IASC Guidelines

1. IASC Guidelines "A significant gap has been the absence of a multi-sectoral, inter-agency framework that enables coordination, identifies useful practices, flags harmful practices and clarifies how different approaches to mental health and psychosocial support complement one another."

2. Brief orientation on the IASC Guidelines on Mental health and Psychosocial Support in Emergencies By Mark van Ommeren, WHO Genevaand Amanda Melville, Ramallah 10 Feb 2009

3. Introductions and agenda • Handouts • Brochure with matrix • Print out of Field Use Version • Full Guidelines on CD ROM (explain) • True False Exercise • Local expertise • Personal thoughts

4. IASC Task Force: UN and non-UN agencies wrote Guidelines INEE IRC MdM-E Mercy Corps MSF-H Oxfam GB RET SC/UK SC/USA Ref Group now also has: • CARE Int. • Ch of Sweden • COOPI • GP-SI • RedR • REPSSI • TdH • UNRWA • World Vision ACF Am. Red Cross ACT International Action Aid International CARE Austria CCF HealthNet TPO IMC ICMC ICVA IFRC Interaction IOM OCHA UNFPA UNHCR UNICEF WFP WHO

5. Exercise 1: First reaction(1 minute) • Reflect on experiences that you had or aware of related to mental health and psychosocial support during and after emergencies. • Reflect on the following question. Is there a potential need for applying here internationally endorsed inter-agency mental health and psychosocial support guidelines?

6. Some typical answers to this exercise are Inter-agency guidelines are needed but • Should be culturally sensitive/adaptable • Should take local situation, capacities and resources into account • Should cover/not cover/ go beyond posttraumatic stress disorder (PTSD) • Should cover staff welfare • Should give advice on how to avoid harmful interventions and 'parachuting' foreign clinicians • Should discuss coordination

7. Inclusive framework: mental health and psychosocial support covers both • protecting or promoting psychosocial well-being and/or (b) preventing or treating mental disorder. PS MH

8. On problems and resources - Emergencies erode normally protective supports and increase risks for a range of problems - Most people have some access to resources (helpers, beliefs) that can be supportive and a very effective way of helping them is to build on existing social support networks (e.g. supporting parents/teachers, getting isolated elderly into community activities)

9. Diverse needs in midst of emergencies • pre-existing social problems • E.g. marginalization • emergency-induced social problems • E.g. family separations, loss of jobs, protection threats • pre-existing psychological/psychiatric problems • E.g. psychosis, severe alcohol use, depression • emergency-induced psychological/psychiatric problems • E.g. normal fear (past, present, future), depression, PTSD • humanitarian aid-induced problems • E.g. conflict between communities, anxiety about lack of information on distributions,

10. Core Principles Human rights and equity Participation Do No Harm Building on available resources and capacities Integrated support systems Multi-layered supports

11. Matrix of Mental Health and Psychosocial Support: All Have Impact on Protecting Well-being Coordination Assessment, monitoring and evaluation Protection and human rights standards Human resources Community mobilisation and support Health services Education Dissemination of information Food security and nutrition Shelter and site planning Water and sanitation 11

12. Specialised services Focused, non-specialised supports What %? Community and family supports Social and psychological considerations in basic services and security 12

13. Level 1: Social and Psychological Considerations in Basic Services and Security All members of the community have responsibility to ensure there is a suitable environment for psychosocial development. These activities help to establish a suitable environment to protect and promote psychosocial healing and well-being. Usually these programmes are conducted by other organisations or under an existing sector Psychosocial and mental health programmes should advocate for ensuring these basic needs are met • cooperate with sectoral programmes to ensure that are implemented in a way that supports psychosocial development and healing

14. Level 1: Social and Psychological Considerations in Basic Services and Security • Document impact of lack of services and security on MHPS wellbeing and use this for advocacy • For children, advocate for the protection of children from violence, abuse and exploitation, the promotion of family unity, re-establishing safe and supportive education • Advocate for delivery of humanitarian assistance in a manner that promotes well-being • Work to promote ways of delivering aid that promote self-reliance and dignity • Facilitate community involvement in decision-making and assistance • Disseminate essential information to affected populations on situation and emergency response

15. Level 2: Community and Family Supports • Support play, art, recreational and sporting activities • Provide structured groups activities for expression and the development of life skills and coping mechanisms • Support children and youth friendly spaces/environments • Promote meaningful opportunities to participate in rebuilding society • Provide information on positive coping mechanisms • Activities that facilitate the inclusion of isolated individuals (orphans, widows, widowers, elderly people, people with severe mental disorders or disabilities or those without their families) into social networks;

