Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective

Abstract

BackgroundMajor gaps remain – especially in low- and middle-income countries – in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations’ mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development.Case descriptionCases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste.Discussion and evaluationThese cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders.ConclusionsGlobal progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

“…This interaction of feedback loops describes a situation in which, even if clinical mental healthcare capacity were to be introduced, community stigma and economic forces would still represent significant barriers to access. This simple visual representation connects a number of important insights that have been shown separately by different studies: limited resources are available for mental healthcare services in Afghanistan despite original initiatives [4, 43, 44], that poverty plays a role in discouraging mental healthcare seeking behaviors [62] and the importance of stigma associated to mental illness [57]. …”

“…Despite important initiatives, the current lack of mental healthcare services is a considerable challenge. To date, Afghanistan lacks widespread access to mental health services despite successful pilot interventions in the province of Nangarhar [4, 43, 44] and the integration and recent scaling up of psychosocial models of treatment into the basic package of health services (health posts, health centers and district hospitals) [44–46]. Moreover, the prioritization of mental health support in community-based interventions such as Community Based Rehabilitation (CBR) [47, 48], has not translated into widespread effective mental health programs in Afghanistan being delievered through the CBR platform.…”

Leveraging Post-Disaster Windows of Opportunities for Change towards Sustainability: A Framework

“…Armed conflicts and natural disasters ravaged communities in low-and middle-income countries creating windows of opportunities to address major gaps in community-based mental health care during disaster times and as part of development. Epping-Jordan et al [90] reviewed 10 cases including Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, the occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste. This seminal article identified lessons emerging across the 10 cases how to seize opportunities created by both natural hazards and armed conflict to establish a mental health care system during the post-disaster recovery.…”

Mental health and psychosocial support in humanitarian emergencies

“…A number of countries in the world, especially in the Eastern Mediterranean Region, have seized opportunities during and after emergencies to build better mental health-care services (21,22). Emergencies often mobilize considerable attention towards, and resources for, the psychological Collaboration with a range of stakeholders, led by the Ministry of Public Health, has been key towards the setting up of integrated mental health services.…”