Inter-Agency Standing Committee Research Articles

Integrating mental health into emergency preparedness and response: lessons learned from Covid-19

Abstract Introduction The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies. Methods A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response. Results Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic. Conclusions The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term. Key messages • Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term. • Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

Арктическая научная дипломатия России: теория и практика

Arctic science diplomacy (ASD) is both a relatively new topic and an acute issue in Russian academic and political circles. There is neither a clear definition of the concept nor a consensus on the stakeholders, tools, and activities of science diplomacy. This article focuses on the main approaches in Russia in relation to the concept of ASD. The first approach considers ASD as a soft power tool of regional players. Science diplomacy helps to promote a positive image of specific states and to gain access to non-state resources that are usually inaccessible to state actors. A technical/instrumentalist approach to ASD involves the use of academic and scientific-technical cooperation between regions, countries, and societies to create reliable international partnerships on a non-ideological basis and to solve generally significant world problems. The third direction considers ASD as a form of new diplomacy, the strategic goal of which is not only to build friendly relations and cooperation with all Arctic countries, but also to develop international scientific cooperation and improve the international image of Russia. This analysis makes it possible to explain the strategic motives and driving forces of ASD and to identify the stakeholders and key forms of Russia’s ASD. It is established that the majority of the participants of ASD share the idea that international scientific cooperation in order to ensure the sustainable development of the Arctic can become an effective mechanism for solving the most acute problems of the region, as well as for improving the current relations of Western countries with Russia. The authors believe that Russia has largely managed to form the necessary platforms for the implementation of both strategic and tactical goals of its ASD. These platforms include both national platforms (the international forum “The Arctic: The Territory of Dialogue” and “The Arctic: Present and Future”) and the active use of international platforms (“Arctic Frontiers,” “Polar Circle,” and “Arctic Science Summit Week”) and organizations such as the Inter-Agency Standing Committee (IASC), the International Arctic Social Sciences Association (IASSA), and the Association of Polar Early Career Scientists (APECS).

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.

DUKUNGAN KESEHATAN JIWA DAN PSIKOSOSIAL DI WILAYAH PESISIR KOTA KENDARI

The COVID-19 pandemic leaves various kinds of problems, including health problems (physical) and psychosocial problems. The Covid-19 outbreak is a stressor for health workers and the community. Psychosocial problems caused have a wider and longer impact than physical injuries, while attention to mental health is not a priority for handling health problems during the COVID-19 pandemic. Common responses from affected people (directly or indirectly) include fear of falling ill and dying, not wanting to come to health care facilities for fear of being infected while being treated, fear of losing their livelihood, not being able to work during isolation and being expelled from work. Then, they are also afraid of being ostracized by the community/quarantining because they are associated with disease (such as racism because they are considered to come from an affected place), feel powerless to protect loved ones, fear losing loved ones, afraid of being separated from loved ones and influence due to quarantine rules. In addition, people also refuse to take care of young children who are alone or separated, people with disabilities, or elderly for fear of infection because their parents or caregivers are quarantined, feel helpless, bored, lonely, and depressed while isolated, and afraid of experiencing previous outbreaks. The term Mental Health and Psychosocial Support (MHPS) is used in the Inter-Agency Standing Committee (IASC) Guidelines for MHPS in an emergency situation, which means any external or local support to protect or enhance psychological well-being and/or preventing or treating mental health conditions.

Serving the Vulnerable: The World Health Organization's Scaled Support to Countries During the First Year of the COVID-19 Pandemic.

