MANUAL ON

COMMUNITY-BASED
MENTAL HEALTH AND
PSYCHOSOCIAL SUPPORT
IN EMERGENCIES
AND DISPLACEMENT
SECOND EDITION
The opinions expressed in this publication are those of the authors and do not necessarily reflect the views
of the International Organization for Migration (IOM). The designations employed and the presentation of
material throughout the report do not imply expression of any opinion whatsoever on the part of IOM
concerning the legal status of any country, territory, city or area, or of its authorities, or concerning its
frontiers or boundaries.

IOM is committed to the principle that humane and orderly migration benefits migrants and society. As
an intergovernmental organization, IOM acts with its partners in the international community to: assist in
meeting the operational challenges of migration; advance understanding of migration issues; encourage social
and economic development through migration; and uphold the human dignity and well‑being of migrants.
_____________________________

This publication was made possible through the support provided by USAID - Office of U.S. Foreign Disaster
Assistance (OFDA).

Publisher: International Organization for Migration

17 route des Morillons
P.O. Box 17
1211 Geneva 19
Switzerland
Tel.: +41 22 717 9111
Fax: +41 22 798 6150
Email: hq@iom.int
Website: www.iom.int

This publication was issued without formal editing by IOM.

Cover photo: Self-portrait elaborated by a Nigerian IDP and psychosocial worker, during a five-day
workshop on autobiographical models through art, organized by IOM in Maiduguri,
Nigeria. © IOM 2018/Rola SOULHEIL.

Required citation: International Organization for Migration (IOM), 2022. Manual on Community-based
Mental Health and Psychosocial Support in Emergencies and Displacement - Second Edition.
IOM, Geneva.
_____________________________

© IOM 2022

Some rights reserved. This work is made available under the Creative Commons Attribution-NonCommercial-
NoDerivs 3.0 IGO License (CC BY-NC-ND 3.0 IGO).*

For further specifications please see the Copyright and Terms of Use.

This publication should not be used, published or redistributed for purposes primarily intended for or directed
towards commercial advantage or monetary compensation, with the exception of educational purposes, e.g.
to be included in textbooks.

Permissions: Requests for commercial use or further rights and licensing should be submitted to publications@
iom.int.

* https://creativecommons.org/licenses/by-nc-nd/3.0/igo/legalcode

PUB2022/014/R
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
TABLE OF CONTENTS

Workshop on autobiographical models through art, organized by IOM in Maiduguri,

Nigeria. © IOM 2018/Rola SOULHEIL

ABBREVIATIONS
ACKNOWLEDGEMENTS
INTRODUCTION
CHAPTER 1. CONCEPTS AND MODELS OF WORK
CHAPTER 2. ENGAGING WITH COMMUNITIES
CHAPTER 3. ASSESSMENT AND MAPPING
CHAPTER 4. PSYCHOSOCIAL MOBILE TEAMS
CHAPTER 5. SOCIORELATIONAL AND CULTURAL ACTIVITIES
CHAPTER 6. CREATIVE AND ART-BASED ACTIVITIES
CHAPTER 7. RITUALS AND CELEBRATIONS
CHAPTER 8. SPORT AND PLAY
CHAPTER 9. NON-FORMAL EDUCATION AND INFORMAL LEARNING
CHAPTER 10. INTEGRATION OF MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT
IN CONFLICT TRANSFORMATION AND MEDIATION
CHAPTER 11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT
CHAPTER 12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT
IN THE FRAMEWORK OF PROTECTION
CHAPTER 13. COUNSELLING
CHAPTER 14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS
CHAPTER 15. TECHNICAL SUPERVISION AND TRAINING
CHAPTER 16. MONITORING AND EVALUATION
ANNEX 1. INTER-AGENCY COORDINATION
ANNEX 2. ETHICAL CONSIDERATIONS
ANNEX 3. GBV CONSIDERATIONS
BIBLIOGRAPHY

