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Medair Q&A: Let’s talk about mental health

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By Jonathan Kyle

The communities aid organisations serve around the world often experience severe traumatic stress, and face immense hurdles when rebuilding their lives. Yet, mental health support has not always been prioritised in emergency responses. We sat down with Riët Kroeze, Medair’s Senior Mental Health and Psychosocial Support Advisor, to try and understand why that is, and if things are changing.

Mental health support is rarely at the forefront of humanitarian responses. Why do you think that is?

Aid work is often understood to be about the needs you can immediately identify and respond to.
For example, a home that needs to be rebuilt, or a community in need of safe drinking water. From those, you can obtain very tangible and precise results. Mental health support is different, because the outcome is not so clear cut. It takes time, sometimes years of work, to finally see a person or a community heal, and become mentally healthy again.

Moreover, mental health has been and remains shrouded with preconceived ideas, including in socalled Western countries. It can be taboo to even start a conversation on this subject. We tend to shy away from mental health issues and try to pretend they don’t exist. This affects aid organisations also.

But progress is being made. The pandemic has increased awareness and conversations around mental health. Lockdowns, isolation, loneliness…many people have come to realise, perhaps for the first time, how mental health affects them, even in small ways.

Why do you believe mental health is just as important as physical health?

You cannot separate the two, because both impact the other. If you are depressed, anxious or traumatised, your daily functioning is affected and even your immune system can be impacted negatively. Equally, if you have a physical condition or develop a sudden illness – such as a disability, cancer, etc. – your mental health will likely be affected, because you will have to learn how to readjust to life in a new way, which can be a heavy mental burden. As is often said, there is no health without mental health.

What does mental health support add in a humanitarian response?

We all need a safe home, clean water, nutritious food. Those things are essential. But even when we have them, we can still feel low or depressed. It takes more to help people than a safe shelter and food, especially when they have experienced traumatic events. I remember a colleague telling me once about a man he had met in Kosovo. This man told him, “It’s great you’ve come to rebuild our homes. But who will help us rebuild our minds?” To me, that really says it all. You can rebuild a community brick by brick, but without addressing the mental health issues it’s facing, you have not fully addressed its needs.

You advise humanitarians working in different countries on mental health issues. Does your approach change, depending on the country or the crisis?

Like any other part of a humanitarian response, mental health and psychosocial projects need to be adapted to the culture and the context. We shouldn’t assume everyone in the world reacts the same way we do. Each context, each community can be very different, and we need to be mindful of that.
For example, how do people feel most comfortable expressing themselves? How do they deal with loss or grief? What kind of resilience system have they built to deal with their experiences and trauma? These are some of the questions we need to ask. It starts with listening to people, and not assuming we already have the answers.

Medair focuses on emergency responses. Yet, mental health affects people over and over in a lifetime. How can we ensure mental health support is sustainable?

Frankly, I’m not sure we can. What we can do, however, is make sure people are better equipped to face life’s challenges. When you build a new home for someone, you also can’t be sure it will be sustainable – it could be destroyed in future conflicts, for example. But if people in the community have also been trained as masons, they are then equipped to rebuild that home. In the same way, if people have integrated tools and mechanisms to deal with mental health challenges, they can also rebuild themselves mentally. Their circumstances may not change but with the right tools, their capacity to adapt and respond to them, will. Simply put, our aim is to help people develop the blueprint to rebuild their lives.

What are some specific ways in which you do this?

A major priority for us is working with local organisations and communities. We aim to work within existing structures, whether it’s a country’s Ministry of Health or civil organisations, to ensure that tools are instilled within the community, well beyond our own temporary intervention.

Another element to ensure sustainability is peer support groups, where people who are facing similar challenges in their community, come together. The truth is, a lot of mental health support doesn’t necessarily need to be done by specialists. A lot of it can be done by families, friends, neighbours – which is why these peer groups are so valuable. They help create a strong support system. People know who they can turn to in challenging times.

Of course, this is still very much a work in progress. More needs to be done. But I’m convinced these steps, among others, are moving us in the right direction.

Riët Kroeze currently serves as Medair’s Senior Mental Health and Psychosocial Support Advisor, based in the Netherlands. She joined Medair in 2006.

Medair is an international humanitarian NGO that provides emergency relief and recovery services to families made vulnerable by natural disasters, conflicts, and other crises. This content was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation.