Mental health and psychosocial support in humanitarian settings: a public mental health perspective

Tol, Wietse A.; Purgato, Marianna; Bass, Judith K.; Galappatti, Ananda; Eaton, William W.

doi:10.1017/s2045796015000827

Cited by 63 publications

(42 citation statements)

References 46 publications

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“…[14]. In public health terms, such interventions may be conceptualized on the continuum of mental health promotion, prevention of mental disorders, and treatment and maintenance [35, 36]. Similarly, participants in the current assessment stressed the importance of basic needs being met, despite the generous settlement policy of the Ugandan government.…”

Section: Discussionmentioning

confidence: 99%

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Adaku¹,

Okello²,

Lowry³

et al. 2016

Confl Health

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BackgroundSince December 2013, an armed conflict in South Sudan has resulted in the displacement of over 2.2 million people, more than 270,000 of whom are presently in refugee settlements located throughout Uganda. Existing literature suggests that refugees are at increased risk for a range of mental health and psychosocial problems. There is international consensus on the importance of needs and resource assessments to inform potential mental health and psychosocial support (MHPSS) interventions.MethodsWe conducted a MHPSS needs and resource assessment in Rhino Camp refugee settlement in northern Uganda, between June and August 2014. We followed World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) guidelines for MHPSS needs assessments in humanitarian settings. The assessment used a range of methodologies including: 1) a desk (literature) review to understand the context for mental health service provision; 2) an analysis of data from existing health information systems (HIS); 3) an assessment of the current infrastructure for service provision using a shortened version of a Who does What Where until When (4Ws); and 4) semi-structured individual and group interviews (total n = 86) with key informants (n = 13) and general community members (individual interviews n = 28, four focus groups with n = 45).ResultsData from the HIS indicated that visits to health centers in refugee settlements attributable to psychotic disorders, severe emotional disorders, and other psychological complaints increased following the refugee influx between 2013 and 2014, but overall help-seeking from health centers was low compared to estimates from epidemiological studies. In semi-structured interviews the three highest ranked mental health and psychosocial problems included “overthinking”, ethnic conflict, and child abuse. Other concerns included family separation, drug abuse, poverty, and unaccompanied minors. The 4Ws assessment revealed that there were very limited MHPSS services available in Rhino Camp.ConclusionsThe types of MHPSS problems among South Sudanese refugees in northern Uganda are diverse and the burden appears to be considerable, yet there are currently few available services. The assessment indicates the need for a range of services addressing social concerns as well as varied types of mental conditions. The idiom of “overthinking” may form a useful starting point for intervention development and mental health communication.

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Section: Discussionmentioning

confidence: 99%

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Adaku¹,

Okello²,

Lowry³

et al. 2016

Confl Health

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“…Although many individuals display remarkable resilience, a sizeable proportion of refugees experience psychological distress that impairs daily functioning, for example symptoms associated with disorders related to stress, mood, anxiety, and somatoform disorders [6, 7]. When mental health problems occur at a time when refugees are confronted with ongoing social adversity, mental health concerns are typically associated with a worse prognosis for a variety of health and social outcomes [8–12].…”

Section: Introductionmentioning

confidence: 99%

Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania

et al. 2019

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Background Multi-sectoral, integrated interventions have long been recommended for addressing mental health and its social determinants (e.g., gender-based violence) in settings of ongoing adversity. We developed an integrated health and protection intervention to reduce psychological distress and intimate partner violence (IPV), and tested its delivery by lay facilitators in a low-resource refugee setting. Methods Formative research to develop the intervention consisted of a structured desk review, consultation with experts and local stakeholders (refugee incentive workers, representatives of humanitarian agencies, and clinical experts), and qualitative interviews (40 free list interviews with refugees, 15 key informant interviews). Given existing efforts by humanitarian agencies to prevent gender-based violence in this particular refugee camp, including with (potential) perpetrators, we focused on a complementary effort to develop an integrated intervention with potential to reduce IPV and associated mental health impacts with female IPV survivors. We enrolled Congolese refugee women with elevated psychological distress and past-year histories of IPV ( n = 60) who received the intervention delivered by trained and supervised lay refugee facilitators. Relevance, feasibility and acceptability of the intervention were evaluated through quantitative and qualitative interviews with participants. We assessed instrument test-retest reliability ( n = 24), inter-rater reliability ( n = 5 interviews), internal consistency, and construct validity ( n = 60). Results We designed an 8-session intervention, termed Nguvu (‘strength’), incorporating brief Cognitive Processing Therapy (focused on helping clients obtaining skills to overcome negative thoughts and self-perceptions and gain control over the impact these have on their lives) and Advocacy Counseling (focused on increasing autonomy, empowerment and strengthening linkages to community supports). On average, participants attended two-thirds of the sessions. In qualitative interviews, participants recommended adaptations to specific intervention components and provided recommendations regarding coordination, retention, safety concerns and intervention participation incentives. Analysis of the performance of outcome instruments overall revealed acceptable reliability and validity. Conclusions We found it feasible to develop and implement an integrated, multi-sectoral mental health and IPV intervention in a refugee camp setting. Implementation challenges were identified and may be informative for future implementation and evaluation of multi-sectoral strategies for populations facing ongoing adversity. Trial registration ISRCTN65771265 , June 27, 2016.

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“…It includes – for example – components to foster pro-social behaviour, self-esteem, coping, decision-making capacity, but also universal interventions such as social and economic interventions to improve people's social determinants of health which would impact on their wellbeing. Prevention is an approach aimed at reducing the likelihood of future disorder in the general population or for people who are identified as being at risk of a disorder (Eaton, 2012 ; Tol et al ., 2015 ). Prevention is further subdivided on the basis of the population targeted, into universal, selective and indicated (National Research Council and Institute of Medicine, 2009 ).…”

Section: Definition Of Mental Health Promotion and Prevention Intervementioning

confidence: 99%

Promotion, prevention and treatment interventions for mental health in low- and middle-income countries through a task-shifting approach

Purgato

Uphoff

Singh

et al. 2020

Epidemiol Psychiatr Sci

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Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic ‘at risk’, to experiencing ‘mental distress’, ‘sub-syndromal symptoms’ and finally ‘mental disorders’. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.

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Mental health and psychosocial support in humanitarian settings: a public mental health perspective

Cited by 63 publications

References 46 publications

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

Developing an integrated intervention to address intimate partner violence and psychological distress in Congolese refugee women in Tanzania

Promotion, prevention and treatment interventions for mental health in low- and middle-income countries through a task-shifting approach

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