World Mental Health Day 2025: Access to Mental Health Care in Catastrophes and Emergencies

This year, the theme for World Mental Health Day is ‘access to services – mental health in catastrophes and emergencies’. Supporting those who face adversity and are the most vulnerable is central to the mission of PLOS Mental Health and something that we have consistently tried to advocate for through our content and initiatives. Given that this specific theme is being highlighted for World Mental Health Day, we wanted to take this opportunity to highlight some content within PLOS Mental Health and across PLOS, which aims to improve well-being in communities that have faced mass trauma. Support may come during events or in the aftermath. But regardless, we should always be guided by the communities that we are aiming to help and this often requires us to revisit frameworks, policies and clinical practice. 

*** Some of the topics discussed below may be triggering for some readers. Please engage with the content at your own discretion and seek professional mental health support if you are affected. Please also note that the below is a commentary on journal publications but does not necessarily reflect perspectives of PLOS Mental Health or PLOS.***

• Violence and Political Unrest
• Sometimes the crisis is not always (directly) due to others
• What if we can measure mental health in real time?
• Do we need to re-evaluate what we think we know?
• Change needs community
• Elsewhere at PLOS

Violence and Political Unrest

Most of the time, it is unavoidable that mental health support comes after, rather than during, traumatic events. Traumatic events can sometimes be unexpected and even when they are not, during emergencies basic survival will take priority and those involved will often focus on just getting from day to day rather than being able to seek support for their well-being. 

PLOS Mental Health has published several articles, which explore the immediate and short-term effects of political unrest and violence in communities. At the start of this year, we published an article from Lawrence Technological University, University of Texas at Dallas, Afghanistan Technical Vocational Institute, and University of Pittsburgh, which explored how the psychosocial wellbeing of adults in Afghanistan changed following the withdrawal of US military forces from the country in 2021 and the subsequent transition to the New Taliban regime. The authors spoke with nearly 900 people and found that 90% experienced symptoms consistent with higher psychosocial stress, which was often linked to experiences of food insecurities and threats of violence. This study serves as an example of how political shifts can worsen socio-economic hardships and how the international community has a responsibility to not turn away and leave behind those who are suffering. 

As important as it is to understand the causes of suffering of those living in the face of conflict and unrest, it is equally important to learn from them. In an Opinion by Nataliia Frolova from Dnipro National University, Ukraine, a call is made to learn from the experiences of those in Ukraine who continue to face prolonged, collective trauma. In this Opinion, we are guided through three phases of the war (identified by the author at the time of writing) and how the psychosocial wellbeing of Ukrainians shifted with each stage – from focusing on basic survival needs, to trauma and emotional burnout. However the author also highlights the resilience of communities and the importance of helping others in shaping this resilience. The Opinion proposes that the act of volunteering to help others is a strategy that allows people to cope with trauma and that other nations could learn from the resilience of the Ukrainian people. 

The war in Ukraine continues and so understanding and support are still needed. Of course, there is no cut-off point at which support is no longer needed. Even decades later, the scars in communities can run deep. In April of this year, we published an article that explored the potential of narrative therapy in reducing symptoms of PTSD among survivors of the 1994 Rwanda genocide. Researchers at University of Rwanda showed that narrative therapy, which gives individuals an opportunity to reconstruct their personal stories, has potential to contribute to community healing. The strengths of the approach in this context include the opportunities for connection and for cultural relevance – the latter of which is missing from many existing frameworks when it comes to mental health care. 

Sometimes the crisis is not always (directly) due to others

Emergencies come in many forms and are not always caused by people. Sometimes, communities find themselves facing natural disasters. Although there is some element of human involvement (due to climate change) the experience of affected communities is likely to be different as they are not being specifically targeted (although we know there are vast disparities in terms of which communities are most vulnerable to climate change).  Last year, PLOS Mental Health published a study, which explored the mental health of pregnant women who experienced climate disasters. Researchers from North Carolina State University, Emory University, and Georgia State University examined data from hundreds of thousands of pregnant women who were specifically exposed to one or more hurricanes. They found that the risk for mood and anxiety disorders was elevated by cumulative hurricane exposure (two or more storms). As the authors point out, most studies focus on the mental health impact of single disasters but not recurrent exposure to climate disasters. This study therefore addresses a gap and a very important one. Pregnant women go on to have and raise children who will then be affected by their mother’s mental health. The ripple effects are vast.

What if we can measure mental health in real time?