3
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ABBREVIATIONS

ABBREVIATIONS

4Ws Who is Where, When and doing What

AAD adversity‐activated development
AAP accountability to affected populations
CB MHPSS community-based mental health and psychosocial support
CCCM camp coordination and camp management
ECHO European Commission Humanitarian Aid Office
GBV gender-based violence
HIG Humanitarian Intervention Guide
IASC Inter-Agency Standing Committee
ICRC International Committee of the Red Cross
IDP internally displaced person
IFRC International Federation of Red Cross and Red Crescent Societies
INEE International Network for Education in Emergency
IOM International Organization for Migration
IPT interpersonal therapy
MEAL monitoring, evaluation, accountability and learning
mhGAP Mental Health Gap Action Programme
MHPSS mental health and psychosocial support
MNS mental, neurological and substance use
NGO non-governmental organization
OCHA United Nations Office for the Coordination of Humanitarian Affairs
PFA psychological first aid
PMT psychosocial mobile team
PTSD post-traumatic stress disorder
RSL religious and spiritual leader
SFBT solution-focused brief therapy
SMART specific, measurable, attainable, relevant and time-bound
UNESCO United Nations Educational, Scientific and Cultural Organization
UNICEF United Nations Children’s Fund
UNHCR Office of the United Nations High Commissioner for Refugees
WASH Water, Sanitation and Hygiene
WHO World Health Organization

4
 ACKNOWLEDGEMENTS

© IOM 2017
5
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ACKNOWLEDGEMENTS

The Manual on Community-Based Mental Health Health Organization (WHO), Co-Chair of the
and Psychosocial Support in Emergencies and IASC MHPSS Reference Group), Sarah Harrison
Displacement was developed by the International (International Federation of Red Cross and Red
Organization for Migration’s (IOM’s) Mental Crescent Societies (IFRC) Reference Centre on
Health, Psychosocial Response and Intercultural Psychosocial Support, Co-Chair of the IASC
Communication Section; field-based managers MHPSS Reference Group), Zeinab Hijazi (United
and coordinators of IOM’s and other agencies’ Nations Children’s Fund (UNICEF), Co-Chair
mental health and psychosocial support (MHPSS) IASC CB MHPSS Working Group), Renato
programmes in emergencies; members of the Libanora (IOM Iraq), Christopher Maclay (Mercy
Steering Committee, including representatives Corps), Chissey Mueller (IOM Headquarters),
from academia, United Nations agencies, Renos Papadopoulos (University of Essex),
international organizations, non-governmental Marine Ragueneau (IOM Brussels), Olga
organizations (NGOs), donor agencies and Rebolledo (IOM Cox’s Bazar), Alessandra Rossi
individual experts; and the co-chairs and Ghiglione (University of Turin), Monica Noriega
various members of the Inter-Agency Standing (IOM Headquarters), Jack Saul (International
Committee (IASC) Reference Group for MHPSS Trauma Studies Program, New York), Marian
in Emergency Settings, particularly the subgroup Tankink (Consultant), Peter Ventevogel (Office
on Community-Based Mental Health and of the United Nations High Commissioner for
Psychosocial Support (CB MHPSS) Programming. Refugees (UNHCR)) and Alys Willman (World
Additionally, the first draft was reviewed in field Bank).
workshops conducted with field-based MHPSS Adjunct participants to Steering Committee:
managers and focal points of several agencies Chiara Giusto (European Commission
currently engaged in MHPSS programmes in Humanitarian Aid Office (ECHO)), Katharina
north-eastern Nigeria (Maiduguri) and Iraq Montens (GIZ Berlin), Elizabeth Stickman (United
(Erbil). States Agency for International Development
(USAID) Office for United States Foreign
Editor: Guglielmo Schininà (IOM). Disaster Assistance (OFDA)), Sharon Weinblum
Editorial support: Roza Copper, Michael (ECHO) and Ann Willhoite (USAID).
Gibson, Valerie Hagger (IOM), Natalia Hortigüela
Gallo (IOM), Renato Libanora (IOM), Leslie
Snider and Emmanuel Streel. FEEDBACK PROCESS
Steering Committee members: Bashir After its initial review in workshops in Iraq
Aboubakar (IOM Nigeria), Mazen Aboul and Nigeria, the Manual underwent a year-
Hosn (IOM Turkey), Nadia Akmoun (IOM long feedback process in 2020 to increase the
Headquarters), Kathy Angi (Action by Churches effectiveness and relevancy of the Manual’s
Together), Tatsushi Arai (School for International contents, improve its usability for readers, and
Training), Amal Ataya (IOM Nigeria), Nancy expand the resources proposed. Through the
Baron (Psycho-Social Services and Training valuable feedback IOM received, the Manual was
Institute in Cairo (PSTIC), Pauline Birot (IOM updated throughout the year and is now in its
Ethiopia), Antonio Bottone (IOM Lebanon), second edition. IOM thanks the Manual’s Steering
Martha Bragin (Silberman School of Social Work Committee and the following contributors for
at Hunter College, City University of New participating in the feedback process.
York), Maria Bray (Terre des Hommes, IASC
CB MHPSS Working Group), Elaine Duaman Feedback contributors:
Joyce (IOM South Sudan), Fahmy Hanna (World Yaasmiin Abdicasis Osman (International

