Inter-Agency Standing Committee Guidelines Research Articles

The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique

The bio-medical model of ‘mental health’ and ‘mental illness’ that relates to the relationship between wellbeing and distress informs psychopathology and dominates conceptualisation in many Western Educated Industrialised Rich Democratic (WEIRD) populations. This paper aims to critique the model, questioning the appropriateness of psychopathology as a conceptual framework when working as a Western trained clinician with populations such as in China, Japan, Asia, the Middle-East and Africa. The paper also considers the cultural appropriateness of western notions of psychopathology when working inter-culturally in relation to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the Review of the Implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

A call for greater conceptual clarity in the field of mental health and psychosocial support in humanitarian settings.

When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions. We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied. Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology. Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.

Post-disaster mental health and psychosocial support: Experience from the 2015 Nepal earthquake.

On 25 April 2015, an earthquake of magnitude 7.8 struck Nepal, which, along with the subsequent aftershocks, killed 8897 people, injured 22 303 and left 2.8 million homeless. Previous efforts to provide services for mental health and psychological support (MHPSS) in humanitarian settings in Nepal have been largely considered inadequate and poorly coordinated. Immediately after the earthquake, the Government of Nepal declared a state of emergency and the health sector started to respond. The immediate response to the earthquake was coordinated following the Inter-Agency Standing Committee (IASC) cluster approach. One month after the disaster, integrated MHPSS subclusters were initiated to coordinate the activities of many national and international, governmental and nongovernmental, partners. These activities were largely conducted on an ad-hoc basis, owing to lack of focus on MHPSS in the health sector's contingency plan for emergencies. The mental health subcluster attempted to implement a mental health response according to World Health Organization and IASC guidelines. The MHPSS response highlighted many strengths and weaknesses of Nepal's mental health system. This provides an opportunity to "build back better" through reform of mental health services. A strategic response to the lessons of the 2015 earthquake will deliver both improved population mental health and increased preparedness for the future.

Are We Prepared for Ebola-Like Diseases?

To the Editor: “Did you wash your hands? Aren’t you scared of Ebola?” I overheard a middle-aged woman talking to her friend after she shook hands with one of her other friends at Dallas/Fort Worth International Airport in Texas. The news of the death of Thomas Eric Duncan, the first Ebola victim who died in the United States, was still fresh on every news channel. Clearly, there were anxiety and stress in the minds of people. The sequence of events over the past few months makes me wonder whether we are ready to deal with the mental and psychological stress associated with Ebola-like diseases in the future, or are we merely giving in to unwarranted “hysteria”? Interestingly, the term hysteria is no longer used in psychiatry. There has been a gradual evolution of this term, which is currently known as somatoform disorder.1 At the time of writing this report, 10 cases of Ebola have been reported in the United States, and 8 of those patients contracted the disease outside the United States. The only 2 people who contracted the disease on US soil were nurses. They were directly involved in the care of an Ebola patient who caught the disease in Africa. Both nurses fully recovered.2 Considering the above-mentioned statistics, it seems that anxiety is spreading faster than Ebola itself! One of my friends and his roommate were so anxious about contracting Ebola that they would check their body temperature several times a day and would ask me to examine their eyes for signs of any bleeding. Both complained of nausea, lack of appetite, and light-headedness. This behavior continued for 4–5 days until their primary care physician referred them to a psychiatrist. Their symptoms were gone within a week after a couple of sessions. Disasters like the recent Ebola outbreak have severe, inevitable psychological consequences, which include posttraumatic stress disorder, major depression, anxiety disorders, and substance abuse. What measures are required to deal efficiently with the disease in the future? The response should comprise trauma signature analysis, a method used to analyze the specific characteristics of a disaster, prepare a hazard profile, identify disaster stressors, and estimate the extent of exposure and synopsis of psychological risk factors.3 In the case of Ebola in the United States, there was exaggerated fear-driven media coverage. The notable characteristics of the Ebola disaster are the low number of affected people, high recovery rates, and the fact that people who came in contact with the Ebola patients did not contract the virus.4 This analysis should be followed by an intervention in accordance with the Inter-Agency Standing Committee guidelines on mental and psychosocial support in emergency settings. These guidelines are centered around a 4-layered intervention pyramid: (1) reestablishment of basic services and security; (2) securing community and family networks; (3) focused individual, family, or group interventions by trained workers; and (4) at the top layer of the pyramid, providing psychological or psychiatric supports for people facing severe difficulties.5 Lastly, the target of intervention should be high-risk populations such as health care professionals dealing with Ebola patients, disease survivors, and bereaved family members. The only exposure to Ebola that the US population has had is through the media, and the reaction has been fear. Apart from addressing psychiatric needs, it is imperative that a responsible, science-based system of mass communication be put in place.4

The IASC Guidelines and the International Disaster Psychology Program at the University of Denver

There is a growing recognition of the signi¢cant psychological and psychosocial damage caused by natural and manmade disasters.This phenomenon has increased the demand for trained professionals with the necessary skills to address these problems, in diverse populations around the world. The Masters of Arts International Disaster Psychology (MAIPD) programme in the Graduate School of Professional Psychology was developed in order to help to meet this increased demand for professionals, required to work in the ¢eld of disaster psychology and emergency management within the United States, and around the world. The Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007) are extensively utilised in this programme. The guidelines provide practical approaches for addressing psychosocial problems in (post)disaster settings, and provide a framework for developing plans and intervention strategies. This article examines the use of the IASCguidelines in an academic setting, and discusses a case example of how the IASC guidelines were utilised by MAIDP students working in Panama. This critical evaluation aims to provide practical information in order to assist faculty, students and practitioners preparing to work in (post)disaster settings.

