Lay therapist delivered low intensity psychosocial intervention for refugees and asylum seekers (PROSPER): protocol for a pilot randomised controlled trial.

Abstract

Background Asylum seekers and refugees (AS&Rs) experience impaired mental health and wellbeing, related to stresses in their country of origin, experiences in transit and reception on arrival, including significant barriers to accessing mainstream services. Their contact with healthcare is often crisis-driven and mediated through non-governmental organisations (NGOs). Problem Management Plus (PM+) is a psychosocial intervention recommended by the World Health Organization to address distress experienced by adults affected by humanitarian crises. We are investigating its application for the first time in a high income country. Methods In a pilot randomised controlled trial, PM+ will be delivered to AS&Rs in contact with NGOs in Liverpool City Region, UK, by lay therapists who have lived experience of forced migration. Following systematic review and stakeholder engagement, PM+ has been adapted to the local context, and lay therapists have been trained in its delivery. We will assess the feasibility of conducting a three-arm RCT of five 90-minute sessions of PM+, delivered individually or in groups by lay therapists to AS&Rs experiencing emotional distress and functional impairment, compared with each other and with usual support offered by local NGOs. Distress and impairment at baseline will be measured by Hospital Anxiety and Depression Scale (HADS) and WHO Disability Assessment Schedule (WHO-DAS). We aim to recruit 105 participants, 35 per arm. Primary health outcomes are anxiety and depressive symptoms at 3 months, measured by HADS. Secondary outcomes include subjective wellbeing, functional status, progress on identified problems, post-traumatic stress disorder, depressive disorder and service usage. Longer term impact will be assessed at 6-months post baseline, on the same parameters. We will assess the feasibility of conducting a full RCT in relation to the following elements: recruitment and retention of lay therapists and study participants; fidelity of delivery of PM+; and suitability of the study measures, including any linguistic or cultural barriers. Discussion We will use these findings to specify the parameters for a full randomised controlled trial to test the effectiveness and cost effectiveness of PM+ in reducing emotional distress and health inequalities, and improving functional ability and wellbeing, amongst asylum seekers and refugees.

Challenges Faced By International Non – Governmental Organizations on Enhancement of Refugees Wellbeing in Dadaab Camp, Kenya

“…According to Murphy et al (2018), where there are barriers to mental healthcare utilization among refugees and asylum seekers, effective treatment for mental disorders may be especially challenging in low middle income countries currently or recently engaged in armed conflict, where the likelihood of mental disorders such as posttraumatic stress disorder, depression and anxiety is increased and health systems are destabilized (Murphy et al, 2018). The effect of Conflict in low-resource setting and non-western countries complicated the uptake of primary mental health care as refugees could never travel to the mental health facility due to disorientation on their mental state and in ability of not being in touch with reality (Rawlinson et al, 2020). A significant challenge in refugee mental health is willingness to access care (Slewa -Younan et al, 2014).…”