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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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How Europe’s (anti-)migration policies are fuelling a humanitarian crisis

When some one million people crossed the Mediterranean in the course of 2015 to seek refuge, European countries called it a crisis. Yet the real crisis was created by European immigration and asylum policies and by the challenges they posed for aid providers. We discussed these issues at the  conference of the International Humanitarian Studies Association (IHSA) in August 2018 that was held at the ISS in The Hague. In this blog we highlight some of the key issues from our just-published conference special issue and show how the issues raised back then are still of concern today.  The Covid-19 pandemic has worsened the violence experienced by people seeking safety in countries such as Italy, Greece, France, Belgium, Germany, Norway, and the UK.

Photo: European Commission DG ECHO. Available at: https://euobserver.com/opinion/136333

Back in 2018, the humanitarian consequences of Europe’s migration policies were a key theme at the IHSA conference. We’ve just published some of the conference contributions in a special issue of International Migration entitled ‘Politics, humanitarianism and migration to Europe’. The issue seeks to unpack how European governments and the EU are creating a policy-induced humanitarian crisis, how this works in the micro-practices of migration politics, and what this means for humanitarian and political action. This blog article provides a brief overview of the key themes in the special issue.

Crisis-creating policy developments

In the issue, we observe many policy developments that are of humanitarian concern. European governments view migration as economically driven or as a threat to their national security. As such, migration has been criminalised for years. Policies such as strengthening border controls, the externalisation of borders, and a focus on smuggling and trafficking rather than on the causes of forced migration all result in humanitarian crisis. In addition, the EU or its member states (and the UK) have made agreements with Libya, Turkey, and Sudan to contain those seeking protection, which risks violating the human rights of those who flee. Support for Libyan coastguards or for Sudanese paramilitary border forces leaves migrants stuck in conflict- and crisis-ridden countries and/or in appalling conditions in migrant detention centres. The UK’s externalised border in France leaves those seeking asylum in the UK stuck in France without basic assistance and vulnerable to police violence. Border restrictions on the Italy-France border have a similar effect. And the closure of legal routes means migrants have to take more dangerous routes and use smugglers or traffickers. Preventing people from leaving or from coming to Europe amounts to a policy of letting die.

Micro-practices and the politics of exhaustion

Border restrictions, mass detention, and forced returns are complemented by a number of less visible deterrence tactics and strategies. The humanitarian crisis in Europe is characterised by these regimes of micro-practices, which include 1) migrants sleeping rough or in makeshift camps with little or no shelter, food and health care, 2) regular police violence, confiscation of possessions, and evictions, and 3) slow, confusing, and inconsistent asylum procedures. The latter make it difficult or undesirable to claim asylum. Migrants who are ‘illegalised’ in this way can be exposed to more violence and can be deported.

Combined with constant uncertainty, these regimes of micro-practices lead to a politics of exhaustion aimed at influencing people’s resolve to claim asylum or to make them leave. Camps and migrants stuck on borders in desperate conditions itself also acts as a deterrent and at the same time highlights action to defend national security for domestic audiences.  Another advantage is that regimes of less visible forms of violence make it difficult to identify intent or overtly illegal practices.

The restriction of humanitarian response and a shift to political action

In terms of humanitarian response, we identify a number of issues, including the criminalisation of assistance provision and the constraints faced by traditional organisations in Europe, as well as the rise in resistance and activism by newly created volunteer groups.

Here’s what been happening in the European countries covered in the special issue: In Italy, accusations by far-right organisations that NGOs are assisting in trafficking made it possible to develop legislation against the docking of ships carrying migrants and to restrict their protection once they have reached land. In Calais, France, local authorities have repeatedly tried to restrict assistance to refugees. In both the Italy and the France cases, providing assistance is deemed illegal and showing solidarity with refugees has become a crime. Examples can be found in many other European countries. As a result, new volunteer groups quickly became politically engaged – not only through assistance as a political act, but also by providing legal assistance, preventing police raids (for example in Belgium), gathering information, and lobbying politicians.

The politicisation of humanitarian action has complicated the role of more established organisations, who are bound by principles of neutrality and impartiality. In Germany, for example, room for manoeuvre for traditional state and non-state actors was legally restricted, but different political narratives enabled some flexibility. In Norway, some volunteer groups shifted to political action and others found ways of working with more established organisations. The greatest frictions between established agencies and volunteer activist groups are often found in humanitarian advocacy. An examination of the activities of these groups in Greece, Turkey and Libya, however, shows that complementarity between negotiating and confrontational strategies is required.

More unwelcome than ever

In the Europe we are living in today, security and political concerns continue to override obligations to respect human rights and to address humanitarian concerns. Crises among migrants and asylum seekers in Europe continue to unfold as a result of the Covid-19 pandemic, Brexit, and the new EU Migration and Asylum pact. Covid-19 is by now known to have a disproportionate impact on displaced people. Even in Europe, many migrants live in overcrowded and unsanitary conditions, in informal camps, on the streets, or in detention and asylum centres where the health risks are acute and conditions abysmal.  But besides the exacerbation of the appalling living conditions a number of other pandemic-related measures make the current asylum procedure more alienating than ever. These include:

Can the trend be reversed? We hope so. As Europe’s humanitarian crisis continues and worsens, the political nature of humanitarian action is becoming ever more apparent. It will require a concerted effort by all concerned actors to monitor, research, advocate, and resist crisis-inducing policies, and to demand that states uphold international human rights and humanitarian laws.

Opinions do not necessarily reflect the views of the ISS or members of the Bliss team.

About the authors:

Dr Susanne Jaspars is an independent researcher and a Research Associate at SOAS, University of London.  She has researched the social and political dynamics of famine, conflict and humanitarian crises for over thirty years, focussing particularly on issues of food security, livelihoods, and forced migration.

Dorothea HilhorstDorothea Hilhorst is Professor of Humanitarian Aid and Reconstruction at the International Institute of Social Studies of Erasmus University Rotterdam.

Are you looking for more content about Global Development and Social Justice? Subscribe to Bliss, the official blog of the International Institute of Social Studies, and stay updated about interesting topics our researchers are working on.