Overview on

Mental Health and

Psychosocial Support
(MHPSS): Definition,
Guidelines and Principles

WHO/L. Mackenzie
 In this module, we will focus on
1 Overview on Mental Health and Psychosocial Support (MHPSS): definition, guidelines and principles

2 Coordinating a team with other sectors / clusters providing Mental Health and Psychosocial Support (MHPSS)

3 Assessing Mental Health and Psychosocial Support (MHPSS) needs and resources to guide programming

4 Working with community members, including marginalised people, to strengthen community self-help and social support

5 Including basic psychosocial support skills in an emergency response or programme

6 Developing and implementing a plan for mental health integration into general health care in humanitarian settings

7 Identifying suitable tools and integrating psychological interventions into health and social sector implementation
plans in emergencies
8 Assessing psychiatric hospitals and residential homes and supporting people with severe mental health conditions

9 Assessment of needs and integrating interventions for the management of conditions related to substance use

10 Engaging multiple stakeholders to build back better sustainable mental health care following emergencies

11 Mental Health and Psychosocial Support (MHPSS) during COVID-19 Pandemic

 What is mental health?

Mental health is a state of mental well-being in which people cope well with
the many stresses of life, can realize their own potential, can function
productively and fruitfully, and are able to contribute to their communities
 Mental health conditions

• There are nearly 1 billion people living with mental disorders

• Mental, neurological and substance use (MNS) disorders account for 10% of total disease
burden (DALYs) and 25% of years lined with disability in 2019
• Global economy loses more than US $1 trillion annually to depression & anxiety
• 1 out of every 100 deaths globally due to suicide
• People with severe mental disorders die 10 to 20 years earlier than the general population
• More than 3 out of 4 people with mental disorders in LMIC do not receive care for their
condition
• Gender: depression tends to be more common among women than men; substance use
more common among men
• Age: more behaviour problems in adolescents, and dementia only common in older adults
 Mental health in emergencies

• Almost all people in humanitarian emergencies will experience psychological distress, which
for most will improve over time
• One in 11 (9%) in humanitarian emergencies will have a moderate or severe mental disorder
• One person in five (22%) in humanitarian emergencies will have any mental disorder
• People with severe mental disorders are especially vulnerable during emergencies and need
access to mental health care and other basic needs
• COVID caused 25% increase in anxiety and depression in 2020
• Higher rates in communities with higher rates of COVID-19
• Higher rates among women & young people
Historically before the IASC Mental Health and Psychosocial Support (MHPSS)
guidelines usage of the term psychosocial support varies with sector

• Health sector staff: non-pharmacological interventions (e.g. psychotherapy)

• Protection, social & community services: non-clinical interventions (e.g. child
friendly spaces)

Lack of common language confusion

IASC Guidelines: Inclusive framework: mental health and psychosocial
support is a composite term that covers the following two aspects

protecting or promoting psychosocial well-being

and/or MH PSS

preventing or treating mental health conditions

 MHPSS needs are diverse

Pre-existing problems
• Social problems/determinants (eg poverty, marginalization, GBV)
• Psychological (incl. psychiatric) problems

Emergency-induced problems
• Social problems (eg isolation, lack of protection)
• Psychological (incl. psychiatric) problems
▪ Psychological problems may involve realistic appraisal (no mental disorder) or distortions
(possible mental disorder)
 Intervention pyramid
(Reference: Adapted from IASC MHPSS Guidelines -2007)

E.g. Clinical mental health care (whether by primary health CLINICAL

care staff or by mental health professionals) SERVICES

E.g. Psychological and practical support to selected FOCUSED

individuals or families PSYCHOSOCIAL SUPPORTS

E.g. Activating social networks, supportive child- STRENGTHENING

friendly spaces COMMUNITY AND FAMILY SUPPORTS

E.g. Advocacy for good humanitarian

practice: basic services that are safe, SOCIAL CONSIDERATIONS
socially appropriate and that protect IN BASIC SERVICES AND SECURITY
dignity
 Recommendations from IASC Principals
(heads of UN & civil society agencies) in 2019

• Treat MHPSS as a cross-cutting issue that has relevance within health, protection, nutrition,
education and CCCM sectors/clusters, in all emergencies.

• Reflect MHPSS indicators in relevant planning documents and establish dedicated budget lines,
as well as specific MHPSS codes within financial tracking systems.

