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��THE TRAUMA PANDEMIC�A GLOBAL LENS FOR GLOBAL ACTION��KELLY O’DONNELL, PSYD AND MICHÈLE LEWIS O’DONNELL, PSYD�MEMBER CARE ASSOCIATES, INC.��

International Trauma Collaborative—6 April 2019

Power point/slide notes and available on: membercareassociates.org

Image source: Cover detail from Global Member Care: Crossing Sectors for Serving Humanity (2013)

Note: We are based in Geneva and the USA and speak regularly on the topics of global integration, global mental health, member care, and integrity/anti-corruption, in person and remotely. We have found that a 90 minute lecture at a graduate school, for example, is good to give an overview, perhaps even inspire folks, yet understandably it can usually only go so far and thus an overall strategy by graduate schools is needed for including “global” perspectives and material throughout the curriculum/training. This might require an intentional, informed, consensual shift. Key to this shift is cultivating a more “global” mentality and mentors/models with not just ‘international” (different nations) experience but multi-sectoral, global experience (with issues that transcend geo-political borders—problems without passports). Note for instance, within the multi-disciplinary field of psychology, the American Psychological Association’s recent Strategic Plan (2019) which explicitly calls the organization and its members to “Embrace a global mentality.”

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��PURPOSE�“YOU CAN’T JUST PONTIUS PILATE 800,000 PEOPLE.” ROMEO DALLAIRE��

Overview the global burden of trauma �and relate it to major efforts for sustainable development and mental health
Present core resources from the humanitarian sector �and comment on them via the lens of trauma

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Quote: Romeo Dallaire, the Commander of the UN Peacekeeping Force during the Rwandan genocide. He pleaded for UN intervention prior to the genocide---and invented a verb to describe how easy it is to forget about the genocide now and wash our hands of what it represents. Ken Ringle, “The Haunting: He Couldn’t Stop the Slaughter in Rwanda. Now He Can’t Stop the Memory.” The Washington Post, Saturday, June 15, 2002, Page C01.

Image: Murambi Genocide Memorial. “Here, on April 21^st, 1994, between 40,000-50,000 Tutsis and Hutu sympathizers were murdered. The perpetrators carried out the slaughter in over eight hours. The site is a haunting reminder of what this country has endured and what it is still overcoming.” Quote from Letter from Rwanda: A Privileged Engagement (November 2018, Global Geneva magazine), Ashling O’Donnell

http://www.global-geneva.com/letter-from-rwanda-a-privileged-engagement/

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�PRESENTATION OVERVIEW

Part 1: Global Burden of Trauma

Overviewing Trauma (Tt)
UN Sustainable Development Goals (SDGs)
Global Mental Health (GMH)

Part 2: Humanitarian Sector and Trauma

UN Agenda for Humanity (A4H)
UN Global Compact for Migration (GCM)
Examples: PFA, CHS, IFRC/WDR, ICRC/MHPSS

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Part One

Global Burden of Trauma

Tt, SDGs, GMH

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GLOBAL BURDEN OF TRAUMA�OVERVIEW—SOME STATISTICS

“The importance of addressing the global problem �of psychological trauma can hardly be overestimated. �Big-picture ‘guesstimates’ of the current levels of trauma �are staggering, running into the hundreds of millions of [people]. Trauma adversely affects human development, �socio-economic development, and even peace.”�Global Initiative for Stress and Trauma Treatment (GIST-T)

Four types of structural violence
Statistics on issues related to trauma
Estimates of PTSD

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Image courtesy GIST-T

Quote from GIST-T website (Global Initiative for Stress and Trauma Treatment).

“Trauma darkens people’s lives—worldwide. Much of that trauma remains hidden, especially in the developing world: unrecognized, undiagnosed, and therefore left untreated.

This trauma tree is a visual metaphor of the causes and consequences of traumas and traumatic stress.

The image of this trauma tree shows the origins or causes of trauma, depicted as root systems, which can be grouped into four categories, or ‘Four Violences’, a distinction borrowed from Johan Galtung¹:

• Direct violence comprises acts intended to harm human beings

• Natural violence, or the violence of nature, in contrast to direct violence, is both unintended and mostly unavoidable

• Structural violence occurs when a social structure harms people and prevents them from meeting their basic needs—physical, economic or social

• Cultural violence manifests itself in prevailing attitudes, based on beliefs about power and ‘necessity’ of violence.

These Four Violences cause the many unseen scars of ‘silent’ and ‘loud emergencies’, of life’s adversities or accidents and of manmade or natural disasters. Those scars are shown here as the trauma-based disorders and diseases, growing out of the leafless branches of the trauma tree.

These trauma-based disorders and diseases affect not only individuals, but also families, communities and even whole societies. They create an ecosystem of profoundly adverse consequences for human development, for world development, and even for world peace.”

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THE FOUR VIOLENCES QUANTIFIED

Direct violence:

1.5 billion people live in countries afflicted by political or criminal violence and war, 300 million people live amidst violent insecurity. One-third of all women in the world experience sexual, physical or other abuse in their lifetime women are more than twice as likely as men to have PTSD.
Women are more than twice as likely as men to have PTSD.
“Silent emergencies” - stress at work, bullying, divorce, abandonment, neglect, emotional abuse, etc.

