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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 18 | Issue 2
Page Nos. 97-183

Online since Monday, November 30, 2020

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EDITORIAL  

Systems Under Strain p. 97
Wendy Ager
DOI:10.4103/INTV.INTV_43_20  
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ARTICLES Top

Rohingya mHealth: Investigating Mental Health in Kutupalong Refugee Camp p. 99
Lars Rune Christensen, Hasib Ahsan, Subrata Kumar Mandal
DOI:10.4103/INTV.INTV_10_20  
The mental health needs of people affected by humanitarian crisis are significant but may be overlooked by healthcare providers. This paper reports on a 3-month, mixed method, field trial of a digital screening tool to identify people suffering mental health issues in Kutupalong refugee camp in Bangladesh. First, findings show that of 958 persons screened 20.46% exhibited indications of significant mental health issues. Second, ethnographic enquiries provide insights into the stressors of camp life, including, socio-spatial confinement, idleness, break-up of families, domestic disputes and uncertain prospects for the future, which in combination may explain the outcome of the screenings. The paper adds to the body of research on mental health in humanitarian crisis, and seeks to demonstrate the value of combining quantitative and qualitative data and analysis.
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The Impact of a Livelihood Intervention on Psychosocial Wellbeing and Economic Empowerment in an Ongoing Conflict Setting: The Gaza Strip p. 108
Jeyda Hammad, Rachel Tribe
DOI:10.4103/INTV.INTV_35_19  
The literature indicates that poverty and unemployment in conflict-affected areas are major stressors that negatively affect civilian wellbeing and mental health. Restoring livelihoods is expected to have a positive impact on wellbeing (Inter-Agency Standing Committee, 2007). There is a lack of research evaluating livelihood interventions in ongoing conflict settings. This study evaluated an economic empowerment programme (EEP) for seven young Palestinian university graduates experiencing poverty and unemployment (as per the selection criteria for the EEP), living in the Gaza Strip, occupied Palestinian territories. Semi-structured interviews were conducted. Thematic analysis was used. Three themes were identified: (1) economic empowerment, (2) psychological benefits (e.g. hope, confidence and improved morale) and (3) income generation fosters psychosocial empowerment. The evaluation findings indicated that despite the difficult economic conditions in Gaza, the EEP was found to help address psychosocial issues and reduced poverty and unemployment. It enabled participants to meet their own and their family’s basic and crucial needs, thus enabling financial survival and facilitating greater economic security. For some participants, income generation was found to increase agency, independence, social mobility, self-sufficiency and decision-making ability. The findings indicated that economic and psychological benefits were maintained 2 years 5 months after the EPP completion, including 8 months postwar. The analysis revealed that participants conceptualised empowerment as being able to work and having a livelihood and that income generation led to empowerment. The implications of this study and the relevance of the findings to mental health and disaster relief are considered, and further areas of exploration are discussed. Key implications for practice
  • A stand-alone livelihood intervention promotes psychosocial wellbeing and empowerment.
  • A local livelihood intervention appears to be viable and sustainable in reducing poverty and unemployment in an ongoing conflict setting including post-war.
  • Local Palestinian conceptualisations and experiences of empowerment are newly identified.
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A Randomised Controlled Trial of the I-Deal Life Skills Intervention with Syrian Refugee Adolescents in Northern Lebanon p. 119
Kenneth E Miller, Gabriela V Koppenol-Gonzalez, Ali Jawad, Frederik Steen, Myriam Sassine, Mark J.D Jordans
DOI:10.4103/INTV.INTV_4_20  
Armed conflict and displacement pose threats to children’s mental health and psychosocial wellbeing. We report on the findings of an evaluation of I-Deal, a life skills intervention aimed at fostering resilience among early adolescent refugees. We used a parallel group randomised controlled trial to compare I-Deal to a structured recreational activity group (SRA). 325 adolescents in Akkar, Lebanon, 74% of them Syrian, were randomised to I-Deal or SRA. The primary outcome was psychosocial wellbeing; secondary outcomes included psychological distress, prosocial behaviour, hope, self-esteem and social connectedness. Assessments were conducted at baseline, endline and 3-month follow-up. Due to low reliabilities, only wellbeing, distress and hope were included in the analyses. These outcomes showed similar results: no statistically significant changes over time, no significant differences between groups and no significant interaction between group and time. Our findings do not support the effectiveness of I-Deal. Several factors are considered that may help explain the lack of effect, including the aspects of the intervention design, possible measurement error suggested by low reliabilities on several instruments and a ceiling effect on our primary outcome. A replication using rigorously piloted instruments, the selection of outcomes more specifically tailored to the intervention and a nonactive control condition could help provide definitive evidence regarding the effectiveness of the I-Deal intervention. Key implications for practice
  • This study contributes to the growing literature on the effectiveness of life skills interventions for refugee adolescents.
  • The lack of any intervention effects in this study raises important questions about the appropriate focus and role of preventive and promotive interventions with refugee adolescents.
  • Methodological issues in the study underscore the vital importance of using validated and well piloted measures of appropriately selected intervention outcomes.
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Ubwiyunge Mubikorwa (reconciliation in action): Development and Field Piloting of Action-Based Psychosocial Reconciliation Approach in post-Gacaca Rwanda p. 129
