HEALTH ACTION

Health Action In Crisses And Emergencies



Health Action In Crisses And Emergencies

Introduction

Mental health is becoming a core public health area in complex emergencies. Many historic milestones have contributed to this situation, for example, studies in war veterans have revealed the serious mental health effects of conflict. Psychological casualties exceeded physical casualties by two to one in World War I and in World War II 33% of all medical casualties were attributable to psychiatric causes. 10 years after the Vietnam war, 15% of US veterans were still affected by post-traumatic stress disorder. These findings were eventually applied to war-affected civilian populations.

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 complex emergencies.

Despite the challenges of determining the prevalence of mental illness across cultures and in insecure environments, progress has been made in assessing the psychological and social effects of complex emergencies. The absence of accurate population estimates and culturally validated screening instruments needs to be overcome before culturally valid mental health assessments can be made. However, validated measures of economic and social productivity and social capital in emergencies are still not available. Studies showing the prevalence of the mental health consequences of mass violence, depression, and post-traumatic stress disorder in adults. Some studies recorded non-specific psychiatric morbidity.

Point prevalences in first four rows, lifetime prevalences thereafter. Different screening methods were used in these studies (see references for details). HTQ=Harvard trauma questionnaire. HSCL-25=Hopkins Symptom Checklist-25. GHQ-28=general health questionnaire-28. SF-36=short form-36. CIDI=composite international diagnostic interview. DIS=diagnostic interview schedule. NA=not measured.

A longitudinal study of Bosnian refugees revealed, for the first time, the serious disability associated with the mental health effects of mass violence. 45% of the refugees studied met DSM-IV criteria for depression or post-traumatic stress disorder or both, and when both were diagnosed there was a high rate of physical disability (45•5%). In 1999, psychiatric disability was unremitting and premature death was identified in elderly people in this population. Other studies support these results, suggesting that suffering continues long after the crisis has ended.

Purpose of Study

the aim of study would be analyzing the mental health action in crisses and emergencies.

Significance of Study

The first on-site refugee mental health survey was undertaken in the largest Thai border camp, Site 2, in 1988, followed by the UN's acceptance of a plan to relieve the mental health crisis. The next milestone was the implementation by humanitarian relief workers of hundreds of psychosocial programmes during the Balkan conflict. Mental health practices that are vidence-based and culturally competent are needed for complex emergencies, and in this review we offer a mental health action plan and an agenda for future ...