Mental Health And Psychosocial Support Research Articles

Shifting from Burden Sharing to Task Sharing: Advancing Community-Initiated Care in MHPSS for Refugee Resettlement

The complexities of refugee resettlement in the U.S. require comprehensive mental health and psychosocial support (MHPSS) strategies, yet significant gaps persist due to resettlement policies prioritizing short-term self-sufficiency over long-term mental health and well-being. This study explores the shift from traditional “burden sharing” to “task sharing” models that emphasize community-initiated care (CIC). Using a two-phase qualitative method, 27 refugee leaders and bilingual service providers from 14 refugee communities, including Afghan, Bhutanese, Burmese, Congolese, Somali, and Sudanese communities, across four states participated in focus groups or key informant interviews. Thematic analysis revealed that peer support models play a critical role as bridges between cultures, service sectors, and formal and informal networks. However, peer support remains insufficient without structural reform, as refugees face barriers such as lack of professional development and power imbalances with professionals while managing their own life challenges. This study emphasizes formalizing CIC models that empower refugees to lead the sharing process in collaborative care. Intersectoral collaboration and supportive policy frameworks are necessary to sustain peer support and build long-term leadership capacity. The findings highlight the need for a system-level shift to ensure equitable responsibility for care, fostering sustainable, community-driven MHPSS solutions in refugee resettlement.

Responding to Trauma: A Critical Review of Mental Health and Psychosocial Interventions for Refugee Women.

This is a critical review of English language literature (January 2023-June 2024) on psychological trauma amongst forcibly displaced migrant women. The Mental Health and Psychosocial Support (MHPSS) Framework was used to organize multi-layered mental health interventions. Findings indicate many promising community-based interventions, often delivered by trained lay facilitators. Interventions address: upstream drivers of mental health such as empowerment and economic security, group-based care focused on social connection and well-being, and trauma focused treatment such as Mindfulness Based Interventions, Cognitive Processing Therapy, and Culturally Adapted Cognitive Behavioral Therapy. The variety of (primarily short-term) interventions must be complemented by longitudinal evaluation. Clinicians and care systems should partner with those delivering psychosocial interventions outside of clinical settings. Continued research on the impacts of cumulative and intergenerational trauma amongst refugee women, and intervention research that centers the experiences of marginalized groups (e.g., sexual and gender minority refugees) is needed.

Beyond Survival: Transformative Impacts of Integrating Mental Health and Livelihood Support in Conflict Zones

This article presents a case study of an integrated humanitarian intervention that combines mental health and psychosocial support (MHPSS) with livelihood assistance to enhance the psychosocial well-being, interpersonal relations, and social cohesion of internally displaced persons. Focusing on International Organization for Migration's MHPSS and Livelihood Integration project in Iraq, this paper critically assesses its outcomes and limitations in a protracted conflict and displacement context. Key findings reveal that MHPSS and Livelihood Integration project participants, compared to those in non-integrated programs, reported improved emotional well-being, new life skills and social skills, enhanced problem-solving and stress management abilities, as well as greater adaptability and motivation. Integration of MHPSS and livelihood activities also facilitated social network development and a sense of connectedness. These results show the effectiveness of integrated interventions in supporting the mental health and well-being of internally displaced persons, returnees, and vulnerable community members while promoting a sense of belonging and community cohesion, contributing indirectly to intracommunal peace and positive social transformation. Offering valuable empirical insights, this study contributes to humanitarian, development, and peacebuilding research by demonstrating how structured MHPSS activities can be integrated into livelihood programs to support the mental health and emotional well-being of affected populations in a protracted conflict setting.

A multilevel modeling analysis of community-based mental health and psychosocial support group intervention for refugee newcomers in the United States.

A growing number of resettlement agencies adopt and implement interventions and programs to promote community-based mental health and psychosocial support (CB-MHPSS) among refugees and asylum seekers in the United States. However, few studies examine how multilevel factors either facilitate or interfere with mental health and other associated outcomes. Adopting a realist evaluation approach, this study examines the effects of multilevel (i.e., community, group and individual) factors on mental health coping and emotional well-being (EW) among asylum seekers and refugee newcomers in CB-MHPSS group interventions. A total of 235 adult refugees and asylum seekers participated in 31 CB-MHPSS intervention groups implemented by 11 HIAS affiliate agencies in 2021. A series of bi-/multivariate and multilevel modeling analyses were conducted to investigate the impacts of individual, group or agency, and community-level factors on competency for coping and EW among intervention participants. Mental health and psychosocial support (MHPSS) interventions grounded to the local community help facilitate individual-level improvement in competencies for mental health care and EW. Multilevel modeling analyses attested to multilevel effects of individual, group, and community settings on MHPSS outcomes, highlighting the impacts of intervention facilitator types and group composition, as well as community's unemployment rates. This study sheds light on the value of community-based, participatory approaches to psychosocial interventions; focusing on the role of refugee community leaders and bicultural staff who deliver MHPSS activities, which was a key feature that enhanced the well-being and coping of refugee newcomers across various settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anxiety, depression and access to mental health services among internally displaced persons in Mogadishu, Somalia: a cross-sectional survey

