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Kaanthan Jawahar is a final year medical
student at King's College London.
Medicine Overseas
 A
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.
 The 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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