Supporting mental health and psychosocial well-being in emergencies: RCCE-IM guidance for preparedness and response

Introduction

For individuals and organizations working in areas affected – or perceived to be affected – by emergencies, understanding and addressing the consequences on individual and community mental health and psychosocial well-being is an essential component of effective preparedness and response.

This guide offers practical strategies and key messages to navigate the complex mental health landscape associated with emergencies. It emphasizes risk communication, community engagement and infodemic management (RCCE-IM) and promotes a proactive approach that integrates mental health and psychosocial support (MHPSS) into all stages of emergency planning and response.

The guidance is designed to be adapted to local contexts. It can be used to develop and implement comprehensive risk communication strategies and produce a range of communication materials tailored to the characteristics of any emergency. This includes crafting clear and impactful messages, designing effective visuals and leaflets, preparing public service announcements and creating other evidence-based materials for dissemination before, during and after an emergency.

The guidance serves as a resource to facilitate collaboration and discussion between stakeholders, including ministries, authorities, civil society organizations and community leaders, ensuring comprehensive preparedness and effective response.

RCCE-IM is the fundamental framework for action throughout this document. RCCE-IM includes

• Strategic coordination. Ensuring all stakeholders, from health authorities to community leaders, work in unison.
• Systematic mapping. Identifying and understanding the needs, concerns and communication channels of at-risk and vulnerable communities.
• Active community engagement. Working with, rather than for, affected populations to build trust, address fears and gather vital insights.
• Collaborative co-creation. Developing messaging, interventions and support mechanisms alongside communities, thereby helping to ensure they are culturally appropriate, accessible and truly meet community needs.
• Evidence-based information flow. Disseminating accurate, timely and empathetic information to counter misinformation and empower individuals to take protective actions.

By applying RCCE-IM principles, stakeholders can leverage the guidance to enhance preparedness, respond sensitively and support the mental well-being of those impacted by emergencies, fostering resilience and facilitating access to essential care and services.

Understanding the mental health landscape in emergencies

Emergencies can include anything from sudden outbreaks and natural disasters to armed conflicts and technological and industrial accidents. Their potential for severe, long-term health consequences can create widespread distress. Even in the absence of actual physical harm, perceived risks can result in substantial psychosocial suffering. People may link unconnected signs and symptoms with the perceived threat, potentially overwhelming health systems.

Psychosocial impacts and stressors

• Intense fear and uncertainty. The chaotic, overwhelming nature of emergencies can amplify anxiety and feelings of helplessness. People may struggle to assess whether they are in a safe or unsafe zone and if/how they are impacted. Fear of unseen hazards and threats to children can become pervasive.
• Economic consequences. Loss of agricultural products and declining trade and tourism exacerbate economic hardship and aggravate psychosocial distress.
• Social stigma and discrimination. Past emergencies show that communities/individuals associated with a crisis, particularly those that have been displaced or are perceived as "affected", can experience stigmatization. There have been reports of bullying among children and of individuals feeling compelled to conceal their place of origin or association with the event due to fear of the social consequences.
• Repercussions from protective actions. Measures implemented during emergencies can negatively impact mental and physical health. These include sheltering in crowded places, with the consequent loss of privacy and basic comfort, evacuation, relocation and long-term displacement which can result in the loss of homes and jobs and rupture communities. Actions such as health monitoring and procedures involving cleaning or sanitation, which involve waiting, discomfort and lack of privacy, can also cause fear, anxiety, confusion and anger and exacerbate feelings of being unable to control the situation or participate in decision-making.
• Rumours, unofficial news sources and lack of information exacerbate distress and undermine effective coping mechanisms. Poor risk communication is a significant stressor.
• Increased mental health conditions. Substance abuse, domestic violence, depression, anxiety and post-traumatic stress disorder are more likely to occur after emergencies. Estimates indicate that at least 1 in 5 people affected by an emergency or disaster will experience a mental health condition, with some groups more vulnerable than others.

In emergencies, the impacts above can all be compounded by limited access to health care and health services.

Remember, your role is not to provide professional mental health treatment but to offer compassionate support, provide accurate information and facilitate access to available resources.