Natural violence:

268 million people are affected annually by natural disasters
Loss of a loved one – in 2012, 56 million people died

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THE FOUR VIOLENCES QUANTIFIED

Structural violence:

1.22 billion people lived in extreme poverty in 2010 (WB)
< US$1.50 a day; in all, 2.4 billion lived on < US$2 a day that year
Hunger and malnutrition (925 million); 218 million are child laborers

Cultural violence:

Discrimination, oppression, apartheid, colonialism, exploitation and racism all exert a chronic stress that may lead to trauma.

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CONFRONTING THE TRAUMA PANDEMIC�(MEMBER CARE UPDATE, MARCH 2019)

Christian worldview and Christian hope:

Trauma reminds us that something is wrong—we are meant for a better world.

Trauma is everywhere in creation--from the micro-atomic to the macro-cosmic.

Trauma is another way to describe the maims and moans of fallen creation. Wherever the Fall goes, trauma follows.

“Yet what we suffer now is nothing compared to the glory he will reveal to us later.

For all creation is waiting eagerly for that future day when God will reveal who his children really are. Against its will, all creation was subjected to God’s curse. But with eager hope, the creation looks forward to the day when it will join God’s children in glorious freedom from death and decay. For we know that all creation has been groaning as in the pains of childbirth right up to the present time. And we believers also groan, even though we have the Holy Spirit within us as a foretaste of future glory, for we long for our bodies to be released from sin and suffering. We, too, wait with eager hope for the day when God will give us our full rights as his adopted children, including the new bodies he has promised us.” Romans 8:18-23 NLT

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�TRANSFORMING OUR WORLD: �THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT�UNITED NATIONS, 25 SEPTEMBER 2015, PARAGRAPH 50�

"Today we are also taking a decision of great historic significance. We resolve to build a better future for all people, including the millions who have been denied the chance to lead decent, dignified and rewarding lives and to achieve their full human potential. We can be the first generation to succeed in ending poverty; just as we may be the last to have a chance of saving the planet…"

The quote above definitely conveys a sense of urgency….See also Doomsday: Next Stop, Global Dis-integration? (Global Integration Update, June 2017).�https://mailchi.mp/24d24e690a01/doomsday-global-integration-update-special-issue-1013925

Also, trauma is very related to SDG 16, emphasizing inclusive and peaceful societies/anti-corruption/crime.��In addition, here are some of the opening remarks by UN Secretary-General António Guterres at the UN General Assembly’s High-level Meeting on Sustaining Peace, 24 April 2018. It would seem that Guterres, like ourselves, is under no illusion that the SDGs mean the Salvific Development Goals.

“We must recognize that in some fundamental ways, our world is going backwards. More countries are experiencing violent conflict than at any time in nearly three decades. Record numbers of civilians are being killed or injured by explosive weapons in urban areas. Record numbers of people are on the move, displaced by violence, war and persecution. We see horrific violations of human rights, and rising nationalism, racism and xenophobia. Inequalities are increasing; whole regions, countries and communities can find themselves isolated from progress and left behind by growth. Women and girls face discrimination of all kinds. These are all indications that we need greater unity and courage – to ease the fears of the people we serve; to set the world on track to a better future; and to lay the foundations of sustainable peace and development.”

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Shining a light on SDG 1: End poverty in all its forms everywhere

The 2018 Global Multidimensional Poverty Index�(click on above link for two summary diagrams)

“The new figures show that in 104 primarily low and middle-income countries, 662 million children are considered multidimensionally poor. In 35 countries half of all children are poor.

In Sub-Saharan Africa for instance, some 560 million people (58 percent of the population) are living in multidimensional poverty, 342 million (61 percent of those living in multidimensional poverty) of them severely so. While in South Asia 546 million people (31 percent of the population) are multidimensionally poor, 200 million of them (37 percent) severely so.

Some 1.3 billion people live in multidimensional poverty, which is almost a quarter of the population of the 104 countries for which the 2018 MPI is calculated. Of these 1.3 billion, almost half – 46 percent – are thought to be living in severe poverty and are deprived in at least half of the dimensions covered in the MPI.”

Source: Oxford Poverty and Human Development Initiative (website, 2018)

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SDG 3.4�A MAIN SDG FOR CONNECTING �AND CONTRIBUTING TO TRAUMA

By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing
Notes about the SDGs (Transforming our World):

MH used two other times, Paragraphs 7, 26
Violence or violent is used 11 times
Trauma is used 0 times

Paragraphs 7 and 26 include the term “mental”

7. In these Goals and targets, we are setting out a supremely ambitious and

transformational vision. We envisage a world free of poverty, hunger, disease and

want, where all life can thrive. We envisage a world free of fear and violence.

A world with universal literacy. A world with equitable and universal access to

quality education at all levels, to health care and social protection, where physical,

mental and social well-being are assured. A world where we reaffirm our

commitments regarding the human right to safe drinking water and sanitation and

where there is improved hygiene; and where food is sufficient, safe, affordable and

nutritious. A world where human habitats are safe, resilient and sustainable and

where there is universal access to affordable, reliable and sustainable energy.

