DIMENSIONES PSICOLÓGICAS

This section contains the various guidelines of different intervention agencies including the UN that guide practice on mental health activities for disaster, conflict and development affected communities worldwide.

i. Sphere Guidelines

One of the first milestones was the eventual inclusion of mental health into the Sphere Handbook in 2004 as mental health and psychosocial issues were omitted from earlier versions. Standard 3, ‘Control of non-communicable diseases: mental and social aspects of health’, states that “people have access to social and mental health services to reduce mental health morbidity, disability and social problems” (Sphere Handbook, 2004, p.291). This standard not only attempted to define “psychosocial” but also highlighted the following fundamental principles: the crucial need for accurate information, the need for respectful burials, the role of “psychological first aid”, the need for the care of those with urgent psychiatric problems, and the essential role of community-based psychological interventions based on an assessment of existing services and an understanding of the socio-cultural context.

ii. United Nations Refugee Agency (UNHCR)

UNHCR does not have direct and specific guidelines on mental health, but their policy on responding to displacement is central to communities. According to Bakewell (2003, p.1), Community Services is the hybrid term for one of the ‘sectors’ of the international aid response to refugee and displacement crises co-ordinated by UNHCR. It used to be known as social services and focused on providing care for refugees whose needs were unable to be met within basic camp provision. Over the past decade its remit has expanded significantly and it has been at the forefront of UNHCR’s move towards a community development approach in its programmes.

Despite its expanded role, community services are not in the same league of influence in the field or in funding as the priority ‘life support sectors’ of food, health, water and sanitation.

“The community services function is a relatively neglected aspect of UNHCR’s work with refugees, attracting significantly less international attention than many other of the organization’s activities. And yet it is a function which seeks to meet some of the

most essential needs of refugees, especially those who are at greatest physical and psychological risk.”

(Bakewell, 2003, p.113)

Basic Principles

UNHCR’s Community Services activities are based on certain fundamental principles about human beings:

• The dignity and worth of individual human beings.

• The capacity of persons to change no matter how desperate their situation. • Inherent desire of all human beings to belong to and contribute to a larger

supportive community.

• Every person has a right to live a full human life, and to improve his / her circumstances.

• Persons are entitled to help when they are unable to help themselves. • Others have a duty to help those who are unable to help themselves. • The ultimate goal of Community Services is self-help.

The Goals of Community Services:

• Individual Level – to restore the refugees’ sense of being human, to enable them to take decisions, and to start living again in a self-respecting way.

• Community Level – to restore a sense of security, create a sense of belonging and to rebuild a self-generating community.

(UNHCR Community Service Guidelines: basic principles and goals, 1996, p.14)

However, despite a previously low profile, during recent years the crucial role of community services and the need for a community based approach has gradually been recognised and UNHCR is moving towards this becoming the dominant ethos within UNHCR operations. This is in line with, and supports and complements, the principles of the IASC Guidelines. The recent UNHCR publication “A Community – Based Approach to UNHCR Operations” (June, 2007) outlines the values underpinning a community-based approach and provides detailed guidance in relation to the implementation of this approach in practice. As the UNHCR staff and partners are using this in their field operations, time will prove whether this is effective or not. It is also explicitly recognised that there are many institutional challenges to effective

community work and that there is a “need for attitudinal change” (p. 1) within UNHCR itself.

iii. World Health Organisation (WHO)

The right to physical and mental health dates back to 1946 when the World Health Organization (WHO) adopted its Constitution. This recognizes that: ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’. It defines health as ‘a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity’. This latter definition presents an integral vision of health, including body and mind that, as will be discussed below, has only now come to assume greater importance.

However, WHO is not an implementing organisation in the field of disasters, development and conflicts. According to its mandate the Organisation provides collaborative support to Member States, in partnership with other intergovernmental and non-governmental organisations (2009). For this reason, WHO does not influence the practice at field level in mental health response to disaster, development and conflict affected communities. However, during 2004 – 2007, WHO took the leadership in the Inter-Agency Standing Committee on Mental Health and Psychosocial Support in Emergency Settings, which developed international guidelines on mental health and psychosocial wellbeing.

iv. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings

The Inter-Agency Standing Committee for the development of Guidelines on Mental Health and Psychosocial Support in Emergency Settings included the participation of the following agencies:

₋ American Red Cross (ARC) ₋ Christian Children’s Fund (CCF)

₋ International Catholic Migration Commission (ICMC) ₋ International Medical Corps (IMC)

₋ International Rescue Committee (IRC) ₋ Mercy Corps

₋ Inter-Agency Network for Education in Emergencies (INEE) ₋ ActionAid International

₋ CARE Austria ₋ HealthNet-TPO

₋ Médicos del Mundo (MdM-Spain)

₋ Médecins Sans Frontières Holland (MSF-Holland)

₋ Oxfam GB

₋ Refugees Education Trust (RET) ₋ Save the Children UK (SC -UK)

₋ International Federation of Red Cross and Red Crescent Societies (IFRC) ₋ International Organization for Migration (IOM)

₋ Office for the Coordination of Humanitarian Affairs (OCHA) ₋ United Nations Children’s Fund (UNICEF)

₋ United Nations High Commissioner for Refugees (UNHCR) ₋ United Nations Population Fund (UNFPA)

₋ World Food Programme (WFP) ₋ World Health Organization (WHO

The Department of Mental Health and Substance Abuse of WHO co-chaired this Committee with the Christian Children’s Fund. More than 500 NGOs, universities and other institutes participated in the development process. The Disaster and Development Centre of Northumbria University acted as a reviewer of these Guidelines and provided field comments through its network of communities.

Building upon the Sphere Guidelines and following an extensive development and consultation process, the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings were launched in September 2007. Being a highly significant milestone, these guidelines pose an immense challenge to all international relief organisations in terms of putting the principles into practice within complex emergency settings.

Development of the IASC Guidelines involved the participation of UN Agencies, International NGOs, Universities and Bi-lateral organisations. The purpose of these Guidelines is as follows:

“The primary purpose of these guidelines is to enable humanitarian actors and communities to plan, establish and coordinate a set of minimum multi-sectoral responses to protect and improve people’s mental health and psychosocial well-being in the midst of an

emergency. The focus of the guidelines is on implementing minimum responses, which are essential, high-priority responses that should be implemented as soon as possible in an emergency.”

(IASC Guidelines, 2007, p.05)

The following are the core principles of the Guidelines:

• Human rights and dignity

• Participation of affected communities • Do no harm

• Building on available resources and capabilities • Integrated activity support systems

• Multilayered support: Basic services and security; Community and Family support; Focused, non-specialised support; specialised support

(2007, p.9-12)

Mental health guidelines and policies in the humanitarian sector have improved since the Sphere Guidelines. However, the IASC Guidelines that are now at the forefront in mental health advice face the challenge of being translated into implementation for local settings.