Psychosocial Care Research Articles

Electronic Health in the Palliative Care Pathway for Patients With Head and Neck Cancer.

The Expert Center of Palliative Care for head and neck cancer offers structural attention to patients' complex physical and psychosocial care needs. Patients are offered remote care, including digital monitoring using patient-reported outcome measures, to enable them to stay as long as possible in their trusted home environment. There is limited literature on qualitative feedback and patient-reported experiences with palliative head and neck cancer care, especially for remote care. To provide optimal palliative care, more information on this is needed. To provide insight into the experiences of patients with head and neck cancer and their next of kin with a hybrid palliative care pathway. A mixed-methods quality improvement study was conducted at a tertiary cancer center. The experiences of patients with head and neck cancer in the palliative phase as of June 2022 and next of kin of patients who had died between June 2021 and March 2022 were evaluated using a patient-reported experience measure that included open-ended questions. Hybrid palliative care pathway. Experiences of patients and next of kin. Of 105 included participants, 54 (51.4%) were male, and the mean (SD) age was 67.2 (12.7) years. A total of 56 participants were patients and 49 were next of kin. The face-to-face consultations on the day of the palliative diagnosis were positively experienced by most patients and next of kin. A total of 42 of 102 participants (41%) and 24 of 79 participants (30%) missed at least 1 topic during consultations with their physician and oncology nurse, respectively, such as discussing life expectancy. During the remote follow-up, 71 of 92 (77%) felt safe with this care: they were able to sufficiently clarify their problems, and if necessary, timely action was taken. However, 17 of 48 patients (35%) and 21 of 46 next of kin (46%) considered the provided psychosocial support to be insufficient. In this quality improvement study, patients and next of kin were satisfied with most aspects of the hybrid palliative care pathway, and remote care seemed to be a promising means of delivery. Key areas needing attention are discussing life expectancy and providing psychosocial support. These insights represent the initial steps toward gaining a deeper understanding of patients' needs during specific moments in a hybrid palliative trajectory. They may support health care professionals in optimizing personalized and value-based palliative care delivery.

Perceptions of nurses from Psychosocial Care Centers (CAPS) about practices performed during home visits

OBJECTIVE: Investigate perceptions about the practices performed by nurses during home visits carried out with patients treated at Psychosocial Care Centers (CAPS). METHOD: This exploratory research with a qualitative approach was carried out with six nurses at CAPS in a countryside city of Southern Brazil. Sociodemographic questionnaires and a semi-structured interview were applied, and the data were analyzed through Content Analysis. RESULTS: Results were organized into three categories: 1) Insufficient training of nursing professionals to work in CAPS; 2) Challenges faced by the nursing team during home visits; and 3) Impacts of the support network on the recovery process of patients. FINAL CONSIDERATIONS: The nurses participating in the study reported not having received adequate training during their undergraduate studies, making it necessary to seek knowledge by their own means. In addition, several challenges were noted during visits, such as patients' resistance to receiving the multidisciplinary team, incomplete or incorrect addresses, patients' absence during home visits, and the difficulty in reaching patients' families. Finally, the importance of family assistance as a support network for users with mental disorders was noted.

Post-traumatic Distress in Adults with Congenital Heart Disease: Protective Factors and Clinical Implications.