26. To promote physical and mental health and well-being, and to extend life

expectancy for all, we must achieve universal health coverage and access to quality

health care. No one must be left behind. We commit to accelerating the progress

made to date in reducing newborn, child and maternal mortality by ending all such

preventable deaths before 2030. We are committed to ensuring universal access to

sexual and reproductive health-care services, including for family planning,

information and education. We will equally accelerate the pace of progress made in

fighting malaria, HIV/AIDS, tuberculosis, hepatitis, Ebola and other communicable

diseases and epidemics, including by addressing growing anti-microbial resistance

and the problem of unattended diseases affecting developing countries. We are

committed to the prevention and treatment of non-communicable diseases, including

behavioural, developmental and neurological disorders, which constitute a major

challenge for sustainable development.�

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NON-COMMUNICABLE DISEASES (NCDS)�WHO 4 X 4 🡪 WHO 5 X 5�ADD AIR POLLUTION(RISK FACTORS)�AND MENTAL HEALTH (DISEASES)� HTTPS://ENOUGHNCDS.COM/THE-ENOUGH-CAMPAIGN/

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G yeongju Action Plan �“Education for Global Citizenship: Achieving the SDGs Together ”

“In addition to literacy and numeracy, education must advance the cause of global citizenship which: promotes integrated development of the whole person emotionally, ethically, intellectually, physically, socially, and spiritually; imbued with an understanding of our roles, rights and responsibilities for the common good in service to humanity and the advancement of a culture of peace, non-violence, freedom, justice, and equality…“ (page 1)

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�GLOBAL MENTAL HEALTH�WE RELATE IT TO: �“MENTAL HEALTH AS MISSION”�

GMH is an emerging domain which promotes �mental health and wellbeing for all. GMH:

is international, interdisciplinary, culturally-relevant, multi-sectoral
emphasizes the right to health and equity in health;
encourages healthy behaviors and lifestyles;
is committed to preventing and treating mental, neurological, and substance use conditions (MNS) especially for vulnerable populations (e.g., settings of poverty, conflict, calamity, and trauma) and in low- and middle-income countries;
seeks to improve policies and programs, professional practices and research, advocacy and awareness, and social and environmental factors that affect health and well being.

Updated March 2019; Based on the definition from:

GMH--Finding Your Niches and Networks, Psychology International, March 2012

Mental Health Action Plan 2013-2020 (2013) World Health Organization�See: Fact Sheets on Mental Health, World Health Organization

Global Mental Health and Sustainable Development; The Lancet Commission on Mental Health and Sustainable Development (October 2018). See the Policy Brief (summary of this report) by Mental Health Innovation Network.�

Turning the Church’s Attention to Mental Health: Binding Up the Broken Hearted (November 2018) �Lausanne Global Analysis, Gladys Mwiti and Bradford Smith

Global Mental Health: Collaborating Across Sectors for Sustainable Development and Wellbeing�Medicus Mundi Switzerland, Bulletin (June 2017) Kelly O’Donnell and Julian Eaton

Well-Being for All: Mental Health Professionals and the Sustainable Development Goals�Journal of Psychology and Christianity (March 2017)

Global Mental Health: Sharing and Synthesizing Knowledge for Sustainable Development Global Mental Health (September 2016) Kelly and Michele O‘Donnell

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“Mental health conditions are responsible for much of the global burden of disease. Mental health conditions cause more years lived with disability (32.4%) than any other health condition and nearly as many disability-adjusted life-years (13.0%) as cardiovascular disease (13.5%). People living with mental health conditions are also more likely to develop physical health problems, less likely to receive quality healthcare and less likely to adhere to treatment, resulting in poorer physical health outcomes— including premature mortality.
But this is not just a health issue. People with mental health conditions are often excluded from development interventions, despite strong evidence of the close links between mental health and virtually every key issue in international development; for example, research has shown a cyclical relationship between poor mental health and inequalities in educational attainment, income, nutrition, housing and social support.
The economic cost is overwhelming. Every year more than 12 billion working days are lost due to mental health conditions. Between 2011-2030, this will cost the global economy $16 USD trillion in lost economic output— more than cancer, diabetes, and respiratory diseases combined.”

Source: �MHIN Policy Brief, Lancet Commission GMH and Sustainable Development

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MENTAL HEALTH ACTION PLAN 2013-2020 �WORLD HEALTH ORGANIZATION (2013)

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Vision: �“A world in which mental health is valued, promoted, and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high-quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination.”

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MH-AP 2013-2020/2030

The four major objectives of the action plan are to:

Strengthen effective leadership and governance for mental health.
Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
Implement strategies for promotion and prevention in mental health.
Strengthen information systems, evidence and research for mental health.

Note: “Trauma”-related words used 7 times, 5 in context of humanitarian settings and two in the context of adverse life events.

