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Box 7 Belize: integrating mental health into the national health agenda 187 Belize’snationalhealthagenda(2007–2011)givesvisibilitytomentalhealth issuesandrequiresthegovernmenttoachieveanumberofkeyexpected resultsinmentalhealthpolicyandservicedevelopment.Itaimstoprevent andreducetheincidenceofmentalhealthconditions,andtoprovidegoodqualitycaretothoseinneed.Servicesconsistofprimary-carebased outpatientservicesthatarecomplementedbyinpatient/specialistcareand communityoutreach.Specificareasforactioninclude:developmentofa mentalhealthhumanresourceplan;trainingofgeneralhealthworkersinthe managementofmentalhealthconditions;developmentofcommunity-based supportservices,includinghousing;andsupporttothedevelopmentof consumerorganizationsnationwide.Cleartargetsforeachoftheseareaswill holdthegovernmentaccountableforachievingtangibleresults. 4.2.3 Integrate mental health into services during and after emergencies The psychological and social impacts of emergencies may be acute in the short term, but they can also undermine the long-term mental health and psychosocial well-being of the affected population. These impacts may threaten peace, human rights and development. One of the priorities in emergencies is thus to protect and improve people’s mental health and psychosocial well-being. Achieving this priority requires coordinated action among all government and nongovernment humanitarian actors. —Introduction to the Inter-Agency Standing Committee on Mental Health and Psychosocial Support in Emergency Settings 99 As described earlier in this report, disasters and other emergency situations lead to an array of mental health problems, ranging from short-term stress reactions, through to anxiety and depressive disorders and psychosis. In addition, people with pre-existing mental health conditions often experience disruptions in their treatment and care, and in some cases are abandoned by their caregivers. Emergency primary care relief workers often are not skilled or equipped to manage and support people with mental health conditions. For example, psychotropic medicines were not included in the Interagency Emergency Health Kit until July 2009. The newly-updated version of the kit (4th edition, 2010) now includes four essential psychotropic medicines, which address the most severe and acute mental health conditions. This kit is sent to countries as part of emergency relief services, and contains essential medicines and medical devices urgently needed in the 3-month period following a disaster. 188 40 MentalHealthandDevelopment:Targetingpeoplewithmentalhealthconditionsasavulnerablegroup
Box 8 Mental health interventions following emergencies often focus exclusively on (shortterm) emergency relief, rather than on medium and long-term development (re)construction. This is a missed opportunity. While short-term mental health support is important, especially for vulnerable groups, development stakeholders should direct the bulk of their resources for mental health care towards (re)construction of communitybased mental health services. This will help ensure enduring access to care for people with pre-existing mental health conditions, as well as those who develop chronic mental health problems as a result of the emergency. It also can serve to overcome historical shortcomings in the quality of mental health services (see Box 8), for example, by encouraging a transition from institutional to community-based care. Post-tsunami Sri Lanka 189 4.Improvingdevelopmentoutcomes:principlesandactions Post-emergency strategies should prioritize community mental health services. Intheaftermathofthetsunamidisasterof2004,theactivenurturingof numerousopportunitiesresultedinsignificantimprovementsintheSri Lankanmentalhealthsystem.Duringthemonthsafterthetsunamistruck, SriLankawasoverrunbyaidagencies,eachofwhichwasofferingshorttermmentalhealthandsocialsupport.Withongoingstrongsupportfrom theWorldHealthOrganization,stepsweretakentomaintainthisinterest inmentalhealthanduseittoinitiateanational-levelpolicydevelopment process.Tenmonthsafterthedisaster,theGovernmentofSriLanka approvedanew,consensus-basednationalmentalhealthpolicy.Thenew policyhasguidedeffortstostrengthenthegovernance,management,and administrationofmentalhealthservices,andtoreconfiguretheorganization ofmentalhealthservicessothatmultidisciplinarycareisavailablelocallyin alldistricts. 41 WHO/Marko kokic
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