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?

The use of the term ‘community approaches’ in psychosocial work often involves multiple meanings, all of which contrast with individual approaches to mental health. The importance of the context emphasizes the need to design and implement emergency programmes in ways that ‘make sense’ to local populations. This requires not only consideration of generational, gender, spiritual, and cultural practices within the community, but also reinforcing existing resilient resources in the face of adversity.