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WHO (2011) HESPER: Humanitarian Emergency Settings Perceived Needs Scale Manual
Category: Specific Tools & Materials, Key Templates, Checklists & Tools
Audience: Implementing agencies
Use the HESPER tool to assess the perceived needs among the community. Items can be adapted to specific settings and include shelter, access to education, water, employment, financial problems, distress etc.[This tool is also part of WHO UNHCR Assessment toolkit- However the HESPER manual is more comprehensive and includes multiple languages] -
CBM (Draft) Framework for Mental Health Care Country Situation Analysis
Category: Specific Tools & Materials, Key Templates, Checklists & Tools
Audience: Implementing agencies
Use this framework to assesses mental health needs, mental health policy, legislation, financing, services, human resources, drugs, and other areas of country specific mental health services and systems.
[Adapted from select tools from the mhGAP Situational Analysis] -
WHO OneHealth Tool
Category: Specific Tools & Materials, Key Templates, Checklists & Tools
Audience: Implementing agencies, Governments, Donors
Access the comprehensive and detailed OneHealth Tool software which can estimate costs of specific mental health interventions to inform national strategic health planning in low- and middle-income countries.Updated versions of the software are regularly released. Please contact the WHO-CHOICE team at whochoice@who.int to get a more up to date version of the tool. -
WHO (2011) Template to Assess Mental Health System Formal Resources in Humanitarian Settings
Category: Specific Tools & Materials, Additional Tools for Planning
Audience: Implementing agencies
Use this tool for planning of (early) recovery/reconstruction, through knowing the formal resources in the regional/national mental health system.[Also part of WHO UNHCR Assessment toolkit– tool 7, pg. 55]
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IMC (2017) PHC MH Training Application Sample
Category: Specific Tools & Materials, Additional Tools for Planning
Audience: Implementing agencies
Use this application form when planning a mental health integration training for PHC providers, including doctors and mid-level staff.
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IMC (2017) Case Management Training Needs Assessment
Category: Specific Tools & Materials, Additional Tools for Planning
Audience: Implementing agencies
Use this tool to carry out an assessment of training needs as a prerequisite to develop/adapt content of training for case managers in mental health.
Application of Tool: IMC Example of Tool Application and IMC Syria Tool Application
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Rapid Assessments
Category: Field Examples and Applications, Rapid Assessments
Audience: Implementing agencies, Governments, Donors
These examples utilized the IASC MHPSS Assessment Guide and the WHO & UNHCR MHPSS Assessment Toolkit and include a comprehensive assessment of MHPSS context, resources and needs (including desk review, stakeholder interviews, and focus group discussions).
IMC Nepal 2015 Rapid MHPSS Assessment
IMC Serbia 2016 Rapid MHPSS Assessment
IMC Malawi 2015 Rapid MHPSS Assessment
IMC Iraq 2016 Rapid MHPSS assessment (English)
IMC Iraq 2016 Rapid MHPSS assessment (Arabic)
IMC Dominica 2017 Rapid MHPSS Assessment: Hurricane Maria Emergency Response
IMC Mexico 2018 Rapid MHPSS Assessment
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Situational Analysis
Category: Field Examples and Applications, Situational Analysis
Audience: Implementing agencies, Governments, Donors
These examples utilized the IASC MHPSS Assessment Guide and the WHO & UNHCR MHPSS Assessment Toolkit (various tools), and include a comprehensive assessment of MHPSS context, resources and needs (including desk review, stakeholder interviews, and focus group discussions).
WHO Somalia 2010 MH Situation Analysis
IMC Ethiopia 2013 MHPSS Situational Analysis
IMC South Sudan 2015 MHPSS Situational Analysis
WHO & UNHCR KRG 2015 MHPSS Situational Analysis
CVT Ethiopia 2017 Assessing Refugee Mental Health
HealthNet TPO & IMC 2016 Nepal MH Assessment
IMC CAR 2014 Mental Health Assessment
IMC Greece 2016 MHPSS Assessment
IMC North Central Greece 2016 MHPSS Assessment
World Bank & IMC 2017 MHPSS Assessment Ukraine
IMC Jordan 2017 Understanding the MHPSS Needs, and Service Utilization of Syrian Refugees and Jordanian Nationals
UNHCR (2015) UNHCR Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians (English)
UNHCR (2015) UNHCR Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians (Arabic)
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Health Facilities
Category: Field Examples and Applications, Health Facilities
Audience: Implementing agencies, Governments, Donors
These examples utilized the adapted versions of the WHO Mental Health PHC Integration Checklist
Utilize the IMC adapted version of the checklist for a comprehensive assessment of MHPSS integration activities within health facilities.
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4Ws Mapping
Category: Field Examples and Applications, 4Ws Mapping
Audience: Implementing agencies, Governments, Donors
These examples utilized the 4W MHPSS tool and include mappings of MHPSS actors and activities (information gathered by interviewing different organizations engaged in MHPSS work).

Step 1. Assess & Plan for Mental Health Integration
A rapid or comprehensive assessment is a process of systematically collecting and analyzing data around the country background and context, existing mental health policies, systems and resources as well as needs and barriers to care. This information is needed to plan mental health integration programs.

WHY is this step needed?
Information from an assessment is needed to make key decisions about program planning & design such as:
- What existing government efforts and policies exist that we need to build on and be consistent with? Are there national mental health plans, policies, guidelines, legislation, and budgetary allocations available (e.g. are certain conditions prioritized to be treated at the PHC level)?
- Who are the actors, academic institutions, or local groups currently working on mental health who need to be engaged (e.g. are others implementing a similar program)?
- Which trainees and health facilities should we target for capacity building and what do we need to provide or advocate for (e.g. where are providers and what are their roles, what psychotropic medication is available?)
- What are perceived needs and barriers to accessing mental health care among affected communities?
An assessment is a dynamic and often continual process and ensures that we design a program that is tailored to the local context, is consistent with government guidelines, builds on existing resources and meets identified needs.
Planning in accordance with national and regional programs and policies and acquiring an understanding of the needs and demands of the local community supports sustainability planning and community engagement from the start.

