Abstract
Addressing mental health challenges in humanitarian settings, where needs are many and resources are scarce, requires innovative solutions. In this manuscript, we describe a quantum complexity informed intervention, Communication for Whole Health (CWH), developed at the request of a large Jordanian healthcare NGO to address mental health needs of patients and staff. In the humanitarian aid context, this health domain is referred to by the acronym MHPSS (mental health and psychosocial support). The focus of this participatory action research project, presented here as a case study, was the collaborative elaboration of an MHPSS intervention in an urban primary healthcare clinic serving mostly Syrian refugees. The intervention capitalizes on the synergistic effects generated from the systemic nature of communication where every interaction is an intervention, and the health implications of research demonstrating communication is bioactive. Rather than treating mental health as an add-on medical specialty targeting patients with “psychiatric disorders,” systemic MHPSS starts from the premise that everyone has mental health, which is inextricably linked to physical and social health. Emphasis is on integrating awareness of mental health as part of whole health and taking advantage of every interaction to facilitate well-being for patients and staff. The intervention facilitated the transformation of the communication ecology of the clinic from a culture of reactivity to a culture of receptivity by strengthening communication resources and practices. Staff reported feeling more empowered to help patients and displayed increased motivation to find innovative ways to use available resources. They felt better equipped to manage their own stress response and support coworkers. Patients learned basic stress management skills, helping them better manage chronic health conditions, and reported sharing this information with family members. Staff reported many examples of patients responding positively to interventions to reduce patient reactivity, leading to beneficial behavior change and improved health outcomes. Results suggest a systemic MHPSS approach can contribute to ameliorating health inequities by expanding resources for patients and staff, empowering them to act into their current circumstances to support whole health. The CWH approach has potential in similar contexts to address mental health needs in a cost-effective and impactful way.
Highlights
One of the biggest challenges in global healthcare is addressing mental health needs in low-resource and humanitarian settings (Wainberg et al, 2017; Patel et al, 2018; Cosgrove et al, 2019)
We have identified a number of small effects, which we glorify with the name theories, and we have demonstrated that they occur over and over and over again, in various situations and with various groups
Due to the complexity of the context as well as the problem we were asked to address, we suggested initiating the project with one clinic, which we will refer to as “the Clinic” going forward
Summary
One of the biggest challenges in global healthcare is addressing mental health needs in low-resource and humanitarian settings (Wainberg et al, 2017; Patel et al, 2018; Cosgrove et al, 2019). Scholars and practitioners in areas such as development (Ramalingam, 2013; Boulton et al, 2015; Burns and Worsley, 2015), business (Richardson, 2008), peacebuilding (Brusset et al, 2016), education (Martin et al, 2019), and healthcare (Cristancho, 2016; Braithwaite et al, 2017, 2018; Greenhalgh and Papoutsi, 2018; Khan et al, 2018; Long et al, 2018) have embraced complexity thinking as a way forward due to its emphasis on concepts like non-linearity, emergent properties, uncertainty, and unpredictability, which seem to better describe the applied contexts they study While those in this latter group utilize the systems language of complexity science, they often do not directly comment on issues of ontology or epistemology. The CWH intervention framework is an application of the CC perspective that seeks to systemically integrate MHPSS services throughout a primary healthcare setting It embraces the World Health Organization’s definition of overall health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” There should be general education for all staff in understanding and interacting with patients with serious mental health conditions that reflects a compassionate care orientation emphasizing human dignity for all
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