience of a disaster may lead to personal crisis.
- There is no health without mental health. Mental disorders cause significant disability and interfere with a person’s daily life, work, ability to learn, physical health, and relationships with others, which in turn impacts social and economic development. In the context of humanitarian crises, mental health is critical to recovering from disasters and the ability to rebuild.
- A tremendous stigmatization remains with regard to mental health. When stigmatized, those who need help are less likely to access care; less likely to stick to medicine schedules; and less likely to receive support from loved ones.
- A general lack of understanding/awareness of mental health issues persists in developing nations. In some areas, epilepsy is still considered a mental illness, rather than a neurological one. Lack of knowledge of issues hinder community members from living active, productive lives.
- Psychosocial support should be integrated into primary healthcare efforts to ensure needs are met during periods of disaster. Healthcare providers in clinics, for example, can be trained in the basics of mental health symptoms and potential treatments for more holistic—and effective—care.
- Those with severe mental issues prior to a crisis must be taken care of so they can better cope when that crisis occurs. The stronger the mental health reserves of the individual, the better able that person is to handle “normal” reactions of shock, grief, loss, insecurity, etc.
How You Can Help
The fields of mental health and psychosocial support are largely untapped areas in terms of disaster preparedness and recovery. Interested donors could:
- Fund activities and programming that are integrated into wider systems. These efforts likely will reach more people, be more sustainable, and carry fewer stigmas. Consider, for example, activities and programming affiliated with community support mechanisms, school systems, general health services, general mental health services, or social services. Stand-alone services—such as those that deal only with rape survivors or people with a particular diagnosis—may be less effective.
- Fund Child Friendly Spaces. Child Friendly Spaces provide children who are living through the stresses of conflict or post-conflict life—or those who have survived terrifying events like an earthquake or tsunami—with a safe, protected, carefree environment where they can learn, play, and grow. A welcoming, stimulating atmosphere, regular routines, and structured time help children to regain a sense of normality and overcome some of their problems.
- Make compliance with the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings a criterion for supporting mental health and psychosocial projects. Composed of experts from more than 30 international agencies, the IASC Reference Group on Mental Health and Psychosocial Support in Emergency Settings produced these guidelines as minimum standards and a guide to best practices in emergency settings based upon extensive, ongoing reviews of evidence-based practice.
- Partner with local NGOs and healthcare providers to address severe mental disorders prior to disasters. Identify people in need; build relationships with and support traditional healers where appropriate; ensure that necessary medications and other supplies will be available should disaster strike; and make sure the general population is aware of available services.
- Foster public awareness programs that can reduce the stigmas associated with mental health issues. Community support and understanding can help ensure that those affected receive the help they need—as well as prevent unnecessary costs and complications.
- Invest in training for healthcare workers to better communicate, recognize, and treat mental health issues in emergency settings. This can cut down on duplication of efforts, waste, and confusion.
- The Lancet (2004): Severe Mental Disorders in Complex Emergencies
- IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
- The Sphere Project: Humanitarian Charter and Minimum Standards in Humanitarian Response [see page 333 re: mental health]
- World Health Organization (2003): Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors
- World Health Organization (2006): Mental Health and Psychosocial Well-being among Children in Severe Food Shortage Situations
- WHO/UNHCR/UNFPA (2004): Clinical Management of Survivors of Rape: Developing Protocols for Use with Refugees and Internally Displaced Persons (revised edition)