A Community Advisory Board (CAB) engages a study’s target population in the research process. However, little scholarship exists to guide research to facilitate an online CAB during complex emergencies. This article describes how research exploring perspectives on good social work in complex emergencies, through a study of Northwest Syria, designed and facilitated an online CAB with international and Syrian practitioners. This study found engaging practitioners in a pilot study helped promote the relevance of the overall research to the Syrian culture and context and that carefully designed research could benefit practitioners. This process also demonstrated how ethical research in complex emergencies should be relevant and useful to participants. Ultimately, this article argues that engaging practitioners through a CAB helps improve research relevance and may benefit practitioners.
This review examines studies reporting the psychometric properties of the three most frequently used mental health screening tools for refugees: the Hopkins Symptom Checklist (HSCL-25), the Harvard Trauma Questionnaire (HTQ), and the Refugee Health Screener (RHS-15 and RHS-13). The review utilized the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We searched the PubMed and PsycInfo databases for relevant studies published between 2008 and 2024. From 2505 studies screened, 13 were ultimately included in the review. Five studies analysed the HSCL-25, showing good internal consistency but problems with cross-cultural and structural validity. Three studies on the HTQ focused on measurement invariance, showing mixed results in cross-cultural and structural validity. One study revised the HTQ to match updated diagnostic criteria, but this revision has not yet been validated. Five studies established the content validity, internal consistency, and criterion validity of the RHS. Additionally, they reported similar psychometric properties for the 13-item and 15-item versions of the RHS. However, only one of these studies examined structural validity, and none examined cross-cultural validity. In conclusion, although the HSCL-25 and HTQ were seminal contributions in refugee mental health screening, more recent evidence suggests that the RHS has since emerged as the preferred instrument.
The genocide against the Tutsi in Rwanda led to the death of over one million Tutsi (Republic of Rwanda, 2007). This caused a severe mental health burden that still reverberates to this day. While significant efforts have been made to promote healing at the individual and community levels, through individual clinical interventions and community-based sociotherapy, the family level has received less attention. Recent evidence of intergenerational transmission of trauma, from direct survivors and perpetrators of the genocide to their offspring, suggests a need to complement existing interventions with family-based approaches (Berckmoes et al., 2017). Against this backdrop, multifamily healing spaces (MFHSs) were developed as a contextually customised intervention to strengthen family resilience, improve dyadic relations between spouses, enhance parenting practices, reduce intergenerational enmeshment, and foster tolerance and trust among families with members with different historical backgrounds. This study aims to describe the process of developing MFHS and provide a detailed description of the principles, phases, and processes of change of the intervention. This multi-format intervention encompasses sessions involving a whole intergenerational group comprising at least four families, along with separate sessions for individual families, parents only, and youth only. By promoting multi-systemic resilience at the individual, family, and community level, MFHS offers a promising pathway for healing, reconciliation, and sustainable peacebuilding in post-conflict societies.
Adolescents in conflict-affected Kashmir are at heightened risk for behavioural and emotional problems due to the longstanding political conflict. This study examined behavioural and emotional problems among 400 school-going adolescents (aged 12–18 years) in South Kashmir, using the Strengths and Difficulties Questionnaire. Among the participants, 63.5% reported direct exposure to violence, while 36.5% reported indirect exposure. Overall, 41% of adolescents reported peer problems, 34% hyperactivity, 29% conduct problems, and 16% emotional issues. Gender differences were noted, with males exhibiting more externalizing problems (conduct and hyperactivity) and females more internalizing problems (emotional distress and overall behavioural and emotional problems). Continued exposure to violence and insecurity appears to contribute to the persistence of these mental health issues. These findings highlight the urgent need for context-sensitive mental health assessments and interventions in schools, particularly those that account for gendered experiences and socio-cultural factors. Integrating school-based mental health services and culturally informed community supports could improve early identification and care for adolescents in conflict-affected Kashmir.
