Where is the ‘social’ in researching mental health and psychosocial support?

In response to the social and psychological suffering caused by humanitarian emergencies, aid organisations implement ‘mental health and psychosocial support (MHPSS)’. However, interestingly enough, academic research in MHPSS tends to only look at individual and psychological outcomes. This blog post outlines what social outcomes can be found in programme documents of aid organisations, and how we can improve the way we research these outcomes.

Mental health and psychosocial support

Armed conflict, disaster, displacement, and other humanitarian emergencies can cause great social and psychological suffering. These crises, as can be seen in Yemen, Ukraine, Ethiopia, and many other countries in the world, lead to loss of lives and homes, and rip families and communities apart. To heal trauma and rebuild social fabric, a wide variety of interventions are implemented under the heading of ‘mental health and psychosocial support’ (MHPSS). This response includes any type of support ‘that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder’ (Inter-Agency Standing Committee Guidelines, 2007). MHPSS starts from the recognition that the psychological and the social are closely interconnected. Examples of interventions include clinical mental health care, psychological first aid, and child friendly spaces. These interventions reflect the aim to address a great variety of needs – from building support through social networks to reducing anxiety with medicine. Approaches are moreover based on the availability of resources (i.e., access to healthcare facilities, community-based structures) in specific contexts. Given the protracted nature of humanitarian crises, as well as the increase in global attention to MHPSS, it is crucial to understand the way the psychological and social interact. Our study therefore reviewed the literature on the social outcomes of MHPSS (Ubels, Kinsbergen, Tolsma & Koch, 2022).

 

Researching the social outcomes

The ample academic research into MHPSS has a tendency to only look at individual and psychological outcomes. As a result, academic studies so far contribute to only a partial understanding of the impact of MHPSS interventions. We, therefore, turned to the programme documents of aid organisations. After reviewing 95 documents, it becomes apparent that aid organisations are more advanced in mapping social outcomes than academic institutions. Various types of social outcomes could be drawn from the literature. For example, strengthening cohesion within communities was a regularly found aim or outcome of interventions. This may be particularly relevant for contexts wherein host and refugee communities live in close proximity to each other. Improving personal relations and socio-economic positions were similarly recurring themes. We can think of families who are reunited after conflict and need to reinvent their family dynamics, or individuals who lost their livelihoods and are in need of social support to find economic resources. This information can help guide academic research, in showing which social outcomes deserve attention or should be further examined. Whilst the reviewed documents resulted in a useful overview, they lacked rigorous analysis (i.e., no inclusion of definitions, description of mechanisms to reach outcomes and measurement instruments).

 

Finding the ‘social’ in researching mental health and psychosocial support

The recommendations resulting from our study can briefly be summed up by looking at the following conceptual model we developed to enable systematic research:

(Ubels, Kinsbergen, Tolsma & Koch, 2022)

We should, first, make a distinction between individual and social level outcomes, and define which outcomes are being targeted by specific MHPSS interventions. Second, we should explain why we think the intervention can reach these particular outcomes. This includes direct outcomes (path A and B), but also changes over time (path C and D) and interactions between social and individual outcomes (path E and F). Third, we should find methods to ensure we properly measure outcomes, drawing tools from social sciences, medicine, and psychology. Fourth, we should find ways to also document the (positive and negative) unintended outcomes of interventions (Ubels, 2020).

Our mental health cannot be understood in isolation, so where is the ‘social’ in researching mental health and psychosocial support? Only through improving our understanding of the social outcomes of MHPSS, we can know its full possible impact. This will ultimately lead us to do more justice to the lived realities of people affected by humanitarian emergencies.

Opinions expressed in Bliss posts reflect solely the views of the author of the post in question.

About the author:

Tessa Ubels is a PhD candidate at the Anthropology and Development Studies department of  Radboud University and affiliated to the Interuniversity Centre for Social Science Theory and Methodology.

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