Overview
Intersectoral collaboration and coordination between emergency mental health and psychosocial support (MHPSS) stakeholders in Brazil was strengthened by WHO SDG3 GAP recovery challenge catalytic funds provided in 2021. This has resulted in the first stakeholder network of its kind in Brazil to improve MHPSS and equity, particularly for underserved groups in emergencies such as populations migrating from neighbouring Venezuela, those impacted by the COVID-19 pandemic and others in humanitarian settings.
The PAHO/WHO country office coordinated the project with the Brazilian Government, engaging stakeholders including IOM, UNHCR and GAP agencies UNFPA and UNICEF. Elements of the project included mapping existing MHPSS, a virtual course for key stakeholders that led to the establishment of the network and a proposal for establishing a MHPSS technical working group. Participants reported that the training course helped them to better understand how to coordinate MHPSS for communities. The project also connected different government resources and funding sources. Stakeholders are continuing to meet in the network, thereby strengthening the country’s formerly fragmented MHPSS landscape.
Improving equitable access to MHPSS in emergencies
‘Order and Progress’ is the motto on Brazil’s national flag. However, national progress to provide MHPSS has been slowed by a lack of stakeholder coordination, leadership and governance. The damaging impact of such fragmentation is particularly evident in humanitarian emergencies. Despite advances in mental health reform, there are still challenges such as insufficient financing and service coverage. Mental health and social support needs have also increased due to emergencies such as floods, droughts, refugee migration from Venezuela - the largest displacement in recent Latin American history1 - and the COVID-19 pandemic.
Brazil’s situation reflects frequent problems in emergencies, when unprepared health systems lack integrated PHC, mental health and social care capacity.2 Without the right support, emergencies can significantly impact mental health and well-being, with long-term consequences for individuals, families, communities and health systems. Often, the most marginalized groups face the worst outcomes. UNICEF reports that “… MHPSS for children and adolescents remains a challenge aggravated by COVID-19 in the context of the Venezuelan migratory crisis in Roraima state… There are no specialized services in the state for this population and professionals in the local MHPSS network do not feel prepared to attend to children and adolescents, particularly migrant populations.” However, if responded to appropriately, emergencies can become opportunities to improve health systems.3
The MHPSS approach
MHPSS is an approach guided by the Inter-agency Standing Committee (IASC), chaired by WHO and the International Federation of Red Cross and Red Crescent Societies (IFRC) and involving GAP agencies UNICEF, UNFPA and WFP.4 MHPSS is intersectoral by nature, linking health and non-health sectors. This approach calls for decentralized and people-centred mental health and social support responses that are adapted for local needs, integrated with PHC and that do not rely on specialist mental health services, which are often inaccessible or scarce in emergencies. Integrating MHPSS and PHC is a priority at Brazilian national, state and local levels and regionally for PAHO/WHO.5
Venezuelan migrant child in the Shelter at Boa Vista, Roraima, Brasil. ©WHO/PAHO
A project to strengthen intersectoral MHPSS collaboration and coordination in Brazil
Brazil was engaged with WHO SDG3 GAP for the first time in 2021 and supported with funds for a six-month project to strengthen MHPSS coordination and collaboration. A virtual MHPSS course provided training and acted as a convening mechanism for key stakeholders. The course content included crosscutting issues such as ethnicity, gender and equity. The 21 participating organizations included humanitarian and migration organizations, UN agencies and government at multiple levels such as the Ministries of Health and Citizenship and Municipality and State Health Secretaries from Boa Vista and Roraima, areas that have seen large numbers of Venezuelan migrants.
The course incentivized multiagency and multisectoral collaboration, as stakeholders decided to meet regularly after the course ended to form the first MHPSS network in Brazil. UNHCR, IOM and GAP agency UNFPA participated in the course and are now part of the network. Additional partners are being engaged as the network develops. A technical working group proposed from this network is a further step towards strengthening long-term MHPSS coordination and collaboration, in line with international best practice.