Due to various reasons explored in previous studies, adults with congenital heart disease (ACHD) are at risk of developing post-traumatic stress symptoms (PTSS). The aim of this study is to explore multiple potential psychosocial protective factors in ACHD and to understand their role in different complexities of congenital heart disease (CHD) and PTSS. This study was part of the "ABS-AHF" study, where 234 ACHD were recruited from November 2021 to August 2022 at a tertiary CHD care center. Data were collected on PTSS (PDS), resilience (RS-13), sense of coherence (SOC-L9), and social support (F-SozU K-14). The mean scores were 70.55 + / - 12.31 [21-91] for resilience, 35.83 + / - 4.81 [15-60] for sense of coherence (SOC), and 4.30 + / - 0.79 [0.93-5] for social support. SOC (OR, .91; p = .024 [.84; 9.98]) and social support (OR, .48; p = .001 [.29; 7.96]) were shown to reduce the likelihood of PTSS. Low resilience (OR, 2.40, p = .0248 [1.18; 5.18]) seems to increase this likelihood. Integrating parents and relatives early on seems to be an important protective resource. Parental support in childhood affects the development of SOC which is in line with social support related to lower PTSS. With regard to resilience and SOC, a brief and manageable screening option for personal resources is available to refer potentially vulnerable patients to specialized psychosocial care. Care offers should address coping styles and life with CHD. Offering multidisciplinary care, integrating the patient's social network, and education for patients to increase resilience and SOC might provide a way to enhance psychosocial outcomes, quality of life, and adherence in ACHD.

Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession.

Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. To conduct a needs assessment among CCLS and examine the role in hospice and palliative care. CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes. Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

Multilevel Facilitators and Barriers to Healthcare Organization and Delivery among Childhood Cancer Survivors.

Childhood cancer survivors (CCS) are at risk for medical and psychosocial late effects of their disease and its treatment and are recommended to receive annual follow-ups. Yet, rates of follow-up adherence are suboptimal and may be influenced by the organization and delivery of their healthcare. This research aimed to examine experts' perceptions of facilitators and barriers to healthcare organization and delivery to CCS. Thirty-one clinicians and administrators in a comprehensive cancer center's research consortium were interviewed about system-level factors that may promote or deter annual follow-ups among CCS. Interview transcripts were coded and inductively analyzed using a study-specific scheme. Three main themes were identified: (1) healthcare system influences (59%); (2) social determinants of health (25%); and (3) intra/interpersonal factors (16%). Prominent subthemes included age-related changes in the transition of healthcare responsibility that disrupt ongoing CCS care (28.1%), the breadth and quality of psychosocial support available to navigate CCS to follow-up (13.5%), and transportation challenges (24.6%; especially in low-resource areas). In contrast, community trust facilitated follow-up (17.3%). The system of healthcare was prominent in receipt of follow-up by CCS, and further influenced by social determinants of health and intra/interpersonal factors. Easing transitions of responsibility (from parents to CCS, and acute care to survivorship teams) may be beneficial, especially when social determinants of health obstacles are present. Psychosocial wrap-around care is essential, along with promoting staff awareness of obstacles that CCS encounter in low-resource communities.

Key features and current challenges of the Brazilian Psychosocial Care Centers for alcohol and other drugs (CAPS-AD)

Key features and current challenges of the Brazilian Psychosocial Care Centers for alcohol and other drugs (CAPS-AD)

VIOLÊNCIA SEXUAL CONTRA CRIANÇAS E ADOLESCENTES: O OLHAR DA PSICOLOGIA SOB O VIÉS SOCIAL

Taking into account that sexual violence against children and adolescents in addition to the emotional and psychological damage constitutes a violation of this public duty, this study aims to point the psychologist in the psychosocial care of child and adolescent victims of sexual violence. Among the specific objectives, present concepts related to the phenomenon of violence, highlighting its main characteristics, type, statistics in order to highlight one of its forms, sexual violence against children and adolescents; Identify significant psychological harm of sexual violence process in childhood and adolescence; Characteristic of the social psychology emphasizing how was the insertion of psychologists in social protection services. The methodology is bibliographical, from the Virtual Library database in Health Psychology (BVS-Psi), in addition to statistical sources, books and technical guidance documents to professional psychology. It is concluded that the look of psychology under the psychosocial bias shows that the psychologist in cases of sexual violence against children and adolescents is not based solely on psychic phenomena, but through joint work with the Social Protection Service, the psychologist seeks to understand the breaks these subjects and meet their needs through psychosocial approach as well, through the implementation of strategies aimed at minimizing the damage suffered, restore ties and prevent occurrences.

