In the new issue of Intervention the central theme is integrating mental health into existing health systems during and after complex emergencies. This is a theme HealthNet TPO works on in all its programmes. Fifteen articles describe a wide range of experiences in a variety of contexts. Such as after devastating earthquakes (Haiti and Peru), after a tsunami (Sri Lanka), or countries recovering from armed conflict (Iraq, Uganda and Burundi), countries dealing with occupation (Palestinian territory) with authoritarian rule (Equatorial Guinea) or countries dealing with influx of large groups of refugees (Lebanon, Syria and Chad).
Some of the articles are (co-)written with HealthNet TPO staff. Editor in chief is Peter Ventevogel, technical advisor with HealthNet TPO and psychiatrist with a long experience in developing mental health care systems in (post) emergency settings. The special issue can be consulted on www.interventionjnl.com, or see the electronic table of contents: http://journals.lww.com/interventionjnl/pages/currenttoc.aspx
Please find the abstracts of the articles written by HealthNet TPO staff below:
Iraq and mental health policy: a post invasion analysis
(Sonali Sharma & Jack Piachaud)
The Iraq war, and the subsequent involvement of various stakeholders in the post conflict reconstruction of the health sector, presented an opportunity to learn about mental health policy development, challenges and obstacles within a post conflict context in 2003.This paper documents and explores mental health policy in post invasion Iraq, using qualitative methods and a health policy framework that analyses context, content and process. Findings indicate that there are many challenges, both in repairing an already weakened health sector, and in maintaining mental health as a health priority. In addition to security issues, fragmentation of power, change of leadership and lack of funding pose significant problems. Achievements are evident, though insufficient to address the overall mental health burden. The policy process is examined over a four-year period. Lessons learned are presented as best practice guidelines for post conflict mental health reconstruction.
Psychosocial assistance and decentralized mental health care in post conflict Burundi 2000 – 2008
(Peter Ventevogel, Herman Ndayisaba and Willem van de Put)
In 2000 the nongovernmental organization (NGO) HealthNet TPO started mental health and psychosocial support services in Burundi, a country that has been severely affected by civil war. Within a time frame of eight years, a wide range of mental health and psychosocial services were established, covering large parts of the country. During the programme period the NGO activities shifted from the delivery of direct services to capacity building activities aimed at embedding psychiatric services and psychosocial assistance within existing local health services and social systems. Among the strategies used were 1) training and supervision in mental health for government nurses and doctors in provincial hospitals, 2) training in psychosocial assistance and supervision of governmental social workers, and 3) building the capacity of psychosocial volunteers and local community based organizations. The handover of mental health and psychosocial services presented formidable challenges arising from difficulties for the state in sustaining mental health and psychosocial services within their systems, and from difficulties for users in contributing financially to the provision of services. Major lessons are that installing basic mental health within general care should be firmly rooted in a general health-system-strengthening approach and also that healing the social wounds of war should be embedded within an approach to strengthening ‘community systems’.
Perez-Sales, one of the editors, stresses the importance of this theme:
‘In aid work one often makes a distinction between humanitarian and development aid. This distinction is more theoretical than real. It is well known that the impact of a disaster (and the possibility to confront it effectively) depends strongly on the social, political and structural conditions of the community in which the event occurred. Real aid should go beyond palliative actions to alleviate the immediate needs of survivors Real aid should also consist of a comprehensive set of actions that work towards a longer term goal.
The World Health Organization and experts agree that probably the biggest global mental health challenge for the twenty-first century is the effective introduction of mental health into primary care health. Access to mental health care is a basic human right. The challenge is to reflect on how emergencies (acute or chronic) may provide opportunities for strengthening local mental health systems.
This special issue demonstrates the emerging consensus about good and bad practices. It is simply not acceptable anymore to spend huge sums of money on short-term mental health programmes that ignore the reality of the communities. Existing resources must be optimized to ensure that humanitarian aid has a genuine transformative power.’