Colombia is one of the first countries in the world to implement the IASC Guidelines for Mental Health and Psychosocial Support in Emergency Settings in the form of a ‘case study' It was shown that the guidelines are in general terms applicable and adaptable to the Colombian context. The guidelines were a useful coordination tool for the stakeholders from three different communities in identifying their priority needs and planning according responses from a holistic mental health and psychosocial support (MHPSS) perspective.

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.