HR MANAGEMENT: CHALLENGES FACED BY EMPLOYERS DURING MARTIAL LAW IN UKRAINE

“Watching my family being killed by terrorists made me really depressed”: Mental health experiences, challenges and needed support of young internally displaced persons in northern Nigeria

Background: In 2021, more than 23 million people were in need of humanitarian assistance in Ethiopia, including four million internally displaced persons and returnees. Displaced populations face an elevated risk of mental health and psychosocial problems, yet they often have limited access to mental health and psychosocial support. Objective: This study aimed to assess: 1) the mental health and psychosocial needs and resources among displaced persons in Ethiopia; and 2) examine barriers, and facilitators, and identify strategies to improve access to culturally appropriate mental health and psychosocial support in this population and context. Methods: We conducted a sequential mixed-methods assessment of mental health and psychosocial needs and resources. First, we conducted 16 key informant interviews with those who had experience and knowledge regarding the mental health situation of displaced persons in Ethiopia, including mental health providers and humanitarian practitioners. Second, we conducted an assessment of available mental health services in 15 internally displaced persons (IDP) sites in Ethiopia along with 28 key informant interviews in this context to explore some of the challenges and strategies to improving access to mental health and psychosocial support. Results: Access to mental health services was limited in IDP sites. Participants identified numerous barriers to accessing services that ranged from limited supply and fragmentation of existing mental health services to an incongruence between formal mental health services and explanatory models of mental illness. Strategies to address these barriers included engagement of community members and key stakeholders (e.g., traditional and religious healers), improving mental health literacy, strengthening referral systems and mental health capacity, and improving coordination and integration of mental health within the national health system. Conclusion: This study highlights several challenges and opportunities for improving access to mental health and psychosocial support among displaced persons in Ethiopia. Efforts to bridge gaps in access to mental health and psychosocial support must consider both systems-level factors that influence availability as well as community factors influencing perceptions and acceptability of services within this context.

Venezuelan migrants in Colombia: COVID-19 and mental health

PurposeThis paper aims to investigate the governance challenges faced by healthcare providers in Kalar, Iraq, particularly regarding the delivery of healthcare services to internally displaced persons (IDPs). By analyzing structured questionnaire responses from healthcare employers, the study identifies key barriers to effective health governance, including resource limitations, legal framework inefficiencies, and the need for enhanced collaboration among stakeholders. The insights gained will inform policymakers and healthcare providers on improving health service delivery in conflict-affected regions, ultimately contributing to better health outcomes for vulnerable populations, including both IDPs and the local community.Design/methodology/approachThis study employed a mixed-methods approach, utilizing structured questionnaires to gather data from healthcare employers in Kalar, Iraq. The questionnaires focused on identifying governance challenges related to healthcare delivery for internally displaced persons (IDPs). Quantitative data were analyzed using descriptive statistics to highlight key barriers, while qualitative feedback provided deeper insights into the complexities of health governance. The combination of quantitative and qualitative methods allowed for a comprehensive understanding of the factors influencing healthcare provision in conflict-affected regions, facilitating the development of targeted recommendations for policymakers and healthcare providers.FindingsThe study revealed significant governance challenges in healthcare delivery for internally displaced persons (IDPs) in Kalar, Iraq. Key findings included that 78.4% of respondents identified a lack of medical equipment as a major barrier, and 67.6% cited financial constraints as critical obstacles to implementing governance principles. Although 70.3% felt that national legal frameworks offered moderate support, gaps in practical application were evident. The involvement of IDPs in health governance through committees was notable, yet only 13.5% recognized community leaders’ influence. Targeted health policies were found effective, while mental health support emerged as a crucial area needing attention.Research limitations/implicationsThis study’s limitations include a reliance on self-reported data from healthcare employers, which may introduce bias and affect the accuracy of responses. The sample size may not fully represent the diverse perspectives of all stakeholders involved in healthcare delivery for internally displaced persons (IDPs) in Kalar. Additionally, the study’s focus on quantitative measures may overlook nuanced qualitative insights. Future research should incorporate broader stakeholder engagement, including IDPs and community leaders, and consider longitudinal studies to assess the evolving governance challenges. These insights can inform more comprehensive strategies to enhance healthcare service delivery in conflict-affected regions.Practical implicationsThe findings of this study have several practical implications for improving healthcare governance in Kalar, Iraq. Policymakers and healthcare providers should prioritize addressing resource limitations, particularly the lack of medical equipment and financial constraints. Strengthening legal frameworks to ensure effective implementation of health rights for internally displaced persons (IDPs) is crucial. Additionally, fostering greater community engagement by involving IDPs and local leaders in decision-making processes can enhance health governance. Targeted health policies, particularly in mental health support, should be developed and implemented to address the unique needs of displaced populations and improve overall healthcare delivery in conflict-affected areas.Social implicationsThe study highlights significant social implications for healthcare governance in Kalar, Iraq, particularly concerning internally displaced persons (IDPs). Enhancing healthcare delivery for IDPs can improve their overall well-being, promote social inclusion, and foster community cohesion. By involving IDPs in health governance and decision-making processes, their voices and needs can be acknowledged, leading to more tailored and effective healthcare services. Improved health outcomes can also reduce social stigma associated with displacement and contribute to rebuilding trust within the community. Ultimately, addressing the health needs of IDPs not only benefits them but also strengthens the resilience of the entire population in Kalar.Originality/valueThis study offers original insights into the governance challenges faced by healthcare providers in Kalar, Iraq, specifically regarding internally displaced persons (IDPs). By utilizing a mixed-methods approach, it reveals critical barriers to effective healthcare delivery, such as resource limitations and financial constraints, while highlighting the need for stronger legal frameworks and community engagement. The research adds value by providing actionable recommendations for policymakers and healthcare stakeholders aimed at improving health service delivery in conflict-affected regions. Additionally, it emphasizes the importance of addressing mental health needs, contributing to a more comprehensive understanding of health governance in humanitarian contexts.