This study explores the experiences and challenges encountered during the formation of a mental health Service User Association (SUA) in Lebanon and how these experiences can inform future practice in similar contexts. Utilizing an exploratory qualitative case study approach within a socioecological framework, we conducted interviews and feedback sessions with SUA members (N = 5). The findings highlight several critical issues: positional challenges and tokenistic behaviours that undermine meaningful SUA participation, financial and structural obstacles that threaten SUA sustainability and the essential need for group support and collaboration between the SUA and other organizations. Additionally, the study emphasizes the importance of robust monitoring and evaluation mechanisms to support the association's development. These insights offer guidance for policymakers and emerging service user associations working in complex settings.
The multi-layered crisis in Lebanon, characterised by an economic collapse, the influx of Syrian refugees, the COVID-19 pandemic, and the Beirut Port Blast, has significantly affected the psychosocial well-being of Syrian refugee children in Beirut. This mixed-methods longitudinal case study investigated the stress factors impacting these children and analysed their improvements in psychosocial well-being after participating in an eight-session, group-based trauma-focused psychosocial support (PSS) program. The longitudinal study combined in-depth qualitative interviews with psychosocial counsellors regarding their perceptions of the children’s stress factors and well-being, alongside self-reported pre- and post-test data from 552 Syrian children aged 6–14 years enrolled in two learning centers. Counsellors identified exposure to a high level of potentially traumatic events, traumatic stress reactions and heightened sensitivity to stressors arising from the multi-layered crisis context. Quantitative findings indicated improvements in sense of safety and adaptability, emotional regulation, hope, well-being and sleep disturbances following participation in the PSS programme. Improvements in safety and adaptability were predictive of better outcomes across the other domains. Despite children’s previous high trauma exposure, active traumatic stress reactions and ongoing exposure to stressors from a multilayered crisis, the targeted, short-term intervention led to significant improvements in participants’ psychosocial well-being. Furthermore, the intervention demonstrates promising results regarding its effectiveness and scalability in crisis contexts.
Wars, armed conflict, climate crises, disasters and other humanitarian emergencies can threaten the mental health, wellbeing and development of children. Lack of specialised services for children with advanced mental health needs in humanitarian settings led to a large treatment gap. The Global Child Protection Area of Responsibility and Inter-Agency Standing Committee Mental Health and Psychosocial Support (IASC MHPSS) Reference Group commissioned this study to understand support pathways for children with advanced mental health needs in contexts with limited specialised services. A descriptive case study design across five humanitarian settings was used to (1) identify common themes in the implementation of specialised mental health services, (2) understand informal care pathways and (3) explore the integration of mental health psychosocial support (MHPSS) across sectors. Between 15 and 18 key informants were chosen at each country site for individual interviews. Interviews were conducted with global humanitarian MHPSS leaders and clinicians, child protection actors and community members. Results revealed common mental health issues and informal pathways children with serious mental health conditions rely on when services are limited. Cross-sectoral partnerships and collaboration with traditional and religious healers are vital components to strengthening local support for children's mental health needs in humanitarian settings
Since the Russia–Ukraine war in February 2022, Europe has faced a significant humanitarian challenge, with approximately 6.3 million Ukrainian refugees seeking sanctuary abroad by the end of 2023. Poland has been a major host nation, registering about 1.4 million refugees under the Temporary Protection scheme by mid-2022. Despite efforts to integrate these refugees, challenges such as language barriers, legal complexities and housing persist. The Mental Health and Psychosocial Support (MHPSS) activities are needed; however, the gap exists in their offer. To address these challenges, the MHPSS Course was developed. This 15-day intensive training program aimed to equip professionals with the skills needed to support Ukrainian refugees’ mental health and psychosocial needs. The course included theoretical and practical components, fieldwork and evaluations, involving diverse experts and trainers. The MHPSS Course trained 23 participants, covering topics from humanitarian law to community-based interventions. 74% participants attended more than 80% of the course. The course facilitated networking among MHPSS practitioners in Poland, with participants engaging in ongoing professional collaboration through various platforms. The fieldwork topics encompassed a range of initiatives including legal aid, educational support, creative therapies and specialised mental health services for Ukrainian refugees in Poland. These efforts, led by various organisations, aimed to address the diverse needs of refugees through community-based interventions and targeted support programs.Despite recruitment challenges, the course’s comprehensive approach proved effective in enhancing local capacity for mental health support. The integration of cultural sensitivity and interdisciplinary perspectives enriched the learning experience. Ongoing support and monitoring are essential to sustain the momentum and impact of these efforts.
Mental health and psychosocial support (MHPSS) practitioners play a key role in promoting and protecting the mental health of forcibly displaced communities. Physical activity (PA) is an evidence-based, cross-cutting strategy to protect and promote mental and physical health and increase resilience. Although PA is recommended, implementation remains ad hoc. Strengthening the collaboration between PA and mental health workforces may help bridge this gap between knowledge and practice. We conducted a 3-h introductory training for MHPSS practitioners in Cox's Bazar, Bangladesh, on principles of PA promotion, including understanding the difference between PA, sport, and exercise, exploring the evidence linking PA and mental health, assessing PA level, and identifying resources for PA promotion. The primary aim was to determine the acceptability, appropriateness, and feasibility of the workshop. Secondary aims included (i) assessing the impact of the workshop on the attitudes, confidence, and knowledge of practitioners, (ii) assessing the self-reported PA levels of the attendees, and (iii) exploring whether a relationship exists between attitudes, confidence, and knowledge of PA and participant's own self-reported PA levels. Seventeen participants attended the training and joined an online WhatsApp to facilitate ongoing communication. Training MHPSS practitioners in PA promotion is acceptable, appropriate, and feasible. Further, MHPSS staff may be at risk of physical inactivity, which may have ramifications for their own health and well-being, in addition to their PA promotion practices. Interventions to increase the PA capability of MHPSS staff are warranted.
The article discusses the early childhood intervention service in Ukraine, which operates in long-term cycles. Early intervention is a service for families with children aged 0 to 4 years who have developmental disorders or are at risk of developing them. The service is family-based, routine-based and transdisciplinary. The article highlights the impact of conflict on children, noting that ongoing negative experiences, or "toxic stress," can severely affect their development. Parents and caregivers play a crucial role in helping children cope, but they also face significant stress, complicating their ability to provide care. Despite the conflict, early intervention services continue for families with children at risk of developmental disorders, including those displaced abroad. Online meetings have become essential, ensuring service quality across formats. Comparing goal achievement in 60 families receiving services offline and online showed no significant difference in outcomes. Families emphasise the importance of continuing early intervention services during the war, noting that regular digital meetings provide vital support and help stabilise the mental state of both parents and children. Key strengths of the service during wartime include family-centredness, regular weekly meetings, service continuity in various formats and assistance in organising daily life, helping families adapt to changes and supporting child development.
This article explores spatial inequality as a conceptual framework to understand the link between poor housing, environmental degradation, and mental health. The dire housing conditions are one of the many struggles that refugees face in South Africa. This paper emerged from fieldwork carried out between 2020 and 2022 among Congolese refugees in Yeoville, a suburb of Johannesburg. They were included in a research project investigating the existing association between displacement, gendered violence, and mental ill-health among internally displaced persons, refugees, and asylum seekers. The article highlights that while mental health challenges can result from various factors, poor housing adds profound psychological distress to Congolese refugees in South Africa. Drawing on 83 interviews with male and female Congolese refugees, this article highlights how precarious housing disrupts traditional, social, and cultural structures. It also weakens parents' control over their children, invades privacy, exposes women and girls to sexual violence, and contributes to the fragility of family bonds. The findings of this paper emphasize the importance of spatial inequality in examining the precarious housing conditions experienced by refugees in South Africa. These conditions, which occur in seemingly abandoned environments, have a detrimental impact on the mental health of Congolese refugees.
