Mental Health and Psychosocial Support Services between Theory and Reality: Happiness as a Long-Term Objective

Mental health of Syrian refugees: looking backwards and forwards

BackgroundEmerging evidence indicates the extreme forms of violence and acute and longer-term mental health consequences associated with trafficking and exploitation. However, there has been little research on post-trafficking mental health and psychosocial support services for survivors. This study explored the availability and accessibility of mental health and psychosocial support services in Cambodia for women, men and children trafficked and exploited for sex or labour purposes.MethodsSemi-structured interviews were conducted with a purposively selected sample of representatives from seven service organizations providing mental health and psychosocial support services for people who have been trafficked. This qualitative method was selected to gain insights into the service approaches and challenges faced by the small number of post-trafficking service providers in Cambodia. A conceptual framework outlining access dimensions associated with service provision guided the structure of the study.ResultsFindings indicate that among the available post-trafficking services, there are few trained mental health specialists, an over-representation of shelter services in urban versus rural areas and limited services for males, people with disabilities, individuals exploited for labour (versus sexual exploitation) and those with more serious mental illnesses. Providers believe that discrimination and stigma related to both mental health and human trafficking hinder trafficked people’s willingness to access services, but suggest that awareness-raising may reduce these prejudices. Care in this sector is precarious due to over-reliance on financial support by donors versus government. Recent increases in newly qualified professionals and providers suggest potential improvements in the quality and availability of psychological support for trafficking survivors.ConclusionsPsychological support for the growing number of identified trafficking survivors in Cambodia will depend on improved geographical distribution of services, more mental health support professionals and growing acceptability of mental health service use among trafficked people and the Cambodian public.

Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries. A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted. Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes. The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions-particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.

In this chapter, the authors describe the essential need of mental health and psychosocial support for people accommodated in mandatory quarantine and isolation facilities during the outbreak of COVID-19 pandemic in Namibia through a multi-sectoral response. Namibia recorded its first two index cases on 13 March 2020 when a married couple arrived in the Windhoek district in Namibia from Madrid, Spain on 11 March 2020. Namibia has since March 2020 provided supervised quarantine services to 12,128 persons in facilities around the country. The Ministry of Health and Social Services provides mental health and psychosocial support services, which were critical in the short and long-term response to COVID-19 pandemic. Public health measures were developed in line with WHO guidelines to contain the virus. These measures include the need of setting up quarantine and isolation facilities. Recommendations for future research in strengthening mental health and psychosocial support services and coping strategies are provided in the chapter.

The war in Ukraine has created an urgent need for integrated health and psychosocial support services, particularly for survivors of gender-based violence (GBV) and conflict-related trauma. HealthRight International, in partnership with national and local authorities and with the support of FHI 360, developed a scalable model - Gender-Based Violence Response and Care Units (GBV RCUs) to deliver holistic GBV, mental health, and psychosocial support (MHPSS) services integrated into primary healthcare in Eastern and Southern Ukraine. Between September 2022 and January 2025, 10 GBV RCUs were established within Primary Health Care Centers across Kharkiv, Odesa, Dnipro, Mykolaiv, and Zaporizhzhia. Each RCU is staffed by multidisciplinary teams, including coordinators, psychologists, child psychologists, social workers, and lawyers, providing services onsite, through outreach, and online. Services include psychosocial crisis support, emergency psychological assistance, case management, medical counseling, legal aid, and referrals to specialized services. Capacity-building activities were conducted in collaboration with the Ministry of Health and the National MHPSS Coordination Council, including webinars and trainings for healthcare workers on mhGAP, Clinical Management of Rape, and the WHO Self-Help Plus (SH+) intervention. SH+ was adapted for conflict-affected populations, with over 75 specialists trained, resulting in improved coping skills and stress management among participants. Since the project launch, over 154,000 clients have received assistance, and more than 365,000 GBV and MHPSS services have been delivered. Outreach services reached nearly 50,000 individuals. More than 700 healthcare providers were trained, with over 90% reporting improved competencies. The model was recognized as a best national practice and presented at national mental health forums organized under the patronage of Ukraine's First Lady as part of the ‘How are you?’ initiative. Key messages • Integrating gender-based violence (GBV) response and mental health and psychosocial support (MHPSS) into primary healthcare services is essential to address complex humanitarian needs during conflict. • The model demonstrates that embedding GBV and MHPSS services at the primary care level can strengthen community resilience and improve health system responses in war-affected settings.