6
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ACKNOWLEDGEMENTS

Organization for Migration (IOM)), Abdikadir Jabbar Bagg (Green Desert), Nastazia Jabbour
Abdifitah (IOM), Abdifitah Abdikadir Jama (IOM), Desalew Jember Tesema, Saleem Jemeen
(IOM), Amira Abdillahi Hassan (IOM), Hazim (IOM), Theresa Jones, Hana Jumah (IOM), Jonas
Abdulkarim (Premiere Urgence Internationale, Kambale (Transcultural Psychosocial Organization
PUI), Ghadah Abdullah (IOM), Thekra Ahmed (TPO)), Robert Kakrah Ketor (IOM), Kateryna
(Mental Health Centre), Abdikadir Ahmed Katrashchuk (Step IN), Emre Karaçaylı (IOM),
Gelle (IOM), Huda Ahmed Ismail (IOM), Rima Kilani (IOM), Edwige Kouamen, Ksenia
Hatem Alaa Marzouk (IOM), Lekaa Albakour Kubasova, Augustine Lambert (IOM), Mary
(IOM), Ibrahim Al Dah (IOM), Hannatu Alh. Lambert (IOM), Nivethana Lazarus (IOM),
Adamu (Borno Women Development Initiative Amira Magan, Shoeb Mahmud (IOM), Lyanna
(BOWDI)), Sandra Alhassany (IOM), Said Matala (IOM), Maria Margarita Theocharopoulou
Almadhoun (United Nations Human Rights (IOM), Mariam Moawi (IOM), Marwan
Office of the High Commissioner (OHCHR)), Mohammed (Un Ponte Per (UPP)), Hodan
Cassandre Amah (IOM), Asaph Andrew Mohamoud Hassan (IOM), Mohammad Mousa
Rufi (Center for Community and Health (IOM), Walaa Musheer Ahmed (Better World
Development International (CHAD)), Laura Organization for Community Development),
Anna Assman (IOM), May Aoun (Save the Fakhria Naistani (IOM), Dmytro Nersisian (IOM),
Children), Sonya Armaghanyan (IOM), Luther Emile Ntampera (United Nations International
Atinya (International Medical Corps (IMC)), Children’s Emergency Fund (UNICEF)), Argiro
Ioannis Avdoulas (IOM), Japhet Ayele (Save Ntrouva (IOM), Moses Nyam (PUI), Khalil
the Children International (SCI)), Omar Aynte Omarshah (IOM), Burak Ozkan (IOM), Panagiota
Abdirahman, Yenehun Azie Ashagrie (United Papaioannou (IOM), Lia Pastorelli (UPP), Anoop
Nations Population Fund (UNFPA)), Natalie Poudel, Ravindra Prasadh Manathunge (IOM),
Barillier (Yazda), Manjula Barnabas (IOM), Anna Mustafa Qasim (Norwegian Church Aid), Ali
Bazelkova (IOM), Amira Beyer (IOM), Nadine Raad, Ali Ridvanogullari (IOM), Sarah Rizk (IOM),
Blankvoort (Amsterdam University of Applied Simon Rosenbaum (UNSW, Australia), Maha
Sciences, Maastricht University, OT-Europe), Sabsaby (IOM), Sozan Safar (Dak Organization
Tarryn Brown (IOM), Blandine Bruyère (IMC), for Ezidi Women Development), Nour Said
Laura Carrillo, Hana Chakhari (International (IRC), Moe Saito (IOM), Suseeka Sandrasekaram
Rescue Committee (IRC)), Mona Chahla (World (IOM), Erika Sasy Lumanta (IOM), Nino
Vision International), Gulistan Chalabi (IOM), Shushania (IOM), Philippa Smith (IOM), Fadia
Christopher Chinedumuije Oguegbu (Goal Prime Soheal (IMC), Maria Sonia Lopez (IOM), Ilknur
Organization Nigeria (GPON)), Matthew Conway Sonmez (IOM), Nemam Sophia Geroy (IOM),
(IOM), Rayane Dagher (IOM), Abeer Daham Fani Stampouli (IOM), Samuel Tarfa (WHO),
(INTERSOS), Noemi Damasceno (PUI), Saido Hizrat Tayib (Bishkoreen for the Development
Daowwd Ali (Jesuit Refugee Service), Luzwellah of Woman and Child), Bem Tivkaa (Neem
Diaca (IOM), Ilova Dorylane Lorenzo (IOM), Foundation), Kalypso Totti (IOM), Maya Tucker
Amara Edeh (INTERSOS), Sara El Hassrouny (IOM), Panagiotis Tzourakis (IOM), Abuhuraira
(IOM), Oya Erbas (IOM), Mary Everesta Lambert Umar (IOM), İrem Umuroglu (IOM), Kosalina
(IOM), Derya Ferhat (IOM), Emmanuel Gadzama Vignarajah (IOM), Ursula Wagner (IOM), Fekadu
(IRC), Wandanje Gaja Yohanna (IOM), Nemam Wakjira (UNICEF), Dennis Wani (IOM), Cafer
Ghafouri (Swedish Charity Organization), Yuksek (IOM).
Luana Giardinelli, Rawan Hamid, Homa Hasan Thanks also to Catherine Panter-Brick (Yale
(IOM), Kim Hwahyun (IOM), Reuben Ibaishwa University) and her collaborators for reviewing
(Street Child), Kennedy Ikwe (IOM), Giorgos the chapters Assessment and mapping, and
Ioannou (IOM), MD. Saiful Islam (IOM), James Monitoring and evaluation, and Alena Huss for
Izang (Médecins du Monde (MDM)), Bryar supporting in compiling the bibliography.

