IMC CAPABILITY STATEMENT
Worldwide , mental illness accounts for 6 of the top 20 leading causes of disability and is the most prominent non-communicable disease, affecting more than 450 million people worldwide. Despite this, only a small percentage of the global population has access to the most basic treatment. IMC stands out as one of the very few agencies that endeavor to address the mental health needs of affected populations with sustainable and accessible services. IMC has played an important role in developing the evidence base for mental health care as an active member of the IASC task force on Mental Health and Psychosocial Support which has produced guidelines reflecting the current global consensus on best practices for mental health and psychosocial programs in emergencies. In addition it collaborates with Fordham University’s Center for International Health and Cooperation and Healthnet TPO in delivering an intensive Mental Health in Complex Emergencies Course for Mental Health professionals and other paraprofessionals wishing to establish mental health programming in Emergencies.
IMCs approach to the mental health needs of disaster and war affected populations is two-fold: We work to address both individual and clinical needs and the broader needs associated with community revitalization. In practice this means firstly developing interventions which address the full range of psychiatric disorders facing communities- including pre-existing mental health problems- not just those that occur as acute or longer term responses to disasters or emergencies. Interventions are both preventative, involving community education through a variety of means; and curative, providing treatment. Secondly, we develop any social activities that help communities rebuild social networks, foster resilience, coping and a sense of normalcy. These include safe play spaces for children, developing child protection programs and providing micro-credit and other livelihood opportunities for adults. This combination aims to provide a continuum of care embracing preventative, curative, and rehabilitative services.
Governments now generally recognize that community based mental health services are the most sustainable, accessible and least stigmatizing way of delivering mental health care. IMC works in collaboration with local Ministries of Health to help integrate mental health services into the primary health care (PHC) system and establish appropriate lines of referral to hospital-based specialist services (where they exist).
IMC understands that direct services by relief organizations are essential in the acute phase of an emergency. However, we also work to ensure long term sustainability of our mental health interventions through local capacity building. These efforts include training of national PHC staff (physicians, nurses, midwives, community health workers among others) to integrate provision of mental health care into their clinical and public health practices. Further, we assist in the development of more specialized mental health staff such as community mental health nurses, who work alongside PHC teams providing mental health consultations within the primary health care setting. Training takes the form of continuing theoretical education and on the job supervision by specialized mental health professionals.
Over the past 5 years IMC has implemented mental health and psychosocial programs in a wide variety of contexts, including mental health and psychosocial programming for the war-affected population in the Lebanon; ex-combatants in Sierra Leone; refugees in Chad and Ethiopia(funded by UNHCR); survivors of natural disasters in Indonesia, Sri Lanka, and Pakistan with particular focus on IDPs; as well as school children coping with devastating losses following Hurricane Katrina in the U.S. Gulf Coast.
Sierra Leone
IMC conducted a pilot mental health program in Kailahun to integrate sustainable mental health services into the community’s health care system. Among the 300 thousand residents it found a high percentage of the population suffered from serious, long-term mental health problems. Most were young men, either returning refugees from Guinea or Liberia or ex-combatants. If left untreated the men were clearly risks to the community’s fragile stability- either as targets of recruitment back to war or as potential criminals. To address the problem, IMC conducted a pilot mental health program through which it trained community mental health officers to oversee the district’s clinical mental health services. In addition it trained 55 health care paraprofessionals at 52 peripheral health units to identify and treat common psychiatric conditions, refer difficult cases and conduct mental health education.
Chad
In Chad, with support from UNHCR, IMC developed a program aimed at positively impacting the mental and psychosocial well-being of Sudanese refugees through provision of culturally sensitive and quality preventive and curative services. Services reflect IMCs continuum of care model, covering areas of case identification, assessment, management and reintegration into the community. The program builds the capacity of the local health care network at every step through mental health care training for Community Health Workers (CHWs), Social Work Assistants (SWAs), traditional healers, Primary Health Care workers and teachers to identify, treat or refer mental health patients to IMC-established Mental Health Clinics.
Pakistan
In response to the emergency needs caused by the devastating earthquake, IMC initiated an extensive mental health training program, in the Northern Frontier Province which enabled IMC PHC staff to effectively integrate mental health into their normal practice at camps and via mobile teams. Training has enabled them to recognize and treat minor and moderate disorders and set up appropriate referral services.
In addition, IMC further expanded into activities that combined community psychosocial support and non-stigmatizing clinical services for those with more severe mental health problems. Further, IMC contributed to the community revitalization process by organizing recreational facilities with the help of local communities.
IMCs mental health approach in Pakistan has led to greater awareness at various levels, including the Ministry of Health. They have acknowledged the need for access to integrated mental health services at primary health care levels. As a result, the Ministry of Health plans to establish a wide scale training program which mirrors IMCs mental health and psychosocial program targeting primary health care staff, Lady Health Visitors and Lady Health Workers, effectively building capacities.
Sri Lanka
IMC’s mental health programs in Sri Lanka exemplify the same mental health model applied in the context of a rapid response emergency. The December 26, 2004 tsunami left thousands of survivors severely traumatized by intense grief and fear. Despite extensive need for mental health care, Sri Lanka had virtually no mental health infrastructure in place prior to IMC’s integration of its mental health model into the countries’ primary health care systems.
IMC will have contributed to the development of a Universal Mental Health Curriculum for Sri Lanka in coordination with the World Health Organization and the Ministry of Health. In addition, in Ampara, Batticaloa and Hambantota Districts, the number of multi-sectoral providers trained in accordance to the National Mental Health Strategy exceeds 900 (including MOH’s, Public Health Midwives, Public Health Inspectors and Community Support Workers). By the end of its Mental Health projects in Sri Lanka, it is expected that mental health services will be available to a combined population of 900,000 in the Eastern and Southern Provinces.
In Sri Lanka, World Health Organization and the Ministry of Health fully recognize IMC as the leading agency in Mental Health in Sri Lanka and are fully supportive of IMC’s efforts to restructure the Health system and strengthen Mental Health capacity across all tsunami affected areas.