Section 1. Communicating effectively in crises

Building trust and connection

• Active listening. Create or find a space where you can communicate openly. Listen attentively and offer comfort and encouragement.
• Validate feelings and emotions. Acknowledge and affirm people’s emotions and experiences. Build trust and connection by demonstrating that their feelings are respected.
• Empathy and respect. Respect local culture, values and confidentiality. Treat everyone with dignity and understanding. Care must be taken to ensure the primacy of community needs and protection from exploitation, abuse and discrimination.

Remember that everyone experiences crisis differently. Avoid making assumptions about individual needs or reactions.

Addressing rumours and misinformation

Misinformation increases stress. Avoid rumours and unofficial news sources. Seek updates from trusted sources of information.

• Be a source of accurate information. Provide accurate information about available services, coping strategies and sources of support. Dissemination of accurate and timely information tailored to specific groups promotes social cohesion and reduces the risk of stigmatization.
• Counter harmful narratives. Address rumours and misinformation with empathy and facts. Implementing risk communication strategies developed by all stakeholders during the preparedness stage increases the effectiveness of protective actions and can reduce fear. Effective risk communication includes clear, inclusive messaging about protective actions, adapted and disseminated by trained communicators who listen to community concerns and provide targeted support for mental health and well-being and accurate information.
• Engage with community leaders. Work with religious leaders, elders and influential community members to disseminate accurate information and promote positive mental health practices. Emergency response planners should identify trusted community leaders and involve them in decision-making throughout the emergency cycle. Affected people should be involved in designing and implementing MHPSS activities that build upon existing community support networks.

Section 2. Understanding the mental health landscape in emergencies

Individual and community mental health and psychosocial well-being can be impacted during and after an emergency. Ripple effects often include severe economic consequences which further aggravate psychosocial repercussions, particularly when the economic situation was already difficult.

Fear and uncertainty about risks – whether they are visible or not – are  common. Emergency protective actions, while designed to save lives, can have repercussions on the physical and mental health of affected people. Social stigma towards evacuees and others affected by emergencies can lead to people hiding their health conditions to avoid discrimination.

Coupled with inconsistent media coverage and misconceptions, these factors can exacerbate people's distress, making substance use, domestic violence, depression, anxiety, post-traumatic stress disorder and other psychosocial outcomes more likely.

Estimates indicate that at least 1 in 5 people affected by an emergency or disaster will experience a mental health condition, with certain groups at much greater risk. Vulnerable groups include:

• people directly affected by the incident or in close proximity to extremely stressful events;
• evacuees and members of hosting communities;
• children, who may face discrimination, stigmatization and bullying, and parents concerned about the long-term impact on their children’s health;
• pregnant women and lactating mothers from affected areas;
• individuals with underlying health concerns;
• people with pre-existing mental health and psychosocial needs;
• people with low literacy levels who may find it difficult to follow risk communications;
• first responders, health workers, clean-up workers and staff of critical of affected infrastructure and their families;
• people living in residential facilities and institutions; and
• people with disabilities.

Section 3. Supporting community resilience and communication

Effective MHPSS hinges on robust coordination and clear communication in response preparations for, and during, the emergency.

MHPSS cross-cutting considerations

MHPSS should be implemented across the preparedness, response and recovery phases of an emergency. Five cross-cutting aspects – the 5 C’s – apply to the entire emergency cycle.

• Building common understanding among actors with diverse views is key to effective coordination. This starts with joint planning for emergency response – identifying roles, establishing procedures and incorporating MHPSS in these plans. Inter-sectoral MHPSS working groups are central to this process, developing functional lines of communication, clear operating procedures and agreed-upon roles and responsibilities among stakeholders.
• Providing accurate and timely information in plain language, via platforms people use and understand and from sources they trust, enables people to make choices and take actions to protect themselves, their families and their communities. Responders should always be honest. If information is unavailable, the response should be: I don't know, but I will try and find out.
• Community involvement. The people most affected by an emergency must be engaged in decision-making. Experience of past emergencies shows the value of community involvement in assessing local impacts and in facilitating risk communication and shared ownership of decisions made by local authorities. Active involvement gives people a sense of control and improves coping abilities.
• Capacity-building. Mental health and psychosocial needs can exceed the existing response capacity of local communities and national and international responders, making planning stage investment in capacity-building During emergencies, training can then be rapidly rolled out to emergency responders, health workers and other professionals involved in the response.
• Core ethical values. Core values include beneficence/non-maleficence, prudence, justice and dignity. Applying these values while implementing protective actions in emergencies helps to ensure risks are avoided and communities kept safe.