The Inter-Agency Standing Committee (IASC), created by the United Nations (UN) General Assembly in 1991, serves as the global humanitarian coordination forum of the UN s system. The IASC brings 18 agencies together, including the World Health Organization (WHO), for humanitarian preparedness and response policies and action. Early in the COVID-19 pandemic, the IASC recognized the importance of providing intensified support to countries with conflict, humanitarian, or complex emergencies due to their weak health systems and fragile contexts. A Global Humanitarian Response Plan (GHRP) was rapidly developed in March 2020, which reflected the international support needed for 63 target countries deemed to have humanitarian vulnerability. This paper assessed whether WHO provided intensified technical, financial, and commodity inputs to GHRP countries (n = 63) compared to non-GHRP countries (n = 131) in the first year of the COVID-19 pandemic. The analysis showed that WHO supported all 194 countries regardless of humanitarian vulnerability. Health commodities were supplied to most countries globally (86%), and WHO implemented most (67%) of the $1.268 billion spent in 2020 at country level. However, proportionally more GHRP countries received health commodities and nearly four times as much was spent in GHRP countries per capita compared to non-GHRP countries ($232 vs. $60 per 1,000 capita). In countries with WHO country offices (n = 149), proportionally more GHRP countries received WHO support for developing national response plans and monitoring frameworks, training of technical staff, facilitating logistics, publication of situation updates, and participation in research activities prior to the characterization of the pandemic or first in-country COVID-19 case. This affirms WHO's capacity to scale country support according to its humanitarian mandate. Further work is needed to assess the impact of WHO's inputs on health outcomes during the COVID-19 pandemic, which will strengthen WHO's scaled support to countries during future health emergencies.

Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines-PART I: A Systematic Review on Methodological Quality Using AGREE-HS.

In 2007, the Inter-Agency Standing Committee (IASC) published its guidelines for mental health and psychosocial support (MHPSS) in emergency situations. This was one of the first sets of MHPSS guidelines, developed during the last decades, to aid policymakers and practitioners in the planning and implementation of disaster mental health risk reduction activities. However, the potential merit of MHPSS guidelines for this purpose is poorly understood. The objective of this study is to review available MHPSS guidelines in disaster settings and assess their methodological quality. MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3–5 raters using the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS) instrument. Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0–100, M = 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1–7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. Ideally, knowledge derived from scientific research aligns with the receptive contexts of policy and practice where risks are identified and mitigated.

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Psychosocial and mental health during the COVID-19 lockdown: A rapid qualitative study in migrant shelters at the Mexico-United States border

Introduction. Migrants could be at increased risk of the psychosocial and mental health consequences of the COVID-19 pandemic. Research is needed to assess their needs and the most useful interventions in this regard. Objective. To describe the mental health consequences of the pandemic and lockdown measures among migrants living in shelters in Tijuana, Mexico, during the COVID-19 pandemic, barriers to mental healthcare during this period, and the key elements of psychosocial support provided by civil society organizations (CSOs), as described by shelters’ staff. Method. In April-May 2020, we conducted a rapid qualitative study through interviews with persons providing services at eight migrant shelters, complementing the information with data from an ongoing ethnographic project. We situated the results within the levels of the United Nations’ Inter-Agency Standing Committee (IASC) pyramid of psychosocial and mental health support. Results. In addition to fear of contagion and economic insecurity, migrants experienced emotional distress associated with hardening migration policies, and the difficulties of having to find shelter in place in non-private spaces. Some CSOs continued or adapted previous psychosocial support activities, helping migrants navigate these issues, but other activities stopped amidst physical distancing measures and because of limited resources. Migrants themselves implemented some group activities. There was a surge of civil society initiatives of online support, but some shelters laeked the technological and other resources to benefit from them. Discussion and conclusion. Migrants require a tailor made response to their mental health needs in the COVID-19 pandemic, such as the one provided by CSOs.

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.

Safety and Precautionary Measures for Staff and Students During the Covid 19 Pandemic: A Malawian College of Health Sciences Case

The coronavirus (Covid-19) pandemic is exacting a huge toll on individuals, families, communities and societies across the world [1]. Furthermore, the pandemic has changed the lives of individuals, families, communities and societies globally (Inter-Agency Standing Committee; 2020). The protection of students, staff and educational facilities is particularly important during Covid-19 pandemic [2]. According to the Centre for Health protection [3]

