title: Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective.
abstract: BACKGROUND
  Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development.
  
  
  METHODS
  Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste.
  
  
  RESULTS
  These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders.
  
  
  CONCLUSIONS
  Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.
authors.affiliation: Consultant to the World Health Organization (WHO), Seattle, USA.
authors.forename: JoAnne E
authors.initials: JE
authors.lastname: Epping-Jordan
authors.affiliation: World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: van Ommeren
authors.affiliation: Ministry of Health, Palestinian Authority, Ramallah, West Bank occupied Palestinian territory.
authors.forename: Hazem Nayef
authors.initials: HN
authors.lastname: Ashour
authors.affiliation: Section on Community Psychiatry, the Indonesian Psychiatric Association, Jakarta, Indonesia.
authors.forename: Albert
authors.initials: A
authors.lastname: Maramis
authors.affiliation: Citizenship INGO, Rimini, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: Marini
authors.affiliation: CBM, Kuala Lumpur, Malaysia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mohanraj
authors.affiliation: WHO Country Office, Baghdad, Iraq.
authors.forename: Aqila
authors.initials: A
authors.lastname: Noori
authors.affiliation: WHO Somalia Liaison Office, Nairobi, Kenya.
authors.forename: Humayun
authors.initials: H
authors.lastname: Rizwan
authors.affiliation: WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: Khalid
authors.initials: K
authors.lastname: Saeed
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.affiliation: WHO Country Office, Colombo, Sri Lanka.
authors.forename: T
authors.initials: T
authors.lastname: Suveendran
authors.affiliation: Municipalidad de la Ciudad de San Luis, San Luis, Argentina.
authors.forename: Liliana
authors.initials: L
authors.lastname: Urbina
authors.affiliation: United Nations High Commissioner for Refugees (UNHCR), Geneva, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Ventevogel
authors.affiliation: World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
keywords: (Source: MeSH); Developing countries; Disasters; Health care reform; Health policy; Mental health; Mental health services; Refugees; War