Mental health in emergencies: the invisible wounds

Crises such as natural disasters or conflicts result in numerous losses: material, economic, and most of all — human. Communities are affected both physically and psychologically. This raises a crucial question: what priority should be given to mental health in emergency situations?

An invisible but immense need

Worldwide, one in four people will experience a mental health condition at some point in their lives. In emergency situations, according to the World Health Organization, this figure can double due to family separation, bereavement, violence, and the loss of homes…

Yet, in the midst of a crisis, it is often the visible needs that take precedence: saving lives, providing medical care, finding food, rebuilding.

“Mental health seems less urgent because we cannot see it, even though it is very much present and can be severely debilitating,” says Raphaële Catillon, a mental health and psychosocial support specialist at HI.

It is everywhere: shock, disorientation, a loss of bearings. For the specialist, a distinction must be made between two things: psychological distress affects everyone following a traumatic event, and it is normal to be deeply affected in an abnormal situation. A mental health disorder, however, requires specialized care. The challenge is to prevent distress from turning into a disorder. And in low- and middle-income countries, up to 85% of people suffering from mental health disorders do not have access to appropriate services.

The first few days of an emergency

Raphaële Catillon, a qualified psychologist, has been working for HI in the Health Department for around five years. For her, one rule is essential: the sooner we intervene, the better.

In Nepal, following the flash floods of August 2026, thousands of people were displaced to temporary accommodation centers; many lost their homes, their livelihoods or loved ones. From the very first days, a HI psychologist based in India was sent to provide support, accompanied by Raphaële from headquarters. The first step was to assess needs and identify what support was already in place, to avoid duplicating the work of other organizations.

The immediate response is organized in several stages: first, basic needs are met – food, water, and shelter. This is essential for psychological care to be effective. Next, initial psychological first aid is offered to anyone in a state of shock: listening to them without pressuring them to talk, and helping them regain a sense of their bearings. We then diversify the support and offer: one-to-one counselling, support groups, activities for children (games, sport, music, etc.) The aim is to help people regain a sense of normality amidst the tragedy. And finally, we set up specialized groups for people suffering from anxiety or depression.

The aim in the first few days is to reduce the risk of a person developing a disorder.

“In an emergency, we plan for what comes next right from the start,” insists Raphaële Catillon.

To identify those in need of help, HI sets up, in certain contexts, ‘static points’ – staffed locations where people can come to ask for support. HI also relies on teams that raise awareness of the risks posed by landmines. These teams are trained in psychological first aid and know how to recognize strong emotional reactions and refer people for further support. “The aim isn’t for everyone to become a psychologist, but for the teams to be able to recognize when they can provide initial support,” explains Raphaële.

Disability and mental health

For HI, disability is not merely a medical issue: it is a factor that influences the extent to which a person can participate in society. Mental health and psychosocial support follow the same principle, to prevent anyone suffering from mental distress from being excluded from their community or even facing discrimination.

A person in distress often lacks the strength to seek help; they may withdraw into isolation, and their distress itself becomes a barrier. On the field, HI teams help these people to overcome these barriers; they provide them with useful contact details, accompany them to their appointments, and refer them to the appropriate services or other partner organizations… For example, when people are displaced, it is common for them to lose access to their medication. As well as posing a health risk, this can lead to deep worry and anxiety, which compounds the trauma of displacement; in such cases, HI – which is not a medical NGO and cannot prescribe medication – refers people to the relevant health services.

The story of Haleema, a refugee in Chad after fleeing the conflict in Sudan, illustrates the difference this support can make. Wounded by a gunshot during an attack in which she lost several family members, she now lives with the after-effects of a very serious injury and immense grief. Thanks to the support groups she attended, she has managed to come to terms with the trauma. She explains:

“The psychosocial support sessions, organized in groups by HI, helped each of us realize how we would live the rest of our lives with a serious injury – this allows us to share our ideas and thoughts, to get through this situation and move forward together. We came to the HI center to receive support, but HI also taught us how to pass this information on to others who cannot attend the sessions. We talk to them to tell them to be patient, that many are in the same situation, and that they can talk to people who share the same mindset.”

Supporting those who provide care

Psychosocial workers are highly exposed to the distress of the people they support. They therefore have a dedicated supervision space, led by a technical supervisor or an external resource, not by their manager.

“There are wounds that are invisible; we need to rebuild the whole person. In an emergency, it is mental health that enables people to ask for help, access the necessary services and find their place again. Mental health is a fundamental human right: it does not come after reconstruction, it is part of it,” summarizes Raphaële Catillon.