HomeEvidence, Evaluation, and Learning...Adapting to Mental Health Challenges: Evaluating Mental Health and Psychosocial Support (MHPSS) Programming

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## Adapting to Mental Health Challenges: Evaluating Mental Health and Psychosocial Support (MHPSS) Programming

July 2022Analysis of the Bureau of Population, Refugees, and Migration’s MHPSS programming from 2018-2021 determined that gaps in care remain in PRM-funded international organizations and non-governmental organizations services. To improve the impact of PRM-funded MHPSS programming, the Department should update the MHPSS strategy to align with current best practices, integrate metric tracking in their programs, and increase MHPSS training.

## Background

Since 2018, the U.S. Department of State Bureau of Population, Refugees, and Migration (PRM) has addressed the needs of people forcibly displaced worldwide by funding MHPSS programs through major international organizations (IOs), non-governmental organizations (NGOs), and community-based organizations. In October 2021, PRM commissioned an external evaluation on the bureau’s MHPSS programming from 2018-2021 to determine how well PRM was meeting the needs of their crisis-affected individuals and to inform programming improvements.

## Findings

                  - Implementing partners (IPs) focused on integrating MHPSS into traditional humanitarian sectors.
                  - IPs used various feedback mechanisms to identify crisis-affected individuals’ needs and adapt programs, but MHPSS service gaps persisted for certain populations.
                  - PRM’s flexible funding helped IPs adapt to the new demands during increased mental health concerns of COVID-19.
                  - The existing MHPSS human resources were insufficient to address the needs effectively.

## Recommendations

Update PRM’s MHPSS strategy to reflect community-based and cross-sectoral programming, funding modalities, outcomes, and impact.

Incorporate tracking MHPSS outcomes and impact, intervention cost benefit analyses, and local strategies into their reporting requirements for IPs.

Increase MHPSS training, including self-care interventions, for MHPSS professionals and volunteers to prevent burnout and turnover.

Prioritize supporting IPs to strengthen the human resource base of qualified MHPSS practitioners.

## Approach, Methods, and Data

Between October 2021 and July 2022, the evaluation team carried out a total of 89 qualitative data collection events with partner organizations and MHPPS program beneficiaries in Belgium, Switzerland, Turk 

## Impact by the Numbers

                  - PRM supports MHPPS programming in  25  countries
                  - 22.1 percent  of people exposed to conflict in the last 10 years suffer from mental disorders
                  - Over 135  NGOs and community-based organizations provide direct MHPSS assistance globally as a result of PRM funding through cooperative agreements

## Inter-Agency Standing Committee Pyramid of MHPSS Needs

The Inter-Agency Standing Committee’s hierarchy of MHPSS are guidelines to protect, support, and improve people’s mental health and psychosocial wellbeing in the midst of an emergency and they inform the practices of the State Departments MHPSS programs. The evaluation served, in part, to analyze the extent to which these needs are met. 

**Level 1:** Social considerations in basic services and security. This includes advocacy for good humanitarian practices and basic services that are safe, socially appropriate, and that protect dignity.

**Level 2:** Strengthening community and family supports. This includes activating social networks and supportive child-friendly spaces.

**Level 3:** Focused psychosocial supports. This includes basic emotional and practical support to selected individuals or families.

**Level 4:** Clinical services, including clinical mental health care. 

## Evaluation Questions

To what extent have PRM-supported programs met MHPSS needs of refugees and IDPs?

How have PRM IPs integrated the needs of program participants into MHPSS Programming?

How has the COVID-19 pandemic affected the efficacy of MHPSS programming from PRM partners?

What updates to PRM’s MHPSS strategy would strengthen the ability of PRM to meet crisis-affected individuals’ needs?

## Detailed Findings

              - IPs are primarily integrating MHPSS into traditional humanitarian sectors. This included health, protection, education, livelihoods to strengthen basic services, and community and family support systems.
              - IPs employed diverse feedback mechanisms to identify crisis-affected individuals’ needs and adapt programs, but MHPSS service gaps remained for some populations. MHPSS service gaps remained for persons with disabilities, rural and/or older people, those on the move, LGBTQI+ people, and men. Some received services, but the services did not necessarily address all the needs of all population members. Crisis-affected individuals who could access services also benefited from some standalone programs for individual counseling and clinical care. When the crisis-affected individuals had access, IPs referred those requiring clinical care to primary health care, regional, and/or national facilities.
              - PRM’s flexible funding helped IPs adapt to the new demands during increased mental health concerns of COVID-19. During pandemic lockdowns, women faced increased sexual and gender-based violence, children lacked access to education, and providers suffered burnout and higher staff turnover. Flexible resources were shifted to address new needs, train crisis-affected individuals as volunteers to support MHPSS service provision, and pivot to virtual or hybrid service provision.
              - The existing MHPSS human resources were insufficient to address needs. Given a rapidly evolving field with reported high health care provider turnover and migration, secondary stress, and language and cultural differences, the existing MHPSS human resources were insufficient to address the needs and expectations at every level of service provision across diverse populations or to go to scale through national integration.

## Detailed Recommendations

To improve MHPSS programming and support the needs of displaced populations, the Department should:

              - Update PRM’s MHPSS strategy. PRM should update its MHPSS strategy to reflect the bureau’s community-based and cross-sectoral programming, COVID-19 adaptations, and expected funding modalities, outcomes, and impact.
              - Incorporate tracking MHPSS outcomes and impact, intervention cost benefit analyses, and local strategies into their reporting requirements for IPs. Encourage IPs through the reporting requirements to develop metrics to track MHPSS programming outcomes and impact, cost benefit analyses of interventions, and local strategies for accessing hard to reach populations.
              - Increase MHPSS training, including self-care interventions, for MHPSS professionals and volunteers to prevent burnout and turnover. Depending on context, the training should include how to provide interventions through in-person, hybrid, and virtual means.
              - Prioritize supporting IPs to strengthen the human resource base of qualified MHPSS practitioners. Support could include the training and/or re-credentialing of community-based volunteers, refugee psychiatrists, a new generation of MHPSS clinicians from POC communities, and PHC clinicians. Improving integration into local healthcare systems could also alleviate this challenge.

## Learning Summary

In 2022, PRM developed and implemented a management plan based on recommendations from this evaluation. Key actions that were outlined and taken include:

1. Developing a bureau-wide MHPSS policy that drew from the conclusions and recommendations of this evaluation.

2. Revising MHPSS indicators for NGO programs to assess the extent to which PRM-funded MHPSS programs are providing support to hard-to-reach individuals and humanitarian staff and volunteers, and the extent to which programs are training community members to serve as MHPSS leaders.

3. Updating the FY 2023 PRM NGO Guidelines to:

              - Solicit proposals which elevate community based MHPSS leaders and practices;
              - Encourage partners to include the use of hybrid approaches for MHPSS programming;
              - Emphasize a focus on sustainability specifically for MHPSS programming; and,
              - Reflect an interest in MHPSS programs that support MHPSS services for staff and volunteers.

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