7
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ACKNOWLEDGEMENTS

Main authors per chapter: Chapter 14. Community-based support for

people with severe mental disorders: Theresa
Introduction: Guglielmo Schininà; Jones, Guglielmo Schininà, Peter Ventevogel,
Chapter 1. Concepts and models of work: Fahmy Hanna;
Guglielmo Schininà, Renos Papadopoulos and Chapter 15. Technical supervision and training:
Jack Saul;
• Technical supervision: Ann Willhoite, Martha
Chapter 2. Engaging with communities: Bragin and Roberto Biella Battista;
Marian Tankink, Guglielmo Schininà and Renato
Libanora; • Training: Guglielmo Schininà and Nancy
Baron;
Chapter 3. Assessment and mapping: Marian
Tankink, Guglielmo Schininà, Emmanuel Streel Chapter 16. Monitoring and evaluation: Martha
and Renato Libanora; Bragin and Emmanuel Streel;
Chapter 4. Psychosocial mobile teams: Annex 1. Inter-agency coordination: Renato
Guglielmo Schininà and Emmanuel Streel; Libanora, Sarah Harrison and Guglielmo Schininà;
Chapter 5. Sociorelational and cultural Annex 2. Ethical considerations: compiled by
activities: Guglielmo Schininà, Pauline Birot, Elaine Natalia Hortigüela Gallo;
Duaman Joyce and Natalia Hortigüela Gallo;
Annex 3. GBV considerations: Louise O’Shea,
Chapter 6. Creative and art-based activities: Victoria Nordli, Alisha Kalra, Natalia Hortigüela
Guglielmo Schininà and Alessandra Rossi Gallo, Heide Rieder, Gladys Cherutos Kios and
Ghiglione; Guglielmo Schininà.
Chapter 7. Rituals and celebrations: Renato
Libanora, Kathy Angi and Guglielmo Schininà;
Chapter 8. Sport and play: Maria Bray, Serena
Borsani and Raphaële Catillion;
Chapter 9. Non-formal education and informal
learning: Sylvain Fournier;
Chapter 10: Integration of mental health and
psychosocial support in conflict transformation
and mediation: Tatsushi Arai, Marine Ragueneau
and Guglielmo Schininà;
Chapter 11. Integrated mental health and
psychosocial support, and livelihood support:
Alys Willman and Christopher Maclay;
Chapter 12. Strengthening mental health
and psychosocial support in the framework
of protection: Chissey Mueller, Nadia Akmoun,
Guglielmo Schininà and Renato Libanora;
Chapter 13. Counselling: Jack Saul and
Guglielmo Schininà;

