MSF focus on mental health

What is Mental Health?

When thinking about health, we tend to think mainly of our physical state and the way our bodies feel—but without including our mental state, we’re not seeing the whole picture. Mental health is a state of wellbeing in which a person is able to cope with the regular stresses of work and home life and make a contribution within their community (World Health Organization).

Being mentally healthy is more than just the absence of specific mental health conditions. Mental health is based on biological, psychological and contextual factors––being healthy in the way we think, feel, and relate to others and our environment.

Why is mental health important?

Mental health conditions are very common. In Australia, a 2018 report projected that nearly half of Australians will experience a mental illness in their lifetime, and, in New Zealand, one study found that one-third of the population have experienced mental distress.

Mental health conditions—which include depression, anxiety, substance use disorders (including alcohol) and psychoses—can be highly disabling, affecting people’s functionality and capacity to live fulfilling lives. These conditions are also associated with increased mortality: World Health Organization (WHO) figures report that worldwide, 800,000 people die from suicide every year.

People with mental health disorders are also likely to experience comorbidities, which make people sicker and increase their risk of death. According to the WHO, the average life expectancy of people with severe mental health disorders is 10 to 25 years less than the general population.

Now during the COVID-19 pandemic, there is increased concern among the medical community about mental health as people face increased health, financial and social pressures.

In October 2020, a WHO survey revealed that the pandemic has disrupted or halted critical mental health services in 93 percent of countries worldwide, while the demand for mental health is increasing. In May, the Australian Medical Association, together with leading mental health experts, reported that COVID-19 is likely to lead to increased rates of suicide and mental illness in Australia.

How can mental health be improved?

Unlike physical symptoms, which can often be easily recognised, symptoms of poor mental health can be difficult to note by ourselves. Having people around you that you trust and who can spot changes in your behaviour can be a huge help in making sure you are able to enjoy a healthy state of mind. MSF psychiatrist Dr Jairam Ramakrishnan and MSF psychologist Dr Trudy Rosenwald suggest the following tips to improve mental health.

One of the most important ways to improve your mental health is to establish a good routine. Start with the basics—wake up on time, eat at the same time each day, and go to bed at a set time each night. Giving yourself this stability can be a great help in improving your overall wellbeing. Once you’ve established a routine, add in other healthy habits like good nutrition, adequate water intake, and physical and mental exercise.

It’s also important to identify your support system—who is looking out for me, and who am I looking out for? Does this person know how to tell me when I start showing signs of distress? Trust is a key part of this process—start these discussions with the people you value so they can support you when you need help identifying mental distress.

If your mental state is causing significant disruption to your life, seek out a mental health professional to talk to as soon as possible. Services like Beyond Blue (Australia) or Lifeline (New Zealand) can provide immediate support over the phone if you need someone to talk to or are concerned about your mental wellbeing.

What challenges are there in improving mental health?

People with mental health conditions represent one of the most marginalised and vulnerable groups worldwide. Despite effective treatments for mental health conditions, only a minority of mental health patients worldwide have access to mental health services and even when they do, they often don’t receive the most effective or evidence-based treatments.

Many people do not understand what mental health is, or that there is treatment available to help them. Mental illness remains heavily stigmatised in most places, and where there is a lack of awareness this can contribute to beliefs that people with mental health conditions are evil, or to be feared. The consequences for people with mental health conditions, whose families or communities don’t know how to care for them, can be tragic: around the world, hundreds of thousands of people with mental illness are still being chained or locked up against their will.

Many countries have limited capacity to provide mental healthcare––whether this is due to a lack of appropriate infrastructure, resources or trained professionals. People who face marginalisation, violence, displacement, natural and man-made disasters and other crises may develop mental health problems (or find that existing conditions worsen), and typically face further barriers to getting care for these due to factors such as the disruption of health and social structures and networks, poverty, and distance from healthcare.

Fatima speaks with an MSF staff member about the long-term mental health issues she and her family face due to attacks and harassment from settlers in her home in Beit Ummar, West Bank, Palestine. © Juan Carlos Tomasi/MSF

MSF’s response

Communities are likely to be more greatly affected by mental health disorders in cases of persecution, the need to flee armed conflict and natural disasters and a lack of access to vital healthcare.

In low- and middle-income countries, 76-85 percent of people with mental disorders do not receive treatment. MSF is committed to providing essential mental healthcare to those in need who may not be able to access treatments that are effective or culturally accepted by communities.

In 2019, MSF’s mental health teams provided more than 400,200 individual mental health consultations and 104,200 group sessions worldwide.

A holistic approach to healthcare

Mental healthcare and psychosocial support is crucial to overall health. Our teams provide mental healthcare both as an integrated part of medical activities and as standalone mental health projects.

MSF aims to alleviate people’s mental suffering, enhance their functioning and respect their dignity, utilising a combination of a holistic approach to clinical care and community-based activities. Often this work is carried out by local counsellors trained by MSF, with psychologists or psychiatrists providing technical support and clinical supervision.

When appropriate, MSF’s counselling services may reinforce or complement mental healthcare approaches that already exist in the local communities where we work. It is important that our approach to mental healthcare includes local and culturally-specific definitions and perceptions of psychosocial health.