Funding also supported mapping of MHPSS literature, stakeholders and resources related to the impact of COVID-19 on mental health, including information sourced from course participants. Knowledge about the current availability of MHPSS is an important first step for coordination. A lack of quality research for the Brazilian context was revealed, particularly at population level and about non-specialized mental health support. Very few studies related to underserved groups, such as migrants and indigenous people. These findings serve as further justification for national-level MHPSS guidelines to focus on PHC, social care and mental health integration and equity. Finally, a mental health stigma awareness campaign was launched during the project implementation period, supported by PAHO/WHO Brazil and Foundation Mapfre, tackling a widespread problem that can stop people from seeking mental health support.
Impact on capacity building and MHPSS provision
“Leaving home causes anguish, but there is also the feeling of joy in arriving here, being welcomed, and seeing that there are people interested in helping, in knowing our feelings and emotions. For me, it was a blessing,” said a Venezuelan migrant describing MHPSS support she received in Brazil.6
Course participants not only indicated how much they had learned, including about improving gender integration in MHPSS, but praised the regular network meetings now being held. As one Ministry of Health participant noted, “the MHPSS… course promoted by PAHO/WHO in Brazil was very important at that moment because it brought a specific discussion about the field of mental health and… humanitarian emergencies and the importance of building intersectoral strategies to respond to the complex questions that arise in these situations. Grateful to participate in this process.”
Lessons learned and applied in the project included how to engage overloaded humanitarian workers as course participants, a challenge partly overcome by online course delivery on an existing PAHO/WHO platform. This enabled 30 individuals in different locations to complete the course, including emergency workers with heavy and unpredictable workloads.
This project sits within wider MHPSS and PHC strengthening work in Brazil involving IOM and GAP agencies UNFPA and UNICEF. UNICEF notes that “collaborative actions have been taking place between UNICEF and PAHO/WHO since 2020… A new package of activities about GBV related to adolescents, young girls and the LGBTQIA+ population is under development. Amplifying service provision intersectorally, including through formal education and social welfare systems, is still a fundamental step needed.”
IOM conducted complementary mapping and training work in 2021, related to civil society organizations providing MHPSS to refugees and migrants.7 Marina Faleiro, IOM Brazil, reflected that “when we talk about the integration of migrants and refugees, we tend to think about concrete and immediate demands such as … employment... Concerns regarding mental health often are put in second place, which embraces not only clinical healthcare but also social connections. However, all these aspects contribute to the successful inclusion of this population... From the data and learnings gained with this mapping, we now have a more precise understanding of needs and the scope of action of organizations that provide MHPSS to the refugee and migrant population in Brazil.”
Forthcoming activities include a workshop co-led by PAHO/WHO and the Ministry of Health developing national MHPSS guidance, acknowledged by the government and stakeholders to be greatly needed. An MHPSS e-book from the course will be published to further disseminate the training. To strengthen the integration of mental health and PHC, another virtual course will be offered in 2022 targeted at PHC and mental health workers.
The course, the network and the longer-term establishment of the technical working group are locally driven mechanisms for overcoming fragmentation and improving the quality and availability of MHPSS, particularly for underserved populations. Alongside work by the Brazilian government, other organizations and agencies, linkages between key actors have been formed, incentivized and harmonized that strengthen leadership, governance and intersectoral collaboration and coordination. All these efforts bring sustainable and long-term progress in integrating MHPSS with PHC to support people suffering during humanitarian emergencies, and for improving PHC, mental health and well-being more widely for all people in Brazil.
MHPSS and SDG progress
Given the health and non-health relevance of MHPSS, strengthening this area contributes to a wide range of Brazil’s SDG indicators with specific contributions towards Brazil’s progress on health SDGs 3.4 (NCDs and mental health), 3.5 (substance abuse), 3.8 (universal health coverage), 3b (vaccines), 3c (health financing), 3d (risk reduction) and a number of other health-related SDGs (1, 2, 6, 7, 11, 13,16).
What is the SDG3 GAP?
The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets. The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies. A “recovery strategy” (Oct 2021) serves as a strategic update on the SDG3 GAP in the context of achieving an equitable and resilient recovery from the COVID-19 pandemic to the health-related SDG targets. The purpose of GAP case studies is to monitor SDG3 GAP implementation at country level.
References
Mental Health and Psychosocial Support in Emergencies (MHPSS), PAHO
Mental Health and Psychosocial Support in Emergencies (MHPSS), PAHO
Source: IOM
Assistência Em Saúde Mental E Atenção Psicossocial À Popul Ação Migrante E Refugiada No Brasil