While staff capacity building is a critical component, it is not enough to establish a functioning system of community based mental health care. Various parts of the system need to work together to ensure that persons with mental health problems can be identified, appropriately managed and cared for, have access to psychotropic medications and can be referred to essential clinical or community services and followed up, as part of a functioning system. Strengthening these systems means that persons receive the care they need, and that integration can be sustained.

Use your assessment/situational analysis to identify where your planned mental health program falls within the larger systems of health, mental health and community services as well as within humanitarian response efforts. Work with national, regional and local authorities as well as with health facility staff to strengthen MH services (e.g. identification, management, referral) and systems (e.g. space and time for services, mapping of service providers, HMIS, psychotropic medication). Ensure that trained staff and other service providers understand their role in the MH system.

This is a continual process which requires ongoing monitoring, planning and active participation of all stakeholders from the beginning. The resources presented as Specific Tools and Materials should be used by those who have been trained as mental health care providers.

• Do ensure that investment in primary care is preceded by, or at least carried out in tandem with, development of community and secondary mental health services.
• Do invest in local human resources (displaced and host) to respond to MH needs.
• Do help ensure provision of a quiet and private space to meet with persons with mental health problems.
• Do address mental health needs at the appropriate level of care, while being aware of available up and down referral systems and pathways if needed.
• Do set up a system where trained health staff can connect with MH specialists for support and guidance, and for emergencies (e.g. responding to acute suicidal ideation).
• Do utilize CHWs and community leaders for outreach and connect with formal and informal service providers for referrals.
• Do respect the privacy and confidentiality of persons with MH problems.
• Do take into consideration that families/carers of people with mental disorders may also need support.
• Do discuss in training how to establish referral links with traditional healers and religious leaders who are often the first point of contact for persons with severe mental illness.

• Do not refer all persons to a specialized provider (e.g. psychiatrist or psychologist).
• Do not set up a parallel system of MH care.
• Do not forget that persons with mental health problems may have other complex needs that also need to be addressed (e.g. other general health conditions or injuries, protection concerns, housing issues).
• Do not assume people with mental illness will come to a health care facility on their own.
• Do not introduce expensive psychotropic medications that cannot be sustained in the long term and work in line with the ministry of health’s essential drug list.
• Do not allow medication supply to be interrupted.
• Do not contribute to an influx of referrals to already stretched services, without working to strengthen those existing services first.