Masahiro Minami
DOI:10.4103/INTV.INTV_5_20  
Reconciliation is a “hazy” construct that calls for further systematic understanding efforts. The purpose of the present study was to illuminate and understand authentic and idiographic processes of interpersonal reconciliation between survivors and perpetrators of the 1994 Genocide against the Tutsi in Rwanda. An original interpersonal reconciliation approach termed action-based psychosocial reconciliation approach (ABPRA) was developed and implemented in two remote villages of Rwanda. Lived experiences of reconciliation dyads (consisting of survivors and their direct perpetrators) who participated in ABPRA were collected employing a postsession, semistructured interview. Thematic content analysis of the data revealed five major themes representing the beneficial impacts of ABPRA. This paper introduces an overview of ABPRA and reports the results from the field pilot study. The reporting features a collection of participant reported narratives highlighting the beneficial effects of ABPRA on their healing and reconciliation process. The paper concludes with the implications of the study to enhance further efforts to support the interpersonal reconciliation process in Rwanda. Key implications for practice
  • The study explored the beneficial impact of a novel interpersonal approach to post-Genocide community reconciliation in Rwanda.
  • The study illuminated the lived experiences of Genocide survivors and perpetrators engaged in the process of interpersonal reconciliation.
  • The study developed a piece of research evidence for a practical, economical and sustainable interpersonal reconciliation programme.
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Relatives of Enforced Disappeared Persons in Mexico: Identifying Mental Health and Psychosocial Support Needs and Exploring Barriers to Care p. 139
Geert E Smid, Margriet Blaauw, Lonneke I.M Lenferink
DOI:10.4103/INTV.INTV_55_19  
In the current study, we explored the needs for psychosocial support as well as barriers to care among relatives of enforced disappeared persons in Mexico. Interviews were conducted with 29 relatives of disappeared persons as well as with representatives from seven organisations working with relatives. Needs and barriers to care mentioned by the interviewees were categorised and rated according to the frequency of mentioning. The interviewers, a psychiatrist and a medical doctor, assessed emotional distress. All interviewed relatives reported and showed signs of severe emotional distress. Frequently reported mental health symptoms included suicidal thinking, sleeplessness, anxiety, changes in appetite, intrusive memories, irritability and major role impairments. The most frequently expressed needs for psychosocial support included peer support, support when in contact with law enforcement officers, treatment of mental health conditions, religious support and family support. The most frequently encountered barriers included having a negative opinion about the quality of available services, feelings of judgement from other people (e.g., due to incrimination), lack of available services and not knowing where to get help. These findings emphasise the need to provide practical and informational support to relatives of disappeared persons as well as to provide emotional support during the entire search process for their missing relative, and beyond. Key implications for practice
  • There is an urgent need to provide practical and informational support to relatives of disappeared persons as well as to provide emotional and family support during the entire process of searching for the missing relative, including during contact with the law, searching, reconnection, and/or before, during and after exhumations and handing over of the remains.
  • Psychosocial support providers should focus on living with uncertainty and refrain from pressure for closure as well as from imposing hope as a moral imperative.
  • Mental health care professionals need to provide adequate treatment for common mental health conditions, including depression and posttraumatic stress disorder, within a supportive context.
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Designing Psychosocial Support for COVID-19 Frontline Responders in Pakistan: A Potentially Scalable Self-Help Plus Blueprint for LMICs p. 150
Asma Humayun, Israr ul Haq, Faisal Rashid Khan, Sarah Nasir
DOI:10.4103/INTV.INTV_21_20  
As part of its COVID emergency response, the Government of Pakistan’s Ministry of Planning, Development and Special Initiatives has promulgated its first ever Mental Health and Psychosocial Support (MHPSS) initiative. Supported by UNICEF, this initiative will be piloted in Pakistan’s federal capital in coordination with other government ministries. The core feature of this initiative is a web-based integrated system that provides MHPSS interventions at multiple levels, including psychosocial support to frontline responders. For this purpose, we developed a self-help tool, MyCare+, to help users assess and manage their own stress, and to consult a counsellor if needed. It is a comprehensive, evidence-driven, confidential application adapted to local needs and consolidates clinical data for further trend analysis. It is a practical, instructed self-guide for assessment and management of stress-related conditions in the field that is based on existing evidence, thus bridging a gap. Overall, the user feedback was positive for the English and Urdu versions of MyCare+, as they found the content relevant and helpful. More than 90% of users were able to follow the instructions and felt confident to use the tool. This article outlines a blueprint for developing this toolkit, which can be easily translated into regional languages and scaled up for supporting larger populations. Key implications for practice
  • An evidence-driven, resource effective, potentially scalable solution is presented to support the frontline responders in the COVID-19 public health crisis in LMICs.
  • A hybrid approach is followed that offers a self-help digital solution, supplemented by person to person contact with mental health professionals.
  • The tool is designed to help conduct individual assessments and set personalised treatment goals to support frontline workers.
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FIELD REPORT Top

