NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 13

LESSON TITLE: Mental Health and Psychosocial Support in Materials:

Emergency Settings
Book, pen and notebook
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Define MHPSS. Emergency Preparedness for Chemical,
2. Identify problems in emergencies. Biological, and Radiological Terrorism and other
3. State the purpose of MHPSS. Hazards 4th Edition
4. Enumerate the core principles of MHPSS.
5. Discuss the intervention pyramid.
http://icn.ch/IASC_MHPSS_guidelines.pdf
6. Develop an appreciation of the role of the nurse in
providing MHPSS.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the environmental hazards and their impact?

MAIN LESSON (40 minutes)

Background
 The Inter-Agency Standing Committee (IASC) was established in 1992 in response to General Assembly
Resolution 46/182, which called for strengthened coordination of humanitarian assistance.
 The resolution set up the IASC as the primary mechanism for facilitating inter-agency decision-making in
response to complex emergencies and natural disasters. The IASC is formed by the heads of a broad
range of UN and non-UN humanitarian organizations.

Objectives of the Guideline

 These Guidelines seek to:
 enable humanitarian actors to plan, establish and coordinate multi-sectoral responses to protect and
improve people’s mental health and psychosocial well-being in the midst of an emergency.
 facilitate an integrated approach to address the most urgent mental health and psychosocial issues in
emergency situations.

The focus of the guidelines is on implementing minimum responses, which are essential, high-priority responses that
should be implemented as soon as possible in an emergency.
 Minimum responses: first things that ought to be done; the essential first steps that lay the foundation for
the more comprehensive efforts that may be needed (including during the stabilized phase and early
reconstruction)
Participating Organizations
 Action Contre la Faim (ACF)
 InterAction (co-chair), through:
• American Red Cross (ARC)
• Christian Children’s Fund (CCF)

• International Catholic Migration Commission (ICMC)

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 • International Medical Corps (IMC)
• International Rescue Committee (IRC)
• Mercy Corps
• Save the Children USA (SC-USA)
 Inter-Agency Network for Education in Emergencies (INEE)
 International Council of Voluntary Agencies (ICVA), through:
• ActionAid International
• CARE Austria
• HealthNet-TPO
• Médicos del Mundo (MdM-Spain)
• Médecins Sans Frontières Holland (MSF-Holland)
• Oxfam GB
• Refugees Education Trust (RET)
• Save the Children UK (SC-UK)
 International Council of Voluntary Agencies (ICVA), through:
• ActionAid International
• CARE Austria
• HealthNet-TPO
• Médicos del Mundo (MdM-Spain)
• Médecins Sans Frontières Holland (MSF-Holland)
• Oxfam GB
• Refugees Education Trust (RET)
• Save the Children UK (SC-UK)

DEFINITION OF TERMS:

 The term “psychosocial” denotes the inter-connection between psychological and social processes and the fact
that each continually interacts with and influences the other.
 The composite term mental health and psychosocial support (MHPSS) is used to describe any type of local or
outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder.

Problems in Emergencies
 Predominantly Social Nature:
1. Pre-existing (pre-emergency) social problems (e.g. extreme poverty; belonging to a group that is discriminated against
or marginalized; political oppression);
2. Emergency-induced social problems (e.g. family separation; disruption of social networks; destruction of community
structures, resources and trust; increased gender-based violence); and
3. Humanitarian aid-induced social problems (e.g. undermining of community structures or traditional support
mechanisms).

 Predominantly Psychological Nature

1. Pre-existing problems (eg. severe mental disorder; alcohol abuse);
2. Emergency-induced problems (eg. grief, non-pathological distress; depression and anxiety disorders, including post-
traumatic stress disorder (PTSD)); and
3. Humanitarian aid-related problems (eg. anxiety due to a lack of information about food distribution).

