Intervention pyramid for MHPSS in emergency

Mental Health and Psychosocial Support

Stages of Multi-Layered Support During Emergencies

Disaster mental health support is not a single act but a graded, layered system in which help is matched to the level of distress. The multi-layered support model (based on the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings) arranges support in four ascending layers, from the whole affected population at the base to specialised clinical care at the top. The stages are:

1. Layer 1 — Basic services and security (basic psychosocial support) This is the foundation layer, reaching the entire affected population. It involves meeting basic needs and restoring safety: food, water, shelter, sanitation, medical care, protection from further harm, and reuniting separated families. It also includes providing accurate information, preventing rumours, and rebuilding community structures. The principle is that protection and basic services are themselves psychosocial interventions, because insecurity and deprivation are the main sources of distress.

2. Layer 2 — Community and family supports This layer targets the affected population through social networks rather than individuals. It includes family tracing and reunification, safe child-friendly spaces, community healing activities, religious and cultural rituals, and support groups. Strengthening family and community bonds mobilises the natural coping resources of survivors and prevents isolation.

3. Layer 3 — Focused, non-specialised supports This layer provides individual, family, or group help to the minority of people who need more than general community support but do not require specialist mental health care. It is delivered by trained non-specialists such as primary health workers, teachers, and community volunteers. It includes Psychological First Aid (PFA), basic counselling, and school-based or primary-care-based interventions for people showing mild to moderate distress.

4. Layer 4 — Specialised services This topmost layer serves the small proportion of survivors with severe mental disorders or profound distress — for example, psychosis, severe depression, or post-traumatic stress disorder. It requires mental health specialists (psychiatrists, clinical psychologists) and includes clinical assessment, psychotherapy, and medication, usually linked to the general health system.

Key features of the model

• The layers form a pyramid: the base is widest (whole population) and the top is narrowest (few cases needing specialist care).
• Support is complementary and integrated — lower layers are not replaced by higher ones; all operate together.
• It follows the principle of stepped care: people are helped at the least restrictive level that meets their need, and only move upward if distress persists or worsens.
• It protects against both under-serving (ignoring distress) and over-medicalising (treating normal reactions to abnormal events as illness).

Thus, multi-layered support moves from broad protection and community care to focused help and finally specialised treatment, ensuring that every survivor receives support appropriate to their level of need.