RESUMEN
BACKGROUND: Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development. CASE DESCRIPTION: Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste. DISCUSSION AND EVALUATION: These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders. CONCLUSIONS: Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.
RESUMEN
This paper describes the mental health and psychosocial response to the Boxing Day tsunami in Sri Lanka. The need to deal with the immediate psychological distress of survivors and provide psychosocial support after the tsunami was recognized early by the President of Sri Lanka and advisory group set up. In conjunction with the WHO regional office and local representatives, a National Plan of action for management and delivery of psychosocial and mental health care needs was set up. Advice was provided on the right type of psychological approaches to use when dealing with survivors--for example, not forcing people to relive their experiences, listening without offering opinions and not diagnosing or labelling people as suffering from post-traumatic stress disorder (PTSD). The early response and community level work are described in this paper as well as how this has led to a new level of disaster preparedness and a new national mental health policy and proposals for new mental health legislation.