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Overview: Mental Health Action Plan 2013-2020
Vision A world in which mental health is valued, promoted, and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high-quality, culturally appropriate health and social care in a timely way to promote recovery, all in order to attain the highest possible level of health and participate fully in society and at work free from stigmatization and discrimination.
Cross-cutting Principles
Universal health coverage Regardless of age, sex, socioeconomic status, race, ethnicity or sexual orientation, and following the principle of equity, persons with mental disorders should be able to access, without the risk of impoverishing themselves, essential health and social services that enable them to achieve recovery and the highest attainable standard of health.	Human rights Mental health strategies, actions and interventions for treatment, prevention and promotion must be compliant with the Convention on the Rights of Persons with Disabilities and other international and regional human rights instruments.		Evidence-based practice Mental health strategies and interventions for treatment, prevention and promotion need to be based on scientific evidence and/or best practice, taking cultural considerations into account.	Life course approach Policies, plans, and services for mental health need to take account of health and social needs at all stages of the life course, including infancy, childhood, adolescence, adulthood and older age.	Multisectoral approach A comprehensive and coordinated response for mental health requires partnership with multiple public sectors such as health, education, employment, judicial, housing, social and other relevant sectors as well as the private sector, as appropriate to the country situation.		Empowerment of persons with mental disorders and psychosocial disabilities Persons with mental disorders and psychosocial disabilities should be empowered and involved in mental health advocacy, policy, planning, legislation, service provision, monitoring, research and evaluation.
Goal To promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders
Objectives and Targets
1. To strengthen effective leadership and governance for mental health Global target 1.1: 80% of countries will have developed or updated their policy/plan for mental health in line with international and regional human rights instruments (by the year 2020). Global target 1.2: 50% of countries will have developed or updated their law for mental health in line with international and regional human rights instruments (by the year 2020).		2. To provide comprehensive, integrated and responsive mental health and social care services in community-based settings Global target 2: Service coverage for severe mental disorders will have increased by 20% (by the year 2020).		3. To implement strategies for promotion and prevention in mental health Global target 3.1: 80% of countries will have at least two functioning national, multisectoral mental health promotion and prevention programmes (by the year 2020). Global target 3.2: The rate of suicide in countries will be reduced by 10% (by the year 2020).		4. To strengthen information systems, evidence and research for mental health Global target 4: 80% of countries will be routinely collecting and reporting at least a core set of mental health indicators every two years through their national health and social information systems (by the year 2020).

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TRAUMA:�PREVENTION AND TREATMENT�CAUSES AND CONSEQUENCES�� < CONFERENCES��TRAINING >�� VIDEOS�V�

Video:

Living Peace: The Story of Abby and Kyalu�Trauma and treatment in Democratic Republic of Congo, Promundo�(watch the overview here)�

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FRAMEWORK FOUR�GLOBAL COMPACT FOR A SAFE, ORDERLY, AND REGULAR MIGRATION �(GCM, 2018)

“The global compact comprises 23 objectives for better managing migration at local, national, regional and global levels. The compact:

aims to mitigate the adverse drivers and structural factors that hinder people from building and maintaining sustainable livelihoods in their countries of origin;
intends to reduce the risks and vulnerabilities migrants face at different stages of migration by respecting, protecting and fulfilling their human rights and providing them with care and assistance;
seeks to address the legitimate concerns of states and communities, while recognizing that societies are undergoing demographic, economic, social and environmental changes at different scales that may have implications for and result from migration;
strives to create conducive conditions that enable all migrants to enrich our societies through their human, economic and social capacities, and thus facilitate their contributions to sustainable development at the local, national, regional and global levels.
The list of the 23 objectives can be found in paragraph 16 of the Global Compact for Migration.”

Quote from website: https://refugeesmigrants.un.org/migration-compact

https://www.who.int/mental_health/mhgap/mhGAP_intervention_guide_02/en/

“This is the second version (2016) of the mhGAP Intervention Guide (mhGAP-IG) for mental, neurological and substance use (MNS) disorders in non-specialist health settings. It is for use by doctors, nurses, other health workers as well as health planners and managers. The Intervention Guide presents the integrated management of priority MNS conditions using algorithms for clinical decision making.�

This update of the 2010 edition is based on new evidence as well as extensive feedback and recommendations from experts in all WHO regions who have used mhGAP-IG Version 1.0. The key updates include: content update in various sections based on new evidence; design changes for enhanced usability; a streamlined and simplified clinical assessment that includes an algorithm for follow-up; inclusion of two new modules - Essential Care and Practice that includes general guidelines and Implementation module to support the proposed interventions by necessary infrastructure and resources; and, revised modules for Psychoses, Child and Adolescent Mental and Behavioural Disorders and Disorders due to Substance Use.�

The mhGAP-IG Version 2.0 is a valuable tool to scale up services for people with MNS conditions and their families.”

Note from Version 1.0: “The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.”

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HUMANITARIAN INTERVENTION GUIDE �(2015, WHO)

https://www.who.int/mental_health/publications/mhgap_hig/en/

Overview

Adults and children affected by emergencies experience a substantial and diverse range of mental, substance use, and neurological problems.

The mhGAP Humanitarian Intervention Guide contains first-line management recommendations for mental, neurological and substance use conditions for non-specialist health-care providers in humanitarian emergencies where access to specialists and treatment options is limited. It is a simple, practical tool that aims to support general health facilities in areas affected by humanitarian emergencies in assessing and managing acute stress, grief, depression, post-traumatic stress disorder, psychosis, epilepsy, intellectual disability, harmful substance use and risk of suicide.