The climate crisis is exacerbating humanitarian crises and significantly impacting mental health and psychosocial wellbeing globally. This paper explores the application of Hobfoll's five essential elements framework-promoting safety, calming, self-efficacy, connectedness, and hope-to address the mental health impacts of the climate crisis. Drawing from existing literature and practical experience, the paper examines how climate change affects mental health through multiple pathways, leading to increased rates of mental health conditions and psychological distress. The framework's relevance to climate-related challenges is analyzed, offering practical guidance for mental health and psychosocial support practitioners and policymakers. The paper argues that integrating mental health considerations into climate action through this established framework can help communities build resilience and cope with climate-related stressors. While acknowledging limitations in current research, particularly regarding a lack of perspectives from the global South, this conceptual work provides a foundation for developing comprehensive responses to the mental health dimensions of the climate crisis. The paper concludes that applying the five elements framework, alongside integrated programming and cross-sector collaboration, offers a valuable approach for promoting community wellbeing in the face of unprecedented environmental challenges.
Power inequalities and structural racism are long-standing problems within the humanitarian aid sector. Staff from high income countries typically work as "international staff," receiving better treatment than "national staff" from low- and middle-income countries. This can result in harm not only to those disadvantaged by the system but also to those who appear to be benefiting from but are morally conflicted by systemic disparities. Ten current and former international humanitarians, with careers spanning from 3 to 15 years, were interviewed for this qualitative exploratory research. Participants were asked to share occupational experiences that they perceived to be morally troubling and to describe any mental health or other implications. Using Thematic Analysis, responses were coded and grouped into key themes highlighting inequities between international and national staff in - (1) decision-making authority and roles, (2) salary, contract status, leave and access to medical services, (3) access to equipment and other resources and (4) security risks. Participants described morally conflicting events vis-& agrave;-vis structural inequities and corresponding psychological, social, and behavioural outcomes that suggest the presence of moral distress in international aid workers. Reform of the humanitarian system is necessary for both individuals and operations to thrive, as we work collectively to decolonise aid.
Mental health and psychosocial support for Uyghurs living abroad need to be acknowledged as an important component of the humanitarian response. To formulate appropriate interventions for promoting mental health, a comprehensive understanding of identified problems is needed. However, several challenges − including language barriers, community perceptions of mental health, and mental health services − must be addressed. In this field report, we draw from our experiences of the Uyghur diaspora in relation to mental health to present the challenges which need to be addressed.
Mental health and psychosocial support is widely acknowledged as an integral part of the assistance offered to victims/survivors of sexual violence in conflict and emergency settings. This scoping review aims to shed light on the evidence for such interventions offered locally to victims/survivors aged 16 and above. The Cochrane, Cochrane Review, MedKnow, ProQuest, PsychInfo, PubMed, Sage Journals and Taylor & Francis databases were searched for articles published between 2009 and 2022 in this PRISMA-compliant scoping review. Data extraction and quality appraisal were conducted by the authors and results were synthesized by core themes. Out of 5,111 publications retrieved, four met the inclusion criteria and provided context-specific evidence for: Cognitive Processing Therapy, Narrative Exposure Therapy, Eye Movement Desensitization and Reprocessing therapy, and basic psychosocial support integrated into a group economic intervention. No studies were found with interventions at the levels of focused psychosocial support and specialized mental health care. Most studies involved task-shifting from professionals to lay counselors and most pre-post measures were related to symptoms of post-traumatic stress. Further research is needed with more diverse populations and settings, to more rigorously explore and inform current MHPSS interventions for victims/survivors of sexual violence in conflict and emergency settings.
This study evaluated the effectiveness of a mental health and psychosocial support (MHPSS) hotline in Afghanistan using quantitative and qualitative data. Results showed that the hotline was effective in providing accessible MHPSS interventions to women who have access to a mobile phone. Overall, 82.4% of the callers were women, and the main themes on the calls were related to gender-based violence or social difficulties. Another common topic was family conflicts and substance use. While callers demonstrated an elevated level of distress, the hotline was found to be cost-effective and well-received by the callers. The WHO-DAS5 well-being scores showed a significant improvement from baseline to endline, with an average of six counseling sessions, indicating that the hotline had a positive impact on the callers’ mental well-being. However, the study also revealed a limitation in that many women had to use their husband’s mobile phones to make calls, which limited accessibility. At the same time, respecting confidentiality was important for the callers. Overall, the study highlights the importance of accessible MHPSS interventions for all but more so for women in Afghanistan and the need to address accessibility barriers to ensure that all women have access to the services they need.
