Lesson 3: Mental Health Psychosocial Support.
Mr Zion Ameh Abba
Let’s understand that the composite term ‘Mental Health and Psychosocial Support’ (MHPSS) refers to any type of local or outside support that aims to protect or promote psychosocial well-being or prevent or treat mental disorders. Among humanitarian agencies the term is widely used and serves as a unifying concept that can be used by professionals in various sectors. MHPSS interventions can be implemented in programs for health & nutrition, protection (community-based protection, child protection and SGBV) or education. The term ‘MHPSS problems may cover a wide range of issues including social problems, emotional distress, common mental disorders (such as depression and post-traumatic stress disorder), severe mental disorders (such as psychosis), alcohol and substance abuse, and intellectual or developmental disabilities.
Protection objectives we must keep at heart:
- To ensure that emergency responses are safe, dignified, participatory, community owned, and socially and culturally acceptable.
- To maintain the protection and well-being of persons of concern by strengthening community and family support.
- To ensure that persons distressed by mental health and psychosocial problems have access to appropriate care.
- To ensure that persons suffering from moderate or severe mental disorders have access to essential mental health services and to social care.
- MHPSS core principles to work with regardless of the sector you are deploying mental health and psychosocial support include;
Principle 1: Ensure human rights and equity Humanitarian actors should promote the human rights of all affected persons and protect individuals and groups who are at heightened risk of human rights violations and at the same time ensure participation.
Principle 2: Do no harm Humanitarian aid is an important means of helping people affected by emergencies, but aid can also cause unintentional harm. Work on mental health and psychosocial support has the potential to cause harm because it deals with highly sensitive issues. In addition, it lacks an extensive evidence base that is available for some other disciplines. Humanitarian actors may reduce the risk of harm in various ways, such as: o Participating in coordination groups to learn from others and to minimize duplication and gaps in response o Designing interventions on the basis of valid information o Committing to evaluation, openness to scrutiny and external review o Developing cultural sensitivity and competence in the areas in which they intervene/work; o Staying updated on the evidence base regarding effective practices; and o Developing an understanding of, and consistently reflecting on, universal human rights, power relations between outsiders and emergency-affected people, and the value of participatory approaches. (Anderson, 1999).
Principle 3: Build on available resources and capacities All affected groups have assets or resources that support mental health and psychosocial well-being. A key principle – even in the early stages of an emergency – is building local capacities, supporting self-help and strengthening the resources already present.
Principle 4: Use Integrated support systems Activities and programming should be integrated as far as possible. The proliferation of stand-alone services, such as those dealing only with rape survivors or only with people with a specific diagnosis, such as PTSD, can create a highly fragmented care system.
Principle 5: Provide multilayered support in emergencies, people are affected in different ways and require different kinds of supports. A key to organizing mental health and psychosocial support is to develop a layered system of complementary supports that meets the needs of different groups. All layers are important and should ideally be implemented concurrently, such as in the IASC pyramid: o Basic services and security.
Principle 6: Anticipation, planning, preparation and advice the services, including the psychosocial and mental health services that are required following disasters and major incidents, are much more likely to work effectively if the need for them has been anticipated and defined. This requires understanding of the dynamic shifts that occur with the passage of time and of the clarity about how these services are to collaborate with other services that offer humanitarian aid and responses to people’s welfare and psychosocial needs after disasters and major incidents. Knowledge about how people may react psychosocially to disasters and major incidents is likely to assist responsible people in making effective decisions prior to events and when they are making decisions while under strain during events.
Principle 7: Needs-oriented planning for families and communities All aspects of psychosocial and mental health care should only be provided with full consideration of people’s wider social environments, the cultures within which they live, and, particularly, their families and the communities in which they live, work and move. The service responses provided from within societies and, in the case of disasters and major incidents that cause greater devastation, the actions taken by external countries and organizations should be proportionate to the needs of the people who have been affected. This requires a strategic stepped model of care to underpin a variety of levels of planning and preparation before events and the multi-layered support that is provided afterwards.
Principle 8: Developing, sustaining and restoring psychosocial resilience This principle means that actions taken, including those that determine how services respond to the needs of communities and people regarding their psychosocial and mental health care, should actively maximize participation of local, affected populations whatever the degree of devastation in each area. Restoring, first, the functioning, and second, the social fabric of communities is extremely important in how societies, communities and services respond effectively to the psychosocial and mental health effects of disasters and major incidents. If communities are to receive comprehensive responses to their psychosocial and mental health needs after disasters and major incidents, the following types of service are required: (a) humanitarian aid; (b) welfare services; (c) services that are able to assist people and communities to develop and sustain their resilience; and (d) timely and responsive mental health services.
Principle 9: Integrating psychosocial and mental healthcare responses into policy and into humanitarian aid, welfare, social care and health care agencies’ work Achieving comprehensive psychosocial care and mental health services for moderate and large-scale emergencies requires that lessons learned through research and experience are translated into integrated, ethical policy and plans at four levels. They are: o governance policies o strategic policies for service design o service delivery policies o policies for good clinical practice. Governance policies relate to how countries, regions and counties are governed. Governance policies require the responsible authorities to develop strategic policies. Strategy should be developed by bringing together evidence from research, past experience, knowledge of the nature of areas of the country for which they are responsible and of their populations, and the profile of risks, to design services. Policies for good clinical practice concern how clinical staff take account of the needs and preferences of patients, deploy their clinical skills, and work with patients to agree how guidelines, care pathways and protocols are interpreted in individual cases. Policy at each of the four levels should be informed by culture and values as well as by evidence and experience gleaned from practice.
Principle 10: All planners, incident commanders, practitioners, volunteers, researchers and evaluators should agree to work to a common set of standards In certain circumstances, especially those in which there is widespread devastation, high standards may not be achievable until there has been restoration of basic community functioning and resources, including clean water and food supplies, shelter and protection, communications, and healthcare. Situations of this kind should be anticipated and covered by planning. Planning should consider the minimum standards required in a range of different circumstances. The standards adopted have substantial implications for training, research, evaluation and information gathering because all of these capabilities should be core parts of all disaster and major incident response plans. This means that the requirement for them is anticipated and standards for research, evaluation and information-gathering should be developed and planned before disasters occur. Research and evaluation should identify the factors that contribute to either the success or failure of particular types of service, their organization and delivery, and particular interventions. Research and evaluation should include follow-up studies that are designed to identify long-term effects that may be associated with psychosocial intervention programs.
So, this are the core principles of MHPSS however, other aspect like the ethical, cultural aspect are key including the ongoing MHPSS response,
- Immediate MHPSS response,
- MHPSS actions before interventions begin,
- MHPSS recommendation for preparedness,
- Social media preparedness phase etc.
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Check the attached documents for MHPSS intervention Pyramid, The MHPSS program including the myths and facts about MHPSS