Early in 2019, a situational analysis of mental health and psychosocial support services for Rohingya refugees in Cox’s Bazar was carried out jointly by International Federation of Red Cross Red Crescent Societies Reference Centre, International Organisation for Migration and United Nations High Commissioner for Refugees. The main objective of this situational analysis was to identify the approaches that were working well within the current response, the gaps within existing mental health and psychosocial support (MHPSS) services for Rohingya refugees in Cox’s Bazar and to provide practical options and recommendations for MHPSS service providers working through different sectors. The methodology included: 1) a review of existing knowledge about MHPSS services for Rohingya refugees in Cox’s Bazar through desk review methodology; 2) analysis of updated 4Ws (who is where, when and doing what) MHPSS service mapping; 3) strategic priorities mapping which was conducted with members of the MHPSS Working Group in Cox’s Bazar; 4) focus group discussions with camp populations; and 5) meetings with service providers. The results from the strategic priorities mapping are shared in another article in the Special Issue of Intervention (Harrison et al., 2019, pp. 206–211). This article draws upon the Cox’s Bazar case study to outline the methodological approaches and process used to conduct a situational analysis, with a view to guiding agencies interested in undertaking future situational analyses in other, ongoing, refugee and humanitarian contexts. Key implications for practice An MHPSS situational analysis conducted in an ongoing emergency or refugee setting is a useful programming and advocacy tool for country-level MHPSS working groups and the agencies that co-lead these working groups. The process of conducting an inter-agency MHPSS situational analysis supports the functioning, purpose and coordination activities of a country-level MHPSS working group. Future MHPSS situational analyses should be conducted with the full involvement of persons with severe mental health conditions, to ensure that the perspectives of service users are included, in addition to persons suffering from psychological distress and persons with transient MHPSS problems.

To describe the design and delivery of emergency mental health and psychosocial support services for the survivors of Post-Election Violence in Eldoret, Kenya. A longitudinal intervention. The North Rift Valley region in Western Kenya. A total of 80,772 survivors received mental health and psychosocial support services. Counselling and Psychological First Aid services were successfully offered to most survivors in the North Rift Valley region. Common issues addressed included looking for lost relatives, sudden traumatic death of relatives, anger at their attackers, feelings of revenge, fear of seeing the corpse, loss of all property and source of livelihood and denial. It is possible and necessary to integrate a mental health and psychosocial support intervention into a disaster response even in limited resource settings. Further studies are recommended to evaluate the effectiveness of this approach.

Over the past two decades, the unique health needs associated with the second decade of life have been recognized, not least the mental health of adolescents. In parallel, the negative health impacts of parental migration on the children and adolescents who are "left behind" in low- and middle-income countries (LMICs) is beginning to be acknowledged. Nepal is a growing supplier of labour migrants - an estimated 3.5 million Nepali individuals are working abroad - resulting in families being separated and thousands of adolescents being left behind. This can increase psychological and emotional stress and feelings of loneliness and abandonment, and reduce self-esteem among left-behind adolescents, which in turn may have a negative impact on their psychosocial health. Globally, mental health and neurodevelopmental disorders are one of the top three causes of disability-adjusted life-years lost among adolescents. The devastating earthquake in Nepal in 2015 brought into sharp focus the lack of prioritization of mental health services and spurred development of the Community mental health care package Nepal, 2074 in 2017. This package, together with the upcoming revised National Mental Health Policy, emphasizes the need to (i) ensure the availability and accessibility of basic mental health and psychosocial support services for all; and (ii) facilitate integration of mental health services into the primary health-care system. Recognizing that mental health and psychosocial support services have been predominantly focused on the adult population only, the package includes a component on childhood and adolescent mental and behavioural disorders. It will be essential for policy-makers to ensure that strategies are in place to ensure that left-behind adolescents, especially those who are not in school, have access to these community-based services. Given the paucity of research on mental health interventions among adolescents in LMICs in general, monitoring and assessment of what works for this special group of young people in Nepal may have broader implications for implementation in other countries where migration has resulted in significant populations of left-behind adolescents.

The recent flood crisis in Pakistan has had significant impacts on the physical, mental and socioeconomic fabric of almost 33 million people. Floods in Pakistan are leading to a range of negative impacts on health and major disruptions to healthcare services. The lack of mental health and psychosocial support services (MHPSS) is a significant concern in rural areas of Pakistan in providing support to communities affected by floods. It is important for the government and mental health policymakers to work with academic coalitions and non-governmental organisations to replicate low-resource MHPSS models that will develop and advocate for effective, gender-sensitive mental healthcare throughout the country.

Mental health is an increasing concern around the world, but there is a substantial gap between Western and non-Western countries in terms of access to quality mental healthcare. To help close this gap and improve the delivery of mental health and psychosocial support services (MHPSS), the UN’s 2016 Grand Bargain declared a new approach of prioritising the localisation of these services. This paper examines the effects of the Grand Bargain on the localisation of mental health and psychosocial support services in non-Western countries, as a means to decolonise mental health. An outcome evaluation was carried out to measure the amount of funding received by local and national agencies that provide MHPSS services in less economically developed countries. All data was gathered from the UN Financing Track System (FTS) and looked at financial contributions over time in six humanitarian sectors: health; water, sanitation and hygiene (WASH); gender-based violence; nutrition; protection, and shelter. The results show that local and national agencies received only 3% of international donors' MHPSS-related humanitarian funding between 2017 and 2021. Most localised MHPSS-related funding is driven by country-based pooled funds, with Middle Eastern countries as the primary beneficiaries, and localised MHPSS funding predominantly went to the health, WASH, and protection sectors. The study found limited localisation of MHPSS services in less economically developed countries, and a limited focus on community capacity building through associated humanitarian sectors. Based on this study, it is recommended that humanitarians should advocate for increased localisation and culturally competent practices in the MHPSS space.

