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Mental Health and Psychosocial Support in Humanitarian Settings

Mental Health and Psychosocial Support in Humanitarian Settings. Current Evidence & Future Research Priorities. Timetable. 11.45 – 12.30 Presentation 13.30 – 15.00 How to link practice & research – A Delphi exercise 15.00 – 15.30 Afternoon Tea 15.30 – 16.15 Delphi continued.

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Mental Health and Psychosocial Support in Humanitarian Settings

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  1. Mental Health and Psychosocial Support in Humanitarian Settings Current Evidence & Future Research Priorities

  2. Timetable 11.45 – 12.30 Presentation 13.30 – 15.00 How to link practice & research – A Delphi exercise 15.00 – 15.30 Afternoon Tea 15.30 – 16.15 Delphi continued

  3. Presentation Overview • Three Questions • What happens in practice? • For what do we have evidence? • What are the research priorities? • Recommendations

  4. Popular Practices • Consensus exists on best practices • Mental Health and Psychosocial Support (MHPSS) is "any type of local or outside support that aims to protect or promote psychosocial wellbeing and/or prevent or treat mental disorder" The Sphere Project, 2011 IASC Guidelines, 2007

  5. E.g. Psychiatrist/ psychologist provides specialized care E.g. person to person support, basic mental health care in PHC E.g. facilitating culturally appropriate support for mourning/ bereavement E.g. making sure that food supplies are safely accessible for all and do not discriminate based on gender/caste/religion/ethnicity/ etc Specialized services Focused non-specialized supports Strengthening community and family supports Social considerations in basic services and security • International consensus favours • Multi-layered systems • Care integrated across sectors • Participation of affected populations IASC, 2010

  6. But…what happens in practice?

  7. Acknowledgements

  8. Funding Grey literature study1 • Searched for reports of MHPSS practice • 2007 – 2010 • All reports mapped on the Who does What Where until When (4Ws) 1 Tol et al, Lancet In Press

  9. Specialized services Focused non-specialized supports Strengthening community and family supports Social considerations in basic services and security 1. Basic counseling for individuals 39.4% 5. Basic counseling for groups families 20.0% 2. Facilitating support for vulnerable individuals 23.1% 3. Child-friendly spaces 21.3% 4. Supporting community-initiated supports 21.3%

  10. Lots of attention for structured social activities and counseling Little emphasis on specialized services • Similar picture in three recent humanitarian settings (Nepal, Jordan, Haiti)

  11. Primary education Medical services Social services STD Control & distress relief Funding • Tracking of the Financial Tracking Service and Creditor Reporting System for 2007 - 2009 • MHPSS is largely funded outside of national mental health, social service or education systems Top 10 categories MHPSS funding (together 79% of funding)

  12. What happens in practice? • In short: • Dominantly non-specialized and community based social supports • Implemented and funded outside of national systems

  13. And…for what do we have evidence?

  14. Evaluation of MHPSS • UNICEF guide on monitoring and evaluation • For evaluation, recommends: • Having a baseline • Having a comparison group

  15. Funding Systematic Review and Meta-Analysis1 • Inclusion criteria • No language/ date limitations • All ages • LAMIC countries • Controlled or randomized controlled • 32 studies with control group identified 1Tol et al, 2011 Lancet

  16. Specialized services Focused non-specialized supports Strengthening community and family supports Social considerations in basic services and security 43.0% (n=9) 28.1% (n=9) 62.5% (n=20) 52.0% (n=11) 9.4% (n=3) 5.0% (n=1) 0.0% 0.0% 21 RCTs 32 in total

  17. Meta-analysis with children & adolescents • PTSD (5 comparisons) • No overall significant effect, high heterogeneity • Internalizing symptoms (8 comparisons) • Overall significant effect, but high heterogeneity

  18. Meta-analysis • Meta-analysis with adults • PTSD (9 comparisons) • Overall significant effects of treatment • Limited heterogeneity

  19. Meta-analysis with children & adolescents • PTSD (5 comparisons) • No overall significant effect, high heterogeneity • Internalizing symptoms (8 comparisons) • Overall significant effect, but high heterogeneity

  20. Specialized services Focused non-specialized supports Strengthening community and family supports Social considerations in basic services and security For what do we have evidence? • In short: • Better knowledge for more specialized interventions • More complex results as we move down the pyramid

  21. What are the main research priorities?

  22. Funding MH-SET • Mental Health and Psychosocial Support in Humanitarian Settings – Research Priority SETting (MH-SET) • Step 1: Focus Group Discussions • Step 2: Generating & scoring research questions Tol et al, PLoS Med 2011; Tol et al, Harv Rev Psychiatry In Press

  23. Acknowledgements

  24. MH-SET Step 1 • Focus Groups in Peru (n=2), Uganda (n=3), Nepal (n=4) • In capitals and remote humanitarian settings; diverse participants • Asking about research priorities/ barriers-facilitating factors for research

  25. MHSET Step 1 Local relevance of measures Reliable & valid measures Importance locally Universal lessons Implement immediately Time to analyze fully Relevance Excellence • Outcomes: • Agreement on priority themes for research • Disagreement research processes

  26. MH-SET step 2 • Advisory group (n=136), representative of humanitarian settings, each generated 5 research questions (total n=654) • Compiled into list of 74 research questions • Research questions rated by 72 people, based on 5 criteria: • Significance • Answerability • Applicability • Equity • Ethics

  27. What research has top priority? In short: • Emphasis is strongly on (a) research that can immediately benefit practice, (b) sensitivity to local perspectives and participation • Major academic debates score low • E.g. only 6% of original list of 733 questions is trauma-focused • Distinction distress and universality of diagnostic categories in bottom 10

  28. Conclusions • Large gap between what is popular in practice and evidence for effect • Researchers focus on issues that are not relevant for practitioners • Person-to-person and clinical supports • PTSD as outcome • Growing evidence base, but interventions can not simply be assumed effective

  29. Recommendations for practice • More focus on sustainability integrate programs in national health and social service systems from early recovery onwards • Better financial tracking necessary • More emphasis on care for severe mental disorders • "Get Evidence Into Practice" • Strengthen collaboration with research partners • More funding for M&E practices as part of programming • Expand M&E from outputs to outcomes/ impacts • Treatments that have been shown effective should be made more available, where applicable

  30. Recommendations for research • "Get Practice Into Evidence" • Prioritize MH-SET agenda • Capacity building and involvement of practitioners • Evaluate care for severe mental disorders • Evaluate programs at the bottom of the pyramid

  31. How to connect Practice and Research to strengthen MHPSS:Delphi Exercise

  32. Step 1 • Split up in smaller groups (to reach group size of 10-12) • Take 20 minutes to discuss: • Successes and challenges: experiences of how researchers and practitioners interacted/collaborated particularly well or poorly

  33. Step 2. Take 20 minutes to make a list of strategies that you feel are the most important to strengthen the connection between research and practice Take 20 minutes to score these Describe why you scored like this

  34. Step 3 Present statements and explanations (30 - 45 minutes)

  35. Step 4. • Combine all statements • Each individual scores again, taking into account the discussion of the group (30 minutes): • 5 ‘Beans’ • Each (covered) glass represents a statement • Put a bean in each glass that you feel is a crucial strategy

  36. Step 5. Is there any consensus on the top 10 strategies?

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