This new tool is an adaptation of WHO’s mhGAP Intervention Guide, a widely-used evidence-based manual for the management of these conditions in non-specialized health settings.

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THE FRIENDSHIP BENCH

“The Friendship Bench project is an evidence-based intervention developed in Zimbabwe to bridge the mental health treatment gap. Their mission is to enhance mental well-being and improve quality of life through the use of problem solving therapy delivered by trained lay health workers. The Friendship Bench focuses on people who are suffering from common mental disorders, such as anxiety and depression. Produced by: Nicky Wimble, United For Global Mental Health”
Video: https://www.youtube.com/watch?v=Th77mCuL5GY

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�LANCET COMMISSION ON GMH �AND SUSTAINABLE DEVELOPMENT �(OCTOBER 2018)�

Summary of Key Recommendations

Address mental health across all the Sustainable Development Goals
Include mental health in the essential package of services for Universal Health Coverage
Take a public health approach to prevention and promotion
Ensure inclusion of people with mental health conditions
Increase investment in mental health
Harness learning from research to help drive change
Measure progress against existing commitments

Source: MHIN Policy Brief October 2018

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Part Two

Humanitarian Sector and Trauma�A4H, GCM, Examples�(CHS, IFRC/WDR, ICRC/MHPSS)

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��AGENDA FOR HUMANITY�5 CORE RESPONSIBILITIES��

Political leadership to prevent and end conflict. “Preventing conflicts and finding political solutions to resolve them is our first and foremost responsibility to humanity.”
Uphold the norms that safeguard humanity
Leave no one behind
Change people’s lives—from delivering aid to ending need
Invest in humanity�

Notes:

Trauma appears once and violence-related words 6 times (4 related to S/GBV), mental 0 times and psychosocial one in relation to S/GBV.
Updates on humanitarian action: Humanitarian Response Plans, UN OCHA .�

The Agenda for Humanity is an Annex in One Humanity—Shared Responsibility (2016) World Humanitarian Summit�http://sgreport.worldhumanitariansummit.org/

In this report to the World Humanitarian Summit, the UN Secretary-General calls on global leaders to commit to five core responsibilities:

Global leadership to prevent and end conflict�Preventing conflicts and finding political solutions to resolve them is our first and foremost responsibility to humanity.

CONFLICTS DRIVE 80% OF ALL HUMANITARIAN NEEDS.

2. Uphold the norms that safeguard humanity�Every day, civilians are deliberately or indiscriminately killed in wars. We are witnessing the erosion of 150 years of international humanitarian law.�But even wars have limits: leaders must recommit to upholding the rules that protect humanity.

90% OF PEOPLE KILLED OR INJURED BY THE USE OF EXPLOSIVE WEAPONS IN POPULATED AREAS ARE CIVILIANS

3. Leave no one behind�The World Humanitarian Summit is the first test of our commitment to transform the lives of those most at risk of being left behind.�This means reaching everyone and empowering all women, men, girls and boys to be agents of positive transformation. It means reducing displacement, supporting refugees and migrants, ending gaps in education and fighting to eradicate sexual and gender-based violence.

In 2015, global leaders adopted the 2030 Agenda for Sustainable Development and pledged to leave no one behind.

4. Change people's lives – from delivering aid to ending need�Success must now be measured by how people's vulnerability and risk are reduced, not by how needs are met year after year. Ending need will require three fundamental shifts in the way we work:�- Reinforce, don't replace national systems�- Anticipate, do not wait for crises�- Transcend the humanitarian-development divide

TODAY, 43% OF PEOPLE LIVE IN FRAGILE SITUATIONS. BY 2030 THAT NUMBER IS ESTIMATED TO CLIMB TO 62%.

5. Invest in humanity�Accepting and acting upon our shared responsibilities for humanity requires political, institutional and financial investment. As a shift is needed from funding to financing that invests in local capacities, is risk-informed, invests in fragile situations and incentivizes collective outcomes. We must also reduce the funding gap for humanitarian needs.

ONLY 0.4% OF OFFICIAL DEVELOPMENT ASSISTANCE SPENT ON DISASTER PREPAREDNESS IN 2014.

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GLOBAL COMPACT FOR A SAFE, ORDERLY, AND REGULAR MIGRATION �(GCM, 2018)

“The global compact comprises 23 objectives for better managing migration at local, national, regional and global levels. The compact:

aims to mitigate the adverse drivers and structural factors that hinder people from building and maintaining sustainable livelihoods in their countries of origin;
intends to reduce the risks and vulnerabilities migrants face at different stages of migration by respecting, protecting and fulfilling their human rights and providing them with care and assistance;
seeks to address the legitimate concerns of states and communities, while recognizing that societies are undergoing demographic, economic, social and environmental changes at different scales that may have implications for and result from migration;
strives to create conducive conditions that enable all migrants to enrich our societies through their human, economic and social capacities, and thus facilitate their contributions to sustainable development at the local, national, regional and global levels.
The list of the 23 objectives can be found in paragraph 16 of the Global Compact for Migration.”

