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 well with the many stresses of life, can realize their own potential, can function productively and fruitfully, and are able to contribute to their communities. (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 2022 report stated that two in five (44 per cent, or 8.6 million) Australians aged 16-85 years experienced a mental disorder at some time in their lives , and, in New Zealand, one study found that almost half of the population (47 per cent) will experience mental distress or illness.

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, more than 700 ,000 people die by 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 WHO data, the average life expectancy for people with severe mental health disorders is 10 to 20 years less than the general population.

Acute outbreaks of diseases can also result in mental health and psychological consequences. During the coronavirus COVID-19 pandemic people all over the world experienced stress and/or anxiety, making them vulnerable to mental disorders and psychosocial problems.

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 (Australia and 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 issues, 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

Mental health needs in humanitarian settings

Communities facing persecution, armed conflict, natural disasters, and limited healthcare access are disproportionately impacted by mental health disorders, they endure severe emotional distress, including separation from family, witnessing loved ones' deaths, and constant displacement in search of safety.

For individuals already grappling with psychological disorders, forced displacement worsens their conditions as they lose access to treatment and regular care, potentially leading to more severe disorders.

Furthermore, the gap between mental health needs and available care is most pronounced in humanitarian settings. A WHO report form 2019 shows that, in conflict areas, mental disorders affect about 22.1 per cent of the population. In low- and medium-resource settings, 76-85 per cent of people with mental disorders do not receive treatment that is effective or culturally accepted by communities.

MSF’s response

Since 1998, Médecins Sans Frontières (MSF) has been delivering mental healthcare as part of our emergency relief efforts. Our teams provide mental healthcare both as an integrated part of medical activities and as standalone projects.

In 2022, MSF’s mental health teams provided more than 425,500 individual mental health consultations worldwide.

A holistic approach to healthcare

Our mental healthcare initiatives are designed to alleviate emotional distress, improve functioning, and uphold dignity through a comprehensive approach that combines clinical care with community-based programs. This work is often led by locally trained counsellors supported by MSF, with guidance and clinical oversight from psychologists or psychiatrists.

The psychosocial support we provide focuses on helping people to develop coping strategies after they have lived through traumatic experiences. The immediate goal is to reduce their symptoms and help them be able to lead a normal life.

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

Educating about mental health

In some contexts, we also focus on educating communities about mental healthcare. This involves teaching them why mental health is crucial and helping them recognize signs and symptoms they should pay attention to. These educational efforts often take place in group settings, with themes tailored to the specific situation.

Providing mental health first aid

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

MSF psychologist consultation in Ukraine

A woman in consultation with an MSF psychologist. In Ukraine, most of our patients are women, as men are, unfortunately, less likely to reach out for psychological care. Ukraine, 2023. © MSF

In Ukraine, the ongoing war has generated a significant demand for psychological support, ranging from immediate psychological first aid to comprehensive psychological care. Many individuals have faced fear, trauma, and isolation, leading to symptoms like anxiety, depression, and stress.

MSF teams are providing mental health first aid to help individuals cope with symptoms such as shock, panic attacks, changes in appetite and sleep patterns, and withdrawal from daily activities.

For some, brief counselling sessions aren't enough. Long-term specialised care is required to prevent mental health disorders, alleviate symptoms, and support relationships while preventing isolation.

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 of war or genocide—are particularly at risk for severe mental health issues.

To help heal patients’ 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.

In Mexico, MSF’s team of doctors, psychologists, and specialists provide comprehensive, long-term care to migrants and Mexicans who've experienced trauma during their journeys or in their home countries. Alicia de la Rosa is a psychologist specialising in animal-assisted psychotherapy, who works alongside four-year-old Labrador, Onnie to provide mental health support at the Comprehensive Care Centre in Mexico City.

Onnie aids with vital mental health support to victims of torture and extreme violence, providing mental health first aid to children, young adults, and families who've fled their homes, coping with symptoms like post-traumatic stress disorder, flashbacks, and anxiety.

Living with disease

Mental health is an essential component of treatment for HIV/AIDS, tuberculosis, malnutrition, non-communicable disease and surgery and burns patients.

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.

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

Mental illnesses

People dealing with severe mental illnesses require specific attention and treatment. In situations where healthcare services fall short, they often face neglect and societal stigma.

At MSF, psychiatric treatment is commonly integrated into general medical care. In some projects, specialised clinicians attend to patients with severe mental illnesses, while in others where specialised professionals are scarce, general practitioners receive training to diagnose and manage psychiatric disorders. Supporting and expanding the capacity of our teams to care for patients with severe mental illness is a priority.

Challenges for providing mental healthcare

Providing mental healthcare during emergencies comes with many challenges. In such scenarios, particularly when violence and trauma persist or when language and cultural barriers deter individuals from seeking support. Our community outreach teams are becoming more important in addressing these issues. They reach out to communities affected by crises, help break down language and cultural barriers, and make mental health support easier to access.

These individuals were unaware of the profound impact their experiences had on their physical and mental well-being. They only recognised their conditions when they reached a point where they couldn't proceed without assistance.

Deborah Duarte

MSF psychologist at the Daadab camp in Kenya

Ensuring the continuity of care in unstable environments is difficult. Patients might face disruptions in their access to ongoing treatment and routine care, potentially leading to the development of further symptoms or more severe conditions.

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 workers 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. Our sessions are foremost conducted to help our patients, but reflecting on our shared experiences allows us, as counsellors, to be comforted as well.

Stanley

an MSF counsellor in the Democratic Republic of Congo

Each situation requires a different approach from MSF’s teams of counsellors, psychologists and psychiatrists. In some cases, counsellors are trained to help people talk about their experiences, process their feelings, and learn to deal with them. In other cases, psychologists conduct individual therapy sessions, often with a specific focus.

Another aspect to mental healthcare is psycho-education, where communities are taught about the importance of mental healthcare and to be aware of the signs and symptoms that they should look out for. Psycho-education, as well as counselling, can be done in groups, which may have predetermined themes connected to the situation.
Our teams use creative approaches to help raise awareness about the importance of psychological care, and they adjust what they do to fit each community's needs and culture.

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).

Mental health