Lessons from IFRC on integrating mental health into humanitarian response

BARCELONA — Donors and humanitarian organizations are still failing to recognize the value of low-cost mental health interventions as part of humanitarian responses, according to Jagan Chapagain, secretary-general of the International Federation of Red Cross and Red Crescent Societies. Mental health is an area that continues to be overlooked and underfunded in humanitarian efforts, Chapagain said, adding that “[we] ignore this at our own peril.” In an interview with Devex, Chapagain spoke about his experiences during the response to the 2008 Sichuan earthquake in China, when IFRC worked with the local Red Cross to distribute psychological support materials to survivors who had lost homes, family members, and livelihoods, and to provide spaces where they could access practical and emotional support. On visiting and talking with these communities, Chapagain said it was an “eye-opener” to learn they had valued this support as much as the construction of new homes. However, historically, mental health has not been a “very attractive topic” for donors, and as a result, implementers haven’t prioritized it. Instead, they have focused on shelter, food, and WASH, which are more “visible elements” of crisis response, Chapagain said. Nonetheless, as well as the direct benefit to recipients, there is evidence that mental health interventions pay off economically. One study published in The Lancet Psychiatry suggests that for every $1 invested in mental health treatment for depression and anxiety, $4 dollars is saved because people in better health are more productive. Chapagain noted that mental health programs are some of the least expensive interventions in response, and don’t require costly infrastructure or huge amounts of additional funding. He shared four tips about how it can be done. 1. Adapt existing response efforts Mental health doesn’t need to be an expensive standalone program. IFRC has started ramping up mental health and psychosocial support in disaster response, and now as part of the COVID-19 response. “We feel that this is a really inexpensive element of our program that we can actually integrate [with] the existing programs,” Chapagain said. “You don't need to create a parallel program to address the mental health issues ... It's not about doing different things, it's about doing things differently,” he added. A recent IFRC report focused on the importance of mental health and psychosocial support during COVID-19. The report notes that psychological support has already been integrated into water, sanitation, hygiene, and health elements of the response in Cox’s Bazar, Bangladesh — where many of the displaced populations living in the camps demonstrated high levels of distress. In Yemen, psychosocial support has been incorporated into health care, and more recently into the COVID-19 response, after 16 staff and volunteers were trained as trainers in psychological first aid and then went on to train almost 150 additional volunteers. Meanwhile, in Niger, more than 250 volunteers, government health care staff, and mortuary staff participated in basic training in psychosocial support to help them support bereaved families, according to the report. This didn’t require a huge investment, Chapagain said, but when these volunteers take this training into the communities they work in, the impact “multiplies massively.” 2. Simple solutions can be effective Mental health programs also don’t need to be high-tech. Sometimes it can be as simple as providing people with a safe space to discuss their concerns. During recent lockdowns, in many countries the organization relied on the “good old-fashioned ways,” setting up telephone helplines and finding that people appreciated having a real person at the end of the line to talk about issues, Chapagain said. Where possible, a more personal approach was taken. In Colombia, six mobile “listening centers” were set up and ran throughout the lockdown. According to the same IFRC report, these centers provided emotional support from trained psychosocial volunteers, in addition to safety information and physical care. 3. Invest in local volunteers and actors Building trust, in part through understanding the culture and value systems that exist in a community, is essential in providing mental health support, Chapagain said. Local volunteers and actors, such as civil society organizations, play a key role in this. “In every community, you find trusted figures, trusted organizations, trusted mechanisms,” he said. “Look for [those] and build partnerships with them.” The IFRC report highlights how in recent months, a group of men in Nairobi, known as “young men’s champions” have mobilized to engage young people living in informal settlements and help dispel myths around the coronavirus, which can contribute to high levels of anxiety. These young men were identified and trained by the local Red Cross some years ago, based on a resilience program, which targeted this group because they face cultural expectations to be strong or to be the breadwinners, for example, that can make them vulnerable to mental health issues in times of high unemployment or hardship. Elsewhere in Kenya, volunteers received training in psychological first aid, adapted to the local context and the current COVID-19 situation, to provide emotional support and promote messages of good health. 4. Partnerships are key The scale of the ongoing crisis and the resulting mental health needs mean a collaborative approach is more important than ever, Chapagain said. However, crises don’t allow for time to establish new partnerships, so organizations need to build on those that already exist. The IFRC report demonstrates that in order to provide quick and context-appropriate training during the pandemic, local Red Cross teams have been working with national health ministries, other chapters of the national society, and existing volunteer networks. Chapagain cautioned against arrogance and working in isolation, adding “we have to work in partnerships, learn from each other and we don't need to create those silos because the scale of the problem [and] the needs are so big.”