Some of MSF’s activities in mental health include:

Community based activities (e.g. awareness raising, anti-stigma campaigns)
Mental health screening
Psycho-education
Psychological first aid
Crisis intervention
Basic counselling and professional counselling
Psychological support
Psychiatric treatment

MSF first provided mental healthcare in Armenia, after the 1998 Spitak earthquake. Mental health and psychosocial interventions were formally recognised as part of our emergency work in 1998. © MSF

Providing mental health first aid

MSF provides psychological first aid to communities experiencing high levels of distress, including in the aftermath of natural disaster. This care provides people with basic support after they have experienced trauma or critical incidents. Community mental health workers or other trained community members can deliver psychological first aid.

After an earthquake struck Mexico City and other municipalities in the centre of Mexico in September 2017, MSF activated an emergency response. In the first 24 hours, MSF began providing psychosocial support to people in areas where structures had collapsed. Teams of psychologists and social workers were deployed at several points where rescue efforts were underway to evaluate people’s immediate needs and concerns, promote safety and link individuals to help and resources, while establishing a human connection in a non-intrusive, compassionate manner.

Trauma counselling and specialised care

For people who have lived through violence or natural disasters, survival goes beyond ensuring physical wellbeing. Even after their physical injuries have been treated, hidden psychological wounds can remain. Those who have survived extremely stressful situations—refugees, displaced people, disaster survivors, victims of abuse and crime, and survivors or war or genocide—are particularly at risk for severe mental health impacts.

MSF staff walk through Mexico City’s San Gregorio neighbourhood during a psychological first aid evaluation for people affected by an earthquake in 2017. © Jordi Ruiz Cirera/MSF

To help heal the patient’s psychological wounds, MSF mental health professionals listen, support, and train survivors in self-care practices so the traumatic experiences do not come to define their lives. The immediate goal is to reduce their symptoms and empower them to lead happy and healthy lives.

MSF’s work with asylum seekers and refugees on Nauru is one example of specialised psychological care, for people experiencing extreme mental health suffering in indefinite detention. Our mental health team provided treatment for 11 months on Nauru, which included psychiatric care for patients experiencing depression, anxiety disorder, post-traumatic stress disorder and resignation syndrome (a severe form of depressive disorder), also working to increase mental health awareness and decrease stigmatisation.

Our team found that while mental healthcare could temporarily relieve some symptoms, there could be no therapeutic solution for asylum seekers and refugees while they remained held indefinitely on Nauru.

Mental health support for medical activities

Mental health is an essential component of treatment for HIV/AIDS, tuberculosis, malnutrition, non-communicable disease and surgery and burns patients. During our recent response to the COVID-19 pandemic, MSF teams have also witnessed the importance of mental healthcare for the recovery of COVID-19 patients.

A counsellor and doctor visit Leonid, a tuberculosis patient in the intensive care unit of the MSF-supported Tuberculosis Institute in Minsk, Belarus. © Viviane Dalles/MSF

HIV and tuberculosis patients must endure lengthy and gruelling treatment plans; for people with these and other chronic health conditions, or contagious diseases like Ebola and Lassa fever, there is also economic stress, loneliness and stigma, and sometimes psychiatric side-effects from medication. Adherence counselling can help patients to stick to their treatment and cope with the challenges they face in living with and tackling their illness.

Children who are malnourished face the risk of delayed development, and mental health treatment can help support them as well as their caretaker, who may also be experiencing a mental health disorder.

Local and culture-specific responses

To provide effective care, it is essential to understand the structures that exist in the communities where our patients live, and the emotional support these structures can offer. When our mental health teams begin work in a new community, one of their first steps is to seek out local leaders who can guide the team on the strategies that will best match people’s needs. Communities often need to rebuild themselves as a whole to help strengthen the identities of the people within them.

In many cases, MSF mental health staff are from the communities being assisted. Their knowledge and understanding of their community’s experiences, as well as values and practices around mental health, are very beneficial to providing effective treatment.

"As counsellors, we help our patients by listening to them, but we can also connect with them through the experiences we share,” says Stanley, an MSF counsellor in the Democratic Republic of Congo. “When someone comes to us suffering because he has lost his house, I say, 'Oh, you lost your home. I understand that you are deeply affected by this. I was also like that.' Our sessions are foremost conducted to help our patients, but reflecting on our shared experiences allows us, as counsellors, to be comforted as well."

A Médecins Sans Frontières mental health worker provides a consultation for a patient at a health post in the Dadaab refugee camps, Kenya. © Robin Hammond/Panos Pictures

Supporting our teams

Staying mentally well is important for everyone, including our MSF staff. They often face huge pressure working long hours in emergency contexts, and are required to process the traumatic stories of the people they provide care for. Whether they are far from home and away from their usual support networks, or working within their own community, they need safe spaces and strategies to stay healthy and well.

Athena Viscusi is a clinical social worker and member of MSF’s Psychosocial Care Unit, which works to support MSF staff with psychosocial care. “We talk about having a plan when they’re unable to rely on their usual coping mechanisms,” she says. “If they usually run five miles a day to relieve stress, but they are going to be confined to a compound, what are they going to do instead? Another big part of preventing burnout is keeping up strong social connections, with both friends and family at home and their MSF colleagues.”

If a team has experienced a traumatic incident or particularly high stress, an MSF psychologist might travel to the project location to provide support. Counselling is also available for all staff by phone or video call.

If this has raised any issues for you, get support. Talk it through with a mental health professional, or call a mental health hotline for 24/7 support like Beyond Blue on 1300 22 4636 (AU) or Lifeline on 0800 543 354 (NZ).

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Mental health

What is Mental Health?