Elsevier

The Lancet

Volume 364, Issue 9450, 4–10 December 2004, Pages 2058-2067
The Lancet

Series
Mental health in complex emergencies

https://doi.org/10.1016/S0140-6736(04)17519-3Get rights and content

Summary

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scienti.c evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.

Section snippets

Conceptual framework

A complex emergency is a social catastrophe marked by the destruction of the affected population's political, economic, sociocultural, and health care infrastructures.9 The figure illustrates the links between mass violence, mental health impairment and services, and the existing damage to economic development, social capital, and human rights. Although these macro-level forces create health and mental health impairments and barriers to mental health service delivery, they can also be used to

Magnitude of the problem

The Global Burden of Disease Study24 established for the first time the substantial burden of mortality and disability associated with mental illnesses. Depression, the fourth leading disease burden in 1990, is predicted to move to second place in 2020. Of the ten leading causes of disability worldwide, five were psychiatric conditions. The Global Burden of Disease Study did not focus on traumatised populations, and the mental health effects of psychiatric disorders might be much greater in

Mental health action plan

A mental health action plan for a complex emergency (panel) should be grounded in recommendations from landmark reports from the World Health Organisation67, 68 and the US Surgeon General.69

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