Mental health support to survivors of VAWG deals with extremely sensitive issues and service providers should be survivor-centred in their work and apply a “do no harm” approach in order to minimise and avoid any further harm. MHPSS service providers can reduce risks of harm in various ways, such as:

• Participating in coordination groups to learn from others and to minimise duplication and gaps in response.
• Designing interventions on the basis of sufficient information.
• Committing to evaluation, openness to scrutiny and external review.
• Developing cultural sensitivity and competence in the areas of intervention.
• Staying updated on the evidence base of effective practices.
• Fully engaging survivors in the decision-making processes of their care, and informing them about the potential risks linked to mental health and psychosocial support services (MHPSS).

All individuals involved in MHPSS should remain alert to possible adverse effects and unintended consequences and develop risk mitigation strategies when working with survivors. For example, services should be located in convenient and safe places and be provided at convenient times considering women’s care responsibilities, working and school hours and so on. MHPSS services should also be available through remote communication methods, such as hotlines.

Programmes that are designed with close involvement from key stakeholders are likely to be more relevant, acceptable and sustainable in the long term. The proliferation of stand-alone services, such as those dealing only with rape survivors or only with people with a specific diagnosis, such as Post-Traumatic Stress Disorder (PTSD), can create a highly fragmented care system. Building on and strengthening existing resources and wider systems also helps to promote the sustainability of MHPSS initiatives, and tend to carry less stigma, for example working with:

• Existing community support mechanisms and peer support schemes
• Locally led women’s rights organisations
• Formal/non-formal school systems
• General health services
• General mental health services
• Social services, etc.

Enhancing coordination across and within these systems, organisations and sectors, can also strengthen local capacity, and support long-term impact. Poor coordination can lead to ineffective, inefficient, inappropriate or even harmful programming.

Some key actions for coordination could include:

• Establishing an inter-sectoral MHPSS coordination group: Forming a single inter-sectoral MHPSS coordination group, including actors traditionally associated with both health and protection, is recommended. This group can then develop a joint workplan setting out roles and responsibilities.
• Coordinating programme planning and implementation: The coordination group can work to ensure that minimum MHPSS actions are carried out as appropriate in the local situation, and facilitate the process of inter-sectoral, inter-agency strategic planning (i.e. coordinating assessments, documenting and sharing information, monitoring and evaluating findings).
• Developing and disseminating guidelines and coordinating advocacy: Any guidelines should be adapted to the local context and aim to be as inclusive as possible. Mechanisms to ensure broad awareness of and commitment to guidelines and policies need to be developed (i.e. formal adoption by national authorities and organisations working on MHPSS), as well as coordinated advocacy efforts.
• Mobilise resources: Identifying and mobilising funds for coordination activities and joint advocacy to donors to ensure MHPSS is appropriately addressed.

In order for MHPSS interventions to work most effectively, ensure that appropriate assessments and consultations are being held with local experts and civil society organisations to assess existing coordination structures and local MHPSS needs and resources to guide programming. An assessment should provide an analysis of threats to and capacities for mental health and psychosocial wellbeing, as well as an analysis of relevant resources to determine when a response is required and, if so, the nature of the response. Some key actions include:

• Ensuring that assessments are coordinated with other stakeholders assessing psychosocial/mental health issues: This promotes efficient use of resources and draws on the coordination efforts and knowledge of already existing stakeholders.
• Collecting and analysing key information relevant to mental health and psychosocial support: The assessment should collect information disaggregated by age, sex and location whenever possible. This includes identifying at-risk groups in the community and their particular needs/capacities.
• Conducting assessments in an ethical and appropriately participatory manner: Participatory and inclusive assessments can be the first step in dialogue with affected populations, which, if done well, not only provides information but may also help people to take control of their situation by collaboratively identifying problems, resources and potential solutions. These should be culturally and contextually sensitive and relevant, respecting the privacy, confidentiality and best interests of the participants.
• Collating and disseminating assessment results: Assessment results should be shared in a timely and accessible manner with the community, the coordination group and with other relevant organisations. Any identifiable information, or private information, should not be disclosed. These assessments must be used as a resource and guide for planning, monitoring and evaluating programming.

Drawing on evidence-based experiences and programmes should always be the basis for developing these (and other) interventions. Local experts and CSOs should also be consulted to map the safety and wellbeing needs of delivery partners at the forefront of interventions.

As mental health is impacted by a range of factors at different levels, it is crucial to address it from a holistic and multi-stakeholder perspective which acknowledges and embraces the complexity of deeply rooted power structures, social norms and beliefs around mental health and violence against women and girls. This can be done by identifying, monitoring, preventing and responding to protection threats and failures identified through MHPSS assessments, and working with social protection, legal measures and community mobilisation to address them. For example, some threats could be best addressed via local, indigenous and traditional healing systems instead of care centred in hospital and clinical environments.

MHPSS should be considered a crucial component of primary and secondary prevention interventions, as well as an essential dimension of a comprehensive approach to VAWG and those at risk of experiencing violence. Different and complementary types of MHPSS should be provided to survivors of VAWG by a range of actors, including community actors, front-line service providers, and specialised MHPSS personnel.