<ul><li>Tuesday 23 rd  September 2008 </li></ul><ul><li>Addressing Mental Health and Psychosocial Needs in Complex Emergen...
Health Priorities in Complex Emergencies <ul><li>Communicable Disease </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Nutriti...
The Psychosocial Consequences of Contemporary Conflict: 1 <ul><li>Post-traumatic stress disorder </li></ul><ul><ul><li>PTS...
The Psychosocial Consequences of Contemporary Conflict: 2 <ul><li>Family separation (approximately 5% of refugee populatio...
 
 
 
 
 
Humanitarian Perceptions of Psychosocial Needs: 1 <ul><li>“ You can’t touch it, you can’t count it, you can’t measure it ....
Humanitarian Perceptions of Psychosocial Needs: 2 <ul><li>“ Saving lives is not just to feed or treat people. That makes t...
Humanitarian Perceptions of Psychosocial Needs: 3 <ul><li>“ We’re at the stage where it’s no longer an anomaly. We used to...
Psychosocial Intervention In Complex Emergencies: A Contested Territory <ul><li>‘ As a field of work, psychosocial interve...
Tensions in the language of psychosocial intervention <ul><li>generalizable  vs.  unique </li></ul><ul><li>technical  vs. ...
Trauma versus community development? <ul><li>71% of sample of 102 displaced Angolan adolescents met diagnostic criteria fo...
Trauma versus community development? <ul><li>71% of sample of 102 displaced Angolan adolescents met diagnostic criteria fo...
Factors influencing psychosocial intervention <ul><li>Local understanding of (dis)stress </li></ul><ul><li>Impact of event...
Factors influencing psychosocial intervention <ul><li>Reality of mental health needs </li></ul><ul><li>Plurality and adapt...
The Psychosocial Working Group <ul><li>International Rescue Committee </li></ul><ul><li>Save the Children - US </li></ul><...
The Psychosocial Working Group <ul><li>IIHD, Queen Margaret University College, Edinburgh </li></ul><ul><li>Refugee Studie...
The Psychosocial Working Group: Workprogramme <ul><li>Conceptual Framework </li></ul><ul><li>Forums </li></ul><ul><li>‘ Gr...
HUMAN CAPACITY mental health livelihoods knowledge & skills
SOCIAL ECOLOGY HUMAN CAPACITY family & peers community social & service  infrastructure
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES cultural practices human rights religious beliefs
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES Human Capacity
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES Social Ecology
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES Culture & Va...
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES Engagement
 
Negotiation
 
 
 
 
 
Transformation
SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL  RESOURCES
                                                                                                                          ...
Collaborative Field Studies <ul><li>Mapping psychosocial interventions in East Timor  </li></ul><ul><li>Long-term outcomes...
IASC Guidelines on Mental Health & Psychosocial Support in Emergencies <ul><li>www.humanitarianinfo.org/iasc/ </li></ul>
Social interventions <ul><li>People have access to an ongoing, reliable flow of credible information on the disaster and a...
Social interventions <ul><li>Adults and adolescents are able to participate in concrete, purposeful, common interest activ...
Social interventions <ul><li>When necessary, a tracing service is established to reunite people and families </li></ul><ul...
Psychological and psychiatric interventions <ul><li>Individuals experiencing acute mental distress after exposure to traum...
Psychological and psychiatric interventions <ul><li>Individuals with pre-existing psychiatric disorders continue to receiv...
 
Planning and policy implications? <ul><li>3 domains of resource (HC, SE, C&V) </li></ul><ul><li>3 perspectives on resource...
Least Affected Moderately Affected Severely   Affected
 
 
 
 
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Ager (Columbia Mailman) on Mental Health/Psychosocial Needs in Complex Emergencies

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  • Ager (Columbia Mailman) on Mental Health/Psychosocial Needs in Complex Emergencies

