INTRODUCTION OF THE MHPSS PYRAMID

Mental health and psychosocial support (MHPSS)

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 (IASC Guidelines, 2007).

Inter-Agency Standing Committee (IASC)

Established by the United Nations General Assembly, is an inter-agency forum for coordination, policy development and decision-making by the executive
heads of key humanitarian agencies (UN agencies, Red Cross and Red Crescent societies, and consortia of non-government humanitarian organizations (IASC,
2007).

IASC MHPSS Layers

1. Basic Services and Security – The well-being of all people should be protected through the (re)establishment of security, adequate governance and services
that address basic physical needs (food, shelter, water, basic health care, control of communicable diseases). In most emergencies, specialists in sectors such as
food, health and shelter provide basic services. An MHPSS response to the need for basic services and security may include: advocating that these services are put
in place with responsible actors; documenting their impact on mental health and psychosocial well-being; and influencing humanitarian actors to deliver them in
a way that promotes mental health and psychosocial well-being. 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.

2. Community and Family Supports – The second layer of the MHPSS structure is aimed at assisting children or adults who are otherwise able to maintain their
mental health and psychosocial well-being if they receive help in accessing key community and family support. In a number of UNRWA fields of operations, the
refugee experience is often characterized by displacement or the threat of disruption to family and community networks, fear, and a lack of safety. Rather than
focusing exclusively on individual counselling, the psychosocial well-being of these refugees can be reinforced by strengthening community and social support
structures and self-help mechanisms. This can include information on self-help, psychoeducation sessions on positive coping methods, supportive parenting
programmes and the activation of social networks, such as through women’s groups and youth clubs.

3. Focused, Non-specialized Supports – The third layer represents the supports necessary for the still 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.

4. Specialized Services - The top layer of the pyramid represents the additional support required for the small percentage of the population whose suffering,
despite the supports already mentioned, is intolerable and who may have significant difficulties in basic daily functioning. This assistance should 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. Although specialized services are needed only for a small percentage of the population, in most large emergencies this group amounts to
thousands of individuals. Examples: Mental health care by mental health specialists (psychiatric nurse, psychologist, psychiatrist, etc.)
THE IASC MHPSS PYRAMID AND THE IFRC FRAMEWORK

The International Federation of Red Cross and Red Crescent Societies (IFRC) has its own MHPSS Pyramid too, consisting four tiers: basic psychosocial
support, focused psychosocial support, psychological support, and specialized mental health care. The IFRC Framework aims to address mental health and
psychosocial needs in accordance with its role and mandate in the society. The framework involves the role of a ‘protective environment’, and much like the IASC’s
notion that the level of demanded expertise increases as the tier increases.

While the IASC leans more on a psychological and clinical perspective, the IFRC focuses on social supports. The two also differs in terms of
application as the former is only applicable in emergency situation while the latter is applicable in all population regardless of the context –may it be
emergent or non-emergent. While the former’s layer focuses on an approach intended for a single target, hence, it adopts a multi-layered approach, the
latter’s layers are applicable to all groups (e.g., community, family, groups, and individuals are all and can be covered by all four layers) hence it leans with
a continuum approach. Nonetheless, despite the huge differences between the two frameworks, the two adopt the same demands with expertise: as the
layer increases the qualification for training and skills also increases for the implementation to be conducted.

CONCLUSION

The IASC represents the framework of mental health and other psychological support services that are required to the unique and delicate needs of
individuals, families, and communities in emergency settings. A fundamental key to meet such needs is to develop a layered system where one can draw an
approach from in the assessment of concerns as well as in advocating notions in relation to the spectrum of full mental well-being.

QUESTION: The True-to-Life Case of a Ten-year Old Orphan

According to a ten-year old girl, it was her fault why her parents and younger brother -who’s an infant- died during the onslaught of a certain super typhoon.
She believes that it was her fault for being negligent and accidentally letting go of him when she was crossing a tightrope with her parents as they were leaving
their damaged vicinity. Her parents were carried by the strong waters and were found dead for trying to save her brother who was never to be found. She’s the
only member in the family who survived. Until now, she is self-blaming and sometimes being unresponsive. There are also times that she would just suddenly scream
while she’s asleep. Which level and what specific intervention from the IASC MHPSS pyramid is best to draw approach from?

References:

Inter-Agency Standing Committee (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Retrieved from
https://hr.un.org/sites/hr.un.org/files/Guidelines%20IASC%20Mental%20Health%20Psychosocial_0.pdf

IASC Reference Group on MHPSS. (2015). Mental health and psychological support. IASC.

World Health Organization (WHO). (2017). Scalable psychological interventions for people in communities affected by adversity: A new era of mental health and
psychological work at WHO. WHO. License: BY-NC-SA 3.0 IGO.

Ziviri, D., Kiani, S., & Broquet, M. (2019). The impact of psychological support on well-being and agency within an inclusive livelihood programme. Intervention,
17(1), 86. https://doi.org/10.4103/INTV.INTV_26_18

REPORTERS: Luzon and Abao