International Medical Corps aims to strengthen mental health and psychosocial services through integration into PHC and community services by training healthcare staff and paraprofessionals to provide mental healthcare and expand community and family supports.
International Medical Corps conceptualizes and implements Mental health PHC integration in humanitarian settings in six incremental steps:
1. Ensure stakeholder engagement and conduct a baseline situational analysis
International Medical Corps gathers information about the context such as national policies pertaining to mental health, staff capacities in the country, current provision of care and attitudes around mental health. This is accomplished through desk reviews, semi-structured interviews, and focus group discussions with stakeholders such as service providers, people affected by mental health problems, policy makers and community members. In Jordan, International Medical Corps piloted and disseminated the WHO MHPSS 4W (“who is doing what where when”) mapping tool and has been completing annual comprehensive MHPSS mapping of current services, capacities and needs since 2011, which informs coordination of services and filling gaps.
2. Build capacity of primary healthcare and other staff to provide mental health care
Depending on findings from the situational analysis, feedback, and experiences, International Medical Corps adapts the World Health Organization Mental Health Gap Action Program (mhGAP)3 training materials to the local context. Where available, local specialists and psychiatrists are identified, involved in policy efforts for building local capacity to scale up training and integration, and receive a training of trainers (TOT) on conducting mhGAP training for PHC staff, and longer term support and supervision. International Medical Corps was included in WHO’s mhGAP TOT in Lebanon, Syria, Jordan, and Iraq for local psychiatrists and psychologists who were mobilized through International Medical Corps and national efforts to scale up training and supervision on mhGAP. International Medical Corps trains a range of personnel including PHC staff (doctors and nurses), other professional staff (e.g. social workers, psychologists) and paraprofessionals (e.g. psychosocial workers) and active community members (volunteers, and community health workers (CHW)) to provide comprehensive mental health care. This comprehensive approach includes non-specialized, capable staff, who are often the first line of contact, able to dedicate more time to patients, and directly manage cases that do not require more specialized interventions—for which there is a referral mechanism in place. In Lebanon, our team found that existing social workers were a valuable resource in PHC integration in Ministry of Social Affairs clinics.
3. Provide clinical and community level interventions for people with mental illness
Facility level interventions provided by trained PHC staff consist of assessment, diagnosis and management of mental health disorders, psycho-education for patients and family members, and psychotropic medication- if needed. Interventions that take place in facility and community levels include: psychological first aid, basic psychosocial support and counselling, peer to peer support activities, and linking to other mental health, psychosocial, health, protection and other services as needed.
International Medical Corps supports the provision of mental health services through trained staff at targeted health facilities and facilitates psychosocial community level interventions such as activities for youth and caregivers, educational and recreational psychosocial activities for children, and awareness/educational messaging for individuals, families and wider communities. This gives rise to the importance of training active community staff, members and volunteers, as they may have developed networks, greater buy-in and insight regarding the needs of the community.
This was demonstrated in the program in Turkey, where our psychologists, social workers and community volunteers provided community-based psychosocial support through educational and recreational activities for children and adolescents, pregnant and lactating mothers, single parent families with small children and older persons to promote social cohesion and community revitalization among Syrian and other refugee populations.
4. Ensure holistic integration by strengthening referral mechanisms, adherence to treatments and medication supply
International Medical Corps has conducted workshops with different services providers (NGO partners, government staff, community care providers, community leaders) to improve the functioning of integrated mental health services through standardized forms, care and referral pathways, appropriate space for services and psychotropic medication supply.
Referral systems can be strengthened through mapping and workshops to ensure PHC and other staff are able to provide comprehensive care to people with mental illness and their families, and are supported by specialists, non-specialist community supports, and other agencies who meet diverse patient needs. In Syria, International Medical Corps is the co-chair of a national MHPSS technical reference group and has supported efforts for developing inter-agency referral pathways between different levels of mental health and psychosocial support. Patient follow up is ensured through: psycho-education around importance of continued treatment, tracking patients through clinic registration and home visits by CHWs & volunteers, text messaging and phone calls, and linking with community leaders and traditional healers to encourage continued treatment. International Medical Corps also collaborates with government officials and local WHO mental health departments to ensure availability of essential psychotropic medications at the PHC level. In Lebanon, International Medical Corps works to supplement existing medications provided through the Ministry of Health, and works in line with the ministry’s essential drug list.
5. Engage in networking, coordination and advocacy
Networking, coordination and advocacy occur at the national, regional, and community levels though policy development, educational/awareness activities and workshops. Partnerships at various levels enabled effective coordinating mechanisms that promote transparency and regular flows of information and referral between stakeholders, and meeting the basic mental health needs of the population8. International Medical Corps is co-leading MHPSS national level coordination groups in Syria, Jordan, and Lebanon. International Medical Corps conducts significant outreach and advocacy through mobile teams in Syria, Jordan, Iraq, Lebanon & Turkey with trained health staff and social workers to reach populations in hard to reach areas.
6. Support sustainability of mental health services integrated into PHC
In line with International Medical Corps’ global approach, we work in partnership with relevant ministries and WHO, to develop country specific mental health programming based on an assessment of existing health systems and strategy. From the start, International Medical Corps works to maximize the use of existing government health care infrastructure and resources that are consistent with national capacities and strategies. This is to promote sustainability and a smooth transition from emergency to long term development. Continuous policy dialogue with government and key stakeholders is necessary to solve issues such as the supply of medicine, supervision, and annual planning.
International Medical Corps understands that integration is most successful when mental health is incorporated into health policy and legislative frameworks that are accompanied by adequate resources. In Lebanon, we have supported the Ministry of Health in the development and implementation of their national mental health strategy. International Medical Corps’ (in partnership with UNICEF and support from different donors) supports the recruitment and financial management of the NMHP staff, provides technical support through revision of program strategies and documents and builds the team’s capacity through the development of MHPSS policies and advocacy plans. International Medical Corps is expanding integration of mental health services within ministry clinics serving refugee and host populations, improving communication and consultation among trained PHC staff and mental health specialists by strengthening referral networks, and supporting longer term supervision efforts and strategies to transition over to the ministry or local organizations, that can sustain the units following International Medical Corps support.