ObjectiveThe study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia.DesignA community-based, cross-sectional survey was carried out in...

Integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador

BackgroundPoverty is a key social determinant of mental health among forcibly displaced persons. This study aimed to design and pilot test a strategy to integrate existing mental health and economic inclusion interventions for displaced families in Ecuador.MethodsWe conducted a series of qualitative interviews (n = 30), focus groups (n = 6), and workshops (n = 3) to develop a set of strategies for integrating cross-cutting and focused mental health and psychosocial support (MHPSS) strategies into an existing economic inclusion program for displaced families in Quito. We non-randomly assigned two field offices in Quito to (1) integrate cross-cutting strategies focused on improving economic outcomes or (2) integrate both those cross-cutting strategies plus focused MHPSS strategies into an economic inclusion program. We measured site-level implementation outcomes (adoption, appropriateness, acceptability, feasibility, fidelity, reach, retention, usability) and participant-level psychosocial (wellbeing, depressive symptoms, anxiety symptoms, functioning) and economic inclusion outcomes (financial resources, diet diversity, social capital/networks, self-reliance) over six months. We conducted a mixed-methods analysis to explore the acceptability and feasibility of the integration strategies and the ability to evaluate their effects in a future cluster randomized trial.ResultsWe developed a toolkit that included 10 strategies for integrating MHPSS into economic inclusion interventions. Fifty displaced persons participating in an existing economic inclusion program (25 per study condition) were enrolled and 88% remained in the study through the six-month follow-up. Participants and implementers reported that the integration strategy was appropriate, acceptable, feasible, and usable. Implementers, including people without prior experience in delivering mental health services, were able to deliver the intervention with high fidelity. Integration of focused MHPSS intervention components into an economic inclusion program appeared to improve MHPSS outcomes, the strength of social capital and networks, and engagement in economic and other programs.ConclusionsThis study provides preliminary evidence of the acceptability and feasibility of integrating MHPSS into economic inclusion programs for displaced people. We found evidence supporting evaluation methods that can be employed in a future study to definitively test the added value of integrated approaches to mental health and economic wellbeing for displaced persons.

Integrating mental health and psychosocial support (MHPSS) and peacebuilding: A critical and constructive perspective from the integrated field of psychosocial peacebuilding.

Integrating mental health and psychosocial support (MHPSS) and peacebuilding: A critical and constructive perspective from the integrated field of psychosocial peacebuilding.

Key mental health differences in conflict-related sexual violence and how sex, severity, and early intervention impact on improvement: a retrospective observational study

BackgroundConflict-related sexual violence (CRSV) is a significant health and human rights issue in humanitarian contexts, but there is a need of further research on differences between sexes in terms of severity of symptoms and improvement. Consequently, we explored the differences in severity and outcomes among male and female survivors of CRSV who received mental health and psychosocial support (MHPSS) in an armed conflict setting.MethodsWe retrospectively analysed medical records from 3442 CRSV survivors in a MHPSS programme in Borno State, Nigeria, between 2018 and 2019. Patient characteristics, severity (measured with Clinical Global Impression of Severity Scale [CGI-S scale]), and improvement (measured with Clinical Global Impression of improvement [CGI-I] scale) were assessed by an attending counsellor. We assessed predictors for severity and improvement using a multivariable logistic regression analysis and time to improvement by sex using Kaplan Meier (K–M) curves and Cox regression.ResultsWe included 3442 patients who had at least one CRSV event in this study (2955 [85.9%] female, 486 [14.1%] male, one unknown). The most prevalent categories of symptoms were depression (49.9%; n = 1716), post-traumatic (25.6%; n = 879), and anxiety (20.3%; n = 697) symptoms. Most patients had mild (59.0%; n = 1869/3170) or moderate (36.4%; n = 1153/3170) symptoms at baseline, with 4.7% having severe symptoms (n = 148/3170). The logistic regression analysis (n = 1106), showed male patients had a 59% higher odds of severe symptoms at baseline than female patients (aOR 1.59; 95% CI 1.04–2.45). Among males, those older than 55 years had three times higher odds of presenting severe symptoms than younger patients (aOR 3.65; 95% CI 1.43–9.34). Women aged 36–55 years were more likely to present improvement than younger female patients (aOR 1.32; 95% CI 1.11–1.58). For both sexes, prompt attention after a CRSV event (≤ 3 days) positively predicted improvement (aOR 13.9; 95% CI 1.48–130 males, aOR 2.11; 95% CI 1.22–3.64 females) compared to late attention. Time to improvement did not differ between sexes, with an average of at least three consultations needed to achieve improvement.ConclusionsOur study suggests that psychological attention of survivors within the first 72 h should be a priority. MHPSS programmes addressing CRSV should be inclusive to all patients, and gender-neutral approaches to ensure access, safety, confidentiality, and non-discrimination for all survivors should be developed.

