This special issue of ‘Intervention’ focuses on programmes for mental health and psychosocial support in three very different war affected contexts: Bosnia-Herzegovina, Sierra Leone and Syria. In this introduction to the issue, the editors present the three case examples and provide reflections on what we can learn from them. They argue that the rather narrow focus of initiatives in global mental health on rapidly scaling up essential psychiatric services needs to be complemented by attention to contextual factors, particularly in relation to (post) conflict settings. They stress the importance of 1) using a thorough contextual analysis that includes a wide range of perspectives of stakeholders at various levels; 2) using a broad public mental health approach that goes beyond treatment of people with mental disorders and focuses on prevention and resilience building; 3) giving attention to meaning making processes and elements, such as justice, reconciliation and reparation; and 4) conceptualising the process of evaluation as an iterative and multidimensional process that is most functional when designed in tandem with programme formation, and which follows and interacts with programme developments.
November 2013 - Volume 11 - Issue 3
From the editors... Introduction to a Special Issue: long term perspectives on mental health and psychosocial programming in (post) conflict settings
Mental health of refugees and displaced persons in Syria and surrounding countries: a systematic review
Over the past two years, Syria went from being the third largest refugee hosting country in the world to the largest refugee producing country. This article provides the findings of a systematic literature review on the mental health and psychosocial support context, and the mental health profile of refugees (primarily Iraqi) and civilians in Syria. This review covers two periods: the complex refugee emergency that started in 2006 as a result of war in Iraq, and the current internal displacement and acute complex emergency starting in 2011. The systematic review of the published and grey literature on the mental health profiles of Iraqi and Syrian refugees and those Syrians who have been internally displaced includes complementing analyses of the needs and resources of different affected populations, using assessment results from Syria and surrounding refugee hosting countries. The problematic lack of recent literature is noted, and the need for more rigorous assessments, applied research and accessible grey literature identified.
Mental health, forced displacement and recovery: integrated mental health and psychosocial support for urban refugees in Syria
This article describes a pilot mental health and psychosocial support programme that was initiated by the United Nations High Commissioner for Refugees, after the massive influx of Iraqi refugees into Syria in 2006. The aim of the article is to provide: 1) an overall description of the programme for refugees within an urban setting, including initial outcome data; and 2) a description of applying a theoretical model to influence programme design and evaluation. This programme, based on good practice, began in 2008. The programme staff implemented a three-fold approach, which included: comprehensive mental health and psychosocial support case management; community outreach and a psychosocial centre to provide a safe healing space; and inter-agency mental health and psychosocial support capacity building of the local mental health system and within the displaced community. The different components were eventually transferred at the end of 2011 to national ownership, in order to ensure national system building, ownership and sustainability. The programme has since been adjusted to apply to the recent acute internal emergency. Results of mixed-method monitoring and evaluation show significant outcomes, including reported improvement in wellbeing among programme participants.
Healing through sharing: an outreach project with Iraqi refugee volunteers in Syria
In 2003, civil conflict and war broke out in Iraq, leading to the displacement of millions across the region. This report describes a project initiated by UNHCR, the UN Refugee Agency, in 2007 that sought to draw on the skills and experiences of Iraqi refugee women, in Syria, in order to assist in identifying and supporting the most vulnerable refugees in the population. Among the 180 Iraqi outreach refugee volunteers were teachers, doctors, psychologists, artists and others. These women assisted more than 6000 refugees every month, with remarkable outcomes for the community, the aid operation, and their own wellbeing.
Personal reflections on a psychosocial community outreach programme and centre in Damascus, Syria
This personal reflection describes the experiences of a Syrian psychologist who works as a (volunteer) supervisor of the mental health and psychosocial support programme of the UN Refugee Agency in Syria. Her reflections touch on the importance of psychosocial community outreach and an outreach counselling centre. The author also reflects on her background, motivation and challenges, as well as the impact of the current situation. She also highlights the impact of the transition of the programme from United Nations High Commissioner for Refugees to a national partner organisation.
Painting glass as a psychosocial intervention: reflections of a psychosocial refugee outreach volunteer in Damascus, Syria
This personal reflection describes the experience of a psychosocial refugee outreach volunteer in Syria. Born and raised in Iraq, the author fled with her family to Syria in an attempt to escape the violence. Trained as an English teacher and educational psychologist in her home country, she volunteered to help other refugees in Syria and describes this as challenging, but very rewarding. Key factors to be able to continue her work are the importance of weekly supervision and being part of a team. Her work includes the facilitation of peer support groups, including groups where participants learn practical skills, such as painting glass objects. As well as providing refugees with some additional income, they also benefit from the mutual support they receive.
Inter-agency coordination of mental health and psychosocial support for refugees and people displaced in Syria
The current crisis in Syria has greatly escalated need, while simultaneously damaging infrastructure within the country. In order for humanitarian efforts to be effective, understanding the mental health profile of the population concerned, pre-existing mental health system, resources and gaps, as well as an evaluation of the current service situation is vital. This paper provides an analysis of the shifting resources and infrastructure available to the affected populations in Syria, complementing the systematic review of mental health outcomes elsewhere in this issue. Assessment results from Syria are presented, and capacities and gaps assessed. This article describes how previous, protracted humanitarian and development centred inter-agency efforts to evaluate and improve the mental health and psychosocial system in Syria can be applied as a foundation, and adjusted to address the current internally displaced persons and refugee crises in the country.
The ADAPT model: a conceptual framework for mental health and psychococial programming in post conflict settings
There is a growing consensus concerning the scope and components of mental health and psychosocial interventions needed to assist populations exposed to mass conflict. The Adaptation and Development after Persecution and Trauma (ADAPT) model offers a unifying, conceptual framework to underpin policy and practice in the field.
The Swedish support to Bosnia Herzegovina: rebuilding mental health services after the war
In the aftermath of the war in Bosnia Herzegovina, a task group of Swedish experts organised and supported training of community psychiatry and social work as part of the mental health reform. Among the basic principles of the programme were a close cooperation with the Ministry of Health, personal continuity, exchange of knowledge and long term engagement. With the support of the programme, community mental health centres were created and staffed with a team consisting of: a psychiatrist, four nurses, a psychologist and a social worker. They catered, on average, for 65,000 people of all ages and saw 25–30 patients a day. Of these patients, 75% had psychiatric problems. Among the trained personnel, a major attitude shift occurred in favour of community psychiatry. As a result of the training, informal networks between local professionals were established. An evaluation, four years after the project ended, found that the community mental health centres were the major providers of psychiatric services in the region.
Mental health capacity building in northern Sierra Leone: lessons learned and issues raised
Ten years after a brutal and protracted war, Sierra Leone remains very much in recovery. Despite the need for increased and long term mental health services, such resources remain scarce. Mental health capacity building is required, and includes: the community sensitisation of mental illness and treatment; the training of health professionals and lay persons; the advocacy for changes in national mental health policy; and the provision of mental health services. The authors worked during a two-year period (2010 – 2012), supporting a community mental health capacity building project in northern Sierra Leone that was designed to address these issues. A study was conducted among different agency and community stakeholders to assist in the end-of-cycle programme evaluation. The results illustrate the broader challenges of providing mental health services in the county, and a discussion of issues and challenges that are likely to be applicable to similar projects in Sierra Leone, and other low or middle income countries, is provided.