Venezuelan migrants in Colombia: COVID-19 and mental health

Venezuelan migrants in Colombia: COVID-19 and mental health

10 Migrants caught in crises: Contexts, responses and innovation

10 Migrants caught in crises: Contexts, responses and innovation

The case for—and challenges of—faith-sensitive psychosocial programming

Drawing upon evidence compiled in a recent literature review, we identify five arguments for seeking faith-sensitivity in psychosocial programming: it is indicated by the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS); it is implied by humanitarian law and principles; religion is an active and effective source of coping in many contexts; local faith actors have a ‘comparative advantage’ in humanitarian settings; and engaging with religion is coherent with emerging policy and practice. However, we also identify three major challenges in implementing faith-sensitive programming: religion may be used as a basis for maladaptive coping; religious engagement is considered a threat to impartiality; and practices of engaging with religion are poorly documented, disseminated and developed. This suggests the value of guidance on faith-sensitive psychosocial programming—consistent with the existing IASC MHPSS guidelines—suitable for implementation by both faith-based and non-faith-based actors. Key implications for practice The role of faith in supporting well-being and recovery and the importance of engaging with local capacities and institutions both point to the relevance of faith-sensitive psychosocial programming. Humanitarian law and principles promote respect for religious practice and freedom of religion. Humanitarian agencies are potentially discouraged from engaging with religion by concerns about partiality, proselytism and the potential for religion to ferment conflict. There is a need to develop, document and disseminate appropriate faith-sensitive programming practices more effectively.

Operational Guidelines for UNHCR’s Engagement in Situations of Internal Displacement

1 February 2016 ... Annex: UNHCR Interventions in Situations of Internal Displacement (the “IDP Footprint”) This document provides guidance on UNHCR’s engagement in situations of internal displacement. As a complement to existing policy, it clarifies UNHCR’s responsibilities and decision-making within the Inter-Agency Standing Committee (IASC) cluster approach. Importantly, it also provides parameters for UNHCR’s operational engagement, including principles for engagement and interventions to consider in support of UNHCR’s leadership of the clusters for protection, shelter and camp coordination and camp management (CCCM) in a coordinated response. These Operational Guidelines establish institutional standards and parameters for UNHCR’s engagement (or expected engagement) in a coordinated response to internal displacement. They apply to UNHCR Representatives and their teams as well as other staff members at all levels involved in the planning, design and implementation of operations in situations of internal displacement, as well those supporting these operations through the Regional Bureaux and Divisions and Services at Headquarters. These Operational Guidelines complement UNHCR’s existing policy and guidance on internally displaced persons (IDPs) as well as those developed by the IASC following the Humanitarian Reform in 2005 and the Transformative Agenda in 2011.1

Operational Review of UNHCR’s Engagement in Situations of Internal Displacement

September 2017 UNHCR has responded to the needs of internally displaced persons [IDPs] for many decades. In doing so and deriving from its mandate for refugees and stateless persons, it has drawn from an intimate knowledge of forced displacement – its root causes, the protection risks that arise from it and the requirements for sustainable solutions. Alongside other UN agencies and international organizations, UNHCR’s engagement in IDP situations has become more robust in recent years, in particular as a result of the United Nations Humanitarian Reform [2005] and the Inter-Agency Standing Committee [IASC] Transformative Agenda [2011].1 In 2007, UNHCR developed a comprehensive IDP policy,2 which was strengthened in 2016 with the issuance of Operational Guidelines3 and an Internal Note on Protection Leadership in Complex Humanitarian Emergencies.4 Equally important are UNHCR’s Strategic Directions for 2017–2021, which amplify the fundamental purpose of protection in the Office’s pursuits and make IDPs an integral part of UNHCR’s overall response to forced displacement. UNHCR is also an active partner on internal displacement in the IASC, where it leads the Global Protection Cluster [GPC] and co-leads the Global Shelter Cluster and the Global Camp Coordination Camp Management Cluster [CCCM].

Key Considerations: Mental Health and Psychosocial Support, North Kivu, DRC

This brief summarises key mental health and psychosocial support considerations in relation to the response to the Ebola Virus Disease (EVD) outbreak in North Kivu, DRC in August 2018. The brief was last updated on 3 October 2018. The brief is based on a rapid review of existing published and grey literature, existing Interagency Standing Committee Guidance materials, professional ethnographic research in DRC and the experience of previous Ebola outbreaks. It was developed through participatory engagement with in-country practitioners, health officials and local leadership. The development and review of this brief was facilitated by Anthrologica and the Social Science in Humanitarian Action Platform, together with the Department of Mental Health and Substance Abuse at the WHO and the Inter-Agency Standing Committee Reference Group for Mental Health and Psychosocial Support in Emergency Settings. Additional inputs were provided by the Mental Health and Psychosocial Support Working Group in Goma, colleagues from Bethesda Counselling Centre, Universite Chretienne Bilingue du Congo, University of Notre Dame, USAID-IMA World Health, Mercy Corps and Environment Management and Systems. The brief was reviewed by IASC Reference Group members.