How NGO Staff Understand Maslow's Hierarchy of Needs and MHPSS Pyramid in Iraq: A Pilot Descriptive Study.

The Maslow's hierarchy of needs (Maslow's pyramid) and the Mental Health and Psychosocial Support (MHPSS) pyramid are integral frameworks in humanitarian settings whose aim is to address individual and community needs. However, confusion often arises among non-governmental organization (NGO) workers about the application and differentiation of these models. This study aims to investigate the extent of confusion among NGO workers in Iraq as regards the Maslow's and MHPSS pyramids, identify the causes of this confusion, and explore its implications in the context of humanitarian mental health support. A pilot descriptive study was conducted in December 2023 through an online survey involving 61 local NGO workers from MHPSS components in Iraq. We created a measure to assess the participants' familiarity with both models, their perceived differences, and their views on the models' applicability in humanitarian contexts. Male participants represented 55.7% (n=34) of the sample, while females accounted for 44.3% (n=27). Most participants were aged 25-34 (57%, n=35) and 35-44 (34%, n=21). A majority held bachelor's degrees (67.2%, n=41), with 21.3% (n=13) holding master's degrees. In terms of occupation, 49.2% (n=30) were engaged in the protection sector (gender-based violence and child protection), followed by health (19.7%, n=12), education (4.9%, n=3), and MHPSS staff roles in other sectors (26.2%, n=16). The study revealed that 54.1% (n=33) of the participants struggled to understand or differentiate between Maslow's and MHPSS pyramids. The causes of this confusion were related to perceived structural similarities (18.03%, n=11), lack of awareness and knowledge about the MHPSS pyramid (63.93%, n=39), and a combination of both (18.03%, n=11). The study underscores the importance of better training and education for NGO workers to improve their understanding of the Maslow's and MHPSS pyramids. Addressing this knowledge gap can increase efficacy in humanitarian aid provision, ensuring that individual and community needs are adequately met in crisis situations.

Integration of livelihood support with MHPSS in rehabilitation of torture survivors in LMICs: Addressing poverty and mental health dynamics.

The integration of livelihood support with mental health and psycho-social support (MHPSS) seems crucial for the rehabilitation of torture survivors in low- and middle-income countries (LMICs). This study aimed to explore the intersec-tionality of poverty and mental health, and the integration of livelihood support with-in MHPSS frameworks related to the rehabilitation of torture survivors in LMICs. A cross-sectional study was conducted using a semi-structured questionnaire distributed to members of the International Rehabilitation Council for Torture Victims (IRCT) in LMICs (n=25). The questionnaire explored the perception of IRCT centres in LMIC countries regard-ing the extent to which poverty contributes to poor mental health outcomes among torture sur-vivors and the effectiveness of integrating livelihood support into MHPSS interventions. The study highlighted the significant economic challenges faced by torture survivors, indicating a high prevalence of extreme poverty among this group. The study found that 92% of respondents believed that poverty and mental health outcomes of torture survivors are strongly linked. Eco-nomic and social inequalities were identified as key determinants of mental health, emphasizing the need to address these inequalities in rehabilitation programs for torture survivors. The study underscores the critical connection between poverty, mental health, and the experience of torture. In the view of most IRCT centres, the integration of livelihood support with MHPSS is essential for addressing economic disparities and promoting long-term resilience among survivors. The results highlight the need to conduct long-term longitudinal studies that provide support to this perception. The study recommends enhancing coordination among stakeholders, addressing cultural and social barriers, securing sustainable funding, and developing strategies to integrate livelihood support with MHPSS for torture survivors. According to participants, rehabilitation programmes should include economic empowerment, mental health support, and social integration, to contribute to a holistic recovery, long-term resilience, and overall well-being.

