|Paper authors||Agnes Meiria, Debora Utami|
|In panel on||What are the best practices for implementing MHPSS interventions in smaller, under the radar crisis?|
|Paper presenter(s) will be presenting||
Fostering a Community Based Mental Health and Psychosocial Support
Mental health and psychosocial support needs increase greatly during emergencies. Therefore, YEU considers MHPSS to be an important sector to address in times of crisis or emergency. Following the IASC MHPSS intervention pyramid, the MHPSS intervention is applicable for the whole population in emergency settings, with focus priority on the at-risk groups, and as a community-based intervention, of the four layers, it focused only on the three bottom layers of the pyramid, i.e., 1) provision of basic services and security, 2) family and community support, and 3) focused non-specialised supports (such as psychological first aid and basic mental health care by primary health care workers). Whereas the highest layer, specialised services, should be provided by professional (such as psychological or psychiatric supports).
Community based MHPSS is defined as an approach of providing mental health and psychosocial support in the community, where every potency and resource in the community are actively involved. Where professional actors like psychologists or counselors are not present, local communities (e.g., local health cadres, evacuation site/camp committee, village disaster response taskforce), as the first responders, can be equipped with the capacity to conduct community-based mental health and psychosocial interventions such as the psychological first aid skill and establishment of self-help group.
In small scale emergencies, YEU implemented community based MHPSS during the emergency response to the Mount Merapi eruption in 2020 and Mount Semeru eruption in 2021, resulting in important recommendations to address the wellbeing of the affected communities, such as preparing them on how to cope with worries and fears and return to normal activities, strengthening the families and caregivers in reducing the risk, and raising awareness on communication and information sharing mechanisms to ensure trustworthiness and inclusion.
Aside for local communities affected by both eruptions, YEU also conducted MHPSS intervention for survivors of terrorist bombing in Surabaya’s churches in 2018 and psychosocial support for the survivors including children of social conflict in Sidoarjo, East Java.
Psychosocial Need Mapping
To provide adequate and right-on-target psychosocial support, it is important to conduct initial psychosocial need mapping to provide baseline analysis on the condition of the at-risk individuals, prioritized for older people, persons with disabilities, and women (pregnant or breastfeeding) during the crisis (emergency response phase). As an example, need mapping can be carried out through a peer group conversation in which the participants appraise their current situation and emotions by using an activity clock and guided question.
Promoting Self-Help Group
As mentioned, strategy on empowering community based MHPSS can also be conducted by involving social and material resources in the community. Beside involving various stakeholders and optimizing existing social structure in the community, the most important actor to be involved is the at-risk persons/groups themselves and their families or caregivers. It aims to increase the participation of at-risk groups and ensure that the interventions are in accordance with the needs. It will also create a culture promoting community based MHPSS.
Psychological First Aid by First Responders
The psychological first aid (PFA) is a non-specialised intervention that can be conducted by trained local communities such as health cadres or camp committee. It is also a form of peer support and can be accompanied by a general stress management session. The IASC Guidelines on MHPSS mentioned that, “Most individuals experiencing acute mental distress following exposure to extremely stressful events are best supported without medication.” Therefore, PFA is not clinical or emergency psychiatric intervention, but “a humane, supportive response to a fellow human being who is suffering and who may need support.”
Reactivating and strengthening community's activities before crisis
Communities have capacities to build their own resilience against shocks or crisis if encouraged to focus on locally available resources. Activating community's activities such as community-based health services, prayer sessions, monthly meetings, arisan, education sessions for children, income generating activities etc makes them able to connect again to one another and support each other, while improving their well-being.
Based on the IASC Guidelines on MHPSS, the PFA entails:
• Protecting from further harm,
• Providing opportunity for survivors to talk about events without pressure,
• Listening patiently in an accepting and non-judgemental manner,
• Conveying genuine compassion,
• Identifying basic practical needs and ensuring that these are met,
• Asking for people’s concerns and trying to address these,
• Discouraging negative ways of coping, and
• Encouraging participation in normal daily routines (if possible) and use of positive means of coping.
• Inter-Agency Standing Committee (IASC) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC.
• Related emergency responses report, YEU