16. Level 2 (cont’d) Strengthening the family: • Provide culturally appropriate guidance on how parents and family members can help children • Support parents and families to cope with their own difficulties • Support and facilitate the establishment of parent groups/committees • Early childhood stimulation (with nutrition) • Informal family visits for caregivers in need of extra support • Support family access to basic services

17. Level 2 (cont’d) Strengthening community supports: • Helping caregivers and educators to better cope and to support children • Strengthen community based supports for adult caregivers • Strengthen child-to-child or youth support • Resumption of cultural and spiritual activities, including appropriate grieving rituals • Strengthening social networks • teacher training on psychosocial care and support • Group discussions on how the community may help at-risk groups identified in the assessment as needing protection and support

18. Level 3: Focused Supports For people who are: • struggling to cope within their existing care network • Not progressing in terms of their development • Unable to function as well as their peers • In need of activities that address their psychosocial needs more directly

19. Level 3 (cont’d) • Focused psychosocial support activities require trained and experienced staff • Activities may include: • Case management • Family visits • Psychological first aid • Support groups • Structured play activities • Psychosocial hotlines • Non-clinical family or individual counselling (e.g. school counselling)

20. Level 4: Specialized Services • Traditional specialized healing (e.g. cleansing and purification rituals) • Clinical social work or psychological treatment • Psychotherapy • Drug or alcohol treatment • Specialised mental health care

21. Specialised services Focused, non-specialised supports What %? Community and family supports Social and psychological considerations in basic services and security 21

22. Multilayered support What does this exercise suggest? Need to ensure support is appropriately divided across layers with good coordination/referral E.g. not focused only at clinical level (e.g. Bosnia) or at social level (e.g. Uganda) Many of the professional animosities disappear as soon as one adopts a pyramid model of multi-layered supports with different tasks for different sectors 22

23. Exercise 2: Do's and Don’t's(15 minutes) • Purpose: to learn whether the contents of the IASC Guidelines are relevant to some issues of concern here in Gaza • 20 minutes: Fill in the TRUE OR FALSE questionnaire together with somebody in the room who you do not know • Followed by presentation on Do's and Don’t's as in the IASC Guidelines

24. TRUE OR FALSE? • It is good to provide single-session psychological debriefing for people in the general population as an early intervention • It is good to organise access to a range of supports, including psychological first aid, to people in acute distress after exposure to a very stressful or traumatic event • Methods from abroad are always better than local supportive practices and beliefs. • It is good to learn about and, where appropriate, use local cultural practices to support local people. • It is good to establish screening for people with mental disorders even without having in place appropriate and accessible services to care for identified persons. • The main issue is that everybody is traumatised, • It is good to use one-time, stand-alone trainings or very short trainings without follow-up to prepare people to do complex psychological interventions

33. Psychological debriefing? • It most probably does not prevent mental health problems (general distress, depression, PTSD etc) • Most probably it is not harmful • But . . . many recipients like it! • As stand-alone intervention it most likely wastes resources • Recommendation: No debriefing but rather psychological first aid

34. What is psychological first aid? • often mistakenly seen as a clinical or emergency psychiatric intervention. • humane, supportive response to a fellow human being who is suffering and who may need support. • it does not necessarily involve a discussion of the event that caused the distress. • Aspects: (1) protecting (2) listening (3) identifying basic needs and ensuring they are met (4) raising social support

35. Exercise 3: Gaza(20 minutes) • Small group discussion • (20 minutes) Please reflect on the following question: how can the Guidelines be used in Gaza? • Come back to plenum and give a 3 sentence summary of your discussion • Plenum discussion

36. Examples from elsewhere • Used for identification of gaps in Philippines • Use picture version to mobilize community in Peru • Influenced a lot of PS programming in Jordan • Moved people beyond counselling in Kenya • Adopted by 4 ministries Gov in Philippines as policy • Training in Iran informed by and consistent with IASC • Some donors only fund consistent with IASC Guidelines • Highlight importance of engaging with unusual sectors on MHPSS

37. Mapping MHPSS using guideline matrix Complete matrix: each group completes one page

38. Key messages • IASC Guidelines provide a common framework and language to communicate and coordinate with one other during large crises • There is substantial technical know how on how to meaningfully reduce suffering and this involves different types of complimentary supports • Using them effectively must be an ongoing process involving multiple humanitarian actors