Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

Figures & data

Table 1.  Structure and Participants in Nine Focus Groups

	Capitals	Humanitarian settings
Peru	Pcap:	Phum:
	n = 13 (4M/9F)	n = 9 (4M/5F)
	Predominantly psychologists (10), but also a lawyer, teacher, and policymaker	All participants were trained as psychologists, and some worked additionally as lawyers, teachers, and managers with the UN or INGOs
	Participants worked with the government (3), INGOs (4), universities (2), and the UN (1), some in combination (3)
		Participants worked with the government (3), INGOs (3), universities (2), and the UN (1)
Uganda	Ucap:	Uhum1:
	n = 10 (4M/6F)	n = 10 (7M/3F)
	Group divided between participants with senior positions in government health care (4), academic affiliations (3; psychiatry, psychology, medical anthropology) and senior/managerial positions in NGOs (3)	Majority of participants working with NGOs (6)
		Others (4) employed by the government (psychiatrist, clinical officer, and nurse) or Gulu University
		Uhum2:
		n = 12 (9M/3F)
		Majority of participants working with NGOs in diverse positions (7; child protection, education, mental health)
		Others (5) working as psychiatric clinical officers within government health centers
Nepal	Ncap1:	Nhum1:
	n = 17 (8M/9F)	n = 16
	Large group of participants associated with NGOs/INGOs (10)	All participants working with organizations involved in assisting populations affected by the Koshi floods, either with NGOs (12) or the government (4)
	Others affiliated with universities (4) or the government (3)
	Ncap2: n = 14 (8M/6F) All researchers working at the national level, with all but one affiliated with NGOs/INGOs
		Nhum2:
		n = 13 (7M/6F)
		All psychosocial care providers working with the designated agency active in providing psychosocial care in the Bhutanese refugee camps

F, female; INGO, international nongovernmental organization; M, male; NGO, nongovernmental organization; UN, United Nations.

Table 2.  Overview of Prioritized MHPSS Research Themes in Humanitarian Settings

Research theme	Focus group	Priority rankings (1–10)	Examples of research questions proposed by participants
Assessing the prevalence and burden associated with mental health and psychosocial problems	Pcap	6	“How can psychiatric diagnostic procedures for people affected by disasters be improved?”
	Phum	7	“What kind of psychosocial problems emerge or worsen after a disaster? How do they affect different subgroups of the population?”
	Ucap	2, 4, 5, 6	“What is the biopsychosocial impact of climatic change?”
			“What are the mental health challenges associated with epidemics and emerging diseases?”
	Uhum1	1, 6, 8, 9	“What are the long-term mental health and psychosocial effects of children being exposed to armed conflict?”
			“What is the burden of mental illness in crisis-affected populations, and what are the costs associated with that burden?”
	Uhum2	7, 10	“What is the relationship between livelihood and mental health/psychosocial well-being?”
	Ncap1	1	“What are the prevalences of mental disorders in humanitarian settings?”
	Ncap2	1, 2, 3	“Which population groups have suffered the worst mental health and psychosocial impact due to the armed conflict?”
			“What are the specific mental health and psychosocial problems of internally displaced people?”
	Nhum1	1, 4, 5, 6	“What are the most common mental health and psychosocial problems, along with their causes, in humanitarian settings?”
			“How many people have psychosocial problems in humanitarian settings?”
Improving MHPSS implementation	Pcap	1, 2, 3, 7, 9, 10	“How can community participation in interventions best be secured?” “How can emotional support for disaster-response teams be put in place during and after interventions?”
	Phum	1, 5, 6, 8, 10	“What mechanisms contribute to optimal coordination between institutions (public and private) involved in emergency response and reconstruction?”
			“What mechanisms help to ensure sustainability of all activities done by all institutions (NGOs and aid workers) and to transfer them successfully to the relevant health authorities?”
	Ucap	7, 8, 9	“What is the role of traditional systems in mental health care, justice, conflict resolution, and psychosocial support?”
			“How can health systems be strengthened in an integrated fashion for provision of mental health care and psychosocial support?”
	Uhum1	2, 3, 7	“How do we care for the carers (including mental health workers as well as families and communities caring for those with mental illnesses)?”
			“To what extent are traditional healers (both herbalists and spiritual healers) involved in treating mental health and psychosocial problems?”
	Ncap1	2, 4, 6, 7, 9, 10	“What are the currently existing services for mental health?”
			“What role is played by civil society in addressing mental health and psychosocial issues in humanitarian settings?”
	Nhum1	2, 3, 8	“What are people's expectations and interests with regard to mental health and psychosocial support in humanitarian settings?”
			“Which organizations are currently providing mental health and psychosocial services?”
	Nhum2	1, 2, 3, 5, 6, 7, 10	“Which generic tools and techniques may be used by service providers in humanitarian settings to improve mental health and psychosocial well-being?”
			“What are appropriate methods to raise awareness on mental health and psychosocial issues in communities affected by disasters?”
Evaluating MHPSS interventions	Pcap	4, 5	“To what extent and through which mechanisms are interventions effective?”
			“What are participants’ views on the effectiveness of interventions?”
	Phum	4, 9	“How are parents and the social environment influenced by psychosocial activities conducted with children?”
			“How can we highlight the results that occur through interventions in the community?”
	Ucap	1, 3, 10	“What intervention models of care are effective in postconflict situations in Uganda?”
			“What models of care (traditional and modern) are effective in rehabilitation and resettlement of orphans and vulnerable children?”
	Uhum1	5	“What are the most effective interventions for treating and preventing mental disorders and psychosocial distress?”
			“How can we effectively monitor and evaluate the various types of interventions?”
	Uhum2	1, 8, 9	“Which interventions actually contribute to psychosocial well-being?”
			“What is the relative efficacy of traditional treatments and modern treatments in humanitarian settings?”
	Nhum1	7, 9, 10	“What are the most effective awareness-raising programs?”
			“What are people's perceptions regarding mental health and psychosocial support after receiving services?”
Risk and protective factors	Uhum1	4, 10	“How does substance abuse contribute to mental illness?”
			“What is the relationship between general humanitarian aid and mental health/psychosocial well-being?”
	Uhum2	2, 3, 4, 6	“What is the relationship between armed conflict and breakdown in cultural norms?”
			“What are the main causes for the high level of neurological problems seen in northern Uganda?”
	Ncap1	3, 5, 8	“What are relevant cultural practices, and how do they affect mental health and psychosocial well-being in humanitarian settings?”
			“How do issues of reconciliation, recovery, and reintegration affect mental health and psychosocial well-being in humanitarian settings?”
	Ncap2	4, 5, 6, 7, 8, 9, 10	“What is the impact of domestic violence on mental health and psychosocial well-being in humanitarian settings?”
			“What are the coping strategies used by people in humanitarian settings, and how do they affect mental health and psychosocial well-being?”
	Nhum2	4, 8, 9	“How does gender affect mental health and psychosocial well-being in humanitarian settings?”
			“How does stigma affect mental health and psychosocial well-being in humanitarian settings?”
Improving research methods and processes	Pcap	8	“What are appropriate methods for conducting research on disaster-affected populations? For example, how could quantitative research be supplemented with qualitative data?”
	Phum	2, 3	“What qualitative result indicators can be used to highlight the successes of our postdisaster intervention projects?”
			“How can we measure the positive impact of play areas and care areas offered to children in emergency situations?”
	Uhum2	5	“What are appropriate indicators for psychosocial well-being in both adults and children?”

MHPPS, mental health and psychosocial support; NGO, nongovernmental organization.

Figure 1.  Research priorities: agreement on context, disagreement on process.