Mental Health Services During and After Armed Conflict: The State of Knowledge and Practice
There is increasing recognition that the violence, displacement, disruption of communities and social networks, and deprivation stemming from war deeply impact the mental health of individuals and the social cohesion of communities. In response, donors and providers are creating programs for psychosocial or clinical services that seek to be culturally appropriate, attentive to the need to build local capacity, and sustainable.
The quality and comprehensiveness of mental health programs offered in crises, however, generally remains mixed. Too often the programs do not sufficiently differentiate among widely varying individual needs or focus predominantly on either community-based interventions or the clinical needs of more severely affected people but not both. Services for people with more severe disabilities often replicate institutional models, and accompanying human rights violations, that existed in the pre-war period. The challenge of providing sound programs, moreover, is complicated by a relatively thin evidence base.
In the face of these challenges, the "Guidelines on Mental Health and Psychosocial Support in Emergency Settings" adopted in 2007 by the Interagency Standing Committee (IASC) offer a promising approach. They stress understanding local context, programming that attends to psychosocial support needs of the entire community, meeting clinical needs of people with more severe conditions, and respecting human rights. Following the IASC and building the evidence base by assuring adequate evaluation of funded programs can help meet the tremendous mental health needs of suffering populations.
About this Brief
The need for mental health services as part of emergency and long-term health development responses in regions of armed conflict is widely recognized. To date, responses have too often been fragmented, lack comprehensiveness, and based on assumptions rather than on evidence of effectiveness. This Peace Brief reviews the challenges and how Inter-Agency Standing Committee guidelines can point a way forward.
Leonard Rubenstein is a visiting scholar at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health and is the coordinator of USIP's Peacebuilding and Health Working Group. Anjalee Kohli is a doctoral student in International Health at the Johns Hopkins Bloomberg School of Public Health.