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The Royal College of Psychiatrists Improving the lives of people with mental illness

Mental Health in Humanitarian Emergencies

Kaanthan Jawahar is a final year medical student at King's College London.

Medicine Overseas

Mental Health in Humanitarian EmergenciesA conference held in April at The Royal Society of Medicine, entitled ‘Medicine Overseas’, focussed on the global health challenges faced in post-conflict situations and humanitarian emergencies. Peter Medway, the director of the International Medical Corps (IMC), addressed the issues that surround mental health in such situations.

 

The IMC is one of the largest non-profit humanitarian aid organisations in the world and they focus their efforts on disaster relief health care, as well as training and development programmes. They currently operate in over 25 countries and look to integrate mental health into their community-based primary health care.

 

When considering a conflict or disaster zone, it is easy to see why mental health is an issue. Globally, mental illness is the most common non-communicable ‘disease’ and, when compounded with the stressors of disasters and conflicts, the baseline level of mental illness in the locality will rise and those with a pre-existing illness will be subjected to higher levels of stress. The IMC argue that too much emphasis has been placed on the more ‘fashionable’ mental disorders, such as post-traumatic stress disorder, as well as a largely Western focus when delivering treatment.

 

Kaanthan Jawahar is a final year medical student at King's College LondonThe IMC look to work with the local population to deduce what normality is and how best to return the situation to the normality of that area. By doing this, tribal leaders, local opinions and cultural practices are key in deploying effective mental health care. As such, Peter Medway argues that psychiatric health care must be location and context specific to achieve the best outcome.

 

He further argued that outcomes are better if psychosocial interventions are deployed in the first instance. He used the example of the IMC food distribution centres in Northern Uganda, where child health care was combined with the formation of mother-to-mother peer support groups. A pilot evaluation has shown this to improve maternal mood.

 

He also highlighted the lack of awareness of psychiatry in many of the countries in which the IMC operate; and that this is viewed as a developmental opportunity by the IMC. By integrating basic psychiatric care in their initial health care package, working with the few and often highly skilled psychiatrists in the area and training local health care workers, the IMC were able to expand mental health care in Haiti far beyond the initial solitary psychiatric hospital in the country. He also believes that by doing this, stigma surrounding mental health could be decreased and awareness raised in the long term.

 

Mental health seems to be a largely forgotten area in humanitarian aid missions. Where it is addressed, it typically follows other aid packages as they tend to be viewed as ‘more important’. The focus also seems to neglect local practices, customs and thus presentations of mental illness. This raises further questions about psychiatric diagnostic labels – can DSM-IV/ICD-10 criteria be effectively applied to extreme situations such as those experienced in conflict and disaster zones? In this respect, the way in which the IMC deploys mental health care is admirable. They look to treat symptoms using local knowledge and train the host country’s health care workers so that when the IMC leave the disaster zone, infrastructure remains for continuing care.

 

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