About the International Medical Corps' Toolkit for the Integration of Mental Health into General Healthcare in Humanitarian Settings
Mental health problems are an important public health concern in humanitarian crises.
Mental illness affects one in four people during their lifetime and is the main cause of disability worldwide. Populations in humanitarian contexts are especially at risk for developing mental health problems due to their exposure to violence, loss of homes, livelihoods, and loved ones, instability of community or social support systems and damaged health infrastructure. Those with pre-existing and chronic mental problems are especially vulnerable and need access to care. Mental disorders in humanitarian settings impair day-to-day functioning and are key barriers to accessing essential services and support needed to recover from conflict and crises.
“International Medical Corps has been implementing programs integrating mental health into general health care for more than ten years in over 15 countries including Jordan, Syria, Gaza, Iraq, Turkey, Lebanon, Philippines, Indonesia, Sri Lanka, Afghanistan, Pakistan, Nepal, Sierra Leone, Liberia, and Haiti."
Availability of appropriate and integrated mental health services remains a critical gap in countries affected by humanitarian crises1. The majority of people in such settings do not receive treatment and there are not enough specialists such as psychologists and psychiatrists. A key strategy for closing this treatment gap is integrating mental health care with general health which is more sustainable, less stigmatizing, more accessible and reaches larger segments of the population (WHO, 2009).
Global guidelines and resources to implement integrated mental health services exist, but there is a need to increase understanding, dissemination and uptake. Staff at agencies who are designing, supporting or implementing integrated mental health programs, are often unaware that these resources exist or do not know how to use them. This can be especially challenging in humanitarian crises with many different actors, weak or absent of MHPSS coordination mechanisms and the need to make quick funding and programmatic decisions. This toolkit aims to support agencies to better plan, design, and implement more comprehensive, effective, and sustainable programs.
“The Toolkit aims to increase understanding of integrated mental health program steps, components, resources and tools among implementing partners, donors and governments. It clearly outlines the steps for integrated mental health programs in humanitarian settings and provides valuable guidance for better resource allocation, program design, contextualization, implementation and evaluation.”
This toolkit is primarily intended for (1) implementing agencies but may also be useful for (2) donors and (3) government actors.
The toolkit aims to inform the response to acute, slow-onset and protracted humanitarian emergencies in different contexts including urban, rural and camp settings, primarily in low and middle-income countries that face constraints and complex challenges including limited human and financial resources for addressing increased mental health needs.
The toolkit includes resources to help agencies and decision makers understand what needs to be implemented, based on the latest global guidelines and evidence on effective mental health integration programming in humanitarian settings, while also including specific field examples. Although there are core steps and cross cutting components that all agencies implementing, supporting or funding integration programming should consider, it is important to acknowledge that every integration process will be unique. For each situation, programs need to be adapted and tailored to (1) different existing capacities and human resources, (2) different systems and contexts, (3) cultural and language considerations, as well as (4) specific needs and priorities that guide design and implementation of programming.
For additional information on translation of resources & instruments, access WHO’s Process of translation and adaptation of instruments, Copyright Translation Guidance , Guidelines on Translation and Adaptation of Instruments, in addition to two key publications Bolton (2001) Translation Across Cultures, and Van Ommeren (1999) Translation Monitoring Form As Way To Translate Measures.
Toolkit Conceptualization & Development
Led by Zeinab Hijazi, with support from Ashley Leichner, Inka Weissbecker (International Medical Corps).
Design and creative development by Bilal Lezeik, Executive Producer & Communication Specialist at Limelight Productions
Key writing and editorial conducted by Rebecca Wener (International Medical Corps), and graduate research assistants Kendall Sauer & Jordana Cohen from the Humanitarian Assistance Applied Research Group (HAARG) at the Korbel International School, University of Denver.
