Mental health and psychosocial support (mhGAP-HIG)
Most people who live through a crisis feel distress, and most recover with safety, basic needs met and the support of family and community. A smaller number develop conditions that need clinical care, and people who already had psychosis or epilepsy are at high risk when their medicines run out. Primary care can do a great deal for all of them.
- For doctors, clinical officers, nurses and community health workers in humanitarian settings
- Reviewed October 2026
Layers of support
The IASC Guidelines describe mental health and psychosocial support (MHPSS) as layers. Everyone needs the bottom layer; fewer people need each layer above it. Primary care works across the top two layers and protects the bottom two.
| Layer | Examples |
|---|---|
| Specialised services | Care by mental health specialists, or by primary care staff with specialist supervision, for severe conditions |
| Focused, non-specialised support | Basic emotional and practical support for individuals and families; brief psychological help from trained, supervised health and community workers |
| Community and family support | Tracing and reuniting families, activating social networks, child-friendly spaces, women's and youth groups |
| Basic services and security | Safety, food, water, shelter and health care delivered in ways that are safe, respectful and protect dignity |
Source: IASC Guidelines on MHPSS in Emergency Settings, 2007; mhGAP-HIG 2015
Psychological first aid (PFA)
Psychological first aid is not a clinical treatment. It is a humane, supportive response to someone who is suffering, and any trained staff member or volunteer can give it.
- Make sure the person is safe and their urgent needs are met.
- Listen carefully, without pressing them to talk about what happened.
- Help with practical needs: food, water, shelter, finding family, information.
- Connect them with people who can support them and with services.
- Protect them from further harm.
If only a few staff can be trained in mental health care, make sure all the others can at least give PFA. A PFA orientation takes about half a day.
Source: Sphere Handbook 2018, mental health standard 2.5; mhGAP-HIG 2015
Priority conditions for primary care (mhGAP-HIG modules)
The mhGAP Humanitarian Intervention Guide covers ten conditions that non-specialist health workers can assess and manage. Assess the whole person; do not stop at one problem.
| Condition | Think of it when | First-line approach |
|---|---|---|
| Acute stress | Distress, poor sleep, bedwetting or physical complaints that started after a frightening event in the past month | Reassure that these reactions are common and usually ease with time; PFA; address practical needs and sleep. No medicines for most. |
| Grief | Distress after a death or loss | Support, listening, practical help; respect cultural mourning practices. Do not prescribe benzodiazepines for grief. |
| Moderate to severe depression | Low mood or loss of interest most days for at least two weeks, with difficulty in daily life | Psychosocial support and brief psychological help first. Consider an antidepressant if this is not enough; continue it for 9 to 12 months after the person feels well. |
| Post-traumatic stress disorder | Re-experiencing, avoidance and feeling under threat, about a month or more after the event | Psychological treatment where available; support and stress reduction. Benzodiazepines should not be used. |
| Psychosis | Hearing or seeing things that are not there, fixed false beliefs, disorganised speech or behaviour | Antipsychotic medicine, family support, protect rights. See again within 1 week. |
| Epilepsy and seizures | Two or more unprovoked convulsive seizures on different days in the past 12 months | One antiepileptic medicine; safety advice; treat a convulsing person as an emergency. |
| Intellectual disability | Child slow to reach milestones; difficulty learning and with daily activities | Support the carers, protect from abuse, link with education and community support. |
| Harmful use of alcohol or drugs | Use that harms health or daily life; withdrawal when supplies stop | Brief advice; manage withdrawal; screen for other conditions. |
| Suicide and self-harm | Thoughts, plans or acts of self-harm | See the red box below. |
| Other significant complaints | Distress or unexplained physical symptoms that do not fit the above | Support, problem-solving, follow-up. |
Medicine choice and doses: follow the mhGAP-HIG, your national guideline and the formulary.
Source: WHO and UNHCR, mhGAP Humanitarian Intervention Guide, 2015
Imminent risk of suicide
Ask about thoughts or plans of suicide (now or in the past month), self-harm in the past year, and access to means such as pesticides, rope, weapons or medicines. The person is at imminent risk if they have current thoughts, plans or acts of suicide, or recent thoughts or self-harm and are now extremely agitated, violent, distressed or not communicating.
- Treat any medical injury or poisoning first (atropine for pesticide poisoning is in the IEHK).
- Remove means of self-harm; offer a quiet, safe space.
- Do not leave the person alone. Agree with carers or staff who stays with them at each time of day, 24 hours a day, until the risk has passed.
- Instil hope; do not jump to solutions. Help them find reasons to stay alive.
- Consult a mental health specialist if one is available.
Source: mhGAP-HIG 2015, suicide module
Keeping psychotropic medicines going
- Keep at least one medicine from each group in stock: an antipsychotic (tablet and injection), a medicine for antipsychotic side-effects, an antiepileptic, an antidepressant and an anxiolytic (tablet and injection).
- Sphere's target: essential psychotropic medicines out of stock on fewer than 4 days in the past 30 days.
- The IEHK holds a small amount of amitriptyline, biperiden, diazepam, haloperidol and phenobarbital. It is not enough for a service that actively finds people with psychosis, epilepsy and depression: order more early.
- If someone was well on a medicine before the crisis, restart the same medicine at the same dose if it is available.
- Never stop antipsychotics abruptly. Missed doses or sudden stopping of antiepileptics can bring seizures back.
- Store all medicines securely.
Source: Sphere Handbook 2018; mhGAP-HIG 2015
Benzodiazepines: use rarely
- Do not use them for acute stress symptoms, PTSD or grief.
- The only exception in the mhGAP-HIG is extremely severe insomnia after acute stress in an adult, when psychological approaches have failed or are not possible: a short course of 3 to 7 days only.
- Never for children or adolescents; avoid in pregnancy and breastfeeding; take care in older people.
- They can slow breathing and cause dependence.
Source: mhGAP-HIG 2015, acute stress module
Setting up mental health care in the clinic
- Train and supervise named staff to manage the priority conditions; supervision is essential.
- Make basic clinical mental health care available at every health facility, not only in a separate service.
- Keep an up-to-date referral list: mental health specialists, protection, legal help, food and shelter.
- Keep records confidential.
- Brief all staff on local rules on consent and reporting (child abuse, sexual violence), and on family tracing for separated children.
- Protect the rights of people with severe mental health conditions, including people in institutions, who are at high risk of neglect and abuse.
Source: mhGAP-HIG 2015, advice for clinic managers; Sphere Handbook 2018
What to say
- Most people feel this way after what you have been through. For most people, these feelings get less over time.
- Try to keep a daily routine, stay with people you trust and avoid alcohol or drugs to cope.
- Come back if you cannot manage daily life, or if you have thoughts of harming yourself.
What happened to you was very hard. Your reactions are common, and they usually get better with time. You can come back to talk to us at any time.
Sources
- Inter-Agency Standing Committee (IASC). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. 2007.
- World Health Organization and UNHCR. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies. 2015.
- Sphere Association. The Sphere Handbook, fourth edition (mental health standard 2.5). 2018.
- World Health Organization, War Trauma Foundation and World Vision International. Psychological first aid: guide for field workers. 2011.