Stories from the Field: Mapping Innovation in Mental Health During the COVID-19 Pandemic p. 159
Alisa Hamilton, Giovanni Sala, Onaiza Qureshi, Julian Eaton
DOI:10.4103/INTV.INTV_22_20  
The COVID-19 pandemic has raised significant concerns for individual and population mental health. Physical health consequences of the virus, public health prevention measures and economic slowdown negatively impact mental health and pose challenges for the continuation of mental health services. To learn how healthcare workers responded to these difficulties, the Mental Health Innovation Network in collaboration with the World Health Organization Department of Mental Health and Substance Use launched a global call for stories from healthcare workers. Published submissions highlighted innovations and adaptations in mental health support, representing a range of geographical regions, resource settings and target populations. This article summarises key lessons learnt and recommendations from the project, including (1) promote access to basic needs, (2) prioritise care for vulnerable groups and people with severe mental health conditions, (3) support staff mental health, especially frontline health workers, (4) engage hard-to-reach groups through informal communication channels and collaboration with caregivers and (5) support central decision-making mechanisms and cross-sectoral coordination. Using case study examples from the submissions, this field report aims to inform and inspire mental health and psychosocial support providers striving to continue services during the pandemic.
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PERSONAL REFLECTIONS Top

“More Alike Than Unalike?” A Personal Reflection on Working to Support the Mental Health and Wellbeing of Unaccompanied Refugee Minors in Greece p. 166
Maria Gialama, Sinead McGilloway
DOI:10.4103/INTV.INTV_19_20  
In late 2018, motivated (and intrigued) by the scale of one of the largest and long-standing humanitarian crises in history, we embarked on two separate but related journeys to the island of Lesvos to work with unaccompanied refugee and asylum-seeking minors and to link in with NGOs working in the region. Peering through the prism of the current pandemic, the aim of this paper is to reflect on this life changing experience to share the on-the-ground reality and the true stories of war, violence and displacement as narrated by the children/young people with whom we worked and whom we met. In particular, we suggest that the integration of culturally appropriate and creative mental health and psychosocial support interventions in schools/educational settings might provide one way of supporting these children, as suggested by several authors in the international literature, but also in the context of a number of key learning based on our own experiences.
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From a Refugee Camp in Ethiopia as a Social Worker to Working with Refugees as an Expert Psychotherapist in Ethiopia: A Story of a South Sudanese Canadian Immigrant p. 172
Nhial Korow Wicleek
DOI:10.4103/INTV.INTV_20_20  
The author is an expert psychotherapist narrating how he became a refugee in his own country of origin after long years of persecution from an Arab-dominated regime. As the war broke out, the author, a young person at the time, was forced out of the country and sought refuge in Itang refugee camp in Ethiopia along with his parents. As a result of this displacement, the author then settled in a number of refugee camps in Ethiopia. During this time, he volunteered as a community worker and his interest in psychology was sparked. Upon arrival in Canada, the author began to pursue his studies and graduated with a Bachelor of Science Degree in Psychology and a Master of Counselling Psychology. In 2019, he then was certified as a Canadian Certified Counsellor. While in the process, the author worked for the Catholic School District Board at an Intercultural Wellness Programme as a Family Liaison Support Worker.
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COMMENTARY Top

Common Global Challenges and Common Stressors of Humanitarian Field Workers Related to the COVID-19 Outbreak p. 176
Boris Budosan
DOI:10.4103/INTV.INTV_11_20  
There are a number of challenges in response to the Coronavirus (COVID-19) disease outbreak encountered by many countries in the world. This commentary divides them into those encountered by (health) care delivery systems and those encountered by affected communities and states. There are also a number of stressors experienced by humanitarian field workers during the COVID-19 outbreak. They are divided into those caused by personal/family issues, isolation and difficulties to travel/ evacuate and those caused by different and sometimes contradictory information on COVID-19 response as well as limited ability to follow the guidelines on self-protection from the virus in the field. The commentary includes information from relevant national and global sources on COVID-19 and information collected by the author during the provision of stress management for humanitarian field staff. The author expresses his personal opinion on a number of challenges.
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LETTER TO EDITOR Top

Call for United Nations and World Health Organization to Tackle COVID-19 Pandemic in the Conflict-Affected Parts of Libya p. 182
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/INTV.INTV_6_20  
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