Trauma-Focused Public Mental-Health Interventions : A Paradigm Shift in Humanitarian Assistance and Aid Work

Abstract

At present, the mission in development and humanitarian aid, crisis assistance, and emergency interventions undertaken by governments, the United Nations, and non-governmental organizations is to support suffering populations medically, economically, socially, and politically. As humanitarians, we aim at alleviating the plight of war and danger, of natural disasters, and of poverty, as well as assisting human beings who experience human-rights violations and persecution. However, the basic postulate of “helping” has rarely been scientifically challenged when it comes to the interplay of aid and mental health. Much of currently extended humanitarian assistance is offered as “social,” “scholastic,” or “economic,” rather than as evidence-based psychological rehabilitation. Issues of the “medicalization” of political problems, “cultural and traditional wisdom” versus “empirically based scientific approaches,” and/or “non-interference” or even intentional policies of exploitation keep blocking the design of efficacious, mental-health interventions for severely affected survivors in resource-poor countries, who may, at times, make up nearly 50 percent of a given population.This chapter makes the case that restoring mental health with trauma-focused interventions is a key feature in and a necessity for effective development and humanitarian assistance. Healing from trauma reduces emotional pain, enables people to live productive lives, decreases the likelihood of aggression by survivors against themselves and others, stops the transgenerational transmission, and thus may help to interrupt the prevalent cycle of violence and under-development. Recent field-based studies have shown the efficacy of short-term, evidence-based, trauma treatment methods, which can be successfully built into large-scale service provision and applied by locally trained lay counselors. The authors’ and their organization vivo’s perspectives are based on research interventions in places such as Sri Lanka, Rwanda, Uganda, Democratic Republic of Congo, Ethiopia, Romania, Somalia, Afghanistan and by working with conflict-affected populations as diverse as asylum seekers, refugees, and internally displaced persons (IDPs) in Western countries, the Balkans, the African continent, as well as Central and Southern Asia. Most specifically, a set of empirically valid, trauma-focused guiding principles for public mental-health interventions after war, violence, and disaster are presented. This research is intended to bring awareness and action into a nearly neglected field of public health, human-rights implementation, humanitarian intervention, development aid, policy-making, and funding. The perspectives presented in this chapter substantiate that a programmatic innovation is needed, rendering a paradigm shift inevitable.