People at Increased Risk

 Elderly people (especially when they have lost family members who were care-givers);
 Extremely poor people;
 Refugees, internally displaced persons (IDPs) and migrants in irregular situations (especially trafficked women and
children without identification papers);
 Those exposed to extremely stressful events/trauma (eg. people who have lost close family members or their entire
livelihoods, rape and torture survivors, witnesses of atrocities, etc.);
 Those with pre-existing, severe physical, neurological or mental disabilities or disorders;
 People in institutions (orphans, elderly people, people with neurological/mental disabilities or disorders);

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 People experiencing severe social stigma (eg. untouchables/dalit, commercial sex workers, people with severe mental
disorders, survivors of sexual violence);
 People at specific risk of human rights violations (eg. political activists, ethnic or linguistic minorities, people in
institutions or detention, people already exposed to human rights violations).

CORE PRINCIPLES:
1. Human rights and equity
2. Participation
 Involvement of local people from the earliest phase of an emergency, in the assessment, design,
implementation, monitoring and evaluation of assistance.
3. Do no harm
 Minimize duplication and gaps in response;
 Design interventions on the basis of sufficient information
 Commit to evaluation, openness to scrutiny and external review;
 Develop cultural sensitivity and competence
 Use evidence-based effective practices; and
 Develop an understanding of, and consistently reflect on, universal human rights, power relations
between outsiders and emergency-affected people, and the value of participatory approaches.
4. Building on available resources and capacities
5. Integrated Support System
6. Multi-layered support

Level 1: Basic Services and Security

 (Re)establishment of security, adequate governance and services that address basic physical needs (food,
shelter, water, basic health care, control of communicable diseases).
 These basic services should be established in participatory, safe and socially appropriate ways that protect local
people’s dignity, strengthen local social supports and mobilize community networks.

Level 2: Community and Family Supports

 Useful responses in this layer include family tracing and reunification, assisted mourning and communal healing
ceremonies, mass communication on constructive coping methods, supportive parenting programs, formal and
non-formal educational activities, livelihood activities and the activation of social networks, such as through
women’s groups and youth clubs.

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Level 3: Focused, Non-specialized Supports
 Supports necessary for the smaller number of people who additionally require more focused individual, family or
group interventions by trained and supervised workers (but who may not have had years of training in specialized
care).
 For example, survivors of gender-based violence might need a mixture of emotional and livelihood support from
community workers.
 This layer also includes psychological first aid (PFA) and basic mental health care by primary health care workers.
Level 4: Specialized Services
 Include psychological or psychiatric supports for people with severe mental disorders whenever their needs
exceed the capacities of existing primary/general health services.
 Such problems require either
 (a) referral to specialized services if they exist, or
 (b) initiation of longer-term training and supervision of primary/general health care providers.

Matrix of Interventions
1. Emergency Preparedness
 Enable rapid implementation of minimum responses.
2. Minimum Response
 High-priority responses that should be implemented as soon as possible in an emergency.
3. Comprehensive Response
 These interventions are most often implemented during the stabilized phase and early reconstruction
period following an emergency.

Sample Matrix of Interventions

Common Functions Across Domains:

1. Coordination
2. Assessment, Monitoring & Evaluation

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 3. Protection & Human Rights Standards
4. Human Resources
5. Community Mobilization & support
6. Health Services
7. Education
8. Dissemination of Information
9. Food Security & Nutrition
10. Shelter & site planning
11. Water and Sanitation

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice:

1. The core principles of MPHSS are the following except:

a. Participation
b. Human rights and equity
c. Incoordination
d. Do No Harm

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 ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The first intervention pyramid for mental health and psychosocial support in emergency is:
a. Specialized services
b. Basic services and security
c. Community and family support
d. Focused, non-specialized supports
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. In the matrix of interventions, which of the following has the high- priority responses that should be
implemented as soon as possible in emergency?
a. emergency preparedness
b. specialized preparedness
c. minimum responses
d. comprehensive responses

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. All of the following are examples of Pre-emergency social problems in Predominantly Social Nature Problems in
Emergencies, except:
a. extreme poverty
b. political oppression
c. belonging to a group that is discriminated against or marginalized
d. family separation

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. What level of intervention pyramid for mental health and psychosocial support in emergencies includes the
psychosocial first aid and basic mental health care by primary health care workers?
a. Level1: Basic services and security
b. Level 2: Community and family Supports
c. Level 3: Focused: non- specialized Supports
d. Level 4: Specialized services

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Muddiest Point:

In today’s session, what was least clear to you?

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