Outcomes of integrating livelihood into mental health and psychosocial support program among survivors of torture: A mixed-method study from western Nepal.

From 1996 to 2006, Nepal experienced a decade-long armed conflict that adversely impacted survivors of torture. The conflict posed threats to various facets of their lives, such as men-tal health, socio-economic status, human rights, and the process of reintegration into their original communities. This study was done with the survivors of torture from the armed conflict. This study aims to generate evidence on the impact of livelihood support (supporting individuals with earning their livelihood through business development, farming/animal husbandry and mi-cro-entrepreneurship) upon mental health and psychosocial wellbeing as well as social empower-ment of survivors of torture. In total, 44 out of 46 torture survivors reported improvement in their mental health and psychosocial well-being after the livelihood intervention was instituted. Significant reduction in the severity of symptoms of depression (21.7% to 2.3%), anxiety (15.2% to 6.8%), and post-traumatic stress disorder (44.4% to 4.5%) was observed with medium to high effect size. Similarly, improvement in social relationship, economic status, and autonomy (increase in self-confidence and motivation) were noticed post-intervention. Our study concludes that the livelihood intervention has significantly contributed to economic uplift, improved mental health, psychosocial well-being, social empowerment and quality of life among the survivors of torture. The data provide preliminary evidence of positive outcomes from integrating a livelihood program into an MHPSS (Mental Health and Psychosocial Support) program. Although the lack of a control group prevents us from isolating the specific impacts of the livelihood program, our qualitative data indicate that the intervention is well-received, culturally rel-evant, and promising. The study has yielded certain recommendations for further research.

Exploring Nonspecialist Preparedness to Deliver an Evidence-Based, Family Strengthening Intervention in Rwanda: A Qualitative Study.

Families in low- and middle-income countries (LMICs) face significant mental health and psychosocial care gaps. In recent years, researchers and practitioners have addressed these gaps by task-sharing evidence-based mental health and psychosocial support (MHPSS) interventions to nonspecialist community providers. Supervision and training approaches are intended to prepare nonspecialists to deliver evidence-based interventions with quality. However, there is still little research exploring nonspecialist experiences with training and supervision and how, if at all, their training and supervision experiences result in fidelity and competence in delivering the intervention. This qualitative study uses data from a cluster-randomized trial of a family strengthening and violence prevention program in Rwanda, known as Sugira Muryango. In semi-structured interviews, the nonspecialists provided examples of using skills such as rapport-building, empathy, and active listening to deliver Sugira Muryango effectively. Because nonspecialists were serving in their own communities, they found that it was easier to earn trust with friends and neighbors, and this facilitated effective delivery of Sugira Muryango. Nonspecialists discussed how training, monthly supervision, in-person monitoring visits, and the use of the manual and audio recorders equipped them to deliver Sugira Muryango with quality. Nonspecialists also provided examples of barriers to quality of delivery, including supervisor lack of availability, delayed compensation, and technology issues. Preparedness was consistent across gender; however, nonspecialists serving in a better-resourced district had previous experiences delivering evidence-based interventions and felt more prepared at the beginning of Sugira Muryango.

Reconstructing theory in mental health and psychosocial support and peacebuilding: Towards an integrated model for psychosocial peacebuilding

AbstractDespite wide agreement among practitioners on the need for integration, mental health and peacebuilding practice remain siloed in conflict‐affected contexts. Yet before the integration of these two fields should occur, a revaluation of existing practice is needed. Within the field of mental health and psychosocial support (MHPSS), critics have long questioned dominant assumptions and treatment models, raising concerns about top‐down implementation, Western‐centric approaches, and a lack of community leadership. These criticisms are largely echoed within peacebuilding literature. Furthermore, both fields underappreciate the overlap between their practices. For example, the relationship between the structural drivers of poor mental health or the social‐psychological drivers underpinning peacebuilding. Accordingly, this article seeks to contribute to the development of a novel, integrated approach to MHPSS and peacebuilding—or ‘psychosocial peacebuilding’. In doing so, we address dominant critiques of both fields, before discussing the relevance of critical (community) psychology as an ideal means in which to bridge a theoretical and practical gap between fields. Using quality peace as a guiding normative theory, we will also reinforce the argument that working to address mental health concerns is essential to creating peace in post‐conflict contexts. It concludes by exploring potential avenues for further research. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Integrating mental health and psychosocial support (MHPSS) into infectious disease outbreak response: Results of an expert consensus study

