This World Mental Health Day, as we focus on mental health in humanitarian emergencies, I'm reflecting on what communities have taught me about resilience. Decades of research and experience have shown us that across emergencies like conflicts, natural disasters and disease outbreaks, mental health is negatively impacted. With significant crises, populations often experience substantial levels of distress, and we typically see rates of depression, anxiety and other mental health conditions doubling under these circumstances. It is clear that we need to make sure good practice in mental health and psychosocial support (MHPSS) is a part of preparation for, and response to, emergencies.
 
Following a very productive four years working alongside partners in Uganda through the UK Public Health Support Team, I have learnt that whilst humanitarian emergencies inevitably create mental health challenges, we have seen something profoundly hopeful: If we are guided by values of genuine partnership and community empowerment when we respond to emergencies, we don't just help people survive emergencies, we help them emerge stronger.
 
Partnership as the foundation of resilience
 
Uganda experiences more infectious disease outbreaks than almost any other African country, creating enormous experience and expertise in emergency response to regular outbreaks of diseases like Ebola and mpox. However, until recently, MHPSS implementation has not been prioritised, despite it being part of Uganda’s Incident Management System. For the last four years, in a collaborative project with the Uganda Ministry of Health and Makerere University, we have been exploring how to integrate mental health into the planning and effective response to public health emergencies.
 
What struck me most was how much we learned from our Ugandan colleagues about the realities of emergency response. One district particularly prone to infectious disease outbreaks is Bundibugyo, as it is close to where people migrate across borders and biological hotspots of animal diversity of the nearby forests. Districts like Bundibugyo have much to teach us about their experiences with managing disease outbreaks, where local health officials understand exactly how diseases spread through communities, which communication channels actually reach remote areas, and how existing support systems function under pressure.  Our collaborator Dr Kenneth Kalani from Uganda's Ministry of Health captured this beautifully when he spoke about using existing resources differently to ensure mental health benefits reach beyond refugee-hosting areas - insights that could only come from years of managing real emergencies.
 
This partnership wasn't about one group of experts teaching others about mental health. It was about bringing different types of expertise together to create something none of us could have achieved alone: a locally owned approach to mental health support that could withstand the pressures of real humanitarian crises.
 
Empowering communities as mental health champions
 
What we discovered in Bundibugyo was that communities already possessed incredible resilience and wisdom about supporting each other through crises - our job was to amplify these existing strengths in preparation for future emergencies, rather than replace them.
 
Working with the District Health Team, we adapted internationally recognised Mental Health and Psychosocial Support Minimum Service Package so that the interventions were relevant to the local culture and context. Working with community leaders, health staff, traditional healers, District Health Leaders, security officers, and sex workers helped us to understand how to most effectively communicate with communities, for example designing messages about infection risks that would be understood by community members. Posters were used for clinics and public buildings, whilst radio messages were recommended for remote communities on the other side of mountains that were difficult for health workers to reach. Perhaps most importantly, these approaches that valued existing sources of resilience and knowledge meant that they became confident advocates who could reduce stigma and encourage help-seeking behaviour long after any formal intervention ended.
 
Building mental health skills in emergency response
 
Another example of building confidence and readiness for response was that our Ugandan partners recognised that healthcare workers also needed to feel empowered during emergencies. Working with non-mental health specialists such as nurses and community health workers who were already within the health system – from major hospitals to small clinics and prison health services – we provided training focusing on strengthening evidence-based mental health care. The programme used the World Health Organization’s (WHO) mhGAP guidelines for training which provided practical tools and best practices for frontline health providers – skills to help them be more effective at providing holistic care. This will ensure that vulnerable community members who are often overlooked could benefit from strengthened mental health support during calm times as well as emergencies. Supportive supervision was also provided, providing an opportunity to refine skills and grow confidence.
 
This approach is essential during emergency conditions, when healthcare workers face enormous pressure whilst potentially dealing with their own stress and trauma. By building mental health skills as core competencies rather than additional expectations, we aim to create capacity that strengthens under pressure rather than crumbling.
 
Building resilient systems that last
 
After the work was completed, we evaluated Bundibugyo’s response capabilities and compared them to a neighbouring district using a table-top simulation exercise. We co-designed and co-delivered this simulation with Ugandan partners, using scenarios that reflected real situations their response teams might face. This demonstrated much better preparedness and confidence in how to respond with appropriate tools to protect mental health compared to the control site.
 
Participants in this neighbouring district are now keen to have the same systems in place, which has led to our next phase of work - Uganda’s national Incident Management System has now decided to integrate MHPSS into the national response system as a dedicated MHPSS pillar. This process has now started, with representatives from Bundibugyo joining national health leaders and international experts to develop recommendations for adoption as a national MHPSS plan. Another success of the national workshop is the stronger links between the formal government system and the civil society sector working in emergency response.
 
Hope through partnership
 
We will always have humanitarian emergencies. In fact, with climate change and other risks, they are likely to become more frequent. The World Mental Health Day theme bringing attention to mental health in humanitarian crises is more vital than ever. What gives me most hope isn't just the technical achievements in Uganda - though they're significant - but the demonstration that when we truly partner with communities, when we empower rather than impose, and respect local wisdom whilst sharing global evidence, we create mental health support systems that allow healing to happen.
 
The WHO has emphasised the importance of reinforcing protective community systems, in addition to formal health systems. Our work in Uganda was built on trusted relationships, both across international institutions, and with affected communities. When mental health support is built on partnership and empowerment of affected people, the best of public health science can be at its most transformative, and communities can emerge from emergencies stronger than ever.
This blog was written by Dr Julian Eaton, UK-PHRST MHPSS Lead, with contributions from Dr Biksegn Yirdaw from the UK-PHRST MHPSS team and Dr Kenneth Kalani from the Uganda Ministry of Health.