8
 INTRODUCTION

Father-daughter recreational activity organized by IOM Psychosocial

Mobile Teams, Gaziantep, Turkey. © IOM 2019

9
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
INTRODUCTION

The present Manual aims to facilitate mental

health and psychosocial support (MHPSS) WHY A MANUAL ON
experts and managers in designing, implementing COMMUNITY-BASED
and evaluating community-based MHPSS (CB MENTAL HEALTH AND
MHPSS) programmes, projects and activities for
emergency-affected and displaced populations
PSYCHOSOCIAL SUPPORT
in humanitarian settings. It is specifically designed IN EMERGENCY AND
to support managers and experts hired by the DISPLACEMENT
International Organization for Migration (IOM).
However, it can also be used, in its entirety or There has been a call in recent years to shift the
in some of its components, by MHPSS experts focus of MHPSS programmes in emergencies from
and managers working for IOM’s partners, psychological symptoms, and their treatment and
including international and national governmental prevention, to collective and contextual elements
organizations, non-governmental organizations of consequences of adversities. This includes the
(NGOs), countries, donors and civil society understanding of the importance of the collective
groups. For this reason, the document is open reactions to adversity and of social cohesion,
source, refers to tools and researches of different social supports, identities and social textures
agencies, and was conceived and reviewed by a in determining individual and social well‑being
variety of experts and practitioners from several after disasters. It also includes the activation of
organizations. Although it is written for an context-specific, multidisciplinary support systems
international intergovernmental organization, that build on existing strengths of affected
smaller non-governmental agencies can make communities, rather than limiting the intervention
use of parts of the manual, based on identified to the provision of services to respond to the
priorities of their own programmes. deficits created by the emergency. In 2019,
the Inter-Agency Standing Committee (IASC)
Box 1
Reference Group on MHPSS issued Community-
Based Approaches to MHPSS Programmes: A
Institutional background
Guidance Note (IASC, 2019a) to respond
IOM’s engagement in MHPSS stems from to this widely perceived need. The guidance
the IOM Migration Crisis Operational Framework aims at better defining principles of MHPSS in
(2012a), which includes psychosocial support emergencies based on the understanding:
as one of the 15 priority areas of IOM’s ...that communities can be drivers for their own
intervention in humanitarian and migration care and change and should be meaningfully
crises. The pursuit of the most attainable involved in all stages of MHPSS responses.
standards of health and psychological well‑being Emergency-affected people are first and foremost
to be viewed as active participants in improving
of migrants and displaced populations is
individual and collective well‑being, rather than
enshrined in both the United Nations Global as passive recipients of services that are designed
Compact for Safe, Orderly and Regular Migration for them by others. Thus, using community-
(2018) and the United Nations Global based MHPSS approaches facilitates families,
Compact on Refugees (2018). The Sustainable groups and communities to support and care
for others in ways that encourage recovery and
Development Goals, from the United Nations
resilience. These approaches also contribute to
2030 Agenda for Sustainable Development, restoring and/or strengthening those collective
call for universal mental health care and structures and systems essential to daily life and
psychosocial support that leave none behind, well‑being. An understanding of systems should
including migrants and refugees. inform community-based approaches to MHPSS
programmes for both individuals and communities
(IASC, 2019a).

10
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
INTRODUCTION

This Manual aims to give operational and than 70 countries worldwide. Based on its
programmatic indications on how to make experiences and engagements, the Organization
this happen within IOM MHPSS programmes, has developed holistic and systemic practices of
and those of partners working with relatable MHPSS that are community based. Community
populations in similar contexts. is indeed a central concept in the Organization’s
MHPSS approach, due to its mandate and
target populations. The psychosocial well‑being
Box 2 of migrants is indeed strongly linked to factors
Complementary resources that are strictly interrelated with the concept of
community. These include a sense of belonging,
The Manual is complementary – not alternative
social roles, culture and cultural adaptation,
– to a series of related tools, including:
the dynamic between tradition and change,
(a) The Inter-Agency Standing differences in paradigms of social support, a
Committee (IASC) Guidelines on sense of identity, and in-group and out-group
MHPSS in Emergency Settings (IASC, relations and stigma.
2007);
For many years, the harmonization of IOM
(b) The IASC Community-Based MHPSS programmes in emergencies has been
Approaches to MHPSS Programmes: based on face-to-face trainings for the IOM
A Guidance Note (IASC, 2019a), experts and managers, but this approach has
available in Arabic, French, proved difficult to sustain, unless accompanied
Portuguese, Spanish and Urdu; and by a factual manual. From the one side, requests
its accompanying webinar; for MHPSS programmes have increased
dramatically in the last few years, making it
(c) The United Nations Children’s difficult to deploy managerial and expert teams
Fund (UNICEF) Operational that are already trained, or to train the deployed
Guidelines: Community-Based Mental teams in a timely manner. On the other side,
Health and Psychosocial Support in the need for a manual that could instruct newly
Humanitarian Settings: Three-Tiered hired managers and experts in the various
Support for Children and Families steps of setting up a CB MHPSS programme
(UNICEF, 2018); with displaced populations has emerged in the
(d) The United Nations Children’s evaluation of several IOM MHPSS programmes
Fund (UNICEF) Compendium in emergencies, such as those in Libya in 2013
of Community-Based MHPSS and the Syrian Arab Republic in 2016.
Resources (UNICEF, 2021). The Manual can be used by:
It differs from those in that it is a programmatic • IOM managers, to be instructed on IOM’s
manual and not a guideline or compendium, approach to CB MHPSS programming;
and is not age- or gender-specific. Reference
• Managers and experts in the wider MHPSS
will be made to the above-mentioned tools
community, to respond to the need to
throughout the Manual.
identify and harmonize practices of CB
MHPSS.

IOM has provided MHPSS to emergency-

affected, migrant, displaced, returnee populations
and host communities since 1999, in more

11
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
INTRODUCTION

Box 3 - Rituals and celebrations;

Background knowledge - Sport and play;
- Non-formal education and informal learning;
IOM, as with most agencies, hires MHPSS - Integration of mental health and
experts and MHPSS programme managers psychosocial support in conflict
based on relevant academic background and transformation and mediation;
prior experience in relatable programmes. This - Integrated mental health and psychosocial
Manual is therefore designed with an expert support, and livelihood support;
reader in mind, although anyone engaging with - Strengthening mental health and
MHPSS in an emergency could find it of use. psychosocial support in the framework of
protection;
- Counselling;
HOW THE MANUAL IS - Community-based support for people
ORGANIZED with severe mental disorders.

The Manual has three versions: Each chapter:

• A printed version that contains only essential • Provides a short theoretical background.
knowledge; • Lists essential information on the topic useful
• A PDF version that complements the printed for managers. This can include the mapping
version, and contains more in-depth readings, out of the activity against the various tiers of
annexes and hyperlinks; and the IASC pyramid of MHPSS.
• A web-based version, that can be found here. • Describes step-by-step the process that needs
This version will be a living document and will to be undertaken by an MHPSS manager
be regularly updated based on new research, to allow the implementation of the relevant
identified best practices and feedback from the activity in a community-based fashion.
field. • Refers to the relevant points of the IASC
The Manual is organized into 16 chapters and Community-Based Approaches to MHPSS
three annexes. The first chapter introduces Programmes: A Guidance Note.
concepts, models and principles of CB MHPSS • Presents examples and best practices.
work; the other chapters are operational and
• Refers to relevant internal and external tools,
programmatic. These chapters are of two types:
models of work and case studies. These are
• Those that have to do with the process of a hyperlinked and can be directly accessed with
CB MHPSS programme: a simple click.
- Engaging with communities;
• Identifies challenges.
- Assessing and mapping;
- Psychosocial mobile teams; • Provides a short list of additional readings,
- Technical supervision and training; on the top of the articles and tools already
- Monitoring and evaluation; hyperlinked in the text.
- Plus two annexes on coordination and
No chapter provides financial, logistical or other
ethical considerations.
administrative indications that are embedded in
• Those that introduce specific CB MHPSS each agency’s rules and regulations.
activities:
- Sociorelational and cultural activities; The Manual can be read in its entirety, or by a
- Creative and art-based activities; single chapter of interest. Indeed, each chapter

12
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
INTRODUCTION

contains internal hyperlinks, bringing the reader guidelines that are available in the public
with a click to parts of other chapters that are to domain and provide a practical complement
be read to comprehend the issues at stake. Each to the processes described in the chapters.
chapter can be read autonomously, making use The corresponding materials have been
of the hyperlinks. researched and vetted by the authors, the
Steering Committee and the editorial team.
The Manual contains three kinds of hyperlinks:
• Some hyperlinks are indicated by this icon COVID-19 Pandemic Response
and will bring the reader with a click to other
parts of the Manual. They are particularly It should be noted that the Manual was validated
important if one reads the Manual starting and finalized during the COVID-19 pandemic,
from any given chapter. and that while the Manual’s contents were not
• Other hyperlinks are indicated by this icon changed to reflect the pandemic response, IOM
and will bring the reader to further developed a specific toolkit to help practitioners
information on the same topic, in-depth adapt MHPSS programmes and activities to these
readings and supporting materials, including new circumstances. The toolkit includes materials
original material developed by experts developed by a variety of actors, including the
specifically for this Manual. IASC MHPSS Reference Group, and is organized
per spaces of displacement. The toolkit will be
• Other hyperlinks will bring the reader further referenced in the following chapters.
with a click to videos, tools, trainings or

South Sudan © IOM 2015

13
 1.
CONCEPTS AND MODELS OF WORK

Festival at IOM Community Centre in Iraq. © IOM 2018

14
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

This chapter introduces the main concepts at the basis of this Manual and presents a few models
that link theory and programming, and can be helpful in designing and managing CB MHPSS
interventions. The chapter introduces theories and paradigms, not practical actions. These theories
and paradigms are fundamental to understanding an approach to CB MHPSS and to contextualizing
the chapters that will follow.