Quote from website: https://refugeesmigrants.un.org/migration-compact

Quote below from website: https://refugeesmigrants.un.org/migration-compact

The global compact for migration is the first, intergovernmentally negotiated agreement, prepared under the auspices of the United Nations, to cover all dimensions of international migration in a holistic and comprehensive manner.

Today, there are over 258 million migrants around the world living outside their country of birth. This figure is expected to grow for a number of reasons including population growth, increasing connectivity, trade, rising inequality, demographic imbalances and climate change. Migration provides immense opportunity and benefits – for the migrants, host communities and communities of origin. However, when poorly regulated it can create significant challenges. These challenges include overwhelming social infrastructures with the unexpected arrival of large numbers of people and the deaths of migrants undertaking dangerous journeys.

In September 2016 the General Assembly decided, through the adoption of the New York Declaration for Refugees and Migrants, to develop a global compact for safe, orderly and regular migration.

The process to develop this global compact started in April 2017. The pages in this section detail 18 months of consultation and negotiation, and provide the relevant documentation for each of the events.

On 13 July 2018 UN Member States finalized the text for the Global Compact for Safe, Orderly and Regular Migration (Text available in all official languages).

The Intergovernmental Conference to Adopt the Global Compact for Safe, Orderly and Regular Migration will be held on 10 – 11 December in Marrakech, Morocco.

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FORCIBLY DISPLACED PEOPLE WORLDWIDE

Highest levels of displacement to on record (UNHCR)

DEFINITIONS: The 1998 UN Guiding Principles on Internal Displacement de ne IDPs as:

[...] persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border.

Refugees – over half are under the age of 18 Article 1 of the 1951 Convention relating to the Status of Refugees, read together with its 1967 Protocol relating to the Status of Refugees, de nes persons who fall within the global legal definition of a refugee. Article 1(A) (2), in particular, states that the term shall apply to any person who:

[...] owing to well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.

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TRAUMA AMONG REFUGEES

Rates of psychotic, mood and substance use disorders similar to host populations.
Rates of post-traumatic stress disorder in refugees and asylum seekers are higher.

Priebe S, Giacco D & El-Nagib R. (WHO, 2016)

Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;15(1):29.

15% PTSD prevalence among refugees

(compared to 1.1% in non refugee/IDP pop.)

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ALL REFUGEES HAVE EXPERIENCED SOME LEVEL OF TRAUMA:

Does this mean they are all traumatized?
Do we pathologize their conditions at the expense of overall mental health & seeing strengths, innovation, & resilience?
What are the risk and protective factors (individual, relational and contextual) ?

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MORE TRAUMA PERSPECTIVES�HUMANITARIAN SECTOR

Psychological First Aid: Guide for Field Workers�(2011, WHO, War Trauma Foundation, World Vision)

Core Humanitarian Standard on Quality and Accountability �(2014, CHS Alliance)

World Disasters Report: Leaving No One Behind �(2018, IFRC)

Guidelines on Mental Health and Psychosocial Support �(2017, ICRC)

�

Quote from CHS Alliance website:

The Core Humanitarian Standard on Quality and Accountability (CHS) sets out Nine Commitments that organisations and individuals involved in humanitarian response can use to improve the quality and effectiveness of the assistance they provide. The CHS places communities and people affected by crisis at the centre of humanitarian action. As a core standard, the CHS describes the essential elements of principled, accountable and high-quality humanitarian aid. It is a voluntary and measurable standard. The CHS is the result of a global consultation process. It draws together key elements of existing humanitarian standards and commitments.

The CHS Guidance Notes & Indicators is a supplement to the CHS. The guidance provides clarification on the Key Actions and Organisational Responsibilities in the CHS and examines some of the practical challenges that may arise when applying the CHS. It explains why each of the Nine Commitments of the CHS is important and provides some examples for different audiences and for different contexts.

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“Evidence-based psychological interventions commonly used in high-resource settings can be effective in low-resource contexts, including when they are delivered by trained and supervised non-specialists. These interventions have proved helpful in the treatment of common mental health problems, such as depression, anxiety and traumatic and chronic stress, as well as other difficulties, such as harmful alcohol use. Cultural and contextual adaptations can increase the effectiveness of psychological interventions, and make them more accessible to people affected by crises. Treatments are best delivered in local languages, using recognisable terminology and case examples, and implemented in ways that do not exacerbate stigma or exclusion. Humanitarian settings demand psychological interventions that are as brief and as low-cost as possible, and which optimise limited human resources.”

Scalable psychological interventions for people affected by adversity, Schaefer et al (July 2018) �Mental Health and Psychological Support in Humanitarian Crises, Humanitarian Exchange/HPN, ODI

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PSYCHOLOGICAL FIRST AID

What is it?

