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EDITORIALS: Lynne Jones, Joseph Asare, Mustafa Elmasri, and Andrew Mohanraj Mental health in disaster settings BMJ 2007; 335: 679-680 [Full text]

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Community psychiatry - a building approach

Pandey Vibha   (1 October 2007)

Implementing Mental Health and Psychosocial Guidelines

Joanne Kiniry, Steve Thomas and Laura Wyness   (17 October 2007)

Application of Research Knowledge and Evidence Based Guidelines To Minimize Disaster-Related Mental Health Problems

John R. Freedy, None   (24 October 2007)

Community psychiatry - a building approach 1 October 2007
Pandey Vibha, Research Assistant, M.Phil (psychiatric social work) Central Institute of Psychiatry Send response to journal: Re: Community psychiatry - a building approach	I Congratulate the Inter-Agency Standing Committee (IASC) for taking such a responsible step towards promoting mental health and preventing mental illness in community at large (Lynne J. et al, 2007). I presume that apart from emergency intervention for psychiatric patients, it will also help in eradicating stigma for mental illness, because in developing and under developing countries, stigma has definite role to play in outcome and prognosis of the illnesses (Hector et al. 2003). Apart from this, such a step will also pave the way for understanding the role of paraprofessionals in promoting mental health and preventing mental illness. In country like India there is a vast gap between the ratio of psychiatric patients and mental health professionals (Srinivasa MR 1987), so National Mental Health Programme launched in India in the year 1987, has made one among the provisions of identifying community leaders, NGOs, Social welfare sectors, lay volunteers, traditional healers, parents and relatives of the patients, for providing training to these group in early identification of illness and referral services (Agarwal AK. 1998). Such agency like Inter-Agency Standing Committee (IASC) is definitely a need of developing and under developing countries and I hope other government would also come forward to take action in this direction and it would not just simply remain in the file. REFERENCES 1. Agarwal AK. The forgotten millions. Indian Journal of Psychiatry 1998;40:103-119. 2. Hector W.H. Tsang and Phidias K.C. Tam (2003). The Hong Kong Polytechnic University Fong Chan University of Wisconsin–Madison W.M. Cheung University of Hong Kong. Stigmatizing Attitudes Towards Individual With Mental Illness In Hong Kong: Implications For Their Recovery. Journal Of Community Psychology Vol. 31, No. 4, 383–396. 3. Lynne Jones, Joseph Asare, Mustafa Elmasri, Andrew Mohanraj. Mental health in disaster settings, British Medical Journal, 2007. 4. Srinivasa Murthy,R. Intigration of Mental Health with Primary Health Care. Paper presented at the IV Indo-Symposium on Community Mental Health, NIMHANS, Bangalore,1987 Competing interests: None declared
Implementing Mental Health and Psychosocial Guidelines 17 October 2007
Joanne Kiniry, Research Assistant Centre for Global Health,Trinity College Dublin, Steve Thomas and Laura Wyness Send response to journal: Re: Implementing Mental Health and Psychosocial Guidelines	We would also like to congratulate the Inter Agency Standing Committee (IASC) on the publication of their guidelines. Yet we must note that there is an ocean of difference between publishing appropriate guidelines and having them used effectively. We have conducted recent research surveying the experience of individuals who have worked in the implementing of mental health and psychosocial guidelines to populations affected by complex emergencies. The research sought to ascertain the level of awareness among field workers of mental health guidelines such as those published by WHO (2004), Sphere (2003) and IASC (2007). While the response rate to the survey was not high, a number of themes emerged. First there was a lack of awareness of mental health as a difficulty in complex emergencies among the individuals who responded. Frequently people were also not aware that guidelines existed or were available. Further participants appeared divided over which organisations should take responsibility for mental health during complex emergencies. Finally, capacity was also raised as an issue that constrained organisations introducing mental health and psychosocial guidelines in these circumstances. Capacity