Home after Isis: A study of Return as A Durable Solution in Iraq

Return to one's place of origin is considered to be one of the three ‘durable solutions’ whereby the displaced can effectively end their situation of displacement. However, to consider return to the place of origin, which in many cases has been transformed by war and conflict, without considering the conditions that people have returned to is to elide a whole host of challenges facing people upon their return. In Iraq, as military actors have reclaimed territory from the Islamic State of Iraq and Syria (ISIS), internally displaced persons (IDPs) have begun to return to their homes in these liberated areas. While the liberation of these territories from ISIS signals the beginning of the end of a conflict that has persisted for almost four years, preliminary data from an International Organization for Migration (IOM) and Georgetown University longitudinal study on displacement in Iraq reveals that the security and material conditions for returnees are precarious. Using the Inter-agency Standing Committee (IASC) Framework on Durable Solutions for Internally Displaced Persons, which offers criteria for whether a durable solution has been accessed, our paper draws on quantitative data and qualitative interviews with returnees to explore the material and security conditions for recent returnees and the strategies returnees employ to cope with these issues.

Alcohol and substance use in humanitarian and post-conflict situations

A wide range of substance use problems are prevalent in a variety of humanitarian settings. The Inter Agency Standing Committee (IASC) guidelines on mental health and psychosocial support during emergencies highlights that during humanitarian and post conflict situations, substance use is associated with problems including gender-based violence, organized crime and the serious neglect of children. Although substance use is a public health issue in humanitarian settings it has always been a neglected area of public health with very limited information available in both published and grey literature on this matter. This review presents an overview of the problem and existing assessment and interventions tools to address substance use in conflict and post-conflict situations.

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.

THE INFLUENCE OF INTERNALLY DISPLACED PERSONS ON THE SOCIAL AND ECONOMIC DEVELOPMENT OF REGIONS IN UKRAINE

In terms of the issues aggravation concerning internally displaced persons and the disproportions in the social and economic development of regions as a result of the antiterrorist operation in Ukraine, an analysis of social and economic transformations in regional development under the migration processes influence and the search for their overcoming mechanisms becomes relevant. The purpose of the article is to analyse the impact of internally displaced persons flows on the social and economic development of regions in order to improve the regional development mechanisms in Ukraine. The research methodology includes a set of scientific research methods that provide a systematic approach to investigating the impact of internally displaced persons on the social and economic development of Ukrainian regions, theoretical approaches to state regulation of internal migration flows in conditions of decentralization of power and reform of public administration in the country. In the course of investigations, the following methods are used: statistical analysis and synthesis while determining the indicators of the IDPs burden on the regional social and economic systems of Ukraine; analysis while studying the main problems of internally displaced persons and their directions; logical synthesis and synthesis while drawing conclusions. The information base for the study consists of the legislative acts of the Verkhovna Rada of Ukraine, the Decree of the Cabinet of Ministers of Ukraine, statistical and reporting information of the Ministry of Social Policy of Ukraine, development of the UN Agency for Refugees, the UN ReliefWeb Specialized Service for the Coordination of Humanitarian Affairs, Inter-Agency Standing Committee, PROMAN, NGO “Labor and Health Social Initiatives”, Ukrainian Helsinki Human Rights Union, research results of domestic and foreign scientists. Results. The article deals with the issues of effective reforming of regional development mechanisms related to solving the internally displaced persons’ issues and their impact on social and economic processes in the regions. The internally displaced persons’ influence analysis on the regional social and economic systems of Ukraine was conducted. The analysis allowed determining the rating of five regions with a significant load of IDPs and identifying the social and economic system in the region and the acutest elements. Practical implications. The peculiarities of internally displaced persons’ migratory flows by regions and their impact analysis on the social and economic development of regions and Ukraine as a whole are to be investigated. Value/originality. The ways of positive social and economic dynamics of regional development enhancement due to the programs and regional development strategies correction, taking into account the resource potential of the IDPs in some areas, are proposed.