Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden

E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention called Step-by-Step (SbS) for refugees in Egypt, Germany, and Sweden. We conducted semi-structured interviews (n = 88) with Syrian refugees, and experts in SbS or mental health among refugees in the three countries. Data collection and analysis were guided by a system innovation perspective. Interviewees identified three contextual factors that influenced scalability of SbS in each country: increasing use of e-health, the COVID-19 pandemic, and political instability. Nine factors lay at the interface between the innovation and potential delivery systems, and these were categorised by culture (ways of thinking), structure (ways of organising), and practice (ways of doing). Factors related to culture included: perceived need and acceptability of the innovation. Acceptability was influenced by mental health stigma and awareness, digital trust, perceived novelty of self-help interventions, and attitudes towards non-specialist (e-helper) support. Factors related to structure included financing, regulations, accessibility, competencies of e-helpers, and quality control. Factors related to practice were barriers in the initial and continued engagement of end-users. Many actors with a potential stake in the integration of SbS across the three countries were identified, with nineteen stakeholders deemed most powerful. Several context-specific integration scenarios were developed, which need to be tested. We conclude that integrating novel e-mental health interventions for refugees into routine services will be a complex task due to the many interrelated factors and actors involved. Multi-stakeholder collaboration, including the involvement of end-users, will be essential.

Mental Health and Perceived Social Support of Humanitarian Workers in Bangladesh During the COVID-19 Pandemic

Humanitarian workers are at risk of experiencing emotional distress and mental health problems. The COVID-19 pandemic created additional stress and challenges for staff in ongoing emergencies who had to continue delivering humanitarian assistance. The primary objective of this study was to assess the mental health status of humanitarian staff working in the Rohingya refugee operation in Cox’s Bazar, Bangladesh, amid the COVID-19 pandemic. A sample of 307 national and international humanitarian staff working in person or remotely within the Rohingya refugee operation in Cox’s Bazar anonymously completed an online questionnaire. Outcome measures included 1) the WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings which measures six symptoms related to mental health problems, 2) the Perceived Social Support Questionnaire and 3) questions about help-seeking. The self-reported mental health burden among humanitarian workers was high. The result demonstrates that most participants felt so afraid and severely upset about the emergency/COVID-19 pandemic that they avoided people or places. One in three respondents felt so angry that they were unable to carry out essential activities at least some of the time. Significant differences between national and international staff were found, with national staff more likely than international staff to feel afraid, angry, hopeless and unable to carry out essential activities (all P-values < 0.05). Nearly three out of 10 humanitarian workers reported a lack of social support. Less than one in five had sought professional help, while around half of all respondents indicated that they would want mental health support. The need for mental health support for humanitarian staff in Cox’s Bazar, Bangladesh, during the COVID-19 pandemic was high. It is important to strengthen strategies to proactively make services for mental health support available and accessible to humanitarians, building upon existing structures and allocating appropriate resources.

Priorities for addressing substance use disorder in humanitarian settings.

BACKGROUND: Populations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings. METHODS: UNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies. RESULTS: Participants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical 'do no harm' approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings. CONCLUSIONS: Results from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings.