Addressing culture and context in humanitarian response: preparing desk reviews to inform mental health and psychosocial support



Greene, M, Jordans, M, Khort, B, Ventevogel, P, Kimayer, L, Hassan, G, Chiumento, AL ORCID: 0000-0002-0526-0173, van Ommeren, M and Tol, W
(2017) Addressing culture and context in humanitarian response: preparing desk reviews to inform mental health and psychosocial support. Conflict and Health, 11 (1). 21-.

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Abstract

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies. Mental health and psychosocial interventions in humanitarian emergencies aim to promote and protect wellbeing, and prevent and treat mental disorders [1]. With growing consensus on best practices, mental health and psychosocial support is increasingly recognized as an essential feature of humanitarian response. However, a challenge for international humanitarian practitioners from different geographic, economic, and socio-cultural origins (i.e., “outsiders”) is ensuring timely service delivery that is appropriate to culture and context [2]. Ignoring information about existing services and socio-cultural context may result in inaccurate assessment methods, ineffective implementation of programs that the population does not want or use, and have potentially unintended consequences [3, 4]. Researchers have documented examples of cases where the provision of culturally inappropriate mental health care or psychosocial support in an emergency has had negative impacts on the target population. For example, in Albania, the provision of gender-based violence counseling to Kosovar survivors of war in the 1990s by a foreign psychologist resulted in public identification of sexual violence survivors, which was regarded as an insult to familial honor that could only be resolved by killing the survivor [5]. In another case, reintegration programs in Angola administered by traditional healers often focused on forgetting ones past; however, outsiders administered psychological debriefing, which encouraged survivors to speak about their trauma history, which may have undermined local approaches to recovery [5]. During a civil war in Nepal, posttraumatic stress disorder (PTSD) treatment programs went unused because the programs did not take language and cultural models of distress into account; the stigma associated with using the culturally oblivious programs was considered worse than the experience of posttraumatic distress [6]. During Sri Lanka’s protracted political violence, widows and other women who lost male relatives participated in mental health humanitarian programs were ostracized by community members because of the perception of violating norms to prevent future violence [7]. Also in Sri Lanka, after the 2004 tsunami many organizations arrived, often uninvited, to deliver psychosocial interventions. These activities generally lacked community consultation, coordination, qualified providers and an evidence-base, which confused and, in some cases, exacerbated distress among community members while also compromising the success of existing local programs [8,9,10]. Despite a general consensus supporting a culturally informed and sensitive response, existing cultural and contextual information is rarely utilized effectively to inform the design of programs delivered in humanitarian emergencies [11]. Academic literature to inform the development, selection and implementation of mental health and psychosocial interventions is generally not available in a format that is accessible and readily applicable by practitioners in humanitarian settings. There is broad agreement in the humanitarian community that secondary analyses of available data should be conducted before primary data collection to rapidly assess existing information, conserve limited resources, and avoid burdening emergency-affected populations by duplicating research [12, 13]. Desk reviews of existing literature are an efficient method to distil available knowledge to assist programmatic decision-making by (1) providing outsiders with a short synthesis of large bodies of literature, (2) delivering a high-quality document produced by experts trained in review methods, and (3) reducing the need for practitioners on the ground to collect background information that diverts time from service delivery priorities. Desk reviews can provide an important first step in achieving balance between internationally recommended interventions and appropriate local practices in situations where outsiders are assisting with mental health and psychosocial response.

Item Type: Article
Uncontrolled Keywords: mental health, psychosocial, humanitarian, emergency, culture, context, desk review
Depositing User: Symplectic Admin
Date Deposited: 26 Jul 2018 08:06
Last Modified: 19 Jan 2023 01:30
DOI: 10.1186/s13031-017-0123-z
Open Access URL: https://doi.org/10.1186/s13031-017-0123-z
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3024169