We are currently living in an era that has the highest levels of forced displacement on record. These experiences of migration of individuals, families and communities face are life-altering phenomena, both physically and mentally.
The ways in which these extra-ordinary psychosocial and social stresses are dealt with by the refugees themselves, but also global humanitarian efforts, are myriad.
A month ago, while following the WHO webinar on “Mental health of refugees and migrants: myths and realities”, one of the panellists used the term ‘Superman Syndrome’. Now before the gender-sensitive amongst us get riled up: the ‘Superman/Superwoman Syndrome’ was describing and critically examining the role of lay-volunteers in the filling of gaps in humanitarian aid responses, in particular towards mental health and psychosocial support (MHPSS) provision.
This up-surge of lay-volunteerism in MHPSS provision may be a result of a multitude of factors. The sudden and immense need for basic services for refugees and forced migrants often overwhelms local host-country resources and their capacity to provide aid. With the majority of migration taking place within the Global South, host countries already struggle in creating resilient and sustainable health systems with equitable coverage and access to basic healthcare. With the added pressures and challenges of an ever-increasing influx of refugees in need of immediate humanitarian assistance, without the necessary support (and coordinated efforts) from local, national, and international actors, the basics of food, shelter, sanitation and healthcare provision can often fall short for both local and refugee populations. Hence, there is always a gap to fill.
Additionally, there seems to be a general belief that anyone can provide advice and counselling. While there is increasing focus and demand for up-scaled, and task-shifted provisions of basic mental healthcare by non-specialists, the need to underscore the role of training and guidance is essential. Whether one is utilising the WHO’s prescribed mhGAP Humanitarian Intervention Guide (mhGAP-HIG) or the Inter-Agency Standing Committee’s Guidelines on MHPSS in emergency settings, these tools remain largely inefficient and ineffective, and possibly even damaging, in untrained and unsupervised hands.
When it comes to mental health and psychosocial well-being outcomes for displaced populations in emergency settings, it is important to remember that not all individual mental health needs are the same. Traumatic experiences of armed conflict, disasters, and persecution may lead to a variety of responses, which can range from resilient coping mechanisms in some to the development of mental disorders in others. While the responses of refugee individuals, families and communities to these stresses differ, the need for integrated and continuous MHPSS is unwavering, especially in settings where there are limited numbers of adequately trained healthcare providers and/or medication supply.
Realistically, the chances are that the volunteer is just a person with a conscience, wanting to do their part. After all, if there were no gaps in the first place – if our intersectoral systems of care and migration functioned seamlessly – there would be no space for the average local person to believe that they can make a difference and rush to the front-line themself. In our current realities, these structural and systemic gaps do exist – the constant underfunding of the global humanitarian system and the overburden on already fragile health systems, in contrast with ever increasing demands, means that there is often too little being done, too late.
In the words of Michel Foucault, “People know what they do; frequently they know why they do what they do; but what they don’t know is what what they do does.”
(in Madness and Civilization: A History of Insanity in the Age of Reason)
Hence, while we should remain wary of mental health vigilantism in emergency settings, perhaps we should not discount it just yet. Perhaps the ‘Superman/Superwoman Syndrome’ is a reminder that not all is lost, yet – after all, there must still be some humanity left in us that prompts us to still try and save the day?
For more in and around this topic, join us in conversation at the 10th European Congress on Tropical Medicine and International Health at the organised session on ‘Refugee Mental Health in the Global South and North: Current Research and Best Practices’ on Wednesday October 18th from 15.30-17.00.