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International Conference on Mental Health and Psychosocial Support in Crisis Situations

Fracarita International was invited in Amsterdam to join the expert group for preparing a two-days International Conference on Mental Health in Humanitarian Context. Mr. Prakash Goossens (International Advocacy Fracarita International) was mandated to participate in this endeavour.

Fracarita International is an International recognized NGO in the field of Mental Health with a special consultative status in the ECOSOC (United Nations) and has been requested in different international conferences to give testimony to the works of the Congregation of the Brothers of Charity. The international advocacy of Fracarita International shows in a modest way the different pragmatic approaches that the Brothers of Charity have taken in 30 countries worldwide in the field of mental health service delivery. Charity out of love combined with professional care is at the hearth basis of the mission of the Brothers of Charity.

This two-day conference at KIT Royal Tropical Institute in Amsterdam, is one in a series of international conferences on MHPSS launched in 2018 on the United Kingdom’s initiative (2018). In 2020 France (Paris) will take the lead for this great advancement of Global Mental Health. The essence of this summit is that mental health and psychosocial support (MHPSS) should be an integral part of the humanitarian response in crisis and emergency situations (no health without mental health).

One of the aims of the International Conference on Mental Health and Psychosocial Support in Crisis Situations in 2019 in Amsterdam is to present promising and evidence-based approaches and interventions and discuss how those can be integrated into routine humanitarian assistance and brought to scale.

On Monday, 7 October, the Dutch Minister for Foreign Trade and Development Cooperation, Sigrid Kaag, opened the International Conference on Mental Health and Psychosocial Support (MHPSS) in Crisis Situations in Amsterdam. Kaag is hosting the conference in order to mobilise commitment from countries and organisations to scaling up sustainable and high-quality MHPSS during and after crisis situations. In her opening speech, she referred to a 1917 poem by war poet Wilfred Owen, stating: ‘No longer will we focus our efforts exclusively on rebuilding bombed-out bridges and providing first aid. We need to acknowledge the soul; that which makes us human.’

(Minister Sigrid KAAG, Foreign Affairs and Development Aid, The Kingdom of the Netherlands)

“In conflict affected areas, one person in five lives with some form of mental condition, from mild depression and anxiety, to psychosis. That’s three times more than the general population worldwide suffering from these conditions. Behind these statistics are people who seek to live their lives with health and dignity. Just because mental health and psychosocial needs may not be as visible as physical health needs, they are no less life- threatening. When not addressed, mental health and psychosocial needs and traumas have a far-reaching and long-term impact on people, their families, their communities, and on the whole society.”

Peter Maurer, President International Committee of the Red Cross (ICRC)

Participants in the Amsterdam Conference stress that armed conflicts, natural disasters and other emergencies take an immense toll on people’s mental health and psychosocial wellbeing. It is impossible to quantify the full range of emotional, behavioral and psychosocial impacts of such situations on girls, boys, women and men, across the life course. Nevertheless, best estimates suggest that these experiences more than double the prevalence of depression, anxiety, and other mental health conditions that impair daily functioning. Given the protracted nature of many crises, participants also recognize the need for longer- term MHPSS-approaches, and the importance of development cooperation in this context. The Inter-Agency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Situations (2007) as well as the WHO Mental Health Gap Action Plan give guidance on what kind of supports should be made available. Special attention should be paid to people who are vulnerable to violations of their basic human rights in crisis situations.

Mr. Prakash Goossens (International Advocacy Fracarita International) highlighted the importance of sustainable service delivery in mental health after manmade or natural disasters. He pointed out that the Brothers of Charity works for decades in a very pragmatic way where emergency relief is combined with professional mental health service delivery long after all the ‘international’ commitments are gone. He referred to the work of the Brothers of Charity in the refugee camps close to Kigoma (Tanzania) but also to the projects established in Bangui (Central African Republic). Furthermore Mr. Prakash Goossens referred to the Dr. Guislain Award ‘Breaking the chains of stigma in mental health’. He launched also the idea of a Belgian Mental Health Fast Response Team (B-Fast Mental Health). The Representative of the Belgian Development Aid and Foreign Affairs will take this idea to the Belgian Government and will see how this can be funded by the Belgian Development Aid.

“MHPSS reduces the emotional suffering of refugees and improves their social functioning; It helps them thrive instead of just survive.”

Peter Ventevogel, Senior Mental Health Officer, UNHCR

Fracarita International prepared intensively in a subgroup with others on the topic of a Just and Inclusive Society: Supporting Societal Shifts, Addressing Stigma and Discrimination

Expert group:

  • Ben Adams (CBM),

  • Chris Dolan (Director Refugee Law Project)

  • Christine Ogaranko (Open Society Foundation, Social Worker)

  • Bro. Hippolyte Manirakiza (Fracarita International)

  • Julian Eaton (Mental Health Director CBM)

  • Marian Tankink (MHPSS and Peacebuilding, Medical Anthropologist, Psychiatric Nurse)

  • Michael Njenga (Users and Survivors of Psychiatry, Kenya)

  • Prakash Goossens (Fracarita International)

  • Sarah Rizk (Humanity and Inclusion, Psychology)µ

In this sub-group the experts discussed about the criteria for a just and inclusive society where stigma and discrimination and social exclusion are addressed as major challenges to realize this. Ther is progress in the international community dealing with mental health. The Societal shifts are there and even the International Community working in the field of health are realizing that there will be no health without mental health. From ignorance to realizing that mental health will become the biggest ‘burden’ in the health of people, more and more donors, governments and civil society movements are joining the campaign ‘breaking the chains of stigma in mental health’.