    1. 1. <ul><li>Tuesday 23 rd September 2008 </li></ul><ul><li>Addressing Mental Health and Psychosocial Needs in Complex Emergencies: Lessons from the PWG </li></ul><ul><li>Alastair Ager </li></ul><ul><li>Program on Forced Migration and Health </li></ul><ul><li>Columbia University </li></ul>
    2. 2. Health Priorities in Complex Emergencies <ul><li>Communicable Disease </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Nutrition </li></ul><ul><li>Mental health </li></ul><ul><li>Reproductive health </li></ul><ul><li>FMO Research Guide: Impact of forced migration and health </li></ul><ul><li>http://www.forcedmigration.org/guides/fmo030 </li></ul>
    3. 3. The Psychosocial Consequences of Contemporary Conflict: 1 <ul><li>Post-traumatic stress disorder </li></ul><ul><ul><li>PTSD prevalence of 37% amongst displaced Cambodians (Mollica 2000); 17% amongst Kosovar Albanians (Lopes Cardozo et al. 2000) </li></ul></ul><ul><ul><li>PTSD prevalence of 82% among displaced Angolan adolescents (Ventura 1997; c.f. 71% estimate of Eyber & Ager 2001) </li></ul></ul><ul><li>Other mental health problems </li></ul><ul><ul><li>acute clinical depression prevalence of 68% amongst displaced Cambodians (Mollica 2000); 42% amongst Burmese refuges in Thailand (Lopes Cardozo et al. 2004) </li></ul></ul><ul><li>Challenge to belonging and identity </li></ul>
    4. 4. The Psychosocial Consequences of Contemporary Conflict: 2 <ul><li>Family separation (approximately 5% of refugee population comprises unaccompanied children; Summerfield 2001) </li></ul><ul><li>Disruption of civic and religious institutions </li></ul><ul><li>Disruption of other agents of socialisation (e.g. school, leisure, trading, ‘gathering functions’ etc.) </li></ul>
    5. 10. Humanitarian Perceptions of Psychosocial Needs: 1 <ul><li>“ You can’t touch it, you can’t count it, you can’t measure it ...With a feeding programme it’s easier to measure your results. You can see something concrete that you’ve accomplished. It’s much more difficult in mental health to be able to see what you’ve done. Mental health is more gradual.” </li></ul><ul><li>(Medical co-ordinator) </li></ul>
    6. 11. Humanitarian Perceptions of Psychosocial Needs: 2 <ul><li>“ Saving lives is not just to feed or treat people. That makes them breathe but they might not feel alive.” (Field staff member) </li></ul><ul><li>“ It’s a given fact, facing war areas, that you can see a serious need in heavily traumatised people.” (Management team member) </li></ul><ul><li>“ You do see it. I have not met one expatriate who is not talking about it once he is there.” (Management team member) </li></ul>
    7. 12. Humanitarian Perceptions of Psychosocial Needs: 3 <ul><li>“ We’re at the stage where it’s no longer an anomaly. We used to have one or two incidental activities, but not a stream. Now it has gained position in the minds of the field, and it’s now coming from the field as an initiative ... In the countries I work in, people have an eye for it. Now it’s getting embedded in the field, as shown by the way people come with initiatives by themselves.” </li></ul><ul><li>(Management team member) </li></ul>
    8. 13. Psychosocial Intervention In Complex Emergencies: A Contested Territory <ul><li>‘ As a field of work, psychosocial intervention remains characterised by a lack of consensus on goals, strategy and best practice’. </li></ul>
    9. 14. Tensions in the language of psychosocial intervention <ul><li>generalizable vs. unique </li></ul><ul><li>technical vs. indigenous </li></ul><ul><li>focussed vs. community-based </li></ul><ul><li>After Ager (1997) </li></ul>
    10. 15. Trauma versus community development? <ul><li>71% of sample of 102 displaced Angolan adolescents met diagnostic criteria for PTSD (Eyber & Ager, 2001) </li></ul>‘ For me to forget is very difficult…..how can I forget what happened?’ [Pedro, 17 years]
    11. 16. Trauma versus community development? <ul><li>71% of sample of 102 displaced Angolan adolescents met diagnostic criteria for PTSD (Eyber & Ager, 2001) </li></ul>‘ For me to forget is very difficult because the work here is very heavy. When you remember the past you think if it wasn’t for the war I wouldn’t be doing this heavy work. I collect firewood sometimes many hours a day. I work from sunrise to sunset for very little money...how can I forget what happened?’ [Pedro, 17 years]
    12. 17. Factors influencing psychosocial intervention <ul><li>Local understanding of (dis)stress </li></ul><ul><li>Impact of events on social and cultural linkage </li></ul><ul><li>Capacity of local personnel </li></ul><ul><li>Potential for doing harm </li></ul>
    13. 18. Factors influencing psychosocial intervention <ul><li>Reality of mental health needs </li></ul><ul><li>Plurality and adaptation of culture </li></ul><ul><li>(Potential) Empirical basis of intervention </li></ul><ul><li>Potential lessons from social psychiatry and public health </li></ul>
    14. 19. The Psychosocial Working Group <ul><li>International Rescue Committee </li></ul><ul><li>Save the Children - US </li></ul><ul><li>Christian Children’s Fund </li></ul><ul><li>Medecins sans Frontieres - Holland </li></ul><ul><li>Mercy Corps </li></ul>
    15. 20. The Psychosocial Working Group <ul><li>IIHD, Queen Margaret University College, Edinburgh </li></ul><ul><li>Refugee Studies Centre, University of Oxford </li></ul><ul><li>Program on Forced Migration & Health, Columbia School of Public Health </li></ul><ul><li>Harvard Program on Refugee Trauma </li></ul><ul><li>Asch Center, UPenn </li></ul>