HOW is this step done?
- Plan your assessment based on global tools (WHO/UNHCR assessment toolkit, IASC assessment guide and IASC ethical guidelines).
- Conduct a desk top review of available information (e.g., data and reports from implementing agencies of mental health and psychosocial programming, peer reviewed publications, newspaper articles).
- Collect data in the field (e.g. by integrating MHPSS into existing multi-sector assessments or conducting a specific MHPSS focused assessment) by utilizing a variety of assessment tools and techniques such as semi-structured interviews, direct observation, and focus group discussions with stakeholders including service providers, people affected by mental health problems, policy makers and community members.
- Analyze and summarize data to obtain an understanding of the sociocultural context, mental health policies and legislation, mapping of mental health resources and services as well as mental health and psychosocial needs of the community.
- Share what you have learned through discussion with key stakeholders, presentation at coordination meetings, and/or dissemination of your assessment report.
- Use assessment information for planning including meetings and workshops that explore who to train, how to provide short term and longer term support & supervision, which stakeholders to involve, how to make drugs regularly available, coordination with government, establishing referral pathways, funding, etc.

MINIMUM elements of assessment & planning
Link to existing sources of information and identify the following critical information:
- Country level analyses: Quick assessment of existing health systems and policies, and available resources, and efforts (e.g. based on WHO AIMS, AIMS country reports, and MH Atlas, discussion with key national stakeholders).
- Community level analyses: Discussion (e.g. with key members of affected community, service providers, service users) about attitudes toward persons with mental disorders, help-seeking for mental health problems, ways of coping and community support, formal (e.g. health clinics) and informal (e.g. social supports, religious and traditional healers) resources and barriers to accessing services.
- Health facilities assessments: Focus on understanding which levels of the health system mental health services exist (if any), to what extent staff are trained in providing mental health services, and which health clinics/settings would be optimal for MH integration (e.g. discussion with heads of health facility and potential trainees).
- Mapping of existing programming, services and gaps, using the basic 4Ws table that outlines who is doing what, where and until when.

COMPREHENSIVE additional elements of assessment & planning
Identify additional information within each of the assessment categories:
- Country level analyses: Conduct comprehensive desk top review (e.g. National Health Policy, National Mental Health Policy), meet with many actors to understand how mental health systems and services are already supported and funded.
- Community level analyses: Assessment of key aspects (see minimum considerations for more information) through engaging diverse groups and sub-groups among affected populations as well as various service providers (formal and informal).
- Health facilities assessments: Assess different health facilities (e.g. using MH PHC integration checklist) to explore staff skills, staff roles,, service provision, referral systems and processes, pharmacy and medication supply, health information system and clinic management.
- Mapping of existing programming, services and gaps, using the more comprehensive IASC 4Ws mapping tool or IASC 4Ws online mapping tool available by logging onto mhpss.net as part of an inter-agency process moderated through coordination groups (e.g. cluster coordination, MHPSS Coordination Group).

WHEN is this step done?
At the time of planning your integrated mental health program:
- A rapid assessment can be carried out during the initial stage of a humanitarian crisis over the course of multiple days1.
- A more comprehensive assessment is generally carried out at any time over the course of weeks to months.
1 Number of days to complete an assessment ranges and is contingent on available expertise and local capacity to support the assessment, whether translation is needed, distance to and number of locations where assessment is taking place, and other factors.

KEY CONSIDERATIONS
- Do carry out a desk review first to identify information gaps and inform data collection in the field.
- Do involve mental health service users and carers at every stage of assessment, planning and development
- Do coordinate with other agencies to find out about existing and planned assessments.
- Do ensure MHPSS technical experts are involved from the beginning when designing assessments.
- Do include local secondary level mental health care in your assessment and consider how it can be strengthened and how local mental health professionals can be engaged to support training, supervision, referral and consultations.
- Do include assessing needs and resources of people with pre-existing and serious mental disorders, such as psychosis.
- Do consider and include the diverse cross-section of the population in terms of age, gender, educational level, geographic location, etc.
- Do use trained data collectors who speak the language of respondents.
- Do ask questions that have practical implications for programming.
- Do ensure the anonymity and protection of the data collected.
- Do document or record consent and protect identifiable personal data when carrying out assessments.
- Do not collect data with pre-conceived notions or expectations.
- Do not conduct surveys on the prevalence of mental disorders (that is, psychiatric epidemiology).
→ Such surveys can be important for advocacy and academic value but are of limited practical value when designing a humanitarian response.
* Note: If you have to make a quick estimate on the prevalence of mental disorders, you can use existing WHO projections for a general indication of mental disorders in crisis-affected populations (refer to UNHCR/WHO Assessment toolkit, tool 2).
→ Why: WHO has existing prevalence estimates of MH issues (e.g. see WHO UNHCR assessment toolkit, page 18); It is difficult to distinguish between normal psychological distress and mental disorders in humanitarian settings (which can lead to over-estimates), Studies with the right methods and expertise are lengthy, costly and resource intensive. - Do not create protection risks for vulnerable segments of the populations by visibly targeting them for assessments, target broad segments of affected populations and ensure privacy, consent and confidentiality when asking sensitive questions or speaking with specific population groups.
- Do not ask potentially distressing questions (e.g. about stressful events, MH problems) without ensuring they are asked in a sensitive way, and that information about available follow-up support is provided.
- Do not ask questions that may stigmatize people or endanger them.
