Mental health in humanitarian settings: Shifting focus to care systems

Research and Development Department, HealthNet TPO, Lizzy Ansinghstraat 163, 1072 RG Amsterdam, the Netherlands.
International Health (Impact Factor: 1.3). 03/2013; 5(1):9-10. DOI: 10.1093/inthealth/ihs005
Source: PubMed


Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly
moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking
about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons
learned. Notably, that mental health assessments need to go beyond measuring the impact of traumatic events on circumscribed
psychiatric disorders; that evidence for effectiveness of interventions is still too weak and its focus too limited; and that
development of service delivery in the context of instable community and health systems should be an area of key priority.

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Available from: Mark J D Jordans, Jan 18, 2016
    • "The failure to detect the expected underlying mechanisms in successful treatment has confused other researchers, too (La Greca, Silverman, & Lochman, 2009 ). Some argued that increasing positive emotions is more challenging than decreasing symptoms and negative thinking among adolescents in CBT (Jordans et al., 2013; Stice, Shaw, Bohon, Marti, & Rohde, 2009). We still lack information concerning mediating and moderating processes among children affected by war who participate in our psychosocial interventions. "
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    ABSTRACT: Emotion regulation (ER) is crucial for children's mental health in general and traumatic stress in particular. Therefore, therapeutic interventions for posttraumatic stress symptoms (PTSS) address ER in various ways. We examined whether a psychosocial intervention (Teaching Recovery Techniques; TRT) could increase functional ER and decrease dysfunctional ER, and whether the positive ER change mediates the intervention effects on children's mental health in a war context. Participants were 482 Palestinian children (girls 49.4%; 10-13 years, M = 11.29, SD =.68) who were randomized either to the TRT or the waiting-list control groups. They reported emotion regulation (ERQ; Rydell, Thorell, & Bohlin, 2007), PTS (CRIES-R), depressive (Birleson, Hudson, Gray-Buchanan, & Wolff, 1987), and psychological distress (SDQ) symptoms and psychosocial well-being at baseline (T1), postintervention at 3 months (T2), and the 9-month follow-up (T3). Results show that the TRT intervention was not effective in changing ER, but there was a general decrease in ER intensity. ER did not mediate the intervention effects on children's mental health, but the decrease in the ER intensity was associated with better mental health, indicated by the decrease in posttraumatic, depressive, and distress symptoms and the increase in psychosocial well-being.
    No preview · Article · Dec 2014 · Traumatology
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    • "On the other hand, critiques of community-based mental health care have highlighted conflict with health professionals, inappropriate incentives, infrequent visits, lack of training of care workers, unrealistic expectations, the lack of partnerships and the remaining dominance of large psychiatric hospitals (Eaton et al., 2011; Schenk & Michaelisb, 2010; Schneider, Hlope, & van Rensburg, 2008). Other recent research has alluded to the fact that community-based mental health can be addressed through community development (Christens, 2012) and an emphasis on human care (Jordans & Tola, 2013). Community-based health care was slow to get off the *Corresponding author. "
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    ABSTRACT: Community-based care is receiving increasing global attention as a way to support children who are orphaned or vulnerable due to the HIV/AIDS pandemic. Using both qualitative and quantitative methodology, this study assesses community-based responses to the well-being of orphans and vulnerable children (OVC) and compares these responses with the actual mental health of OVC in order to evaluate the South African government’s approach of funding community-based organisations (CBOs) that support and care for OVC. The study results show that the activities of CBOs mainly extend government services and address poverty. Although this should not be seen as insignificant, the paper argues that CBOs give very little attention to the mental health of OVC.
    Full-text · Article · Jan 2013 · Vulnerable Children and Youth Studies

  • No preview · Article · Mar 2013 · International Health
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