Mental health in crisis and post-crisis situations

Individual and collective mental health in disaster, conflict, exile or pandemic situations is a complex issue that involves both the implementation of a response that is adapted to the needs of victims and the provision of support to national and international staff who are deployed to deliver assistance.

The conflicts that devastated the former Yugoslavia caused a breakdown in trust and relations that led to severe trauma for those who experienced them. “It is life as a whole, in every form, and reality that are directly attacked. What is more, it is not only civilian life that is destroyed, with its cultural events and productions, its monuments and cities. It is also people’s names, their origins, their family ties, their religion, their houses, their land, and their accents that are targeted or annihilated, in other words, everything that goes towards making up an individual” (Chauvenet, Despret and Lemaire, 1996, p13)⁶.

In Liberia, more than two years after the Ebola epidemic which caused the deaths of as many as 4 800 people, there is still psychological trauma. “Among those suffering from post-traumatic stress, traumatic memories tend to come back in a destructive form: the patient relives the traumatism, at night in dreams, or during the day in flashbacks, causing the same fear as the original trauma. Patients suffering from depression continually think about the trauma, unable to exist without it. As such, the trauma is like a wound that will not heal because the patient continually scratches it”. (MSF, 2018)⁷.

Beyond psychological imbalance, post-traumatic disorders have social and financial consequences, such as, for example: the non-participation of the subject in professional or recreational activities, which can be due to discrimination; a financial burden for families; and an emotional burden related to the illness. Also, in addition to the cost of these disorders for the health and social services, they can lead to the subject losing their job or becoming less productive. This can have worrying effects on economic growth and the social capital of a population”. (J. Milleliri and T. Liscia, 2013, p.27-28⁸).

Humanitarian staff are also at risk of developing post-traumatic disorders when a sudden, violent event affects them directly or indirectly. Though this is a well-known aspect that is almost always treated today in major humanitarian organisations, psycho-social disorders related to working conditions are more insidious as they lead to ‘invisible wounds’ (Bierens de Haans). There are many accounts of physical exhaustion linked to the significant volume of work, the accumulation of painful emotions from dealing with victims, frustration due to increasingly cumbersome project management procedures and mechanisms, or the feeling of powerlessness when faced with the repeated cycle of crises and disasters. These are all “sources of intense emotion that can overwhelm individuals’ capacity to cope and threaten their psychological and physical integrity”, (Bierens de Haan, 2010) ⁹ According to C. Demaegdt (2010), though psychological adaptation and defence mechanisms allow humanitarians to cope with difficult situations in the short term, they are nevertheless faced with a significant risk of “being overwhelmed by reality, and their relation to the world, to fear, to others, and to themselves, and eventually of experiencing clinical effects in terms of cognitive disorders (altered consciousness, mental confusion, feelings of inadequacy, rumination, childish reasoning, etc.), or even of becoming violent towards others or towards themselves ¹⁰”.

A discussion and exchange group

A francophone action-research group on the topic of humanitarian psycho-social assistance in crisis situations (GRAPSH) was set up in 2011 to help to improve understanding of humanitarian mental health and psychosocial activities and improve their competencies by sharing practices and learning lessons collectively.

Having been the joint instigator of the GRAPSH with AFD in 2011, Groupe URD is aiming to re-mobilise mental health and psychosocial organisations and practitioners involved in crisis and post-crisis contexts. The objective will be to share lessons and experience on two main themes:

• Treatment mechanisms and practices in crisis and post-crisis situations, taking into account humanitarian know-how and local knowledge, based on an anthropological approach;
• Prevention and treatment mechanisms for psychosocial disorders and psychological trauma among humanitarian personnel.

If you are interested, please complete this questionnaire which aims to gather the views of actors and practitioners in order to organise the network: https://www.urd.org/survey/index.php/857848/lang-fr

Photo : UNMEER/Martine Perret

1. A. Chauvenet, V. Despret and J.M. Lemaire (1996), Clinique de la reconstruction. Une expérience avec des réfugiés en ex-Yougoslavie. L’Harmattan, Collection santé, sociétés et cultures.
2. ‘Libéria, les « cicatrices psychologiques d’Ebola’, 25/10/2016 updated 07/03/2018.
3. J. Milleliri and T. Liscia (2013), La prise en compte du traumatisme psychologique des populations. Quelles modalités d’intervention pour l’Agence Française de Développement (AFD) dans les États en post-conflit ? Ed. universitaires européennes.
4. Statement made at the conference ‘Les humanitaires une culture du stress?’, June 2010, organised by Action Contre la Faim (ACF) and the Conservatoire National des Arts et Métiers (CNAM) in Paris.
5. Ibid.
6. A. Chauvenet, V. Despret and J.M. Lemaire (1996), Clinique de la reconstruction. Une expérience avec des réfugiés en ex-Yougoslavie. L’Harmattan, Collection santé, sociétés et cultures.
7. ‘Libéria, les « cicatrices psychologiques d’Ebola’, 25/10/2016 updated 07/03/2018.
8. J. Milleliri and T. Liscia (2013), La prise en compte du traumatisme psychologique des populations. Quelles modalités d’intervention pour l’Agence Française de Développement (AFD) dans les États en post-conflit ? Ed. universitaires européennes.
9. Statement made at the conference ‘Les humanitaires une culture du stress?’, June 2010, organised by Action Contre la Faim (ACF) and the Conservatoire National des Arts et Métiers (CNAM) in Paris.
10. Ibid.