Essential health services – mental health standard 1: mental health
People have access to health services that prevent or reduce mental health problems and associated impaired functioning.
Key actions (to be read in conjunction with the guidance notes)
Ensure interventions are developed on the basis of identified needs and resources.
Enable community members including marginalised people to strengthen community self-help and social support (see guidance note 1).
Ensure that community workers including volunteers and staff at health services offer psychological first aid to people in acute distress after exposure to extreme stressors (see guidance note 2)
Ensure that there is at least one staff member at every health facility who manages diverse, severe mental health problems in adults and children (see guidance note 3).
Address the safety, basic needs and rights of people with mental health problems in institutions (see guidance note 4).
Minimise harm related to alcohol and drugs.
As part of early recovery, initiate plans to develop a sustainable community mental health system (see guidance note 5).
Key indicator (to be read in conjunction with the guidance notes)
All health facilities have trained staff and systems for the management of mental health problems.
- Community self-help and social support: Community self-help and social support form a key element of overall mental health and psychosocial multi-sectoral supports (see diagram below)(see Core Standard 1, Protection Principle 4, guidance notes 9-13 and Protection Principle 3, guidance note 15). Health agencies often employ or engage community workers and volunteers who can enable community members, including marginalised people, to increase self-help and social support.
- Psychological first aid: Acute anxiety after exposure to extreme stressors (e.g. traumatic events) is best managed following the principles of psychological first aid, which is often mistakenly seen as a clinical intervention. Rather, it is a description of a humane, supportive response to a fellow human being who is suffering and who may need support. It entails basic, non-intrusive pragmatic care with a focus on listening but not forcing talk, assessing needs and concerns, ensuring that basic needs are met, encouraging social support from significant others and protecting from further harm. Psychological debriefing (i.e. the promotion of ventilation by encouraging the person to briefly but systematically recount perceptions, thoughts and emotional reactions experienced during a recent, stressful event) is at best ineffective and should not be applied. Similarly, benzodiazepines should be avoided in the management of acute distress because they may interfere with natural recovery.
- Basic mental healthcare: People’s mental health problems may be emergency-induced, pre-existing or both. People with severe mental health problems should have access to a network of community-based social supports as well as clinical care through available health services (e.g. general hospitals, primary care clinics, etc.).Organising basic clinical mental healthcare usually involves either organising rapid training and supervision of general health staff or adding a mental health professional to the health clinic. Essential psychotropics and anti-epileptics need to be available. Individuals who have been receiving mental health treatment before the crisis need to have access to continued treatment.
- People in institutions: Mental hospitals and residential homes for people with severe mental problems need to be visited regularly, especially early in the crisis, because the risk of severe neglect or abuse of people in institutions is extremely high. Safety, basic physical needs (water, food, shelter, sanitation and medical care), human rights surveillance and basic psychiatric and psychosocial care must be provided throughout the crisis.
- Early recovery: Because humanitarian crises increase the rates of a broad range of mental disorders, plans need to be initiated to develop the mental health system to scaleup effective mental health treatment coverage across the affected area (see Core Standard 4).