Mental health aspects of emergencies highlighted

While most humanitarian emergencies, such as the current food security crisis in Southern Africa, elicit relief aid for the affected populations, the mental health aspect of their needs is often ignored. The World Health Organisation (WHO) has urged that the mental health of populations caught in acute emergencies receive attention, wherever possible. In its report, "Mental Health in Emergencies - Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors", WHO said the number of people exposed to conditions of extreme stress was "very large", and created a mental health risk that could lead to social problems. The document is aimed at providing guidelines for assisting populations "exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors, and terrorism, war or genocide-exposed populations". The principles and strategies outlined in the report were "primarily for application in resource-poor countries, where most populations exposed to disasters and war live". Some 15 million people had required food aid in Southern Africa this year, mainly due to drought and HIV/AIDS. This excludes the four million Angolans who required assistance - including food, shelter and social services - following the end of the country's 27-year long civil war in 2002. "During the acute emergency phase (when the mortality rate is substantially elevated due to deprivation of basic needs, such as food and shelter, because of the war/disaster), it is advisable to conduct mostly social interventions that do not interfere with acute needs such as the organisation of food, shelter, clothing PHC (primary healthcare) services, and, if applicable, the control of communicable diseases," WHO noted. Valuable early social interventions could be undertaken, however, through collaboration between governmental and non-governmental organisations working in acute and complex emergencies. Among the recommendations in the report was that agencies should seek to: "establish and disseminate an ongoing reliable flow of credible information on (a) the emergency; (b) the efforts to establish physical safety for the population; (c) information on relief efforts, including what each aid organisation is doing and where they are located; and (d) the location of relatives to enhance family reunion (and, if feasible, establish access to communication with absent relatives)." Information should be "uncomplicated (understandable to local 12-year-olds) and empathic (showing understanding of the situation of the disaster survivor)". Families should also not be broken up when shelter was allocated, the report noted. Tracing the families of unaccompanied minors, the elderly and other vulnerable groups was important. So too, was the briefing of field officers in the areas of health, food distribution, social welfare and registration, regarding the issues of grief and disorientation, WHO added. It was important that normal cultural and religious events were encouraged. The manner in which corpses were disposed of could also impact on the mental health of disaster/emergency survivors. "The bereaved need to have the possibility to conduct ceremonious funerals and - assuming it is not mutilated or decomposed - to see the body to say goodbye," the report commented. "Most acute mental health problems during the acute emergency phase are best managed without medication, following the principles of 'psychological first aid' (i.e. listen, convey compassion, assess needs, ensure basic physical needs are met, do not force talking, provide or mobilise company from preferably family or significant others, encourage but to not force social support, protect from further harm)," the report said. WHO also highlighted the need for public education on normal stress reactions. Typically, the acute phase of an emergency was followed by a reconsolidation phase, when basic needs were again at a level comparable to that before the emergency. However, with complex emergencies, such as in Angola, different parts of a country could be in different phases at the same time. In the reconsolidation phase, it was important to facilitate the creation of community-based self-help support groups. "The focus of such self-help groups is typically problem sharing, brainstorming for solutions or more effective ways of coping," the report noted. These groups could also generate emotional support and community-level initiatives. WHO said it was important that relevant national-level mental health programmes were developed. "The long-term goal is a functional public health system, with mental health as a core element," the report concluded. For the full report go to: www5.who.int