MHPSS around the world

There are dozens of interventions and treatment options that professionals use to help people confront the psychological effects of adversity and trauma.  Sadly, specialized treatment options are not accessible to everyone. In fact, mental health professionals are often incredibly difficult to find. They can be expensive, and often come from cultural backgrounds very different and often irrelevant to those who need support. Furthermore, therapists, psychologists, and psychiatrists are often in high demand during and after crises–the demand for care outpaces the supply of appropriate and meaningful options. 

But there is still lots of hope. First of all, human beings carry inside of them many innate resources for healing. Suffering has been around much longer than psychiatric medication and psychologists, and people have found ways to survive and thrive. And when it comes to mental health and psychosocial support (also known as MHPSS), we already possess many assets that help us confront the past and the present, and chart a new, healthier course forward.

One of our most important assets is community. Your community—your family, friends, and loved ones—are your primary support. As we move forward, please remember that our individual health and well-being affects and is affected by those around us, by our relationships and our community. We are part of a broader ecosystem, and individual mental health and psychosocial well-being is inextricably linked to our collective, to our community’s well-being.

Mental health– is not an issue that stands by itself. The people and the structures around us affect mental health. For example, the quality of your house affects your mental health. 

Living surrounded by four solid walls is safer and less risky than living in a tent. If you live in a tent, it is harder to protect your belongings, to keep your children healthy, and to stay warm. In this way, mental health is a part of every minute, every day, and anyone who works with survivors of war, conflict, and crisis should understand the basics of MHPSS and understand how individual health and well-being cannot be dissociated from structures and structural challenges in community and society. 

There are a number of resources used by people who work in the mental health and psychosocial support (MHPSS) sector in places around the world, and particularly by those working in humanitarian or natural disaster emergencies. Many of those resources are available in multiple languages, and we recommend you take the time to read those. 

One of the most useful frameworks for understanding how individuals and organizations address mental health is the pyramid framework developed by the Interagency Standing Committee. It specifies different types and levels of interventions. 

Not everyone who plays football should be a football coach. And not every football coach should coach the national football team. The IASC framework explains a similar idea when it comes to mental health.

The IASC framework recognizes that many types of activities can be used to promote healthy coping and addressing negative consequences of stress and trauma, but it is important to recognize what each type of activity targets, and who should, therefore, conduct and lead such activities.

IASC MHPSS service pyramid

Indeed, just as activities in daily life can cause stress, small things can help us heal. Starting with basic things like a solid roof and safe living conditions, the IASC pyramid suggests that different services address different needs. Food, water, and shelter are necessary if we are to survive and feel safe. Almost anyone can help provide these services. This is “Level 1.”

Relationships can add an extra layer of support, listening ears, and help in times of stress and crisis. And community programs for sports, art, and education can provide supportive friends, teachers, and colleagues that make stressful times easier to bear. This is “Level 2,” addressing community support structures. 

“Level 3” of the pyramid describes focused and intentionally designed programs that target the management and reduction of distress and the effects of stress and trauma. For example, drawing, painting, and writing can be excellent ways for a person to uncover and release certain negative thoughts and emotions. When these types of activities are planned and executed by someone trained in the proper techniques for art therapy, they can do tremendous good for those who participate. This Field Guide would classify as a Level 3 intervention.

The final level, “Level 4,” refers to activities that can be carried out by highly trained professionals, many of whom may come from outside of the community. Things like therapy and counseling, or psychiatric doctors, fall under this category because only a few trained people can implement them, and they are used not for all cases, but for those most in need of help.

The IASC framework distinguishes between basic services that anyone can provide and programs and activities that require specific training and set-up. For example, while many people could read a book to their children, not everyone could teach a classroom full of children. Specialized services require specialized training. And specialized services have more specific outcomes. Similarly, when it comes to mental health, IASC suggests that specific interventions might target specific behaviors and psychological challenges, and therefore, individuals conducting or providing those activities will need specific training.

WHO model for “optimal mix of services” in global MHPSS work.

 Many types of useful MHPSS activities can be implemented by lay community members (i.e. people who are not clinical professionals) who receive sufficient training. The Field Guide is an example of such a program. That said, not all activities work for all individuals, and it is important to reiterate that people will respond to activities differently and in their own way.

Despite the many specific guidebooks, reference manuals, and training programs to equip workers to better understand the importance of mental health during and after emergencies and crises, and the number of specific activity programs that exist in the MHPSS sector, few of these resources delve into the science behind the effects of conflict, displacement, or other adversities on the mind and body. 

In other words, there are almost no resources that explain why stress and trauma affect us as they do, or why certain emotional experiences are common after experiencing adversity and trauma. Again, most existing resources are program guidelines or technical guides on how to set up specific activities or how to protect people from further psychological risks in an emergency. In The Field Guide, we explore the underlying causes and impacts from a psychological and biological perspective, and then briefly explore how we can heal and grow by tapping into some of the same systems negatively affected by stress and trauma through specific exercises.