Box 4
Chapter Video
The following concepts and models of work are explained in this video, which was developed
as a complement to the Manual. For a visual explanation of the information presented in this
chapter, please watch before or after reading the material.

The informing principle of this Manual is that individuals are part of a socioecological system that
includes families, larger human systems and communities (see fig. 1), and therefore communities are
a cornerstone of MHPSS programmes that usually tend to focus on individual needs instead.

Figure 1: Socioecological system

MACROSYSTEM
Attitudes and ideologies of the culture

EXOSYSTEM

MESOSYSTEM

Industry Social
MICROSYSTEM services

Family Peers

INDIVIDUAL
(sex, age, health, etc.)

School Church

Mass Health services Neighbours

media

Local politics

Source: Bronfenbrenner (1979).

15
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

• History and historical perceptions;

1.1. CONCEPTS
• Sociopolitical interests;
• Visions of the future;
1.1.1 The meaning of community
• Historical artefacts and monuments;
In its widest sense, “community” refers to
a group whose members share certain • Societal discourses and narratives.
commonalities – such as geographical location or Finally, community includes institutions such
location of perceived origin, language, interests, as political representative bodies, schools,
beliefs, values, tasks, political affiliation, ethnic or health centres, and religious and civil society
cultural identity, sense of belonging and others – organizations.
and whose size varies from very small, such
as a nuclear family, to extremely large, such as
inhabitants of an entire continent. More precisely, Box 5
communities are human systems characterized Power dynamics in communities
by interrelationships and interactions among
their members in a given context. As such, a Hierarchical and non-hierarchical
community is a composite of clusters of: interrelationships among individuals, groups
and systems of meaning characterize each
• Individuals; community. Power is an important element to
• Nuclear and/or extended families; consider when engaging communities, especially
• Tribes and/or clans; after disasters and in migration.

• Confessional groups;
• Political parties; Communities are dynamic and changing, not only
• Congregations; in terms of their actual membership, but also in
terms of their characteristics and preoccupations.
• Men’s, women’s, disability and youth Communities, like all systems, need both a degree
associations; of stability and a degree of change in order to
• Professional associations; survive and thrive. If there is too much stability,
the system stagnates; and if there is too much
• Amateur artistic groups;
change, the system is put into chaos. Communities
• Sports teams; always need to keep a viable contact with their
• Interest groups, such as people who like a certain roots and traditions, while they also need to adapt
kind of music, or a football club, or a star; to the new circumstances and challenges they
face along the time continuum, especially when
• Many others. encountering adversity.
The interrelationships and interactions between The interactions between individuals, human
these groups are also informed by less actual and systems, and these systems and more
more constructivist elements, and include: transcendent elements – such as culture, beliefs
• Cultures; and epistemologies – create a sense of belonging
and safety and are central in defining identity.
• Belief systems;
Identity is a cornerstone of a sense of community
• Epistemologies; and of psychosocial well‑being, and is central to
• Ideologies; understanding the psychosocial well‑being of
crisis-affected and migrant populations.

16
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

1.1.2 The meaning of identity

Identity is a central concept in the psychosocial well‑being of individuals and groups, and remains
so after adversity, disruptions and displacement. The simple definition of identity refers to the
characteristics determining who a person is (OED, 2019), and the same would apply to collective
identities, including community and group identities. Generalizing for the use of a manual the
common elements to most underlying psychological and sociological theories, identity can be
considered a system constructed by the interrelation of three components:
• The first component (illustrated in red in Figure 2), is the self-concept, which corresponds to who
one is to himself or herself (for instance, individual differences, self-attributions).
• The first component is not entirely neutral, since one self-attributes qualities, characteristics,
cultural beliefs and roles based on interiorized societal factors, such as the culture, beliefs,
education, gender and learned social roles. Dynamic theories add the influences of archetypes,
and the subconsciously inherited cultural elements that are informed by the hegemonic and
secondary cultures one belongs to, either for assimilation or for contraposition. (This part is
illustrated in green in Figure 2).
• Finally, there is a relational component to identity, which is determined by how one is perceived
by others: family, friends, colleagues, clients, neighbours, persons of authority (in blue in Figure 2).
These three components are continuously feeding back on each other.