Screening for Psychosocial Distress: A Brief Review with Implications for Oncology Nursing.

Psychosocial care is an integral component of caring for individuals living with cancer. The identification of psychosocial distress has been acknowledged as a hallmark of quality cancer care, and screening for distress standards has been established in several countries. The purpose of this brief review is to highlight recent developments in screening for distress in oncology populations; to provide insight into significant trends in research and implementation; and to explore implications for oncology nursing practice. This paper reports a brief review of the literature from March 2021 to July 2024 on the topic of screening for distress in oncology. The literature was accessed through PubMed and reviewed by two authors. Trends in the topics presented were identified independently and then discussed to achieve consensus. The search within the designated period produced 47 publications by authors in North America, Australasia, and Europe. Topic trends included the design and adaptation of tools for special populations, the use of technology, descriptions of programs, identification of benefits, challenges, and overcoming barriers to screening for distress. Screening for distress is endorsed as part of the provision of quality oncology care. Nurses have an important role in screening individuals at risk for developing psychosocial problems and acting to reduce the associated morbidity. By continuing to be informed and educated about the emerging developments in screening for distress, nurses can understand and overcome barriers to implementation.

A ATUAÇÃO DO PSICÓLOGO NAS PRÁTICAS MULTIPROFISSIONAIS DA GESTÃO DA SAÚDE PÚBLICA

The psychologist’s role in public health management has become essential in providing comprehensive care to users of the Brazilian Unified Health System (SUS). Through a multidisciplinary approach, psychology contributes to understanding the psychological and social demands of individuals, while promoting mental health care strategies that complement medical and social practices. This chapter explores the role of the psychologist in public health, emphasizing their integration into multidisciplinary teams, especially in Psychosocial Care Centers (CAPS) and Primary Health Care. The challenges and potentialities of psychological practice in a context of shared management focused on promoting biopsychosocial well-being will be discussed.

A mindfulness-based intervention for Substance Use Disorder in a Brazilian vulnerable population: a feasibility mixed method study.

Substance Use Disorder (SUD) is a chronic condition that impacts various facets of an individual's life, and society as a whole. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention that can help to prevent relapse, particularly when used as a post-treatment approach. However, although there is significant evidence of its effectiveness in studies from high-income countries (HICs), there is a dearth of studies examining its feasibility and efficacy in low- and middle-income countries (LMICs). Thus, this study investigates the feasibility of MBRP as an adjunct to outpatient treatment for SUD in a socially vulnerable Brazilian population. The study employed a mixed-methods design in eight Psychosocial Care Centers for Alcohol and Drugs (CAPS-ad) in the city of São Paulo, and involved 140 participants, 24 healthcare professionals and 7 CAPS-ad managers. In total, 17 MBRP intervention groups were conducted. The study assessed qualitative indicators of acceptability, demand, implementation, adaptation, integration, and limited efficacy testing through group interviews, in-depth interviews and field diary records. It also included limited efficacy testing of the protocol using a quantitative pre-post pilot study to investigate consumption behavior, using the Timeline Followback (TLFB) assessment method; depression, using the Center for Epidemiologic Studies Depression (CES-D) scale; anxiety, using the state trait anxiety index (STAXI-2); craving, using the Penn Alcohol Craving Scale (PACS); readiness to change, using the Readiness-to-Change Ruler (RCR); and severity of dependence, using the Severity of Dependence Scale (SDS). The qualitative data were triangulated with the quantitative data to comprehensively evaluate the feasibility of the intervention. The sample comprised socially vulnerable participants with a high dropout rate, primarily due to social factors. Despite facing challenges in respect of regular engagement and initial cultural misperceptions of meditation, the intervention showed positive acceptance and mental health benefits, including impacts on consumption behavior. The study emphasizes the importance of adapting the format of the protocol to better suit vulnerable populations, and to ensure its effective integration into the public healthcare system. Future research should explore protocol modifications, assess its effectiveness in different contexts, and conduct cost-benefit analyses for broader implementation.