(A66) Integration of Psycho-Social Social Support and Mental Health Services in to National Disaster Management Guidelines

Integration of Psycho-social Social Support and Mental Health Services in to National Disaster Management Guidelines India is vulnerable, in varying degrees, to a large number of natural as well as man-made disasters and also a high risk country for disasters due to expanding population, urbanization and industrialisation, development within high-risk zones, environmental degradation and climate changes. The creation of National Disaster Management Authority (NDMA) in 2005, as the apex body for disaster management, has brought out a paradigm shift in the area of disaster management. One of the important mandate of NDMA is to issue National Disaster Management Guidelines (NDMG) to the ministries/ departments to assist them to formulate their respective Disaster Management (DM) plans. In this direction NDMA has issued number of NDMG on different themes to provide basis of preparation of DM plans at different levels. There are policies & guidelines on Psycho-social Support and Mental Health Services (PSSMHS) in disasters at the international level in the form of Inter Agency Standing Committee guidelines (IASC) which advocates PSSMHS in disasters. In India there was no such policy which streamlines the Psycho-social Support and Mental Health Services in Disasters. During preparation of various National Disaster Management Guidelines, one remarkable factor noticed was the need for psycho-social care, subsequently preparation of NDMG on Medical Preparedness and Mass Causality Management brought out an overwhelming consensus to formulate a separate NDMG for PSSMHS. In order to translate the critical need for psycho-social care and support into guidelines, NDMA adopted a mission-mode approach for integrating PSSMHS in disaster response by involving participatory and multi step methodology to formulate NDMG on Psycho-social Support and Mental Health Services in Disasters.

Orienting psychiatrists to working in emergencies: a WPA-WHO workshop.

Orienting psychiatrists to working in emergencies: a WPA-WHO workshop.

Guidelines need a more evidence based approach: a commentary on the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

Mental health and psychosocial surveys in emergency settings provide essential information on the psychological and social consequences of armed conflict and natural disasters. They also have programmatic implications. The Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergency Settings fails to recognize the importance of data driven programmes. Outcome evaluations of mental health and psychosocial programs in emergency settings would provide crucial information for a best practices approach, which is currently lacking. Evidence based information will be more likely to convince all humanitarian players to follow the recommendations in the MHPSS guidelines.

Humanitarian intervention and cultural translation: a review of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

In this article, we place the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings' within the historical context of trauma healing and humanitarian intervention. The IASC taskforce has done important work by bringing to the fore the cultural and local experiences of suffering in humanitarian intervention. The guidelines' recognition of suffering and social repair as a holistic experience is a significant boon to applied understandings of populations in crisis. Our critique of the guidelines addresses some aspects of the practical application of mental health and psychosocial care. We highlight (1) the framing of ‘culture’, and (2) the institutional cultures and structural hierarchies of humanitarian intervention. The article concludes with recommendations for integrating a blend of mental health, psychosocial care, and humanitarian intervention into the humanitarian established order.

Responding to the needs of children in crisis

This paper explores the issues confronting service providers setting up child and family mental health programmes in conflict, post conflict and disaster areas. Drawing on clinical experience and research in humanitarian settings, it calls for greater attention to the child's perspective, their individuality and the cultural, social and political context in which they live. It argues that those concerned with the psychopathology of children in crises should widen their frame of reference beyond narrowly defined traumatic reactions to include other mental health and psychosocial issues, including the current problems of daily life and the needs of children with pre-existing psychiatric disorders. It recommends culturally valid means of assessment, the creation of age-appropriate services and training for primary healthcare workers. Children's mental health needs in crises are varied, complex and intimately connected with their needs for security, food, shelter, education and family connection. This requires holistic, rights-based approaches that can access resources to address basic needs, advocate for security and protection, and recognize and address the needs of the more vulnerable children. This is the approach recommended by the Inter Agency Standing Committee Guidelines for Mental health and Psychosocial Support in Emergency Settings.