constraints related to both limited funding and scarce expertise. While publishing guidelines is important, effective implementation requires much more. Collaboration and resources are needed to ensure that the problems identified above can be fully addressed. Joanne Kiniry, Steve Thomas, Laura Wyness Trinity College Dublin 1.Inter-Agency Standing Committee (2007). IASC guidelines on mental health and psychosocial support in emergency settings Inter-Agency Standing Committee. (Online) Available : www.humanitarianinfo.org/iasc/mentalhealth_psychosocial_support 2.Sphere Project (2004) The Sphere Handbook; revised edition. Sphere Project (Online) Available: http://www.sphereproject.org/handbook/ 3.WHO (2003) Mental Health in Emergencies; mental and social aspects of health of populations exposed to extreme stressors. Geneva; World Health Organisation (Online) Available : http://www.who.int/mental_health/media/en/640.pdf Competing interests: None declared
Application of Research Knowledge and Evidence Based Guidelines To Minimize Disaster-Related Mental Health Problems 24 October 2007
John R. Freedy, Director, Behavioral Science Curriculum Trident/MUSC Family Medicine Residency 9298 Medical Plaza Dr. Charleston, SC 29406, None Send response to journal: Re: Application of Research Knowledge and Evidence Based Guidelines To Minimize Disaster-Related Mental Health Problems	October 24, 2007 To the editors: I would like to add my compliments to the Inter-Agency Standing Committee for producing a comprehensive, well-informed, and much needed guideline.1 My opinion on this work is informed by my experiences across three areas: personal (Hurricane Hugo, 1989), clinical (involvement in various U.S. disaster relief efforts), and academic (research concerning both physical and mental health impact of disasters).2,3 In my view, one editorial point deserves clarification. In particular, the editorial states that there is “…continuing limited quantitative evidence base for many of the mental health interventions introduced in disaster settings.”4 In point of fact, a massive literature concerning the mental health impact of community wide disasters exists.2,5,6 Also, several consensus evidence-based guidelines for the management of trauma induced mental health problems exist.7-10 In order to heed the maxim “do no harm”, all involved in disaster relief efforts should be aware of existing disaster mental health literature and associated consensus evidence-based guidelines. The design of offered mental health interventions should be entirely consistent with existing relevant research literature and evidence-based guidelines. Respectfully submitted, John R. Freedy, MD, PhD Assistant Professor Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina E: freedyjr@musc.edu 1-Inter-Agency Standing Committee (IASC). IASC guidelines on mental health and psychosocial support in emergency settings. 2007. www.humanitarianinfo.org/iasc/mentalhealth_psychosocial_support. 2-Freedy, JR, & Simpson, WM. Disaster-related physical and mental health: A role for the family physician. American Family Physician 2007; 75: 841-846. 3-Freedy, JR. Post-traumatic stress disorder. In M. Ebell (ed.), Evidence Based Medicine, in press; New York: John Wiley & Sons. 4-Jones, L, Asare, J, Elmasri, & Mohanraj, A. Mental health in disaster settings (editorial). BMJ 2007; 335: 679-680. 5-Norris, FH, Friedman, MJ, Watson, PJ et al. 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981- 2001. Psychiatry 2002; 65: 207-239. 6-Norris, FH, Friedman, MJ, Watson, PJ. 60,000 disaster victims speak: part II. Summary and implications of the disaster mental health research. Psychiatry 2002; 65: 240-260. 7-American Psychiatric Association. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Arlington, VA: American Psychiatric Association; 2004 Nov. 57 p. (463 references). 8- Foa, EB, Keane, TM, & Friedman, MJ (eds.); 2000. Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies; New York: Guilford Press. 9-National Collaborating Centre for Mental Health. Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London, UK: National Institute for Clinical Excellence (NICE); 2005. 167 p. (69 references). 10-Veterans Health Administration, Department of Defense. VA/DoD clinical practice guideline for the management of post-traumatic stress. Version 1.0. Washington, DC: Veterans Health Administration, Department of Defense; 2004 Jan. (479 references). Competing interests: None declared