Perspectives of patients, partners, primary and hospital-based health care professionals on living with advanced cancer and systemic treatment

Abstract Purpose An emerging group of patients lives longer with advanced cancer while receiving systemic treatment. This study aimed to investigate psychosocial aspects of living longer with advanced cancer, and experiences with psychosocial care, from the perspectives of patients, partners, and health care professionals (HCPs). Methods From May to December 2020, participants were purposively selected. In-depth, semi-structured interviews were conducted by video or phone call, containing open questions regarding psychosocial aspects and psychosocial care in oncology. The data was analysed following thematic analysis, leading to overarching psychosocial themes and indications for optimal organisation of psycho-oncological care. Results Fifteen patients, seven partners and eleven HCPs were interviewed. The main psychosocial aspects were increasing loss in several life domains, complexity of making life choices, ongoing uncertainty, and fluctuating fear and hope. Partners were affected by their loved ones’ condition and reported to put themselves second for longer periods of time, while sometimes missing adequate support. HCPs were challenged by addressing the altering psychosocial needs of patients, and tools to identify those in need for psychosocial support are currently lacking. Conclusions Living longer with advanced cancer presents unique challenges for patients and their partners, as well as for HCPs in delivering optimal psychosocial care. Implications for Cancer Survivors Identifying and addressing patients’ psychosocial needs from an early stage on, appointing a central hospital-based contact person, limiting the waiting time between scans and consultations, and addressing the partners’ wellbeing are suggestions to organise optimal psychosocial support in advanced cancer.

Faculty Building for Personalized Medicine and Care

Personalized medicine and care always places the patient at the center and requires psychosocial interprofessional skills. Using the example of personalized care, which is conceived as clinical, biopsychosocial work in an interdisciplinary, care-relevant manner, it is shown why comprehensive and differentiated abilities are required for this activity. According to grounded theory methodology, an interview-study with several experts in the field was carried out in a cyclical research design. As a result, problem definitions and solution concepts suggested to focus existing and development of new curricula or curriculum elements, to focus training processes and students’ qualification profiles for the respective personell-, organizational- development and faculty building. The qualification profile, definitions of learning objectives, as well as their effective implementation and didactic mediation possibilities are empirically reviewed and presented in an overview and exemplary manner. The training is designed to be practice-relevant, patient-centered with sufficient personal reflection skills, which are conveyed through teaching in continuous small groups. Selection procedures and internships take into account the requirements of psychosocial care and academic standards. Workplace-based examinations and case-oriented feedback develop the trainees into professional workers. A priori necessary basic competencies are presented and discussed in order to further elaborate empirical research and curricular strategies. Therefore the respective faculty building can be derived.

Informing Psychosocial Care for Young Couples Coping with Early-Onset Breast Cancer: A Cross-Sectional Examination of Unmet Service Needs and Their Association with Psychological Distress in the First Year Post-Diagnosis.

Objective: Young women diagnosed with breast cancer report greater psychological and physical morbidity than both older women and healthy peers. Similarly, young partners experience elevated cancer-related distress. Psychosocial oncology programs are not frequently attuned to the needs of young adult patients and may exclude their social networks. This marks a critical gap in psychosocial care delivery. The study investigated unmet service needs, psychological distress, and care preferences of young couples managing breast cancer in the first year post-diagnosis. Methods: Forty dyads (n = 80) of women aged 18-45 and their partners completed measures of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and a service use questionnaire adapted from previously published Adolescent and Young Adult (AYA) literature. The resulting 25 items assessed perceived care needs and service utilization across three domains: informational, emotional/supportive, and practical issues. Descriptive statistics, cross-tabulations, and bivariate correlations were computed. Actor and partner effects of unmet needs on mental health outcomes were investigated with generalized estimating equations (GEE). Results: Patients and partners were in their late thirties, mostly non-Hispanic White, married, highly educated, and employed. Approximately 60% of patients and 43%-66% of partners presented one or more unmet service needs, which correlated with greater distress. Unmet needs about information related to exercise, recurrence, nutrition, and symptom management were prevalent. Unmet supportive service needs of both patients and partners included age-appropriate programs, sexual health, and family counseling. Women reported practical needs for work/school accommodations, integrative care, financial issues and health coverage; while financial concerns, health insurance, and caregiving demands were priorities for partners. Conclusion: Young couples facing early-onset breast cancer experience large proportions of unmet service needs. These challenges were exacerbated by the lack of developmentally targeted psychosocial programs pertaining to informational, supportive, and practical care needs. Enhancing providers' understanding of the psychosocial issues affecting young couples' well-being, and the implementation of systematic procedures to detect and respond to their distress, is urgently needed.