• Support for the creation of and the work of country-level MHPSS Working Groups in all migration,
refugee and humanitarian contexts as crosscutting groups.
Mental health identified as a priority during COVID-19 response

Raised as a concern by WHO Director-General

UN Secretary General Secretary’s policy brief

Calls for action from UNICEF, IOM, UNFPA, UNHCR

and WHO

GHRP inclusion

Included in WHO definition of essential health

services

Executive Board and World Health Assembly

decisions
Actions by the health system Sphere Handbook 2018
 Sphere Handbook 2018 mental health standards:
9 key actions
1. Coordinate
mental health
and psychosocial
support across
sectors

WHO / NOOR / Sebastian Liste

A model for coordinating Mental Health and Psychosocial Support (MHPSS)
in humanitarian crisis in line with the IASC MHPSS Guidelines

Humanitarian Coordinator / Government leader

Inter-sector Coordination Group

Health Protection Education

sector sector and other
(with sectors
sub-sectors
e.g GBV, CP)

MHPSS Cross-sector Technical Working Group (with focal points in each of the sectors and with
accountability in sectors, with MHPSS activities as relevant in Appeal chapters under health,
protection and education, rather than in a separate Appeal chapter)
A model for coordinating Mental Health and Psychosocial Support (MHPSS)
in WHO Public Health Emergencies

Humanitarian Coordinator / Government leader / WHO

Incident Management Team

Partners Risk Case management Operations &

Coordination Communication and continuation others
& Community of essential
MHPSS role Engagement health services MHPSS role
MHPSS TWGs Psychosocial
MHPSS role MHPSS role wellbeing of
Integrating mental health
Developing and
disseminating health and workforce and
psychosocial other
message on
considerations into responders.
stress coping and
psychosocial clinical case
wellbeing for management and
different groups. essential health
services.

MHPSS Cross-sectoral Technical Working Group

with MHPSS focal points in all relevant the pillars
 Inter-agency MHPSS surge support

Global level Country level

Dutch Surge Support (DSS) Request made by MHPSS RG Member Agency

agency who has signed an MoU with DSS (UNICEF,
contracts, deployments, finances, insurance, MoUs UNHCR, IOM, ACF and WHO)

IASC MHPSS RG
Building & maintenance of roster, identification of
persons, capacity building component, ToR
development
MHPSS Technical Advisor hosted by one RG
agency but deployed to support the work of
the MHPSS WG
 Sphere Handbook 2018 mental health standards:
9 key actions

2. Ensure interventions are developed on the basis of identified needs and resources.
 Sphere Handbook 2018 mental health standards:
9 key actions

3. Enable community members including

marginalized people to strengthen
community self-help and social support
 Sphere Handbook 2018 mental health standards:
9 key actions

4. Ensure that community

workers, including
volunteers, as well as staff at
health services offer
psychological first aid to
people in acute distress after
exposure to extreme
stressors
 Sphere Handbook 2018 mental health standards:
9 key actions

5. Ensure that there is at least one staff member at every health facility who manages
diverse, severe mental health problems in adults and children.
Sphere Handbook 2018 mental health standards:
9 key actions

6. Make psychological interventions

available when possible for
people impaired by prolonged
distress
 Sphere Handbook 2018 mental health standards:
9 key actions

7. Address the safety, basic needs and rights of people with mental health problems
in institutions

Destroyed psychiatric hospital, Aleppo. AA

 Sphere Handbook 2018 mental health standards:
9 key actions

8. Minimize harm related to alcohol

and drugs
Sphere Handbook 2018 mental health standards:
9 key actions

9. As part of early recovery, initiate plans to develop a sustainable

community mental health system. In the publication examples
are provided from the following countries:
Afghanistan Kosovo

Burundi Somalia

Indonesia Sri Lanka

Iraq Timor-Leste

Jordan West Bank and Gaza Strip

 Minimum Service Package for Mental Health and Psychosocial Support (MSP)
Testing started in 2021

Need for the MSP

• Scale-up of services to address gap in MHPSS services and
activities in acute and chronic emergencies
• Accessible, practical guidance on which activities should be
prioritised at a minimum; and
• A way to estimate the costs of these activities, to facilitate
quick resource mobilization
Goals of the MSP
Maximize positive impact through:
• better-informed response based on best-available evidence
• more effective use of limited resources
• faster resource mobilization
• more predictable & better coordinated response
• easier division of tasks among implementing agencies
• easier to feed into HNO, HRPs, etc.
The MSP is inspired by the MISP for reproductive health
• easier to advocate for MHPSS to donors
 In this module, we learnt that

• Recommended services should range from basic services and community supports to clinical care

• Mental health care needs to be made available immediately for specific, urgent mental health problems as
part of the health response

• Emergencies, despite their tragic nature and adverse effects on mental health, have shown to be
opportunities to build sustainable mental health systems for people in need
 In the next module, we will focus on
1 Overview on Mental Health and Psychosocial Support (MHPSS): definition, guidelines and principles

2 Coordinating a team with other sectors / clusters providing Mental Health and Psychosocial Support (MHPSS)

3 Assessing Mental Health and Psychosocial Support (MHPSS) needs and resources to guide programming

4 Working with community members, including marginalised people, to strengthen community self-help and social support

5 Including basic psychosocial support skills in an emergency response or programme

6 Developing and implementing a plan for mental health integration into general health care in humanitarian settings

7 Identifying suitable tools and integrating psychological interventions into health and social sectors implementation
plans in emergencies
8 Assessing psychiatric hospitals and residential homes and supporting people with severe mental health conditions

9 Assessment of needs and integrating interventions for the management of conditions related to substance use

10 Engaging multiple stakeholders to build back better sustainable mental health care following emergencies

11 Mental Health and Psychosocial Support (MHPSS) during COVID-19 Pandemic