Health Services for Survivors of Gender-Based Violence in Northern Uganda: A Qualitative Study

The 20-year war in northern Uganda has resulted in up to 1.7 million people being internally displaced, and impoverishment and vulnerability to violence amongst the civilian population. This qualitative study examined the status of health services available for the survivors of gender-based violence in the Gulu district, northern Uganda. Semi-structured interviews were carried out in 2006 with 26 experts on gender-based violence and general health providers, and availability of medical supplies was reviewed. The Inter-Agency Standing Committee (IASC) guidelines on gender-based violence interventions in humanitarian settings were used to prepare the interview guides and analyse the findings. Some legislation and programmes do exist on gender-based violence. However, health facilities lacked sufficiently qualified staff and medical supplies to adequately detect and manage survivors, and confidential treatment and counselling could not be ensured. There was inter-sectoral collaboration, but greater resources are required to increase coverage and effectiveness of services. Intimate partner violence, sexual abuse of girls aged under 18, sexual harassment and early and forced marriage may be more common than rape by strangers. As the IASC guidelines focus on sexual violence by strangers and do not address other forms of gender-based violence, we suggest the need to explore this issue further to determine whether a broader concept of gender-based violence should be incorporated into the guidelines.RésuméLa guerre qui sévit depuis 20 ans au nord de l’Ouganda a déplacé jusqu’à 1,7 million de personnes à l’intérieur du pays, et appauvri la population civile, la rendant vulnérable à la violence. Cette étude qualitative a examiné les services de santé pour les victimes de violence sexiste dans le district de Gulu, au nord de l’Ouganda. Des entretiens semi-structurés ont été menés en 2006 avec 26 experts sur la violence sexiste et des soignants généralistes, et on a évalué la disponibilité des fournitures médicales. Les Directives du Comité permanent interorganisations (IASC) sur les interventions contre la violence sexiste dans les situations de crise humanitaire ont été utilisées pour préparer les guides d’entretien et analyser les données. Quelques lois et programmes traitent de la violence sexiste. Néanmoins, les centres de santé manquaient de personnel suffisamment qualifié et de fournitures médicales pour détecter et prendre correctement en charge les victimes ; le traitement et le conseil confidentiels ne pouvaient être garantis. Il existait une collaboration intersectorielle, mais davantage de ressources sont nécessaires pour élargir la couverture et relever l’efficacité des services. La violence du fait des partenaires intimes, l’abus sexuel de mineures, le harcèlement sexuel et les mariages précoces forcés sont peut-être plus fréquents que les viols perpétrés par des inconnus. Puisque les directives de l’IASC se centrent sur les actes de violence sexuelle d’inconnus et n’abordent pas d’autres formes de violence sexiste, nous pensons qu’il faut approfondir cette question pour déterminer s’il faut inclure un concept plus large de violence sexiste dans les directives.ResumenLa guerra de 20 años en Uganda septentrional ha ocasionado el desplazamiento interno de 1.7 millones de personas, así como empobrecimiento y vulnerabilidad a la violencia entre la población civil. Este estudio cualitativo examinó el estado de los servicios de salud disponibles para las sobrevivientes de violencia basada en género, en el distrito Gulu de Uganda septentrional. En 2006, se realizaron entrevistas semiestructuradas con 26 expertos en violencia basada en género y prestadores de servicios de salud, y se analizó la disponibilidad de suministros médicos. A fin de preparar las guías de las entrevistas y analizar los resultados, se utilizaron las directrices del Comité Interinstitucional Permanente (IASC) respecto a las intervenciones relacionadas con la violencia basada en género en ámbitos humanitarios. Aunque existen algunos programas y legislación sobre este tipo de violencia, los establecimientos de salud carecían de personal suficientemente calificado y suministros médicos para detectar y manejar adecuadamente a las sobrevivientes, y no se podía garantizar tratamiento y consejería confidenciales. Hubo colaboración intersectorial, pero se necesitan más recursos para ampliar la cobertura y eficacia de los servicios. La violencia entre parejas íntimas, el abuso sexual de niñas menores de 18 años, el acoso sexual y el matrimonio temprano y forzado posiblemente sean más comunes que la violación perpetrada por extraños. Dado que las directrices del IASC se centran en la violencia sexual por extraños y no tratan otras formas de violencia basada en género, sugerimos explorar más este asunto para determinar si se debe incorporar en éstas un concepto más amplio de la violencia basada en género.

IASC Releases New Guidelines

Back to table of contents Previous article Next article Professional NewsFull AccessIASC Releases New GuidelinesDawn DuarteDawn DuarteSearch for more papers by this authorPublished Online:2 Nov 2007https://doi.org/10.1176/pn.42.21.0008bOn September 14, the Inter-Agency Standing Committee (IASC)—a broad coalition of 26 United Nations (U.N.) and non-U.N. agencies—released new guidelines that identify how different approaches to mental health and psychosocial support can complement one another in the midst of emergencies.Emergency responders sometimes view the mental health and psychosocial well-being of communities undergoing disasters or conflicts as the sole responsibility of psychiatrists and psychologists. The IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings, however, seeks to dispel that belief by emphasizing that protecting and promoting mental health and psychosocial well-being are the responsibilities of all humanitarian agencies and workers.The IASC committee established the guidelines to focus on social interventions, with emphasis on the utilization of local resources, such as teachers, health workers, healers, and women's groups. Additionally, the guidelines provide direction on strengthening social networks and building on existing ways in which community members deal with distress in their lives. Such strategies include attention to protection and care of people with severe mental disorders and severe trauma-induced disorders, as well as access to“ psychological first aid” for those in acute distress.The guidelines will be available in various languages and posted at<www.humanitarianinfo.org/iasc/content/products/default.asp>.▪ ISSUES NewArchived