The number of people affected by humanitarian crises has risen substantially in the first decades of the 21st century. In 2015, displacement reached its highest level ever, with over 59.5 million people forced from their homes. It was also the hottest year on record, contributing to food shortages and extreme weather events, and one of the most dangerous years to be a child or an aid worker. Humanitarian needs are expected to increase in 2016, with the UN estimating that 125.3 million people will require humanitarian assistance across 37 countries before the year is out. Overshadowed by the urgent calls for food, water, medicine and shelter, the mental health needs of people living in humanitarian settings are often forgotten or ignored. Building on Canada’s commitment to provide humanitarian assistance to the most vulnerable, Canada through Grand Challenges Canada is beginning to tackle this hidden crisis through innovation.
The mental health needs of populations in humanitarian contexts merit particular attention. The prevalence of mental illness increases substantially during crises, as a result of exposure to violence, deprivation, displacement and the destruction of pre-existing support structures. Research in conflict-affected communities shows a substantial increase in the proportion of the population suffering from post-traumatic stress disorder and depression. Meanwhile, the destruction of already limited mental health infrastructure makes it difficult and dangerous to access treatment. Those with severe mental illness are also less able to access other forms of humanitarian aid, such as food, water and shelter, further threatening their chances of survival.
The burden of mental illness outlasts periods of acute crisis, limiting the ability of individuals to recover, adapt and move on with their lives, and impacting the next generation. Children and adolescents who grow up in the midst of armed conflict or chronic adversity experience long-term repercussions to their physical and mental health, putting them at risk of further exploitation and impeding their chances at educational attainment and employment. Even refugees who eventually find asylum in stable countries, are three times more likely to have schizophrenia and non-affective disorders than the host population, and 66% more likely than other migrants to suffer from mental ill health (Hollander et al, BMJ 2016).
Grand Challenges Canada has invested $12M in 17 innovative projects to improve treatments and expand access to evidence-based care for people living through natural disasters, conflict and situations of chronic adversity. In Colombia, for example, the OSITA project has succeeded in supporting nearly 300 women displaced by the armed conflict in Bogota to manage depression, anxiety and PTSD through the provision of interpersonal therapy and specialist care. By training women survivors to deliver care, this model also helps break down access barriers. In Sierra Leone, the Youth Readiness Initiative is helping to prepare conflict-affected youth who suffer from mental illness to benefit from youth employment schemes that would normally be out of reach – an approach that could eventually be extended to Ebola survivors.
To help bridge the gap between evidence and practice in the delivery of mental health care in humanitarian settings, Grand Challenges Canada has also supported the development of the Mental Health and Psychosocial Support Network website, MHPSS.net. This online platform provides a critical space for humanitarian actors to share resources and coordinate evidence-based responses to mental health needs as they arise. The site has played an important role in relation to recent major humanitarian emergencies, such as the Syria conflict, the 2013 Philippines Typhoon, the Ebola crisis and, most recently, the Zika outbreak, providing a neutral space for local and international actors to exchange information and access relevant technical guidelines, programme resources and coordination information.
We need to do more. The inclusion of mental health in the Sustainable Development Goals marks growing recognition among the international development community that there can be “no health without mental health.” Further investment into scalable, sustainable and evidence-based approaches to improving treatment and expanding access to mental health care in humanitarian contexts is needed to make sure no one is left behind. This means continuing to invest in the innovative potential of individuals and communities living in situations of adversity to transform their lives; adopting an inter-sectoral approach that integrates mental health care with emergency nutrition, shelter, education and medical assistance; and ensuring that mental health care is delivered according to the principles of humanity, impartiality and neutrality. Donors, NGOs and other actors must prioritize the provision of mental health care during humanitarian crises and seize the opportunity to build back better by ensuring that mental health care is a fundamental part of long-term development. Through its commitment towards humanitarian action and leadership in mental health innovation, Canada can play an important role in this transformation.