Health care workers, first responders and MHPSS providers should receive training in basic psychosocial support and hazard protection.

Resources for psychosocial support include Doing what matters in times of stress, an illustrated guide developed by WHO that equips individuals with practical, evidence-informed skills for coping with adversity.

The WHO EMRO MHPSS platform is a digital hub offering basic psychological support and guidance to help individuals, including the general public and frontline workers, cope with psychosocial reactions and distress.

Identifying resources for basic hazard protection depends on the emergency context.

When evacuation is necessary, agencies and institutions involved in the emergency response should ensure that families remain together and evacuees are involved in decision-making regarding logistics and living arrangements.

The implementation of safety procedures should be arranged so that people undergoing triage, monitoring and other protective measures are as safe and comfortable as possible. This process should be accompanied by communication tools that clearly explain the reasons for the protective action.

Emergency responders should keep in mind that it can be very stressful, especially when a large group of people needs to be processed and waiting times are long. Uncertainty, fear of unseen or pervasive hazards, not being allowed to leave and feeling trapped, can easily feed feelings of insecurity and helplessness. People may be frightened. They may panic or become angry and aggressive. Handing over personal objects or undergoing intrusive or private procedures can add to feelings of discomfort, embarrassment and insecurity. Know that all these measures can exacerbate mental health and psychosocial issues.

Policies and procedures should also be established to support the mental health and well-being of first responders, clean-up workers, workers in critical infrastructure and affected facilities, and health care staff.

Local authorities should engage communities in the decision-making process and communicate any health risks and implications for local businesses in a transparent and honest manner. Building trust is a long process. It needs to start in the preparedness stage, with community leaders engaged in emergency planning as equal partners.

• Use effective communication tools to explain the process and the need for protective actions (pictures and leaflets are helpful, especially when responders are wearing personal protective equipment which can hamper communication).
• Explain the reasons behind any protective procedures and, when possible, how long they will take.
• Arrange that people undergoing triage, monitoring and personal safety and health procedures are reasonably safe and comfortable (e.g. allow sufficient space to prevent people from feeling trapped, set up screens to allow privacy and treat personal belongings with respect).
• Ensure that children are accompanied by a parent or relative.
• Whenever possible, involve members of the community who have already participated in procedures to assist others.
• Make sure to communicate the result of any monitoring and what it implies.

Community-level MHPSS interventions should be implemented in collaboration with community stakeholders. Whenever feasible, these interventions should include:

• re-establishing community activities, such as cultural and religious events;
• ensuring access to education for children, and recreational activities; and
• restoring informal support networks and providing psychological first aid (PFA).

PFA is an evidence-informed, modular approach to helping individuals cope with the immediate aftermath of a traumatic event or crisis. It focuses on reducing initial distress and promoting long-term adaptive functioning. PFA involves establishing a human connection, ensuring safety, providing practical assistance and fostering resilience. It is a simple yet powerful way to provide emotional support and help people cope with shock, panic and other immediate reactions to trauma.

Key principles of PFA

• Ensure the person feels physically and emotionally safe.
• Establish a human connection in a non-intrusive, compassionate manner.
• Practical help. Provide practical assistance and information to help address immediate needs.
• Foster hope and optimism realistically.

What PFA is not

• PFA is not a substitute for professional mental health care.
• It is not a diagnostic or treatment intervention.
• It is not about giving advice or making judgments.

Who can provide PFA?

• Anyone can provide PFA, including family members, friends, neighbours, community members and emergency responders. Anyone can learn PFA skills through training programmes.

Benefits of PFA

• Reduced distress. PFA can help reduce initial distress and prevent the escalation of emotional distress.
• Improved coping. It can help individuals develop coping mechanisms and foster resilience.
• Increased resilience. By providing support and promoting natural recovery, PFA can enhance the ability to cope with future challenges.

