Delivering effective and accountable mental health and psychosocial support (MHPSS) during emergencies and beyond

Delivering effective and accountable mental health and psychosocial support (MHPSS) during emergencies and beyond

War, armed conflict, and natural disasters such as the recent Türkiye and Syria earthquakes cause profound distress, and can cause or exacerbate mental health conditions. Although most people will recover without help, an estimated 1 in 5 people will experience a mental health condition in the next 10 years. 

Good-quality mental health and psychosocial support (MHPSS) is therefore essential for the recovery of those caught up in emergency situations. But in order to be effective and accountable, MHPSS in emergencies must be well coordinated to avoid duplication and the inefficient use of scarce resources, and designed and delivered with local responders and affected communities.

Supporting MHPSS coordination in emergencies: a new resource

Local MHPSS response efforts in Syria following the earthquakes involved 37 partner organizations across 450 locations. Communities impacted by the earthquakes in Syria had access to mental health services and interventions, including: Psychological First Aid, basic psychosocial support, mental health consultations using WHO’s Mental Health Gap Action (mhGAP) programme, case management and referrals. These vital services have been accessed over a million times since the earthquake. 

The core actions outlined by the MHPSS Coordination Handbook strengthened collaboration between WHO and its partners in Syria, allowing for the delivery of a coordinated, multisectoral MHPSS response following the devastating earthquakes. 

Launched  in 2022, the MHPSS Handbook was developed by WHO and partners in the Inter-Agency Standing Committee (IASC) Reference Group on MHPSS in Emergency Settings. Building on best practices from past emergencies, it provides tools and resources to promote better coordination, including through the integration of local agencies and partners, and by the overall promotion of an equitable, multisectoral approach.

 The handbook outlines seven core actions for better coordination during a humanitarian emergency response:   

  1. (Re)establishing and maintaining one technical working group that unites MHPSS actors across sectors instead of having multiple disconnected groups working in silos.
  2. Managing information to create a shared understanding of the situation at ground-level and agreement around what is needed in response.
  3. Establishing links between stakeholders, including those not affiliated with any formal group or humanitarian agency, to facilitate an integrated multisectoral MHPSS response.
  4. Building capacity of responders, facilitating an exchange of knowledge and fostering peer support through workshops and training that leverage local expertise and align with global standards and tools.
  5. Monitoring and evaluation to minimize wide variation in the quality and consistency of MHPSS activities during a humanitarian response and thus demonstrate collective impact.
  6. Advocating for MHPSS with decision makers, donors, and other stakeholders to prioritize the MHPSS needs of those affected.
  7. Promoting long-term sustainability to ensure that actions taken during the immediate and medium-term response to emergencies create sustainable and durable systems and build back better after the emergency.   

Building mental health and psychosocial support systems during emergencies 

When the Syrian conflict began in 2011, many health professionals left to escape the war and over 23 million Syrians were left with little to no mental health care. To bridge this gap, WHO and partners trained health professionals and first responders to provide care for people with mental, neurological and substance use disorders. Prior to the conflict, Syrians could only access MHPSS services at two psychiatric hospitals located in Aleppo and Damascus. Today, with WHO support, there are over 5000 community workers, volunteers, and health workers,trained over the last two years to provide integrated MHPSS services. Additionally, over 51% of PHCs (600 centers) and 8% of schools across the country offer MHPSS services. 

These prior investments in scaling mental health services across Syria were key to enabling a more coordinated response following the recent earthquakes. MHPSS Technical Working Groups (TWGs), formed several years ago to coordinate MHPSS responses during the Syrian conflict, were  mobilized to deliver MHPSS responses to meet the needs of people affected by the earthquakes. Nabil Samarji, a WHO Mental Health Officer who co-chairs the Damascus MHPSS TWG, describes the  group as “a demonstration of the power of collaboration — offering support to those who have suffered unimaginable hardship and helping them find a way forward.”   

WHO leveraged existing teams of trained and supervised health and community workers to deliver integrated MHPSS services. Psychological consultations were provided in-person and via mental health helplines, which enabled service delivery in more remote, difficult-to-reach areas. Dr Khalid Saeed, Regional Adviser for WHO’s Mental Health and Substance Use programme noted that “MHPSS response efforts in Syria benefitted from previous investments to upgrade Syria’s national mental health system with an emphasis on community-based approaches.”  

Strengthening mental health systems through MHPSS responses 

Beyond Syria, the core actions outlined in the MHPSS Coordination Handbook have been  implemented across humanitarian emergencies around the world, leading to effective and efficient MHPSS responses in Gaza, Ethiopia, Sri Lanka among others. Through MHPSS coordination efforts by WHO and partners in Yemen, over 3,500 healthcare staff, first responders, frontline workers, school teachers, and child protection and gender-based violence (GBV) case managers had been trained in mental health and psychosocial support. Additionally, the country is implementing an updated national mental health strategy that strengthens MHPSS service delivery. 

The humanitarian response to the arrival of refugees from Ukraine into Poland is another example of how better coordination has boosted mental health care provision. Sanem Ozen, an MHPSS officer with UNHCR, who co-chairs the Poland MHPSS TWG alongside WHO, highlighted how TWGs have improved coordination: “It was challenging to engage partners, particularly local partners, in mapping MHPSS services. This information is crucial to enabling us to deliver MHPSS services to those impacted by the war in Ukraine. With the working group, we have been able to coordinate across partners and stakeholder groups, and efficiently map MHPSS services at all levels.” 

Thus, coordinating efforts among humanitarian responders not only ensures more efficient MHPSS responses and better access to the support people need following emergencies, but  lays the foundation for stronger national mental health systems and ultimately, improves the mental health and psychosocial wellbeing of affected communities.   

For more details, contact: Dr Fahmy Hanna ([email protected]) and Dr Brandon Gray ([email protected])


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