Many studies that explore mental health in those who have experienced trauma come after the event, or at least after the start of an ongoing event. This is unavoidable but what it means is, we rarely have a baseline or pre-event comparison. Last month however, we published a study from Tel Aviv University and Stanford University, which was able to use smartwatch data to detect early signs of PTSD among people in Israel who were exposed to the October 7th events. The study included nearly 5000 people and had already started prior to the mass traumatic events. In light of October 7th, more in-depth explorations of well-being were collected, but smart watch data was available from 2020 onwards. Having such a longitudinal, large data set that includes data from before, during and after traumatic events is very rare and something we need to learn a lot from. The authors indeed find that smartwatch data (e.g. sleep and physical activity) along with mental health assessment surveys could indeed help to detect early signs of PTSD and as with all mental health conditions, the earlier the intervention the better. This study is a demonstration of the potential of technology when it comes to access to mental health care in emergencies. But the study also highlights the other side of the coin when it comes to technology. Whilst smart watch data was useful for early detection, exposure to graphic content through media on smart devices worsened mental health in the study population. This is a perfect example of the benefits and risks when it comes to technology and the difference likely depends on how we choose to use it. 

Do we need to re-evaluate what we think we know?

Violent conflicts have surged in the last two decades. Not only do we need to learn from experiences of trauma, but it is also time to revisit what we think we know. Two decades of elevated violence makes the world a different place. As outlined in this Review from PLOS Mental Health Section Editor Dr Joseph El-Khoury, along with authors from all continents, despite the evolution of the mental health field, trauma may have been left behind. One of the main barriers to development in this field is, according to the authors of this Review, the neglect of cross-cultural applicability…

…cross-cultural applicability continues to be an afterthought in the way all these disorders are conceptualized, researched and used in clinical practice. They particularly fail to adequately and inclusively capture the experiences of populations living under conditions of protracted oppression and violence.

The authors call for a fundamental shift towards universal, context-sensitive diagnostic frameworks. An emerging field, which plays an instrumental role in such a shift is geopsychiatry. PLOS Mental Health published an Opinion last year, also written by Dr Joseph El-Khoury along with an international group of authors, which introduced and stated the need for the geopsychiatry framework. The authors explain that geopsychiatry underscores the importance of addressing the root causes of conflict-related mental health issues. This not only tackles symptoms but also helps to understand and mitigate broader societal impacts of conflict.

Change needs community

Shifts in our understanding and treatment of trauma needs an international community. For World Refugee Week earlier this year, we published an Opinion piece, which provides a first hand account of the power of community. Mohammad Yasir Essar, who is currently a student at University of Calgary shares his experiences as a refugee from Afghanistan. Faced with numerous hardships including loss of community support, stigma, racism, discrimination from local authorities, and language barriers, Yasir explains the importance of community in strengthening refugee youth success and well-being.

As Khaled Hosseini reminds us, refugees share the same aspirations for safety, belonging and opportunity as others. Yet structural barriers persistently prevent them from rebuilding their lives and contributing fully to society.

Yasir calls for greater measures to empower displaced youth. In doing so, we will  also foster global resilience, prosperity, and mental health in the face of future displacement crises.

Elsewhere at PLOS…

We have also seen some powerful publications that are relevant to the topic of World Mental Health Day across PLOS.

At PLOS Global Public Health, a Scoping Review from University of Michigan and CUNY School of Medicine was published at the end of last year, which discussed health care delivery among migrants in humanitarian settings. The authors found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. What was found to be rare however, was rigorous methods and formal implementation models, suggesting that we may not be using what we already have in place as effectively as we could be. This is a much needed avenue for research. It does not matter how much potential an approach has – if it is not implemented effectively and specifically for the community it aims to help, much of the potential is lost. 

Not only do we need to focus on effective implementation, but we also need to support the people who are providing support. Caring for others can be emotionally difficult and carers, in any capacity, can only provide optimum support when they are mentally and physically well. During the COVID-19 pandemic, healthcare workers were exposed to unprecedented circumstances globally and many experienced the loss of family, friends and colleagues. Many will still be experiencing the trauma of that today and so we need to ask ourselves – if it happens again, will we be able to support people? 

PLOS Medicine published a study last month from University of Utah and University of California San Diego that explored the potential of psilocybin-assisted group psychotherapy and mindfulness to tackle depression and burnout among healthcare workers in the US during the pandemic. They reported that the approach did indeed result in a significant improvement in well-being and adverse effects were not serious. Whilst more research is needed to confirm the reproducibility and longer-term benefits of this, it is a great example of trying something different in unprecedented times in order to try to improve the well-being and the people who care for others. This is something that should never be overlooked in times of crisis.

We cannot know for sure what is coming in the future but we can learn from the past and learn from the present. Nobody is immune to the effects of emergencies and crises and having effective mental health support in place is vital not just in the moment, but to protect in the long-term and to protect future generations. PLOS Mental Health will continue to provide a platform for content that strives to improve access to mental health care in times of crisis. This integral part of our mission will continue beyond World Mental Health Day.