Early psychosocial support following traumatic events/disasters
Brief evidence-informed intervention
Serves individuals, families & local communities

Primary aim of PFA:

Reduce distress & promote basic needs
Deliver important information
Connect people with available support networks
Enhance long-term coping and functioning

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PFA - SIX CORE COMPONENTS

Global Initiative for Stress and Trauma Treatment (GIST-T)

The primary aim of PFA as an initial intervention is to reduce distress, promote basic needs, deliver important information, connect people with available support networks and enhance long-term coping and functioning

1. Looking - basic needs

This involves providing safety, comfort and support, as well as delivering practical help including food, water, shelter, information and, if necessary, medical assistance

2. Listening

PFA workers need to listen properly to individuals in order to understand their particular situation and specific needs, and to identify the best way of assisting them

3. Comforting

People in distress can feel overwhelmed by a crisis situation. It is important to acknowledge their feelings and emotions such as the loss of loved ones or of their homes. When assisting individuals affected by a distressing event then it is important to respect the safety, dignity and rights of the people being helped

4. Connecting

After crisis events people often experience high levels of powerlessness, isolation and vulnerability. This may be because they are unable to access their usual support systems. Connecting people with other family members, loved ones, friends and members of the local community is a major part of PFA.

5. Protecting people from further harm. It means helping individuals to cope with their needs and concerns.

Protection also involves offering essential and relevant information and providing access to resources.

It could also mean reducing further exposure to disaster sights, sounds and smells by limiting contact as much as possible.

Another important aspect is to be mindful of children as it often helps if they know that parents, family members or trusted adults are protecting them.

6. Instilling hope

Favourable outcomes from using PFA are frequently associated with instilling a sense of hope and a sense of future for individuals. When engaged in PFA a positive approach is essential and often requires encouraging a person to be positive and to focus upon doing what is required to survive and move forward. This is a form of empowerment. Connecting people with their faith-based beliefs may also lead to a more hopeful and positive outlook

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PSYCHOLOGICAL FIRST AID: GUIDE FOR FIELD WORKERS

(2011, WHO, War Trauma Foundation, World Vision)�

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�PFA RESEARCH�

How has the WHO PFA 2011Guide been perceived and used?

“In conclusion, the PFA retrospective study allowed us the chance to Look at the progression of the WHO PFA guidance, Listen carefully to people’s experiences and perceptions and hopefully now Link PFA within holistic, comprehensive MHPSS responses in emergencies. Just as medical first aid does not constitute a comprehensive health response, so PFA is not a panacea for all the mental health needs of people affected by crisis events – it must be integrated as a component of wider MHPSS frameworks and services to most effectively ‘reach out a helping hand’.”[bold added for emphasis]

Psychological First Aid Around the World: Summary of a Five year Retrospective, �Snider, Schaefer, Winberg (July 2018). Mental Health And Psychosocial Support in Humanitarian Crises, HPN/ODI

“As the MHPSS field evolved, with a growing evidence base and a variety of innovative intervention strategies undergoing field testing, the time was right to critically reflect on PFA and its place within the spectrum of MHPSS approaches. The Church of Sweden, with advisory support from World Vision International (both Reference Group members), commissioned a five-year retrospective (2011–16) to understand how the WHO PFA guidance has been perceived and applied since its launch.+Utilising a desk review, online survey, case studies and interviews, the retrospective looked at:

translation and adaptation processes;

applications (and misapplications) in different crisis contexts;

use by different types of helpers, from lay people to professionals;

the place of PFA in the larger field of MHPSS in emergency response; and

recommendations for the future.”

“Five key recommendations summarise the priorities that emerged from these varied perspectives, and provide a roadmap for next steps for practitioners, the authors of the guide and stakeholders in the global MHPSS community:”

1. Provide an updated overview of the MHPSS field that clarifies the place of PFA within the broader spectrum of support

2. Keep attention to PFA as a foundational component of MHPSS approaches and tend to its applications in practice

3. Continue to develop innovative PFA resources and technologies

4. Promote fidelity to the model with support to capacity-building initiatives and dialogue among communities of practice

5. Develop common approaches and tools for monitoring and evaluation of and research on PFA”

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CORE HUMANITARIAN STANDARD�ON QUALITY AND ACCOUNTABILITY �(2014, CHS ALLIANCE) �SEE ALSO SPHERE HANDBOOK

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WORLD DISASTERS REPORT: �LEAVING NO ONE BEHIND �(2018, IFRC)

The report identifies five fatal flaws that are allowing so many people to fall through the cracks: too many affected people are 1) out of sight, 2) out of reach, 3) left out of the loop, or find themselves in crises that are 4) out of money, or deemed to be 5) out of scope because they are suffering in ways that are not seen as the responsibility of the humanitarian sector.

Fig. 2 Five different reasons that affected people may not receive the assistance they need

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GUIDELINES ON MENTAL HEALTH�AND PSYCHOSOCIAL SUPPORT �(2017, ICRC) �SEE ALSO: IASC MHPSS IN EMERGENCY SETTINGS

Example of one of the many approaches for MHPSS�group session for families of missing persons, �facilitated by an “accompanier” IFRC, Uganda

From website: https://www.icrc.org/en/publication/4311-guidelines-mental-health-and-psychosocial-support

“War and violence destroy communities and countries all over the world, and have a devastating impact on the mental health of millions of people.

These ICRC guidelines outline the organization’s approach to mental health and psychosocial support (MHPSS) during and after armed conflict and other situations of violence. They provide a framework for harmonizing MHPSS programmes within the organization, and an insight into its strategic processes and field practices.