  • The Inter Agency Standing Committee (IASC) Guidelines for Mental Health and Psychosocial Support in Emergency Settings lay out an approach that ensures that people receive the most appropriate care for their level of need, with the great majority not needing focused professional treatment, but the re-establishment of basic needs and supportive networks.

  • The Report of the Special Rapporteur to the Human Rights Council (2019) on the right to the enjoyment of the highest attainable standard of physical and mental health highlighted the critical role of social and underlying determinants of health in advancing the realisation of the right to mental health.

  • The Lancet Commission on Global Mental Health and Sustainable Development (2018) emphasised that without addressing social determinants, it would not be possible to reduce the burden of mental health conditions and meet wider developmental goals. It advocated a shift in focus to research and interventions to strengthen prevention and promotion of mental health.

  • The Disease Control Priorities report, 3rd Edition (2016) for the first time included mental and neurological health in its recommendations for the most cost-effective in prevention and promotion.

Mental health and wellbeing after emergencies rely on just societies that are able to include all members. The principle of ‘leave no-one behind’ has been emphasised in the Sustainable Development Goals and is applicable to the specific contexts of humanitarian emergencies and protracted conflicts. In these circumstances, when social structures that protect vulnerable populations are weak or have been weakened through crisis, particular attention must be paid to their needs. In 2019, the IASC underwent a major review of recommendations across sectors to strengthen consideration of inclusion of people with disabilities, including those with psychosocial and intellectual disabilities.

A second core principle that must increasingly apply to emergency response is ‘nothing about us without us’. Historically, people directly affected by humanitarian and development interventions have had little voice in the decisions taken about interventions developed for them. This is particularly the case for people with mental health problems and other marginalised groups. This is also increased when people are disadvantaged in multiple ways. Structures and procedures can be put in place to ensure proper participation and access to equal rights, for all people, both in the intense phases of emergency response and in the long-term rebuilding of communities. It is communities themselves who best understand what justice, reconciliation and fairness means to them, and local cultural understanding and leadership is central to effective work in restoring communities after emergencies.

Key recommendations of the subgroup ‘A just and inclusive society: Supporting Societal Shifts, Adressing Stigma and Discrimination. These proposed recommendations are based on the deliberations of the ‘Just and Inclusive Society’ group established to support the Summit.

  • Promote wellbeing and recovery during and after emergencies by shifting to a greater focus on the things that promote mental wellbeing (like security, justice and strong communities), and addressing risk factors for mental ill health (like poverty, unemployment and exposure to violence). Policies and practices to do this must ensure that all groups are equally able to meaningfully participate and access response and recovery activities. A just and inclusive society is inherently more likely to lead to greater wellbeing and recovery after conflicts/human-made and natural emergencies. There must be greater investment in addressing social exclusion of marginalised groups, including through evidence-based anti-stigma work, as an essential complement to access to appropriate treatments for mental health problems. This mainstreaming approach promotes equal access to human rights for all.

  • Strengthen the voice and representation of people with disabilities and other excluded groups so that MHPSS programming addresses their particular needs. In addition to mainstreaming access to rights, emergency preparedness, response and rebuilding must recognise the particular needs of groups who tend to be excluded. This can only be done by emphasising the essential role of people who are themselves affected in taking a lead in processes and organisations in the field. Concretely this means investing in strengthening Disabled Persons’ Organisations (e.g. to include people with psychosocial disabilities), establishing good consultation and representation procedures, and employing people with lived experience in response organisations.

On 8 October 2019, in presence of Her Majesty, Queen Maxima, Ministers and high- level representatives from countries and international organizations convened in Amsterdam to address the importance of addressing the mental health and psychosocial support needs of people affected by emergency situations and protracted crises. See for official declaration:

“Mental health and psychosocial needs can double in populations affected by conflicts, disasters and other emergencies. If left untreated these invisible wounds have far reaching and longer-term negative impacts for individuals, communities and entire societies. Acting on mental health is simply an expression of our shared humanity.”

Elhaj As Sy, Secretary-General of the International Federation of Red Cross and Red Crescent Societies (IFRC)

Upcoming: April 2020

Fracarita International is already invited to join the expert group for organizing a conference in Brussels on Global Mental Health together with the Antwerp Tropical Institute and the BE-CAUSE HEALTH platform of the Belgian Development Aid. The idea is to have a Conference in April 2020 as just between Amsterdam and Paris Conference. The purpose is to strengthen the approaches in mental health of the French-speaking countries in Africa.

In order to ‘keep the momentum’ in this important initiative of giving voice to Global Mental Health, we would like to make a commitment from Belgium. As representatives from the Mental Health Working Group of “BeCause Health” in Belgium, we commit ourselves to organizing an event in April 2020. We would then like to take stock, timewise and geographically exactly in between the Amsterdam and Paris conferences, of where we are in taking the next step in Paris. We would seek advice from the organizing committees of the earlier conferences and the upcoming conference in Paris. We are seeking support from the Belgium Ministry of Foreign Affairs, and are already supported by “BeCause Health” and the “Institute of Tropical Medicine Antwerp”. We would hope to welcome Queen Mathilde of the Belgians, who adopted mental health as advocate for the United Nations’ Sustainable Development Goals.

Willem van de Put, International Health Policy, Antwerp Tropical Medical Institute

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