On World Mental Health Day, Reflections on Mental Health-Informed Approaches in Humanitarian Relief

Every 40 seconds, somewhere across the world, someone loses their life to suicide. While our global understanding of the importance of mental health care is growing, there remain important gaps to be filled. We live in an age where conflict, poverty, and climate emergencies are fueling unprecedented levels of forced displacement and global refugee flows. However, there is an alarming shortfall in providing targeted, trauma-sensitive, and identity-informed mental health support as a standard component of humanitarian relief.

When we think about mental health, we should see suicide as the tip of the iceberg: the most salient dimension of mental illness, the most visible expression of its destructive force. To understand mental illness, however, we must be able to look beneath the surface. At the accumulation of self-doubt and anxiety, at the many potential acts of self-harm that can pave the way to suicide. Beneath the surface lies the nuance we need to understand both mental health and mental illness, and to develop therapies to support vulnerable individuals and groups before they succumb to mental illness.

Four years ago, as Europe’s migration crisis shifted from the Central to the Eastern Mediterranean route, hundreds of relief workers traveled to Greece, driven by a sense of solidarity, by a wish to provide arriving refugees the support we would hope to receive should we find ourselves in their position. These journeys inspired the launch of dozens of small, innovative NGOs, committed to mobilize solidarity and resources quickly and flexibly, and to fill gaps where we found them. This journey inspired the launch of Refugee Trauma Initiative.

Why? Because what we saw in Idomeni—on European soil—was not just a gap, but a mental health emergency. Twice-traumatized families (first in their countries of origin, again in their forced migration) whose daily struggle to survive Idomeni was traumatizing them thrice over. Children whose lives were built not on schooling, nor play, nor happiness, but rather on a relentless accumulation of toxic stress.

At RTI, we made it our mission to tackle this mental health crisis, by providing direct support to refugee families, and by building tools and offering trainings to partner NGOs to help them mainstream mental health considerations into their programming. On the basis of these efforts, we advocate today for humanitarian and development actors worldwide to integrate psycho-social support principles into every aspect of aid delivery.

Why? Because by treating mental health not as a standalone discipline, but rather as a guide to every aspect of aid delivery, we enable ourselves to uphold and ensure the dignity we owe to each and every individual whom we serve. Whether we are serving food or distributing seeds, financing cash transfers or running job skills workshops, the effectiveness of our interventions is a function of the consideration we show to those receiving this aid. Aid without dignity might keep vulnerable people alive, but it will also keep them vulnerable. Aid that considers vulnerable people’s lived experiences, and treats them with dignity and respect, can help them build up resilience and find the way out of dependency.

Why? Because in an economy that is increasingly sophisticated, refugees are under pressure to integrate into their host communities from the moment of arrival. Confidence and self-esteem are an essential foundation to developing the language skills that will allow them to succeed in school and in the workplace, to build up the cross-cultural instincts that will enable them to thrive in a foreign society. In all too many cases, mental health support is an essential foundation to building up that confidence and self-esteem.

Why? Because in a day and age where immigrants have become the foil of every demagogue, and where those seeking asylum are unfairly tarnished as agents of the conflict and repression that led them to seek asylum, refugees are under extreme pressure to reassure their host community of their benevolence. Of their kind intention to give back to the societies that receive them. Of their desire to achieve, in their countries of asylum, the generous deeds they could have only dreamed of in their countries of origins. Self-love is essential to nurture hope and to overcome the barriers we all face in life.

Today, on October 10, 2019, we stand alongside myriad fellow organizations large and small, providing relief at every point on the routes that lead from conflict zones to asylum, in every discipline from the development efforts that seek to forestall conflict, to the humanitarian efforts to strive to alleviate its consequences. Today, on World Mental Health Day, we invite all our partners in solidarity to reflect on the inseparability of mental health from every dimension of the work we do, and to redouble our efforts to mainstream mental health support into all our operations—wherever and whichever those might be.

Joel Hernàndez