These actions should always comply with relevant safety and protection requirements and aim to promote well-being and long-term community resilience. Disseminating accessible, accurate and timely information tailored to specific groups promotes social cohesion and reduces the risk of stigmatization.

A key focus should be on promoting the integration of MHPSS activities into existing support structures. For individuals with mental health issues and disorders, this includes:

• creating linkages with social and health services;
• establishing a referral and treatment system for patients with mental health needs;
• ensuring the continuation of essential services for people with severe mental health conditions or neurological conditions who may not have had access to relevant medication during the emergency; and
• where possible, making psychological interventions available for people impaired by prolonged distress.

Section 4. Practical skills for supporting mental health and psychosocial well-being in emergencies

In emergency contexts, practical skills for supporting mental health should focus on immediate needs, managing intense anxiety and fostering collective resilience.

Promoting healthy coping mechanisms

• Focus on immediate needs and support. Rather than dwelling on long-term goals that feel overwhelming, help individuals concentrate on their immediate needs and what they are feeling in the moment. Offer practical assistance whenever possible. Share accurate information about protective actions. Connect people to available resources. Or simply offer a listening ear. Acknowledge the overwhelming challenges and lack of definitive answers. Provide whatever immediate assistance is possible under the circumstances.
• Encourage basic self-care. Emphasize the importance of self-care in emergencies. Promote healthy coping strategies that can be practiced in stressful environments.
• Breathing exercises. When anxiety takes hold, encourage slow, deep breaths. Suggest inhaling for 3 seconds, holding for 3 seconds and exhaling for 3 seconds. This simple practice can help decrease stress levels and promote a sense of calm.
• Gentle movement. Amid uncertainty, and during confinement, gentle stretching can help ease the tension carried in the body. Encourage slow rolling of the shoulders and tensing and relaxing each muscle group. Start with the toes and work up to the head.
• Shift focus. Try to gently shift attention away from unseen threats to something specific. The 5-4-3-2-1 technique can be grounding. Name 5 things you can see right now, 4 things you can feel, 3 sounds you can hear, 2 things you can smell and 1 thing you can taste. Even when the list cannot be completed, the technique can help ground individuals in the moment.
• Simple routines. In chaotic times, routines can offer a sense of order and control. This could be saying a prayer at the same time each day, making a point to share a story with a loved one each evening, or setting aside a few minutes each morning and night to find a quiet corner and breathe deeply. Small, regular acts can make a significant difference when so much feels out of control.
• Remember your strengths. Remind people that small acts of kindness, caring for those around them or simply getting through the day are powerful signs of personal strength and resilience.
• Be kind to yourself. Encourage individuals to treat themselves and those around them with patience and understanding. Remind them that everyone is doing their best to cope.

Remember to avoid false hope. Do not minimize suffering or offer unrealistic expectations about the future.

• Sharing and supporting one another. Stress the power of human connection. Encourage people to share stories, traditions or songs that remind them of their shared strength and resilience. Even in the darkest times, moments of connection can be a source of comfort and strength.
• Emphasize collective strength. Frame resilience as a communal effort rather than an individual burden. Highlight that resilience is built and sustained together, not in isolation.

Remember, the goal is not to pretend things are normal but to offer small, meaningful ways to cope with stress and uncertainty.

Recognizing signs of distress and taking action

People react to emergencies differently. Pay close attention if someone is:

• withdrawing deeply from others, even those they trust;
• expressing hopelessness or despair that seems outside their usual emotional state;
• showing increased agitation, aggression or recklessness; and
• seems unable to cope with daily tasks or care for themselves or their children.

De-escalation

When medications or treatments are unavailable, de-escalate heightened anxiety or agitation by using the following techniques.