This publication is not intended to serve as a training manual for specific MHPSS techniques. In sharing these guidelines with an external audience, the ICRC aims to raise awareness of its approach among professionals and other interested parties.”

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CORE READINGS

Transforming Our World: The 2030 Agenda for Sustainable Development) United Nations (2015) UN Sustainable Development Knowledge Platform See: Frequently Asked Questions
One Humanity: Shared Responsibility. Report of the Secretary-General for the World Humanitarian Summit. UN General Assembly, 70th Session. (2016).
Mental Health Action Plan 2013-2020. World Health Organization. (2013).
Global Compact for a Safe, Orderly, and Regular Migration, United Nations (2018)
World Disasters Report 2018: Leaving No One Behind International Federation of the Red Cross and Red Crescent Societies (2018)
Lancet Commission on Global Mental Health and the Sustainable Development. (October 9, 2018). The Lancet, 392, 1553–1598.
O’Donnell, K. & Eaton, J. (June 2017). Global Mental Health: Collaborating Across Sectors for Sustainable Development and Wellbeing. Bulletin, Medicus Mundi Switzerland
O’Donnell, K. & Lewis O’Donnell, M. (2016). Multi-Sectoral Member Care: Engaging Our World as Global Integrators. Journal of Psychology and Theology, 44(4), 303-314
O’Donnell, K. & Lewis O’Donnell, M. (2017). Well-Being for All: Mental Health Professionals and the Sustainable Development Goals. Journal of Psychology and Christianity, 36(1), 70-75.

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THE TRAUMA PANDEMIC �A GLOBAL LENS FOR GLOBAL ACTION

��

“We can’t just Pontius Pilate 7.7 billion people!”

Thank you!

Michèle and Kelly O’Donnell

Member Care Associates, Inc.�mcaresources@gmail.com �www.membercareassociates.org

--Dr. Michèle Lewis O’Donnell and Dr. Kelly O’Donnell are consulting psychologists based in Geneva. Respectively they are the CEO and COO of Member Care Associates, Inc (MCA), an NGO focusing on the wellbeing and effectiveness of staff and their organizations. Their multi-sectoral emphases for consultation, training, and writing include: personnel development, Global Mental Health, and integrity/anti-corruption. Kelly and Michèle are International Affiliates of the American Psychological Association and Representatives of the World Federation for Mental Health to the United Nations. Their publications include over 70 articles and five books in the member care and mental health fields (see recent publications) as well as ongoing Member Care Updates and Global Integration Updates (archived on the MCA website). They did their doctoral training in clinical psychology and theology at Rosemead School of Psychology, Biola University, USA and have two wonderful adult daughters, Erin and Ashling, raised in five countries. MCAresources@gmail.com�

�

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FRAMEWORK THREE�GLOBALINTEGRATION

A framework for actively and responsibly engaging in our world—locally through globally—for God’s glory:

By connecting relationally and contributing relevantly �on behalf of human wellbeing and the issues facing humanity
In light of our integrity, commitments, and core values �(e.g., ethical, humanitarian, human rights, faith-based).

See Global Integration: Staying Current and Relevant (March 2019 update)

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�PARTNERING--FAITH-BASED INITIATIVES�MATERIALS-MILESTONES�

Building from Common Foundations:The World Health Organization and Faith-Based Organizations in Primary Care (2008), Geneva Global, World Health Organization (overview and guidelines)
Ending Extreme Poverty: A Moral and Religious Imperative (2015), World Bank �(joint inter-religious statement)
Laudato Si: Caring for Our Common Home (2015), Pope Francis �(encyclical on creation care)
Faith-Based Health Care (7 July 2015), The Lancet (special issue)
International Partnership on Religion and Sustainable Development (organization/website)
A Faith-Sensitive Approach to Humanitarian Response: Guidance on Mental Health and Psychosocial Programming (2018) The Lutheran World Federation and Islamic Relief Worldwide
Source for the first five items:�Multi-Sectoral Member Care: Engaging Our World as Global Integrators �Journal of Psychology and Theology 44(4), 2016, pp. 303-314. K and M O’Donnell

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�SEVEN DIRECTIONAL COMMITMENTS ENGAGING OUR WORLD AS GLOBAL INTEGRATORS�WELL-BEING FOR ALL: MHPS AND THE SDGS �(JOURNAL OF PSYCHOLOGY AND CHRISTIANITY, SPRING 2017)�

Commitment 1. We commit to diligently pursue our own journeys of personal and professional growth—to grow deeply as we go broadly. �Commitment 2. We commit to integrate the inseparable areas of our character (resilient virtue) and competency (relevant skills) with compassion (resonant love). �Commitment 3. We commit to go into new areas of learning and work: crossing sectors, cultures, disciplines, and comfort zones. �Commitment 4. We commit to embrace our duty to work in difficult settings, including those permeated by conflict, calamity, corruption, and poverty as those in great need are often in places of great risk. �Commitment 5. We commit to have clear ethical commitments and standards that guide our work, respecting the dignity and worth of all people. �Commitment 6. We commit to working with others to promote wellbeing and sustainable development, building the future we want--being the people we need. �Commitment 7. We commit to base our work on the practice of fervently loving other people—agape. This type of love is the foundational motive and the ultimate measure of our GI work.