Mental health is key to disaster risk reduction

The mental health systems of many countries, like Sierra Leone, have been neglected for long periods of time. Given the impact that humanitarian crises have on the mental health and psychosocial well-being of the population, these weak mental health systems make it extremely difficult to provide an adequate response to the psychosocial needs that arise out of such crises. In Sierra Leone, by 2010, after a terrible civil war, only one psychiatric hospital in very poor conditions was available for those suffering from mental health conditions in the country. With only one retired psychiatrist, lack of psychotropic medications and absence of services in the provinces, Sierra Leone was one of the countries with more fragile services for mental health in the world. If that had stayed the same, the need created by the Ebola outbreak in terms of mental health and psychosocial support would have been extremely difficult to meet. 

Strengthening resilience

It is known that humanitarian crises have a great impact in mental health by

• producing grief and acute stress as transient psychological reactions to adversity and loss,
• triggering common mental disorders such as depression, post-traumatic stress disorder and prolonged grief disorder
• the vulnerability created by pre-existing chronic mental health conditions and
• magnifying acute health risk and social problems due to alcohol and drug use.
   

Working to strengthen resilience of communities at risk of disaster is an aspect of CBM’s work that is becoming increasingly important. In this case, CBM and partners have demonstrated that basic health systems, if properly prepared can make a significant contribution to supporting mental health and wellbeing, particularly in countries that have been prone to many disasters in the past.

A related principle is that we aim to ‘Build Back Better’ after emergencies. While in the short term there is a lot to do in meeting immediate needs, CBM is an organisation committed to long-term disability inclusive development.  This means that as well as investing in preparation (Disaster Risk Reduction), we also work to build on the emergency work we do to establish sustainable systems that will survive well beyond the emergency response.

Innovative project in Sierra Leone

Due to the 2014-2015 Ebola Virus Disease outbreak in West Africa, communities were severely affected in many ways: many people died in what is a distressing way, many were separated from their loved ones, or had to cope with quarantine and separation. Health care providers were overloaded and stressed. Social stigma increased towards those who are connected to people with the disease, worsening distress and isolation. Ultimately, whole communities experienced the fear and suffering that disease outbreaks often cause.

This intervention aimed to reduce psychological trauma associated with Ebola disease by providing psychological and social support to those affected by the Ebola disease outbreak in Sierra Leone, as well as preventative psychosocial interventions aimed at children and their families. The intervention succeeded by scaling up and building on an existing programme in country, which trained 20 mental health nurses and created a strong relationship with the Ministry of Health and Sanitation, as well as creating a national Coalition of Mental Health stakeholders that was at the core of all MHPSS activities in the county. From that programme, this innovation efficiently decentralized services and made MHPSS support available in all areas and all sectors of the population, where they were needed the most. 

Impact

• 14 District Mental Health Units created in all 14 districts of the country, run by 20 mental health nurses providing care to an average of 20 patients per month
• Support to 12 Ebola Treatment Centres and served as mayor referral point for organizations responding to the emergency and identifying mental health issues.
• Provision of care in 5 Survivors Clinics.
• Supervision of and referral point for more than 300 health professionals trained in Psychological First Aid and 150 health professionals trained in basic mental health care provision.
• Mental Health Care and psychosocial support provided to: health professionals at Ebola Treatment centres, members of the burial teams, survivors, member of the Ebola hotline, persons with EVD, relatives of persons with EVD, quarantined communities, and patients suffering long term mental illness.