In humanitarian emergencies, violence, fear and uncertainty can create chaos and deplete community resources. As a result,people experience stress reactions that may impair daily functioning and social interaction.149 In many instances, these reactions are transient or people are able to adapt to the sudden changes. With appropriate socialand emotional support, many people will overcome these difficult experiences. To achieve this outcome, however, it is necessaryto draw on and strengthen the resources in families and communities that foster resilience and mutual support. In protractedhumanitarian crises, lack of hope and prolonged and accumulated stress can lead to persistent distress, increasing the incidenceor severity of mental health conditions, including severe depression and suicide. Some people, particularly individuals whohave been particularly severely affected, or who have pre-existing mental health and psychosocial needs, or who face discriminationand exclusion, may need focused additional support delivered by trained non-specialists or mental health and psychosocialhealth (MHPSS) specialists.
People with psychosocial and intellectual disabilities frequently experience discrimination and exclusion. Their human rightsmay be violated by segregation, confinement, restraints on their autonomy, or threats to their physical and mental integrity.Emergency responses should include action to redress rights abuses and inequities that were present before the crisis occurred,as well as to create opportunities for people with psychosocial disabilities to enjoy their rights fully, including theirrights to health and to live in dignity.
MHPSS should not focus only on persons with psychosocial and intellectual disabilities. It should focus on all community members,including persons with disabilities who experience different levels of distress in humanitarian contexts. However, these guidelinesrecognize that persons with psychosocial and intellectual disabilities face specific forms of structural discrimination, areparticularly at risk of human rights violations, and are in addition markedly underrepresented in decision-making fora. Theprotection sector should look closely at this subgroup in the population and take steps to make sure that its members canparticipate socially and in all matters that are of concern to them.
The health and protection sectors should work closely to protect, support and care for people living in prisons, social welfareinstitutions and other residential institutions, or who are homeless. They should act to develop and strengthen community-basedservices and structures, to both prevent institutionalization and end coercive treatment, violence, abuse and other violationsof human rights in such places. These forms of mistreatment disproportionately affect people with mental health conditionsand psychosocial and intellectual disabilities with higher support requirements. In the course of providing community care,support and living arrangements for this population, the protection sector should also promote independent and effective monitoringof all institutions, including prisons, in which persons are detained, and secure appropriate housing for those who are homeless.
When an emergency occurs, the mental health and psychosocial support system of the region affected is likely to be disrupted.In many instances, it may not be equipped to provide community-based and human rights-oriented mental health care and support.Humanitarian crises are an opportunity to invest effort and resources to construct an equipped, comprehensive community-basedsystem that is aligned with international human rights standards.
In practice, it is frequently difficult during an emergency to respond adequately to the needs of people with psychosocialand intellectual disabilities. This is particularly true in countries that have not ratified the Convention on the Rightsof Persons with Disabilities. Where mental health systems are not community-based or human rights-oriented, additional guidanceshould be provided on core aspects of care and support, at all levels, including in the community and in families. For instance,capacity-building programmes should focus attention on establishing procedures that secure and effectively safeguard informedconsent (to treatment, for example), supported decision-making and non-coercive interventions.