Mental Health and Psychosocial Support

USAID’s Victims of Torture Program works to provide direct services to survivors, their families, and communities; and to strengthen the capacity of country-based institutions to deliver services to survivors.

With funding from USAID’s Victims of Torture Program, HEARD will carry out a set of activities that aim to strengthen the evidence base and accelerate data liberation and evidence use related to community-level mental health and psychosocial support (MHPSS) interventions. Activities will include: (1) Funding studies to better understand the effectiveness and implementation of community-level MHPSS interventions, with an emphasis on the PSS intervention components and impacts; (2) Supporting a Cross-Study Learning Collaborative to facilitate connections and coordination across study teams and between study teams and technical and policy partners at the local, national, regional, and global levels, fostering joint learning and evidence advocacy and uptake; and (3) Establishing an implementation science collaborative network on MHPSS, which is connected to existing MHPSS communities of practice and networks, and that facilitates real-time research agenda development and implementation science support.

Learn more about the Mental Health and Psychosocial Support Studies below:

The focus on PSS levels of the ‘intervention pyramid’

One of the biggest challenges facing victims of torture (VOT) and those living in emergency contexts, is the lack of mental health care and psychosocial support in the areas that they live. MHPSS interventions are commonly used by non-governmental and humanitarian organizations in challenging settings to improve psychosocial wellbeing and mental health. Whereas mental health interventions target treatment of mental disorders (levels three and four of the pyramid), psychosocial support interventions target prevention of disorders and promotion of psychosocial wellbeing (levels one and two of the pyramid). There is growing evidence on the importance of a continuum of MHPSS service options, however the evidence base on the effectiveness of PSS interventions has lagged behind that of mental health interventions. HEARD-supported studies in this area will focus on PSS intervention effectiveness/level two interventions.

The Inter-Agency Standing Committee Reference Group (IASC RG) is a body of more than 30 members, including UN and International Agencies, academics and non-governmental organizations dedicated to establishing guidelines and promoting best practices in MHPSS. In 2017, the IASC RG published a Common Monitoring and Evaluation Framework to guide the assessment, research, design, implementation, monitoring, and evaluation of MHPSS programs in emergency settings. Included in the framework is the intervention pyramid for MHPSS (See Figure 1).

PSS Interventions: Gaps in the Evidence

A recent systematic review of evaluations of PSS programs in low- and middle-income countries (LMICs) assessed what is known about the effectiveness of PSS programs to guide future research on PSS implementation and effectiveness in humanitarian settings. The systematic literature review, paired with a series of interviews and meetings to solicit key stakeholders’ perspectives on PSS research priorities, found the need to: 1) apply principles of community-based PSS to evaluation of programs, 2) focus on hybrid implementation-effectiveness designs that address internal and external validity as well as replication of studies, and 3) encourage donors to fund and evaluate priority PSS programs in accordance with the IASC (2017) Framework. Stakeholder interviews revealed that the most frequently mentioned PSS programs to prioritize for further evaluation research were community-based programs. Furthermore, when stakeholders were asked to prioritize programs and outcomes in an online survey about PSS program priorities, the top two programs listed were 1) community-based PSS, and 2) MHPSS integrated into other sectors – specifically the bottom two layers of the pyramid.

The review also found that community focused PSS interventions have been less rigorously studied and highlighted a general lack of specificity in terms of what defines “community-based PSS.” A lack of evidence on replicability was also identified as a challenge across all PSS interventions, demonstrating the need to test applications of existing interventions rather than develop new ones and the need for hybrid effectiveness-implementation approaches in the research agenda. Considering these findings and IASC recommendations, HEARD funding will support research into PSS interventions which a) focus on community health-based and other pyramid level one and two interventions, b) measure intervention effects on PSS indicators, c) explore the potential replicability of existing interventions rather than developing novel ones, and d) demonstrate the internal and external validity of PSS interventions through hybrid effectiveness-implementation approaches.