ObjectivesOutbreaks are associated with increased risk of anxiety disorders, depression, and severe mental conditions. Integrating mental health and psychosocial support (MHPSS) into outbreak response facilitates the delivery of holistic care to the affected community. As there is an increasing incidence of outbreaks globally, integrating MHPSS into preparedness and response plans is paramount to strengthen the capacity of existing health systems and respond to mental health and psychosocial needs. However, the attention given to MHPSS during outbreak response is critically low. The objectives of this study were to identify areas of MHPSS integration and explore the challenges that hinder the delivery of an integrated care during outbreak response. MethodsA participatory qualitative study was conducted to explore how MHPSS can be incorporated into outbreak preparedness and response plans as a cross-cutting intervention in the context of low- and middle-income countries. We brought together civil society representatives, key stakeholders, and public health experts to explore areas of MHPSS integration during outbreak response. ResultsSystematic integration of MHPSS into outbreak response was perceived to be feasible. Study participants strongly agreed that MHPSS can be integrated into most of the outbreak response pillars including partner coordination, case management, infection prevention and control, staff health and well-being, and risk communication and community engagement. However, the effort requires multi-sectoral collaboration, political commitment, and adequate recognition in planning and financing. ConclusionsDespite complex challenges, integrating MHPSS into outbreak pillars is possible. Moreover, emphasis should be placed on cultural adaptation of MHPSS guidelines and strong leadership in coordinating MHPSS into outbreak planning and response.

Barriers and Facilitators to Co-Creating Interventions with Refugee and Migrant Youth: A Process Evaluation with Implementors

The rise in children experiencing forced displacement and the associated negative mental health effects have led to the proliferation of novel interventions targeting their educational development and mental health and psychosocial support (MHPSS) needs. To improve the acceptability and effectiveness of these interventions for refugee communities, co-creation is often used. However, there is a need to understand the mechanisms that support the co-creation process. This paper explores the process of co-creation within the REFUGE-ED project: an international consortium identifying, co-creating, and implementing educational and MHPSS interventions for refugee youth. The data are drawn from consortium members and site staff who participated in a range of meetings, focus groups, and interviews which occurred before, during, and after the implementation. A qualitative content analysis grounded in the (updated) Consolidated Framework for Implementation Research (CFIR) was then used to identify barriers to and facilitators of the co-creation process. Although numerous barriers and facilitators were identified only two traversed both categories and every stage of the co-creation process: namely, the quality of interpersonal relationships and the clarity of the implementation plan. We discuss relevance of these two factors to the field of co-creation as a means to adapt health interventions targeting youth refugee populations. Considerations, needs, and recommendations for future co-creation interventions are also outlined.

The call for an "educational footprint" in conceptualizing mental health and psychosocial support: the case of Norwegian kindergarten teachers.

This article presents an in-depth qualitative case study asking, "How do Norwegian kindergarten teachers conceptualize and negotiate the field of psychosocial support?" This article thoroughly explores how Norwegian kindergarten teachers perceive of the field Mental health and psychosocial support (MHPSS). Recognizing the global imperative to advance mental health and psychosocial support for children, the study highlights the crucial need for interprofessional grounded concepts and logics in developing MHPSS interventions. The study employs a grounded theory approach to actively develop concepts in the MHPSS field in Norway. The six selected Norwegian expert teachers can make up a so-called "unique case", representing a high-income country with a robust welfare system and child-centered pedagogy. Yet, they reveal challenges in embracing the concept of psychosocial support: The analysis shows that the teachers seem to neglect and even reject the concept of psychosocial support, while also expressing inferiority and lack of agency towards other professions. However, the teachers also express the desire for more knowledge, and with proudness they energetically engage in fostering children's agency and functioning by their everyday descriptions of «meeting with the child». The study calls for the kindergarten teachers' increased efforts to actively participate in MHPSS interventions, advocating for the further development of an «educational footprint» that can empower interprofessional work.

Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East.

Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.

