Mental Health in Disaster Settings: Integration into Current Health Systems for Sustainable Care

Mental Health in Disaster Settings: Integration into Current Health Systems for Sustainable Care

The theme of this year’s Global Health Council annual conference was Securing a Healthier Future in a Changing World. As populations are shifting, so are their health priorities. Increasing urbanization has led to more people living in and around cities, creating a series of problems that are new to public health professionals. Nutritional challenges, the need for improved water and sanitation infrastructure, and addressing the issue of unregulated health care providers are all problems facing governments, ministries, NGOs, donors, and populations. In addition, non-communicable diseases (NCDs), including cancer, diabetes, cardiovascular conditions, and mental illness, are adding a new strain to many already resource constrained health systems. Of course, immunization, malaria, pneumonia, diarrhea, and maternal death are all still very serious challenges in many of these systems and remain key priorities.

On Tuesday, June 14, I attended two sessions on mental health. Mental health is one of the most prevalent and challenging NCDs. The World Health Organization reports that more than 450 million people around the world are affected by mental health conditions. Only a small portion of them have access to appropriate and effective mental health services---meaning that many of the people suffering mental health disorders as result of conflict or disaster are not receiving the care that they need. Not only is the provision of mental health care services a challenge, it’s often neglected by governments and implementers; they cite requisite specialized and highly trained providers, identified and specific spaces for care giving, and working with a set of highly stigmatized and underutilized conditions as reasons why mental health is too costly and burdensome to tackle.

The session I attended, entitled ‘Addressing mental health needs in humanitarian settings: how can we do more?’ was hosted by the Humanitarian Health Worker Caucus and touched on many of the key areas related to providing these kinds of services to populations struggling in post-conflict and disaster settings. Many of the challenges that providers face include a weak or disrupted health system, lack of support or prioritization of these services from the national level government, providing services to a population who views the conditions as highlight stigmatized, and a difficult environment in which to provide coordinated services.

The need for mental health services is great---especially in places where you’re treating a population with conditions like depression, post traumatic stress disorder, sleeping problems, and anxiety as a result of armed conflict or natural disaster. Former child soldiers in northern Uganda and Liberia, children in Haiti and Southeast Asia after the earthquake and tsunami, rape victims in eastern Congo, and employees at the nuclear plant in Japan all come to mind as populations in dire need of these services, yet live in countries with weak health systems and little to no support for mental health services. Shekhar Saxena (WHO) discussed the challenge of integrating mental health services into a health system following a conflict or disaster and suggested that in some senses it’s easier than trying to integrate it otherwise. Disasters can often times help reduce the stigmas that are barriers for mental health services, as many people are all processing the disaster and may be experiencing similar reactions or feelings. As these programs are established to help meet the need following a disaster of some kind, with successful integration and support from key players, mental health programs can become part of the overall health system.

One of the most fascinating things I learned was that often times, mental health conditions are easily treated by non-specialized health care workers---including community health workers and social workers. By utilizing the workforce that is already in place, and smoothly integrating into the current health care system, mental health programs can become sustainable and systemic in countries where they are desperately needed.

Mental health care services, especially in post-disaster settings, are so critical. I hope that the focus on NCDs and systems strengthening helps bring this issue to the forefront and can help foster the development of sustainable services for populations that will undoubtedly benefit from these services.