Field Notes

• Field Notes

Field Notes

Psychosocial Interventions in Humanitarian Settings

By Mary Jo Baca

Mental illness is one of the great invisible burdens on developing societies, accounting for four of the 10 leading causes of disability worldwide. In emergencies and conflict zones, the problem is greater still, as the percentage of the population suffering severe mental disorders rises and those with pre-existing mental illness are exposed to new levels of stress.

 The World Health Organization (WHO) estimates that 450 million people worldwide suffer from mental or behavioral disorders or psychosocial problems, and that one person in four will be affected by a mental disorder at some stage of life. Mental and neurological disorders account for 14 percent of the global burden of disease and contribute 28 percent of the burden of disease attributed to non-communicable diseases.

The drag of mental illness on many of the world’s weakest nations, coupled with an alarming shortfall in treatment, led International Medical Corps to make sustainable, accessible mental health care a cornerstone of its relief and development programming.

In the Middle East, the inherent complexities of problems, including war, sectarian violence, and displacement, have significantly affected the mental health and psychosocial well-being of large portions of the population. For instance, a 2007 International Medical Corps report on Iraqi displacement found that many refugees from Iraq were dealing with immense psychological trauma, with up to a quarter of the population exhibiting some form of mental/psychological disorder.

In particular, refugees who have fled violence and persecution possess very specific psychosocial needs that often differ from non-refugee populations. Many refugees are coping with collective and individual emotional stress due to the dire circumstances they have fled, compounded by living displaced in countries where they often cannot legally work, lacking access to adequate services, and being targeted frequently for discrimination and harassment.

Developing Innovative, Tailored Approaches

Key to tackling such complex and increasingly protracted challenges is ensuring that mental health and social services are affordable and equitable so that all levels of society can access them. International Medical Corps provides mental health and psychosocial services in Iraq, Lebanon, Jordan, Syria and Gaza that are free – or in rare cases offered for an extremely nominal fee. Although program activities vary according to the localized needs and contexts, International Medical Corps’ approach throughout the region focuses on direct intervention and advocacy, with mental health services that are integrated into primary health-care services that target vulnerable populations.

Aside from being cost-effective, offering services through existing primary health-care centers at the community level is an accessible, non-stigmatizing way to provide local populations assistance for mental disorders without overtly singling out those who require subsequent treatment. A key aspect of our strategy is to train local paraprofessionals to recognize and treat the signs of mental disorders as part of mainstream community level primary health care, and to work at the grassroots level to change attitudes towards the mentally ill.

These programs build on International Medical Corps’ years of experience delivering mental health-care services in emergency settings – work that included evidence-based research on depression rates among populations in Iraq, Darfur and the United States after Hurricane Katrina.

The Story of Mohammed

Mohammed is a 6-year-old boy from Baghdad who currently lives in Jordan with his mother. They fled Iraq when he was four years old. International Medical Corps began working with Mohammed when he was identified by his teacher as exhibiting troubling classroom behaviors, including angry outbursts and physical and verbal aggression toward others.  His teacher described him as “hopeless.”

Mohammed was referred by his teacher for a mobile medical screening facilitated by International Medical Corps. The team that conducted an initial screening assessed Mohammed as being in good physical health but identified unusually anxious behavior in him outside of his mother’s presence.

Mohammed was then referred for a complete bio-psychosocial assessment to be conducted by an International Medical Corps case manager working with school medical teams. During the course of the assessment it was learned that Mohammed had been in five different schools that year alone due to his uncontrollable and unpredictable behaviors.

International Medical Corps established a small multidisciplinary team that included his mother, school officials and mental health professionals to create an individual care plan for Mohammed. The plan clearly described the roles and responsibilities of Mohammed’s mother, teacher and International Medical Corps case manager. The plan was kept simple and included a common approach to re-directing Mohammed in a non-punitive and consistent manner. Importantly, mom and teacher communicated regularly through daily progress notes and bi-weekly meetings.

The care plan allowed Mohammed more time to transition among activities and a clear and structured daily schedule. In the beginning, Mohammed’s mother accompanied him into school, but after a two-week period of diligently following the plan, she was able to drop him off before school and pick him up at the end of the day. In addition, she was referred to supportive services at a local center with a women’s group in consideration of her own individual well-being.

Today, for the first time, Mohammed is able to cite his favorite subjects in school. He willingly completes his homework before playtime, has made four best friends, and has successfully completed kindergarten. He is now thriving in first grade.

Mohammed’s story is proof in the powerful efficacy of programs that facilitate collaboration, and identify and draw from existing strengths and resources within families and communities. 

Mary Jo Baca is the Psychosocial technical advisor at International Medical Corps.