BackgroundAustralian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people’s mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people’s experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful.MethodWe conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants’ experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants’ understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking.ResultsThematic analysis highlighted that, through the lens of participants, young people’s mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people’s existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs.ConclusionsWe propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people’s mental health development which comprises: 1) maximising young people’s emotional investment (engagement); 2) developing young people’s mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.

BackgroundA growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.ObjectiveIn this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.MethodsThe review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical s, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.ResultsThere is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.ConclusionsThere is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

This study explored the emerging role of ChatGPT in mental health and psychological support. Employing a narrative case study approach, I examined vignettes from users who interacted with ChatGPT for various mental health and psychological needs. These cases were purposively sampled. The analysis revealed a diverse range of applications for ChatGPT, including coping with grief and loss, simulating conversations with deceased loved ones, seeking emotional support, developing social skills, managing ADHD symptoms, and serving as an on-demand mental health resource. Users consistently reported finding comfort, practical assistance, and immediate accessibility in these interactions. However, highlighted also are the potential risks associated with AI-assisted mental health support. These included the possibility of reliance on AI, complications in natural grieving processes, and the blurring of boundaries between AI and human connections. This paper emphasizes that ChatGPT may provide valuable support, but it should not be seen as a replacement for human therapists or comprehensive mental health treatment plans. The study also suggests that AI chatbots like ChatGPT are emerging as complementary tools in mental health support. However, their integration into mental health care requires careful consideration of ethical implications, privacy concerns, and the preservation of essential human elements in therapeutic relationships. Further research is recommended to guide the development of effective and ethical AI-assisted mental health and psychological support.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR=1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI: 0.78-0.91). Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support. This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. This study is registered as PROSPERO CRD42019135722. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

