The authors respond to commentaries in this journal about the 2007 IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Overall, influential commentators coming from opposite academic traditions and knowledge bases appear to welcome these guidelines and value them. In this response, the authors focus on a few critical comments, which may be explained by divergent understandings about what is meant by minimum response and what priority activities may be part of that response.

The authors identify several factors that have limited the utility of epidemiological assessments in emergency settings, such as a narrow focus on post traumatic stress disorder (PTSD), an inattention to cultural variations in distress, and a failure to distinguish between normal distress reactions and actual disorder Rather than rejecting epidemiology altogether, however, as the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings do, recommendations are made for ways to enhance the usefulness of large scale mental health and

In the Middle East mental health and psychosocial support systems are underdeveloped. Seven criticalfactors are identified that hinder the initiation of well functioning mental health and psychosocial intervention programmes: 1) shortage of national professional leadership; 2) absence of infrastructure to support mental health and psychosocial programmes; 3) stigma around mental disorders; 4) multiple models of inter- vention; 5) lack of funding; 6) competing interests of non governmental organizations (NGOs) and UN organizations; and 7) insufficient political will and instability.

Five dilemmas inherent in emergency response are presented and discussed from a public mental health perspective in reference to the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. These are: (1) Who should take the lead in the planning and implementation of the guidelines? (2) At what level are the guidelines to be used? 3) What evidence do we have for the usefulness of the guidelines? 4) What are the costs for the proposed interventions, and how are the activities to be financed?