Step 1. Assess & Plan for Mental Health Integration

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.

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.

  • 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.

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.

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 as part of an inter-agency process moderated through coordination groups (e.g. cluster coordination, MHPSS Coordination Group).

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.

  • 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.