• Respect personal space. Maintain a distance of at least two arm's length, respecting both the individual's and your own space.
• Do not be provocative. Remain calm in language and demeanor to avoid escalation. Keep your hands visible and avoid staring.
• Establish verbal contact. Only one person should verbally interact with the agitated individual to prevent confusion. Introduce yourself, listen attentively, provide orientation and reassurance, and maintain politeness.
• Be concise. Use short sentences and simple vocabulary. Allow time for information to be processed and repeat essential points to aid understanding.
• Be honest. Honesty is crucial. Dishonesty can lead to greater problems and erodes trust.
• Identify needs and feelings. Use structured questions to understand needs and feelings. For example, ask: I really need to know what you expected when you came here. Even if I can’t provide it, I would like to know so we can work on it.
• Family and friends as allies. Identify trusted individuals who might help in the situation. Do not assume you know what the person wants.
• Agree to disagree. Find common ground without necessarily agreeing completely. For instance, if the agitated person complains about disrespect, you can agree in principle by saying: I believe everyone should be treated respectfully. This acknowledges their feelings and emphasize mutual respect.
• Set clear limits. Set reasonable limits, emphasizing mutual respect and safety.
• Propose alternatives and coach self-control. Quickly propose alternatives to violence to prevent aggression spiraling. Coach the person on maintaining control. Say, for example: It would help me understand better if you were to tell me your concerns calmly.
• Offer extra reassurance and support. Provide additional reassurance and support as people navigate their health needs amid chaos and uncertainty.

Connecting people to services

For effective support, it is essential to establish clear linkages between affected people and social and health services.

• Familiarize yourself with – and map – available services. Know what MHPSS services, health facilities and community support networks are operational and accessible in your area.
• Provide clear information. Share accurate and timely information about where and how to access these services, tailored to your audience (e.g. use simple language for those with low literacy, or communicate through trusted community leaders).
• Facilitate access. Whenever possible, assist individuals in navigating barriers to access. This can include providing directions, offering transportation, making direct referrals or accompanying someone to access care. Given the likelihood of service disruption, knowing what is accessible and how to navigate any barriers is crucial.
• Prioritize continuity of care. Work to ensure people with pre-existing mental health conditions can continue essential treatments and access their medications, even when supplies are scarce.
• Know when to refer. You may not be a mental health professional, but recognizing when someone needs additional support, particularly if their distress is persistent or significantly impairs their functioning, is essential. When this happens, contact the relevant mental health professionals or MHPSS services.

Section 5. Addressing specific needs and vulnerabilities

Emergencies present challenges that disproportionately affect certain groups. Tailored approaches are crucial to providing effective mental health and psychosocial support.

Children and parents

Children are profoundly affected by the disruption and fear caused by emergencies, even if their reactions are not immediately obvious.

• Prioritize safety and reassurance. While direct control over the situation may be limited, consistently reassure children that you are there to care for them and keep them as safe as possible. Be a source of comfort and protection amid the fear and uncertainty.
• Offer comfort through familiar activities. Engage children in simple, familiar activities that provide a sense of normalcy. This can include singing songs, telling stories, offering a hug or a gentle touch (as appropriate), or using a calming voice. Even brief moments of these activities can offer significant comfort.
• Reduce media exposure. Shield children from overwhelming and potentially misleading media coverage. It can exacerbate their distress and anxieties.
• Acknowledge expressions of fear. Children may regress in behaviour, become withdrawn or display other behavioural changes. Be attuned to these signs and offer understanding and support. Parents, too, intensely concerned about the long-term impact on their children's health, may require specific reassurance and information.

Older adults

Older adults often face heightened vulnerabilities during emergencies.

• Support access to necessities and social networks. Older adults may experience increased isolation or difficulty navigating new environments. Assist them access essential supplies and maintain connections with social support networks, and ensure they have access to information relevant to their needs.

People with disabilities

For people with disabilities pre-existing barriers to service access can be exacerbated and new barriers created.

• Advocate for inclusive access. Champion efforts to ensure that services and support are accessible to people with disabilities.
• Help meet basic needs. Provide as much assistance as possible to ensure basic needs are met, including access to essential equipment like wheelchairs, diapers, hearing aids, white canes and glasses.

People with chronic conditions

Existing physical health needs can be compounded during times of crisis.

• Facilitate access to essential medications and treatments. Strive to help individuals access vital medications/treatments, even when supplies are scarce. Be proactive in seeking alternative solutions and available resources.

