MHPSS Issues

1. Mental health and psychosocial support after the recent violence in Gaza Christine Gale, UNICEF JerusalemRaijah Abu Sway, WHO Jerusalem11 February 2009IASC Weekly

2. MHPSS Issues • Recent violence comes on top of years of occupation, restriction, loss and economic deprivation • Unprecedented scale and type of violence during recent conflict has created profound and enduring sense of despair, indignity and fear “This was different this time” • Multiple sources of ongoing fear and anxiety: Continuing insecurity, difficulties in meeting basic needs and uncertain future • Demand for accountability. If not delivered likely to undermine belief in justice and rule of law

3. MHPSS problems/capacities • Rates of mental disorders very difficult / too early to measure but severe disorder projected to be 3-4 % • All reactions to be seen in context of pre-existing mental and social problems, including misuse of the substance tramadol • Resiliency: Despite intense sadness and distress, many members of the population continue to function and provide social support to each other

4. Context Strong pre-existing mental health and psychosocial services and supports • Well developed, experienced programming on MHPSS • Most government mental health services have resumed function as before • Same is true for most psychosocial activities Extremely restricted humanitarian access • Poor and highly unpredictable access for UN international staff (due to IDF changing rules and tight UNDSS rules) • Very restricted access for INGOs (due to severe IDF restrictions)

5. Key determinants of Mental Health and Psychosocial Wellbeing • Safe and secure environment is foundation of Mental Health and Psychosocial Wellbeing “The improvement of human security is the probably the most important psychosocial boost you can give the population. If there is no change towards a political solution and people remain under threat, the provision of psychosocial support alone will have limited impact” Member of the MHPSS working group • Need to reestablish basic services in a way that supports Mental Health and Psychosocial wellbeing e.g. safe and supportive education • Need to provide mental health and psychosocial interventions, integrated in other sectors

6. The coordination challenge • Numerous actors in mental health and psychosocial supports (MHPSS) (eg more actors than in "Health or Education Cluster") • Largest Flash Appeal ever for MHPSS (38 million dollars) • Need to update the coordination mechanism to address new challenges • Strengthen collaboration between mental health and psychosocial • Reinforce coordination capacity in Gaza to deal with scale of challenge

7. Planned MHPSS in humanitarian coordination in Gaza Humanitarian Coordinator Health Cluster Protection Cluster (with Child protection Sub-cluster) Education Cluster MHPSS inter-sectoral coordination subgroup

8. Key Coordination actions • Dedicated MHPSS coordination group established building on existing coordination mechanism • MHPSS coordination group under health and protection clusters • Gaza coordination lead by UNICEF WHO UNWRA • Technical Support Unit will provide strengthened capacity to Gaza group • Liaison between West Bank and Gaza MHPSS coordination groups ongoing • Roll-out of IASC MHPSS Guidelines to provide strategic planning framework and technical guidance on good practice • Mapping of responses and identification of gaps ongoing

9. Intervention Challenges • Intense, multiple and sustained stressors to wellbeing • Existing referral and support systems and services severely strained • Access almost non-existent for necessary additional human resources to support coordination, provide technical expertise, training and staff support • Changing poor practice e.g. Psychological debriefing widely used despite its ineffectiveness and possible harmful effects when misapplied; counselling training initiatives without supervision • A relative over-focus on services provision vis-à-vis other supportive interventions outlined in the IASC Guidelines e.g. community mobilisation • Difficulty of consistent inter-agency planning for support and services in highly politicised, restricted environment

10. MHPSS Programming • Build capacity of primary health care (PHC) workers to address MH issues • Building overall mental health system (early recovery) • Integration of psychosocial support in Early Childhood Development centers • Psychosocial support through education system (teachers, school counsellors) • Recreational and sporting activities and child friendly spaces • Range of counselling activities (individual, group) • Awareness raising on MHPSS issues • Staff care: support to professionals and front-line workers

11. Key opportunities • Strengthen sustainable systems for MHPSS • Planned interagency assessment based on pre-existing baseline • Operationalise MHPSS intersectoral group as per IASC MHPSS guidelines • Expand MHPSS interventions to other sectors not previously addressed e.g. shelter, food, nutrition • Opportunity to strengthen community mobilisation • Prioritise information to the population • Highlights the need to address environment as part of MHPSS response