BackgroundThe Philippines faces a challenge in addressing the mental health needs of internally displaced persons (IDPs) following disasters. The lack of an integrated mental health triage system within evacuation centers and the shortage of specialists trained in post-traumatic stress triaging have hindered effective emergency response. Existing interventions primarily focus on traditional trauma and psychiatric symptoms, often lacking standardized mental health triage classifications and leading to data gaps, complicating resource allocation decisions.ObjectiveTo develop a culturally relevant mental health triage system, this study proposes the “Unahon Tool” to meet the needs of Filipino IDPs. Integrating with existing medical triage protocols equips frontline responders to identify stress-related concerns, enables informed decision-making for mental health and psychosocial support (MHPSS) allocation, and optimizes resource utilization.MethodsThe study involved key informants, including disaster responders, mental health specialists, and government officials, who participated in interviews and focus group discussions. Thematic analysis was used to identify behavioral aspects affecting IDP communities. The Unahon Tool development incorporated disaster response frameworks, mental health interventions, and other existing triage tools. A red-yellow-green categorization system was employed based on the severity and urgency of observed behaviors. Stakeholder consultations and expert reviews guided tool refinement.ResultsThe final Unahon Tool includes 17 behaviors categorized into red (urgent), yellow (moderate), and green (low) severity levels. It provides corresponding recommended interventions to aid responders. During direct observations, yellow-category behaviors like shouting and cursing were prevalent. Responders focused on reminders for peace and order in response to these behaviors. The tool's “Notes” section was identified as a potential area for contextual information inclusion.ConclusionThe Unahon Tool fills a crucial gap in the Philippine disaster response infrastructure by offering a behavior-based mental health triage system. It enables responders to prioritize mental health resources effectively, reducing the burden on specialists and enhancing overall disaster response effectiveness. Future directions include expanding tool adoption beyond Metro Manila, translating it into regional languages, and developing a version for children and teenagers. Collaboration with other regions and age groups will ensure broader applicability and effectiveness in addressing mental health needs among diverse IDP populations.

BACKGROUND Barriers to accessing mental health support are common experiences reported by university students. Digital tools can improve equitable access to the indicated level of support and provide actionable insight and recommendations. OBJECTIVE This study aimed to evaluate the acceptability and effectiveness of a web-based self-guided mental health and well-being support platform (U-Flourish Platform) that was tailored specifically for university students. METHODS The i-spero® platform was adapted in partnership with students to provide evidence-based well-being plans, mental health symptom tracking, and automated alerts and recommendations based on self-report data from students. After providing informed consent, students registered to access the platform and completed baseline demographic information and weekly validated screening measures of anxiety (GAD), depression (PHQ), and well-being (SWEMWEBS) over 8 weeks. At 6 weeks, students completed a user-experience survey. Paired t-tests were used to compared symptom scores and chi-squared tests assessed changes in symptom screening status over the 8-week period. Unadjusted logistic regression was used to assess whether baseline demographic factors and symptom screening status were associated with user-experience outcomes. RESULTS The analyses included data from 404 consenting students. At 6-weeks, most students (75%) expressed satisfaction with the platform, felt it was easy to use and understand (85%), and found the platform helpful for supporting their mental health (58%). Adherence was relatively high (76%) and attrition was relatively low (26%) after 6 weeks but reduced substantively thereafter; associated with timing of the end of incentivized use and end of term examinations and assignments. Mean anxiety (1.55 vs. 2.19, p<.0001; Cohen’s d=0.36), depression (0.94 vs. 1.36, P=.0001; Cohen’s d=0.33), and well-being (24.87 vs. 22.28, P<.0001, Cohen’s d=0.34) scores were improved at 8-Weeks vs baseline, with the greatest positive effects for students who screened positive for anxiety (Cohen’s d=1.16) and depression (Cohen’s d=2.22) at baseline. There was no evidence of differences in user-experience across demographic factors (i.e. gender, international student status, and lifetime history of a mental disorder) or baseline screening status, except for males who had lower odds (OR=0.40, 95% CI: 0.18-0.90) of finding the platform easy to use compared to female students. Of the 404 student-users, 142 created at least one well-being plan, with 75% and 57% of them being endorsed as helpful and being satisfactory in the support they provided, respectively. Most students reported satisfaction with the Platform (75%), it being easy to use (85%), and it having a positive impact on their mental health (58%). CONCLUSIONS Evidence supports that a self-guided digital well-being and mental health support platform is an acceptable and useful resource for university students. Therefore, student-tailored digital tools should be considered as part of an integrated and comprehensive whole-university approach for student well-being and mental health support.

There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours. A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours. Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours. AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.