Mental Health Emergencies: PAHO Training Boosts Readiness in Costa Rica, Honduras, Guatemala and Panama

When a hurricane rips through a town or a pandemic locks people indoors, the damage isn’t only broken roads and crowded ERs. It’s trauma, grief, sleepless nights, and the quiet rise of substance use and domestic violence. That’s the part of disaster response that often arrives last and leaves late. From July to December 2023, the Pan American Health Organization (PAHO) tried to change that story in Central America, helping Costa Rica, Honduras, Guatemala, and Panama build stronger systems for mental health and psychosocial support (MHPSS) in crises.

The effort ran under PAHO’s Cooperation Among Countries for Health Development project, a model built on peer learning rather than top-down lectures. Teams compared notes, tested tools, and developed plans they can actually use when a storm, disease outbreak, or mass displacement hits. By the end, all four countries had either formed or reactivated national MHPSS working groups, mapped who does what in emergencies, and drafted or refined work plans to guide action.

Why does this matter? Central America knows disasters up close. Hurricanes Eta and Iota in 2020 displaced hundreds of thousands. The COVID-19 pandemic strained health systems for years. Migration through corridors like the Darién Gap has stretched social services across borders. In each case, there’s a mental toll: anxiety, depression, complicated grief, burnout among health workers, and trauma in children. Without a coordinated plan, people fall through the cracks.

Why this training matters now

Emergency teams are trained to move fast. But psychological support needs structure, not improvisation. The PAHO-backed work focused on three things: organizing teams, sharpening tools, and making sure everyone knows their role. Countries worked from widely used frameworks, like the Inter-Agency Standing Committee (IASC) guidelines for MHPSS in emergencies and WHO’s mhGAP approach for non-specialists. That means a clinic nurse or a community worker can give basic support, and specialists step in only when needed.

The project mixed virtual sessions with an in-person workshop that brought country teams together to compare playbooks. That face time mattered; coordination works better when people know each other before the sirens go off. Teams reviewed case scenarios, from flood evacuations to disease outbreaks, and debated simple questions that become complicated under pressure: Who leads the MHPSS cell at the emergency operations center? Which hotline handles psychological first aid calls? How do you protect data if a shelter fills up overnight?

Core elements strengthened across the four countries included:

• Clear governance: reactivated or newly established national MHPSS working groups with defined focal points.
• Actor mapping: using a “4Ws” approach (Who does What, Where, and When) to avoid duplication and gaps.
• Preparedness plans: step-by-step guides for activation, referral, supplies, and data flow during a crisis.
• Training pipelines: modules for psychological first aid, mhGAP for non-specialists, child protection, and staff care.
• Tools for damage and needs assessment: rapid methods to estimate mental health and psychosocial needs in the first 72 hours and beyond.

Another theme was equity. Teams discussed how to reach people who often miss out: indigenous communities, migrants in transit, older adults living alone, people with disabilities, and survivors of gender-based violence. Plans now call for interpreters and culturally relevant materials where needed, and protocols to make referrals safe and discreet.

There was also a focus on the basics that keep responses steady: reliable supply chains for essential psychotropic medicines, backup power and connectivity for tele-mental health in remote areas, and supervision for frontline workers who face distressing situations day after day. Burnout doesn’t wait for budgets to arrive; staff care is now baked into training plans.

What each country built—and what’s next

While the four countries moved at different speeds, they all made measurable progress. The shared approach helped them borrow ideas and avoid dead ends. Here’s where each one stands and what their next steps could look like.

Guatemala: The team moved fast from planning to implementation. Officials developed and rolled out a national MHPSS preparedness plan, setting activation triggers, roles, and referral routes. They also distributed a Practical Guide for Mental Health Assessment and Interventions in Emergency and Disaster Situations with a multi-threat lens—useful for everything from volcano ashfalls to floods and epidemics. Alongside that, they mapped key actors so responders know who to call by sector and region.

What’s next? Guatemala can now stress test the plan through simulations. One drill could focus on a flood scenario: activate the MHPSS working group, run a 72-hour assessment, open a hotline slot for psychological first aid, and track referrals across health districts. Small tweaks—like standardizing screening tools for anxiety and depression—will make data easier to compare across regions.

Honduras: The country produced a detailed “Guidelines for MHPSS Preparation in Emergencies” and a practical guide to build response plans at regional and local levels. The team didn’t stop at writing; they rolled out training and mapped key actors in Tegucigalpa, El Paraíso, and Santa Bárbara, three areas with different risks and resources. That regional focus is key, because response rarely starts at the capital—it starts where the water is rising or the ground is shaking.

What’s next? Expand the mapping to more departments and embed MHPSS focal points in regional emergency operations centers. Honduras could also link community health workers with tele-mental health services, so support reaches isolated communities after landslides or road closures.