The areas around Ukhiya and Teknaf in Cox’s Bazar district in Bangladesh are the location of some of the world’s largest and most congested refugee settlements. The refugees have myriads of needs, and hundreds of different organisations provide assistance in an enormously complex and at times chaotic humanitarian operation. The humanitarian community in Bangladesh has identified the provision of effective mental health and psychosocial support (MHPSS) services as a priority. However, the multi-sectoral nature of MHPSS can create challenges especially when it comes to coordination of services. A central coordination mechanism, the MHPSS working group, was established in December 2017. It is a sub-working group of the health sector and it has close ties with other sectors, mainly protection. This central MHPSS working group is attended mostly by mid-level and senior staff involved in policy and programming. We found that adding ‘field-level coordination’ with actors who work in the same geographical area helped to strengthen communication, cooperation and local coordination. It assists field-based staff to stay informed of each other’s work and can promote collaboration. For example, in the elaboration of the Emergency Preparedness and Response Plan to mitigate the effect of monsoon-related events in Cox’s Bazar, the field-level coordination mechanism proved very useful. Moreover, an area-based coordination mechanism can be a suitable platform to engage the affected communities in MHPSS coordination. This field report highlights the rationale, challenges and lessons learned from field-level coordination experience and argues that in large humanitarian settings establishing such area-based coordination mechanisms can have a clear added value and should be routinely considered.

Disaster responders play a crucial role in providing aid to individuals and communities following catastrophic events. Being tasked to protect and preserve life and property, these groups of professionals are constantly exposed to various hazards, which puts them at risk of negative mental health consequences. This chapter describes and discusses these mental health effects and interventions for disaster responders in Southeast Asia. The chapter defines who the disaster responders are in Southeast Asian countries. Drawing from the literature, this chapter enumerates the various positive and negative psychological consequences of disaster response, and the risk and protective factors associated with disaster response work. This chapter also describes the different interventions, such as psychological first aid and psychotherapy, following the Inter-agency Standing Committee (IASC) (2007) guidelines on conducting mental health and psychosocial support services (MHPSS), and focusing on the Southeast Asian context. This chapter ends with a discussion of the different challenges of providing MHPSS in Southeast Asia and with some recommendations on how to improve the delivery of these services and the mental health of disaster responders in general.

BackgroundThe conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering.MethodsThis qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF’s NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used.ResultsRespondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman’s theory of social suffering. There was a ‘disconnect’ between staff and patients’ perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent’s low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors’ own cultural standpoints.ConclusionSyrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.

BackgroundNorthwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services.MethodsThe study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries.ResultsFindings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services—especially among health workers seeking MHPSS services—findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach.ConclusionThe study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.

Background: Foreign employment is a key livelihood strategy in Nepal, contributing to economic stability through remittances. However, it also imposes social costs, affecting the mental health and psychosocial well-being of migrant workers and their families. This study evaluates a mental health and psychosocial support project, assessing its progress and impact on interventions aimed at improving overall well-being. Methods: A midterm evaluation was conducted using a cross-sectional study design with a mixed-methods approach. The quantitative survey included 91 participants, utilizing validated tools such as the General Health Questionnaire-12 (GHQ-12), Hopkins Symptom Checklist-25 (HSCL-25), Life Satisfaction Tool, and Happiness Tool. Additionally, 13 Focus Group Discussions (FGDs) and 26 Key Informant Interviews (KIIs) explored community perspectives on mental health and psychosocial issues. Data were analyzed using SPSS version 21.0 for quantitative findings and thematic analysis for qualitative insights. Ethical approval was obtained from the Nepal Health Research Council (Ref. No: 660), and written informed consent was secured from all participants. Results: The evaluation demonstrated a positive impact on mental well-being, with anxiety decreasing from 37.25% at baseline to 20.95% at midterm and depression declining from 26.2% to 13.2%. Happiness and life satisfaction levels improved, and mental health services expanded from 4 to 19 health facilities. Challenges remain, including stigma, resource constraints, and policy implementation delays. Conclusion: While the project has significantly improved mental health outcomes, addressing systemic barriers is essential for sustaining progress. Strengthening policies and increasing resources can enhance long-term mental health support for migrant workers and vulnerable populations.