    16. 21. The Psychosocial Working Group: Workprogramme <ul><li>Conceptual Framework </li></ul><ul><li>Forums </li></ul><ul><li>‘ Gray Literature’ Resources </li></ul><ul><li>Research Agenda </li></ul><ul><li>Program of Collaborative Field Studies </li></ul><ul><li>Programming Considerations </li></ul><ul><li>Objectives & Measurement </li></ul><ul><li>Training </li></ul><ul><li>Available:www.forcedmigration.org/psychosocial </li></ul>
    17. 22. HUMAN CAPACITY mental health livelihoods knowledge & skills
    18. 23. SOCIAL ECOLOGY HUMAN CAPACITY family & peers community social & service infrastructure
    19. 24. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES cultural practices human rights religious beliefs
    20. 25. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES
    21. 26. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES Human Capacity
    22. 27. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES Social Ecology
    23. 28. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES Culture & Values
    24. 29. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES
    25. 30. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES
    26. 31. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES
    27. 32. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES Engagement
    28. 34. Negotiation
    29. 40. Transformation
    30. 41. SOCIAL ECOLOGY HUMAN CAPACITY CULTURE & VALUES ENVIRONMENTAL RESOURCES ECONOMIC RESOURCES PHYSICAL RESOURCES
    31. 42.                                                                                                                                                                                    Psychosocial Working Group Inventory of Key Resources       Child Protection and Psychosocial Programs Consortium   Care and protection of children youth and families in East Timor : Project Proposal to the US State Department Bureau of Population, Refugees and Migration (1999)           International Rescue Committee   Kosovo psychosocial needs assessment : Report of the Delegation Visit, September 7-13.1999 (1999)           Save The Children Alliance, West Bank and Gaza   Palestine: The education of children at risk (2001)                  
    32. 43. Collaborative Field Studies <ul><li>Mapping psychosocial interventions in East Timor </li></ul><ul><li>Long-term outcomes for child soldiers in Mozambique </li></ul><ul><li>Comparison of community impacts of psychosocial and water & sanitation projects in Afghanistan </li></ul><ul><li>Outcomes of psychosocial support in the context of exhumations in Peru and Guatemala </li></ul><ul><li>Impact of strengthening primary health care capacity for mental health intervention in Bosnia </li></ul>
    33. 44. IASC Guidelines on Mental Health & Psychosocial Support in Emergencies <ul><li>www.humanitarianinfo.org/iasc/ </li></ul>
    34. 45. Social interventions <ul><li>People have access to an ongoing, reliable flow of credible information on the disaster and associated relief efforts </li></ul><ul><li>Normal cultural and religious events are maintained or re-established. People are able to conduct funeral ceremonies. </li></ul><ul><li>As soon as resources permit, children and adolescents have access to formal or informal schooling and to normal recreational activities </li></ul>
    35. 46. Social interventions <ul><li>Adults and adolescents are able to participate in concrete, purposeful, common interest activities, such as emergency relief activities </li></ul><ul><li>Isolated persons, such as separated or orphaned children, child combatants, widows and widowers, older people or others without families, have access to activities that facilitate their inclusions in social networks. </li></ul>
    36. 47. Social interventions <ul><li>When necessary, a tracing service is established to reunite people and families </li></ul><ul><li>Where people are displaced, shelter is organised with the aim of keeping family members and communities together </li></ul><ul><li>The community is consulted regarding decisions on where to locate religious places, schools, water points and sanitation facilities. The design of settlements for displaced people includes recreational and cultural space. </li></ul>
    37. 48. Psychological and psychiatric interventions <ul><li>Individuals experiencing acute mental distress after exposure to traumatic stressors have access to psychological first aid at health service facilities and in the community </li></ul><ul><li>Care for urgent psychiatric complaints is available through the primary care system. Essential psychiatric medications, consistent with the essential drug list, are available at primary care facilities </li></ul>
    38. 49. Psychological and psychiatric interventions <ul><li>Individuals with pre-existing psychiatric disorders continue to receive relevant treatment, and harmful, sudden discontinuation of medications is avoided. Basic needs of patients in custodial psychiatric hospitals are addressed. </li></ul><ul><li>If the disaster becomes protracted, plans are initiated to provide a more comprehensive rage of community-based psychological interventions </li></ul>
    39. 51. Planning and policy implications? <ul><li>3 domains of resource (HC, SE, C&V) </li></ul><ul><li>3 perspectives on resource (loss, retained capacity, ‘bolstering’) </li></ul><ul><li>3 key processes (engagement, negotiation, transformation) </li></ul><ul><li>3 dimension of social capital (bonds, bridges and links) </li></ul>
    40. 52. Least Affected Moderately Affected Severely Affected

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