People with pre-existing mental health conditions

The stress of an emergency can severely impact those with existing mental health conditions. Let them know you will do everything possible to help during this incredibly difficult time. This includes assisting them in accessing essential medications and treatments even when supplies are scarce, and acknowledging that managing their mental health during this period is incredibly difficult

• De-escalation as a primary tool. When medications or treatments are unavailable, de-escalating the situation may be the best immediate option.
• Ongoing support and reassurance. Emphasize that you are there to offer extra support and reassurance as they navigate the challenges of the crisis.
• Encourage established coping strategies. If they have coping strategies that worked for them in difficult times before, encourage them – as far as possible – to use the same strategies, adapted to current circumstances.

Groups with specific communication needs

Consider individuals with low literacy levels and those who face language barriers when disseminating information and support. Adapt communication methods and formats to ensure optimum accessibility.

Section 6. Self-care for health workers and responders

Working during and in the aftermath of emergencies places immense strain on health workers, first responders and all those involved in the emergency response. Supporting your own well-being is essential, for you and for those you support.

• Acknowledge your own stress. Recognize that emotional well-being is as important as physical health. You are not immune to the impacts of an emergency. The overwhelming and uncertain nature of the threat and widespread fear can affect you too.
• Prioritize your needs. The simplest of comforts can feel impossible during a crisis, but even tiny moments of peace matter. Find a quiet corner, if only for a few breaths. You could close your eyes, slowly count to ten, or share a moment of silence with a trusted colleague. If finding a quiet place is impossible during the day, try to make room for moments of calm at night, when it might be more feasible. Short pauses help you keep going.
• Seek support when needed. Do not hesitate to talk to trusted colleagues, friends or family members about what you are experiencing. If you find yourself struggling with anxiety, sleeplessness, irritability or other signs of distress, access professional support. Procedures should be in place to support your mental health and well-being.

Remember, prioritizing self-care better equips you to support others during challenging times. The WHO EMRO MHPSS platform is a useful resource.

Section 7. Available mental health and psychosocial support resources

You are not alone in navigating the mental health and psychosocial impacts of emergencies. Services and resources are available to support individuals, communities and responders struggling with mental health and well-being. Familiarize yourself with these and proactively assist individuals in accessing them, including – when available – medications to support people with pre-existing mental health conditions.

Details to facilitate access to support, and specific mental health and psychosocial resources, are provided below.

This guidance is a living document, meaning it will be updated as the situation evolves and more resources become available. This adaptable framework allows new information and support mechanisms to be integrated as they emerge.

Examples of the types of resources and support platforms that should be leveraged and, where possible, connected with those in need.

• Doing what matters in times of stress. A widely accessible WHO guide offering practical strategies for coping with stress, it empowers individuals to manage their reactions with self-help techniques.
• WHO EMRO MHPSS platform. This online platform provides basic psychological support designed to help individuals better cope with the psychosocial reactions they might experience when facing difficult circumstances.
• Psychological first aid (PFA). PFA provides community members, health workers and responders with guidance on providing humane, supportive and practical help to people facing serious crises. It offers strategies to provide immediate support and understanding, reduce initial distress and foster adaptive coping.
• Local health services and community centres. When operational and accessible, these facilities serve as vital hubs for initial assessments, basic MHPSS and referrals. They can also serve as points for information dissemination and community gathering.
• Referral and treatment systems. Establishing clear referral pathways to professional mental health services and ensuring the continuation of essential treatments for those with severe mental health or neurological conditions is of overwhelming importance. This includes efforts to secure and distribute necessary medications.
• Community-led initiatives. Support and collaborate with community stakeholders to re-establish normal community activities such as cultural and religious events and ensure children have access to education and recreational activities. These actions, when compliant with relevant safety and protection requirements, contribute to psychosocial well-being and community resilience by restoring a sense of normalcy and connection.

Remember, the focus is on promoting positive elements of mental health and well-being and integrating MHPSS activities within existing support structures for the long-term resilience of the community.

Sources

IASC common monitoring and evaluation framework for mental health and psychosocial support in emergency settings: with means of verification (version 2.0)

IASC guidance: mental health and psychosocial support in emergency settings: monitoring and evaluation

IASC guidelines on mental health and psychosocial support in emergency settings (2007)

IASC reference group on mental health and psychosocial support in emergency settings