Costa Rica: The team executed its training plan and built a tool for rapid damage and needs analysis specific to MHPSS. Instead of guessing, responders can estimate—How many people likely need basic psychosocial support? How many need focused counseling? How many require specialized care? The tool helps sort by age, location, and risk factor, which means stronger referrals and fewer people lost in the shuffle.

What’s next? Costa Rica can integrate this tool into national emergency assessments and connect it to digital dashboards used by the health ministry. Building a roster of trained providers who can deploy within 24–48 hours will close the loop between assessment and action.

Panama: The team identified key actors and sketched a framework for training. It’s the right starting line, especially given the country’s unique pressure points, including migration through the Darién region. With clearer roles in place, Panama can build a basic-to-specialized care pathway: from psychological first aid at shelters to psychiatric referrals in hospitals, with mobile teams reaching transit points.

What’s next? Finalize the training plan, run a pilot in one high-traffic border area, and add a feedback loop so frontline workers can flag gaps in real time. A small logistics fix—like a shared inventory sheet for essential medicines and phone credit for outreach teams—can pay off fast.

Beyond country specifics, the project delivered regional gains. An in-person workshop gathered representatives from all four countries to swap lessons learned: what worked, what didn’t, and what surprised them. They also pulled findings into a shared report with recommendations for future emergencies. Common to all four:

• Use simple, shared data tools so teams can merge information quickly across agencies.
• Embed an MHPSS cell in national and regional emergency operations centers with clear leadership and backup coverage.
• Adopt the 4Ws mapping and update it every six months, not just during crises.
• Train non-specialists in psychological first aid and referral basics; reserve specialists for complex cases.
• Protect staff with peer support and supervision; schedule rotations to reduce burnout.
• Address child and adolescent needs early with safe spaces and family-based support.

Two cross-cutting issues stood out. First, communications. People in distress don’t navigate bureaucracies well. Public messages during emergencies should say exactly where to get help, in plain language, in the right languages, and through trusted local channels—radio, churches, community leaders, and schools. Second, protection. MHPSS teams often encounter survivors of gender-based violence and trafficking, especially along migration routes. That requires tight coordination with protection services, private interview spaces, and data safeguards.

There’s also the question of money. Preparedness is cheaper than a late scramble, but it still needs funding. Countries discussed building small, flexible budgets for MHPSS that can be triggered during alerts, covering basics like transport for outreach teams, phone credit for hotlines, and printing for quick guides. Donor support can help, but plans should work even if new funding takes time.

Technology isn’t the whole answer, but it helps. Tele-mental health can reach people after roads wash out. Simple mobile forms replace paper in shelters. And a shared calendar prevents three NGOs from visiting the same shelter while another is ignored. The trick is to keep tech light and usable, especially in places with patchy power and internet.

One more piece often gets overlooked: the needs of responders themselves. Health workers, police, firefighters, teachers, and volunteers deal with trauma repeatedly. The training plans now include staff care modules—briefings before deployment, check-ins during operations, and confidential support after. You can’t ask people to carry a heavy load forever without giving them a way to set it down.

The result of all this work isn’t a glossy binder on a shelf. It’s a network of people who have met, trained together, and know how to coordinate under pressure. It’s a set of tools—guidelines, rosters, assessment forms, and referral pathways—that cut down guesswork. And it’s a mindset shift: mental health is not an optional add-on to disaster response; it’s a core service that protects lives, families, and social stability.

The region is better positioned now. Guatemala has a plan in motion and a practical guide in circulation. Honduras has guidelines and regional training under way. Costa Rica has a decision tool ready for the next activation. Panama has mapped its players and designed a training framework. Together, they’ve set a baseline that can be strengthened every year through drills, audits, and shared learning.

There will be more emergencies. Floods will return. Outbreaks will flare. People will keep moving across borders in search of safety and work. The difference now is that the next wave—the surge in distress that follows any crisis—has a clearer response. And that saves time when it matters most.

Call this what it is: an investment in readiness. By building MHPSS into national emergency systems, the four countries—and PAHO, as the regional backbone—are closing a long-standing gap. The test will come in the next activation. But the groundwork is there: a common language, trained teams, mapped partners, and a plan to catch people before they fall through.

That’s the value of preparedness. It’s not dramatic. It doesn’t make headlines like a landfalling storm. Yet it’s what helps families sleep after the floodwaters recede, what keeps a teenager in school after a shelter closes, and what lets a nurse finish a shift and come back the next day. In other words, it’s what makes response humane—not just fast.

As Central America builds on these steps, one phrase should keep guiding the work: protect the basics, and keep it simple. Psychological first aid at the right time. Clear referrals. Safe spaces for kids. Respect for privacy. Steady supervision for teams. And consistent messages that tell people where help is and how to get it. That’s how countries turn plans into results when facing mental health emergencies.