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Key facts

• People are more likely to suffer from a range of mental health problems during and after emergencies.
• Children, including adolescents, people with health conditions such as pregnant women and frail older adults, and people at risk of discrimination are most likely to need special attention in a crisis.
• People who feel safe, connected, calm and hopeful; have access to social, physical and emotional support; and find ways to help themselves after a disaster will be better able to recover long-term from mental health effects.
• Key signs of distress include physical symptoms such as headaches, fatigue, loss of appetite, aches and pains; grief and crying; insomnia and nightmares; survivor guilt; disorientation and confusion.
• WHO and partners have developed an intervention pyramid – from basic services and actions at the base to highly specialized at the top – to help countries match response strategies with community needs and appropriate expertise.
• Most people will recover well over time, if they are able to restore their basic needs and get support when they need it.

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Background

During and after emergencies, people are more likely to suffer from a range of mental health problems.

Some people develop new mental disorders after an emergency, while others experience psychological distress. Those with pre-existing mental disorders often need more help than before.

WHO-recommended psychological first aid involves humane, supportive and practical help to people who are suffering after crisis events. This support should be provided to people in ways that respect their dignity, culture and abilities. It covers both social and psychological support.

Psychological and psychiatric help need to be made available for specific, urgent health problems and led by mental health professionals as part of the health response.

Impact of emergencies

Some problems are brought on by the emergency, some by the response to the event, and others are pre-existing or more serious.

• Significant social problems are:
  • emergency-induced: family separation, safety, discrimination, loss of livelihoods and the social fabric of everyday life, low trust and resources;
  • humanitarian response-induced: overcrowding, lack of privacy in camps, loss of community or traditional support;
  • pre-existing: belonging to a marginalized group.
• Problems of a more psychological nature are:
  • pre-existing: people with depression, alcoholism or severe mental disorders such as schizophrenia;
  • emergency-induced: grief, distress, alcohol and substance abuse, depression and anxiety, including post-traumatic stress disorder (PTSD);
  • humanitarian-response induced: anxiety due to a lack of information about food distribution, or how to obtain other basic services.

Symptoms of distress

Some common ways that people show their distress in reaction to a crisis are:

• physical symptoms: headaches, fatigue, loss of appetite, aches and pains
• crying, sadness, grief
• anxiety, fear
• being on guard, or jumpy
• insomnia, nightmares
• irritability, anger
• guilt, shame (so-called survivors guilt)
• confused, in a daze
• withdrawn, or very still (not moving)
• disorientation (not knowing their name or where they are from)
• not being able to care for themselves or their children.

Not everyone who experiences a crisis will need or want support.

Most people will recover well over time, if they are able to restore their basic needs, find ways to return to normalcy, and get some support when they need it.

Who is most at risk?

People who are likely to need special attention in a crisis are:

• Children – including adolescents – especially those separated from caregivers. They need protection from abuse, exploitation and help to meet their basic needs. In general children cope better when they have a stable, calm adult with them.
• People with health conditions or disabilities, pregnant women and frail older adults – for protection from abuse, how to find a safe place and help to meet their basic needs. These groups should be asked about special health needs, such as medicines or care, to assess their needs and help them find services.
• People at risk of discrimination or violence, such as women or people of marginalized ethnic backgrounds – they may need special protections to be safe. This group benefits from information on targeted assistance and helping them to link with available services.

Effective community response

• Evidence and experience show that people who feel safe, connected, calm and hopeful; have access to social, physical and emotional support; and find ways to help themselves after a disaster will be better able to recover long-term from mental health effects.
• WHO and partners have developed an intervention pyramid – from basic services and actions at the base to highly specialized at the top – to help countries match response strategies with community needs and appropriate expertise. For example, clinical mental health services at the apex of the pyramid should be provided under the supervision of mental health specialists such as psychiatric nurses, psychologists or psychiatrists.
• Psychological first aid can be provided by field workers, including health workers, teachers or trained volunteers, and does not always need mental health professionals.
• Distressed people can benefit from psychosocial support during or immediately following an event.

Looking forward: emergencies can build better mental health systems

In spite of their tragic nature, many countries have capitalized on emergency situations to build better mental health systems. The surge of international donor aid combined with increased attention to mental health issues creates opportunities to improve mental health care.

Examples of progress

• Following the tsunami of 2004, mental health services in Indonesia’s Aceh province were transformed from a sole institutional hospital to a functioning system of care, revolving around primary health care services and supported by secondary care through general hospitals.
• The influx of displaced Iraqis into Jordan enabled pilot community-based mental health clinics to be established. The success of these clinics built momentum for broader reform across the country.
• Sri Lanka was able to capitalize on the resources flowing into the country following the 2004 tsunami to leap forward in the development of its mental health services. Today, this community-based mental health system reaches most parts of the country.

We know from these and other experiences from around the world that it is possible to build mental health systems in the context of emergencies.