Three models of scaling up mental healthcare post-disaster : common challenges

There are number of challenges in strengthening mental healthcare services in underserved areas post-disaster. The objective of this paper is to identify common challenges by comparing and contrasting three models of scaling up mental healthcare services post-disaster. Primary and secondary data were collected before, during and after mental health programming in Sri Lanka, Haiti and the Philippines. A qualitative case study methodology including a set of narrative topics and programme indicators developed by the London School of Hygiene and Tropical Medicine was employed to document the services of the programmes. The authors added a set of outcome indicators to address the outcomes of programmes at community and individual level. We discuss challenges and conclude that sustainability of programme achievements, change of practices of trained non-specialised healthcare providers and their supervision and evidence of impact of clinical interventions are common challenges for scaling up mental health (MH) services post-disaster. We believe that more comparative evidence is needed on how MH services initiated by different actors’ post-disaster function in actual practice, especially in the longer term.
Key implications for practice

• Mental health services can be significantly scaled up at community, primary and secondary healthcare level within a relatively short period of time post-disaster.
• Essential principles/components to be considered as key standards in MHPSS strategies post-disaster include regular consultations with local and national government and health authorities, a clear perspective on how to continue with longer term supervision after theoretical trainings, enough programme time allocated to clinical MH consultations (including follow-up) and focus on monitoring of improvement of clinical symptoms and functionality of clients.
• It would be useful for developers of MHPSS programming post-disaster to respect the key standards in designing an innovative service model with an optimal mix of community-based psychosocial, outpatient clinic and inpatient clinic-based interventions to improve wellbeing and resilience of clients at community level and access to PHC and SHC level including affordability of psychiatric medications.