Hosting and Dissemination support by Mental Health Innovation Network (Onaiza Qureshi, Platform Coordinator & Natasha Salaria, Communications Officer), and Manta Ray Media (Matty Sayer, Support Manager, Mike Parmanand, Developer & Russ Urwin, Head of Development)
Toolkit Advisory Group
International Medical Corps project team
- Zeinab Hijazi: project implementation, content development & technical lead
- Inka Weissbecker: technical support & oversight
- Ashley Leichner: project management
- World Health Organization (WHO): Fahmy Hanna and Mark Van Ommeren
- United Nations High Commissioner for Refugees (UNHCR): Peter Ventevogel
- Coordinator of the Inter-Agency Standing Committee (IASC) MHPSS Reference Group (RG): Sarah Harrison
Field Testing Agencies & Focal Points
- Action Contre La Faim in Iraq: Alexandre Letzelter
- International Medical Corps in Ethiopia: Anteneh Mamo, Jordan: Michelle Heidrun Engels, Lebanon: Jihane Bou-Sleiman, and South Sudan: Dr. Esubalew Wondimu.
- International Rescue Committee in NE Syria, Kenya and Myanmar: Ashley Nemiro & Alex Kalatu
- Malteser International in Peshawar: Dr. Rasheed Gulshan
- Médecins du Monde in Egypt: Magdy Eissa
- Syrian Arab Red Crescent & UNHCR in Syria: May Al Laham and Riwa Dahman
Abdulbaqi Sharif Jannay (ALDA), Alexandre Letzelter (Action Contre La Faim, ACF), Asma Humayun (Consultant Psychiatrist, Pakistan), Ana Maria Tijerino (MSF), Allie Sharma (WHO, consultant), Alison Schafer (representing World Vision International, WVI at time of contribution), Anne Filorizzo Pla (ACF), Barbara Lopes-Cardozo (U.S. Centers for Disease Control and Prevention, CDC), Bashir Ahmad Sarwari (Ministry of Health, Afghanistan), Benyam Worku (Department of Psychiatry, Addis Ababa University), Brinda Wachs (Beautiful Mind), Caoimhe Nic A Bhaird (in non-affiliated capacity, MHPSS consultant), Carolina Echheverri (UNHCR), Carmen Martinez (Pan American Health Organization, PAHO), Carrie Vopelak (IMC), Claire Whitney (IMC), Christina Carreno Glaria (MSF), Dan Chisholm (WHO), Dereje Assefa Zewude (Federal Ministry of Health, Ethiopia), Edith van ‘t Hoff (WHO), Ellen Morgan (Grand Challenges), Georgia Lockwood (in non-affiliated capacity, MHPSS consultant), Georgie Campbell (Birkbeck College), Helen Herman (World Psychiatric Association), Houdou Seyni (in non-affiliated capacity, MHPSS consultant), Jaak Le Roy (in non-affiliated capacity, MHPSS consultant), Jolene Nakao (OFDA), Jorge Castro (PAHO), Katy Wall (Humanity & Inclusion), Marie Darmayan (Médecins du Monde, MdM), Massimiliano Reggi (GRT Italia), Mohamad El Shazly (UNHCR), Miriam Yu (in non-affiliated capacity, MHPSS consultant), Natalia Tejada (World Bank), Neerja Chowdhary (WHO), Nick Rose (Oxford University), Peter Hughes (Royal College of Psychiatrists, United Kingdom), Rabih Chammay (Ministry of Public Health Lebanon), Richard Gater (WHO EMRO, consultant), Samah Jabr (Ministry of Health, Palestine), Sonia Walia (USAID/OFDA), Sudip Ghimire (in non-affiliated capacity, MHPSS consultant), Suraj Koirala (TPO Nepal), Tabasum Abdul-Rasul (in non-affiliated capacity, MHPSS consultant), Taiwo Sheikh (Ministry of Health, Nigeria), Wissam Kher (Ministry of Public Health Lebanon), Yutaro Setoya (WHO).
This Toolkit for the Integration of Mental Health into General Healthcare in Humanitarian Settings is made possible by the generous support of the American people through the United States Agency for International Development's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) . The contents are the responsibility of International Medical Corps and do not necessarily reflect the views of USAID or the United States Government. World Health Organization. (2008). Scaling up care for mental, neurological and substance use disorders. Mental Health Gap Action Program. . Geneva, Switzerland.