The impact of mental health & psychosocial programmes for adults affected by humanitarian emergencies

As part of EvidenceAid's Humanitarian Evidence Week (#HEW2017), Kelly Dickson and Mukdarut Bangpan from the EPPI-Centre, Social Science Research Unit, UCL Institute of Education, contribute to our #MHPSSMatters campaign by discussing their recently published report. The full report is available as a MHIN Resource.

Events leading to humanitarian emergencies continue to rise. In 2015 alone, 103 million people were affected by natural disasters and 65.3 million were forcibly displaced from their homes by conflict and violence. We know that in addition to physical, environmental, and financial costs, humanitarian emergencies can impact a person’s mental health and psychosocial wellbeing. While many programmes have been designed to reduce negative impacts and provide support to affected populations, our knowledge of what works can quickly become out of date. To generate a more recent evidence base,  Oxfam and the Feinstein International Center humanitarian evidence programme, commissioned us to draw together draw together primary research on mental health and psychosocial support (MHPSS) programmes for people affected by humanitarian crises in low- and middle-income countries (LMICs).

The MHPSS evidence base

We found twenty outcome evaluations, published since 2004, which randomly assigned people to a group which received an MHPSS programme or one that received another type of support or ‘usual care’ and compared their findings. The majority of programmes were delivered to adults affected by armed conflicts compared to those exposed to natural disasters. Programmes were most likely to offer short term 1:1 talking therapies (e.g. cognitive behavioural therapy, narrative exposure therapy, counselling etc.) of between 4-13 sessions, for 1-2 hours, and delivered over a maximum of three months. 

MHPSS programmes can support the mental health of adults exposed to armed conflict and natural disasters

When statistically combining the findings from all studies we found that MHPSS programmes can reduce symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety.  However, we are unable to draw any conclusions on whether gender or other psychosocial stressors (e.g. family conflicts, grief and loss, domestic violence, or poverty) influence whether people’s mental health and psychosocial well-being improved or not. Neither did further exploration of the study findings reveal whether types of MHPSS programmes or their length and intensity reduce or increase their intended impacts.

What next?

Although there is a growing evidence base showing a positive trend in favour of delivering MHPSS programmes to adults, further evidence is needed to develop our understanding of how programmes work and why. This gap could be filled by conducting evaluations investigating providers’ and participants views of programmes alongside evaluations of impact; analysing findings by gender or other relevant factors; or exploring whether improvements in people’s mental health and psychosocial well-being are sustained when programmes are scaled up. Clear evidence gaps were also identified that need to be met, such as whether MHPSS delivered immediately after disasters (e.g. Psychological First Aid) are effective, and whether basic services and security programmes can also support people’s mental health and psychosocial well-being in times of crises. The current attention of MHPSS programmes remains largely focused on clinical mental health symptoms, however further consideration could also be given to psychological well-being that falls outside of this remit, such as substance misuse or suicidal ideation, in addition to strengthening resilience, social support networks, and coping strategies. 

How did we get these findings?

We conducted a comprehensive search of 12 bibliographic databases and 25 websites. Evaluation studies employing prospective experimental and quasi-experimental studies, published in English from 1980 onwards were included if they reported empirical data on the impact of MHPSS programmes.

Acknowledgements

The research was funded by The Humanitarian Evidence and Communications Programme (HEP), a partnership between Oxfam and the Feinstein International Center, Tufts University on behalf of the Department for International Development. To find out more about the systematic review and evidence on the effectiveness of programmes for adults and children, please see the evidence summary of the full report.