Experiences and the psychosocial situation of parental caregivers of children with spinal muscular atrophy against the background of new treatment options: a qualitative interview study

BackgroundSpinal muscular atrophy is a rare neurodegenerative disorder in children which leads untreated to muscle wasting, respiratory impairments, and a shortened life expectancy. Parents as primary caregivers are often physically and psychologically burdened. In recent years, new and promising treatment options have been approved, but it remains unclear if they have an impact on the psychosocial situation of affected families.ObjectivesThe aim of this study was to explore the views and experiences of parents as informal caregivers of children with SMA in the course of the disease against the background of new treatment options (Spinraza® or Zolgensma®).MethodsWe conducted qualitative interviews with 27 parents of children with SMA treated with Spinraza® and Zolgensma® from April to September 2020. The analysis was done using thematic analysis and reported according to the COREQ criteria.ResultsThe data analysis resulted in three main themes: a) caregiver burden and negative consequences for families, b) resources and protective aspects, c) psychosocial care needs. The results are discussed against the background of new treatment options and previous models of supportive care needs. Parental caregivers of affected children face multiple burdens in different stages of the child’s disease progression.ConclusionAlthough new treatment options for SMA showed observable effects for most parents, the main caregiver burden and reported symptoms were attributable to the overburdening care tasks. To unburden families, more screening for unmet needs, family-centered help services, professional caregivers, childcare, and sufficient financial support are needed.

The Effect of Mindfulness-Based Stress Reduction on Pediatric Oncology Nurses' Stress Level, and Pediatric Oncology Patients' Psychosocial Symptoms and Care Satisfaction: A Prospective Non-Randomized Trial.

Studies investigating the effects of relaxation practices on nurses and patient outcomes are limited. This study aimed to evaluate the impact of Mindfulness-Based Stress Reduction (MBSR) on pediatric oncology nurses' stress levels, as well as the psychosocial symptoms and care satisfaction of pediatric oncology patients. A non-randomized prospective study with a pretest-posttest design was conducted, involving 112 children and 8 pediatric oncology nurses between November 2021 and August 2022. The study was conducted in 3 stages. First, the children's nursing care satisfaction and psychosocial symptoms were evaluated during the first 3 months before the MBSR intervention. Second, the nurses participated in the MBSR program for 2 months. Third, the children's nursing care satisfaction and psychosocial symptoms were assessed again 3 months after the MBSR intervention. The results showed that children who received nursing care post-MBSR had lower scores in the Psychosocial, Hopelessness, and Communication Difficulty subscales compared to those who received care pre-MBSR. Additionally, these children had higher scores in Evaluation of Quality of Care from the Children's Point of View, Psychosocial, Physical, and Information subscales. There was a significant reduction in the stress levels of nurses between the pre-MBSR and post-MBSR assessments. MBSR is an effective method for reducing pediatric oncology nurses' perceived stress levels and should be utilized to support both pediatric oncology nurses and patients in enhancing their psychosocial functioning.

The Importance of Honoring Family Caregiver Burden: Challenges in Mental Health Care Delivery.

There is growing recognition of the profound mental health challenges faced by the 53 million U.S.family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.

