Mental health conditions in conflict situations are much more widespread than we thought
Dr Mark van Ommeren
Department of Mental Health and Substance Abuse
But there’s a lot we can do to support people
It is difficult to describe the mental suffering you see when you go to a war zone and you meet people affected by conflict or war. Sometimes you think it can’t get any worse. And then you go to another conflict situation and it is worse, another kind of hell.
This week, new WHO estimates published in The Lancet show there are more people living with mental disorders in areas affected by conflict than we previously thought – many more. One person in five is living with some form of mental disorder, from mild depression or anxiety to psychosis. Worse, almost 1 in 10 is living with a moderate or severe mental disorder.
These people desperately need to be able to obtain treatment and care. Their disorders often impair their ability to function – so access to care isn’t just about improving mental health, it can be a matter of survival.
Today, there is no shortage of countries in conflict. UN estimates suggest that in 2019, nearly 132 million people in 42 countries around the world will need humanitarian assistance resulting from conflict or disaster. Nearly 69 million people worldwide have been forcibly displaced by violence and conflict, the highest number since World War II.
Fortunately, there’s a lot we can do to help them. Indeed, there’s a lot we are doing.
In 2019 WHO is addressing mental health in countries and territories with populations affected by large-scale emergencies across the world, in Bangladesh, Iraq, Jordan, Lebanon, Nigeria, South Sudan, Syria, Turkey, Ukraine and the West Bank and Gaza Strip, among others.
When we’re asked to support coordination of the mental health response in an emergency situation, whether during conflict or after a natural disaster, our first task is to quickly clarify what people need.
Our second task is to determine as quickly as possible what resources are already available ̶ which government services, local nongovernmental organizations, and international partners have the capacity and knowledge to manage mental health problems. They need to be able to support people through acute stress and grief and assess and care for mental disorders, from mild to severe.
The third task is to help provide the capacity for support when what exists isn’t enough. This typically involves coordination with partners and rapid capacity-building of local providers.
Over the last decade, in collaboration with our partners, we have developed a range of practical guides to help establish and scale up psychosocial and mental health support in emergency settings. We have also adapted our “mhGAP Programme”, through which general health workers are trained to recognize and provide first-line support for common mental disorders, so that it can be used in humanitarian emergencies.
In many countries in the world, ignorance about mental health and mental illness remains widespread. The uptake of mental health care during conflict and other emergencies, in countries where such support has been limited, can lead to the identification of people who are tied up, locked in cages, hidden from society. In many cases, it is this very support that helps dispel myths about mental illness and leads to treatment and care and a path towards a more dignified life.
We have also learned that, when the political will exists, emergencies can be catalysts for building quality mental health services.
In Syria, for example, before the conflict, there was scarcely any mental health care available outside of the mental hospitals in Aleppo and Damascus. Now, however, thanks to a growing recognition of the need for support, mental health and psychosocial support has been introduced in primary and secondary health facilities, in community and women’s centres, and in school-based programmes.
In Lebanon, the population of 4 million has grown by a further million in recent years, as refugees have crossed the border from Syria. Quick to recognize the rapid increase in needs for mental health services, the Government has been using the opportunity to strengthen its mental health services, so that today these benefit not only the new arrivals but also the local population.
The 2004 tsunami in Sri Lanka and Indonesia, and the 2013 typhoon in the Philippines provided the catalyst for decentralizing mental health care to the community level, where it was most needed. In most cases, the infrastructure put in place remained once the crises were past.
In fact, if one looks at the global landscape of mental health service development over the last 20 years, it’s fair to say that some of the biggest leaps forward have been made after emergencies.
All countries have an obligation to invest in mental health. But it is particularly important in conflict-affected populations where the rate of mental health conditions is more than double that of the general population.
The examples provided above show how investing in mental health pays dividends, not just in helping people survive extreme distress and hardship, but also to support a nation’s recovery.