The Impact of Dramatherapy on the Mental Health of Socioeconomically Disadvantaged and Refugee Women in Lebanon

The need for Mental Health and Psychosocial Support (MHPSS) is ever-present for vulnerable populations in the Arab World. High rates of psychological disorders including post-traumatic stress disorder (PTSD), depression and anxiety have been observed in the refugee and socioeconomically disadvantaged female population within Lebanon. MHPSS services are lacking and in need of reform to provide better services to disadvantaged populations. This study aims to examine the psychological impact of dramatherapy intervention (DTI) on the previously mentioned population. To evaluate the psychological effects of DTI, this study utilizes a quantitative and repeated measure design. Six scales were used to measure PTSD, depression, and anxiety prior to and after participation in a 3-month long, 12-session dramatherapy program. Eight DTI programs were implemented across Lebanon between October 2020 and August 2022. The participants of this study consisted of adult socioeconomically disadvantaged and refugee women who took part in DTI programs implemented by Intisar Foundation.

Implementing supportive supervision in acute humanitarian emergencies: Lessons learned from Afghanistan and Ukraine.

Mental Health and Psychosocial Support (MHPSS) practitioners working in humanitarian contexts are at significant risk of mental health conditions, ultimately hindering the quality and sustainability of their work. Supportive supervision has shown to be effective in improving the wellbeing of MHPSS staff and volunteers and enhancing the effectiveness of MHPSS service delivery. Despite these proven benefits, there is a lack of standardised guidelines to inform supportive supervision within humanitarian contexts. To address this gap, the Trinity Centre for Global Health and the International Federation of the Red Cross Red Crescent Societies' Reference Centre for Psychocosial Support co-developed the 'Integrated Model for Supervision' (IMS) Handbook and supporting tools and led IMS trainings with four humanitarian organisations in Ukraine, Afghanistan, Jordan, and Nigeria from June-August 2021. The subsequent acute humanitarian emergencies that occurred in Afghanistan and Ukraine provided the opportunity to (i) examine the implementation of the IMS in the acute stages of two humanitarian crises and (ii) identify the challenges and lessons learned from this process. This study employed a case study design using semi-structured qualitative interviews with five MHPSS personnel (female: 4; male: 1) who had received training in the IMS and were directly involved in the implementation of supportive supervision using IMS guidelines in either Ukraine or Afghanistan. Results showed that participants identified the key steps needed for the implementation of supportive supervision and reported two significant barriers to implementation including the stress of a humanitarian crisis leading to competing responsibilities and priorities, staff shortages and time constraints as well as the challenge of creating a new supervision structure when none had existed previously. Overall, participants felt that the IMS resulted in improved knowledge, confidence, perceived support, team cohesion, staff wellbeing and was a helpful blueprint to guide the implementation of supportive supervision in humanitarian contexts.

Prevalence and factors associated with psychological distress among key populations in Nigeria.

Stigmatization and discrimination within healthcare settings deter key populations (KPs) from seeking mental health and psychosocial support (MHPS). Consequently, understanding the prevalence, associated factors, and impact of the MHPSS intervention on psychological distress among Nigeria's KPs is crucial. This is a cross-sectional study focused on KPs, including Female Sex Workers (FSW), Men who have Sex with Men (MSM), and People Who Inject Drugs (PWID) enrolled in Heartland Alliance LTD/GTE across 17 One-Stop Shops (OSS) in six states of Nigeria. Data were extracted from the databases of the OSS. PD was assessed using the Mental Health Screening Form III (MHSF-III). Descriptive statistics and univariable and multivariable binary logistic regression models were done using IBM-SPSS version 28. The prevalence of PD among the KPs was 9.7%. Higher rates were observed among FSWs (12.0%). Of the 22310 KPs, the prevalence of PD was 9.7%. The major dependants of PD include being a PWID with PD prevalence of 8.5% and AOR of 1.95 (95% CI: 0.60-0.98, p = 0.015), alcohol intake with PD prevalence of 97.7% and AOR of 21.83 (95% CI: 15.13-56.83, p<0.001), and having experienced gender-based violence with PD prevalence of 99.0% and AOR of 25.70(95% CI: 17.10-38.73, p<0.001). All Participants (100%) were given brief intervention, and 1595 of 2159 (73.8%) were referred for further psychological intervention. The services with the highest proportion were psychoeducation (21.20%), followed by coping skills training (17.70%) and motivational enhancement (12.90%). The study highlights the critical need for targeted mental health interventions among KPs in Nigeria, primarily focusing on those with a history of substance abuse and gender-based violence. Despite universal brief interventions, the proportion enrolled in further Psychosocial support indicates a need to improve mental health service utilization among the KPs in Nigeria.