the levels below in some cases, that counselling and therapeutic group work may well be needed, though practical needs cannot be ignored as well. The top apex of the pyramid –a very small segment of the whole- is for those who need specialist psychiatric and/or psychological help. This will include those with serious mental health problems which preceded the crisis, who are likely to have suffered severe neglect because of the lack of services, those who have developed chronic mental health problems during the crisis and those who are affected by PTSD or PTSD type symptoms which persist long after the event, and may well relate to on-going stresses rather than to one particular event. While counselling may help with some of the issues surrounding those who are suffering in this way, there is little research evidence for its efficacy in directly addressing conditions such as PTSD.xlix. Specialist help (based as far as possible on research evidence) is needed at this level to alleviate symptoms which will be likely to seriously disrupt the ability of sufferers to lead a normal life. It is also important to note that, in Zimbabwe, research indicates that a large number of people may in fact fall within this top segment of the pyramid (see Table 3), though further research is needed to clarify their needs and look at the responses that may be helpful. Relatedly, Zimbabwean mental health professionals need to begin collaborative work to clarify what forms of intervention (specialised psychotherapy, pharmacology, etc) could be most effective and how such skills can be made available to sufferers in this category. As Wessells emphasises, the challenge in work for transformation after conflict and violence is to identify needs and then to connect and link work done at different levels to achieve an integrated approach. Too often, excellent work is done at one level while the different needs of those who fall into another category are not identified and met. Strong work at village level will be undermined if structural violence at other levels of the system remains unchallenged, for example, or the need for specialist treatment goes unrecognised. Another learning point over the last decades of experience, has been the sense of powerless amongst those who have been victimised, something which is clearly observable in Zimbabwe. A sense of agency and empowerment is clearly linked to psychological well-being; while NGOs and mental health practitioners may offer ideas and their own understanding of mental health and the wider healing agenda, each individual, community or local group needs to look at their own situation and debate what is needed , whether this be a transitional justice process based in existing local structures, traditional rituals to cleanse and re-integrate offenders or creation of a safe space for the sharing of stories and suffering. This is very clearly emphasised in the IASC guidelines. The process of discussing and deciding in itself can constitute part of the healing process and begin to restore some sense of agency to those involved. It seems unlikely that, as mental health practitioners, much can be achieved with the victims of violence and trauma until a new political and legal dispensation is established. However, we can begin the work needed (as expressed in this document) and as many agencies have already begun to react over the past decade. In this regard the establishment of a group of practitioners and researchers would be a very valuable contribution in the clarification of the effects of violence and trauma in the specifics of various Zimbabwean contexts, and in the detailed description and evaluation of competing modes of intervention. One of the main lessons we can already draw from the past decade is the effects of violence and constant threat on practitioners and researchers who have often had (and continue to have) highly conflictual and fractured relationships with one another, thus undermining cohesion and progress in these crucial areas.