MENTAL HEALTH-ILLNESS PROCESS IN THE CONCEPTION OF PSYCHOLOGY GRADUATES

The objective was to understand, based on the narratives of students from an undergraduate psychology course, the social representation regarding the mental health and illness process. This is narrative research carried out at a public university in Bahia. Data collection took place online, using an electronic form made available in 2021, for data analysis dialectical hermeneutics was used. 34 students participated in the study. The results were presented in two empirical categories: biomedical model in the mental health and illness process and social determinants model in the mental health and illness process. The students narrated their social representation about the mental health and illness process, both from a perspective that favors the biomedical model and based on the psychosocial care model. Considering the analysis carried out, there is an urgent need for undergraduate courses in Psychology and other courses in the health field to review their curricula in order to meet the precepts of the Brazilian Psychiatric Reform, making use of mandatory and optional components with active methodologies of teaching-learning that address the topic, thus aiming to resolve stigmatized conceptions in the field of mental health and prepare professionals who base their work on the precepts of psychosocial care.

Guidelines Within And For Public Health Services: Results Of An Online Survey On Current Practical Needs

Evidence-based guidelines are recognized and well-established in everyday medical practice. However, in the Public Health Service (PHS), evidence-based guidelines are not yet widely available. To promote the development of guidelines within and for the ÖGD, the Federal Joint Committee (GBA) issued a funding directive in June 2024. This study presents the results of an online survey on the prioritization of guideline topics in the ÖGD, conducted by the German Society for Public Health Services (DGÖG). The survey focused on 17 guideline topics proposed by the GBA, which were divided into six task areas. Out of over 900 participants, comprehensive responses from nearly 500 respondents were analyzed, 85% of whom work in local health departments. The results showed that all 17 guideline topics were assigned high or very high priority. Particularly frequently prioritized were the areas of infection hygiene monitoring, medical expert assessment, and psychosocial emergency care. Additionally, experts highlighted dental screening, health literacy on oral health, and monitoring of drinking and bathing water. The qualitative analysis further identified additional relevant topics, including health reporting and planning, health promotion and prevention, child welfare, as well as crisis management and communication. The survey provides insights into the priority topics for guidelines as perceived by practitioners and ÖGD researchers. The results underscore the significant need for evidence-based guidelines in and for the ÖGD and provide valuable insights for further development and prioritization.

What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?

To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care. Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding. There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%). Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.

What matters for sustainable psychosocial interventions and who decides? Critical ethnography of a lay counselling program in Nepal

Lay counselling, or the delivery of talk-based therapeutic support by people without a clinical degree, is gaining popularity as a way of addressing global shortages of mental health professionals. In Nepal, lay counselors have made significant contributions to mental health and psychosocial care over the last two decades, particularly in the aftermath of major emergencies. However, research on the longer-term integration and sustainability of lay counselling interventions remains limited. This ethnographic study explored the meaning and importance of sustainability to different stakeholders in a lay counselling program implemented following Nepal’s 2015 earthquake. We conducted participant observation in the everyday lives of five counsellors as well as four focus group discussions and 51 semi-structured interviews with counsellors and other key stakeholders. Our analysis revealed significant discrepancies in perceptions of sustainability; while organizations involved in implementing the program described it as a sustainability success due to continued government financing, counsellors emphasized their own and the government’s failure to sustain high-quality service delivery in practice. Program-level barriers included inadequate budget and remuneration, lack of clinical supervision, and poor integration within existing systems. We also identified wider sociopolitical influences on sustainability, including the social positioning of counsellors, low understanding and acceptability of counselling, and a rapidly changing political landscape. These findings reveal the need for a critical approach to sustainability in global mental health, warning against superficial engagement that prioritizes continuity of government financing over quality of care and workers’ rights. Advocating for an ecological orientation within sustainability research, we also discuss the importance of looking beyond program design factors to consider how local and national sociopolitical dynamics influence frontline service provision.