Figure 2: Identity

1. Who I am, according to myself

2. Interiorized social factors: gender, sexuality,
culture, race, nation, age, class and occupation,
traditions, traditional roles
3. How others perceive me

Source: Schininà (2012).

Identity is multifaceted. The self is composed of different selves, for instance the parent self, the
family self, the professional self, the partner self, and so on. The three components can have
different “weights” in different communities in shaping an individual’s identity, and identity is the
result of a continuous negotiation that the individual conducts with themselves, their culture
and their community. Therefore, identity is in continuous evolution, and changes based on one’s
own experiences, encounters, education and cultural transformations at the level of the system,
among others. These changes are organic.
Adversity and forced displacement affect identity, on all levels. Self-concepts are questioned by
victimization, inhumanity, torture and violence. The adherence to interiorized societal factors,

17
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

such as belief systems, is put into question extent the evolution of these identities. As a
by the causes of an emergency (especially in consequence:
the case of conflict). In the case of migration • Identity should be understood in its
and displacement, the hegemonic culture in community-relational and more individual
the host community may not share the same components.
societal factors as that of the migrants, since
language, understanding of social roles, systems • Identity should be respected, as for the fact
of meaning and simpler elements, such as that identities may be in a crisis or a transition.
sense of humour, may differ. More importantly, • Identity should be empowered, restoring a
the feedback migrants receive from significant sense of agency and efficacy.
others suffers due to the loss of some of them,
the fact that significant others are left behind,
and finally by the fact of being immersed in 1.1.3 The meaning of culture
a new community where one is not known
Although the definitions of “culture” greatly
and often stigmatized. Identities need to be
vary in literature, for the purposes of this
readapted. This process may be painful and
Manual, culture is considered to be a system
challenging, but its outcomes are not necessarily
of shared beliefs, symbols, myths, behaviours,
negative. In the process, however, confusion,
canons, images, narratives, metaphors, artistic
disorientation and polarization can happen. In
productions, rituals, values and customs that
situations of war, in particular, the individual
the members of a society use to signify their
core of the identity tends to be assimilated to
world and relate with one another. They are
the hegemonic narrative of identities in war.
transmitted from generation to generation
The adherence to a core of values that are
through learning, and are interiorized to varying
determined by opposition to the values of the
degrees by individuals. Culture encompasses
other conflicting party becomes a fundamental
collective materials and immaterial elements
prerequisite to be considered as part of a
that allow a specific community to represent
community.
itself as distinct and cohesive.
In the emergency environment, humanitarian
In this perspective, culture and its elements
workers become significant others for affected
might offer protective, restorative and
individuals. In this respect, humanitarian actors
transformative support after disruptions,
are co-constructing the identity of the affected
promoting participation, a sense of continuity,
populations they serve from a peculiar
acceptance, resilience and a venue for positive
position of power.
social interactions in emergency settings.
It is therefore important that humanitarian
Culture can’t be understood as a closed system,
workers do not contribute to creating a
and the perfect juxtaposition of one culture,
negative identity of the affected populations,
including language and religion in one social group
basing the relationship only on their deficits
in one territory, is a rare occurrence. It is most
and vulnerabilities, which risks creating a
likely that culture derives from the coexistence of
victim identity, or relying on predetermined
subcultures with their own characteristics. Usually,
categorizations. A community-based approach
the main culture and subcultures are not exclusive
stems from the protection of the richness of
or necessarily alternative to each other, and
the identities of the populations of concern
cultural and subcultural elements will both coexist
to the CB MHPSS programme, and from the
in the same individuals and groups, and they will
awareness that a humanitarian organization is
feed back on each other.
part of a system that determines to a certain

18
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

These dynamics are also at work in emergency Box 6

settings and with migration, where even main Cultures
cultures may differ between migrants and their
hosts, with the problems to a sense of identity Cultures should never be read in hierarchical
that this can bring to both communities. On the (better or worse, superior or inferior), ethical
positive side, subcultures can cross-cut the main (good or bad, advanced or backward) or
cultural frameworks with alliances, fostering functional (competitive or cooperative) ways.
integration. In fact, subcultures allow for mutual Rather, an MHPSS programme manager should
recognition and converging interests between look at cultures as systems that need to be
people of the same subculture within different understood in their essence and respected in
main cultures, such as migrants and members of their values to inform effective programming.
the host communities who share a cultural or
subcultural identity (for example, same religion,
same musical culture, LGBTQI individuals).
Culture is immaterial in essence, but it brings 1.2. THE NECESSARY
objective manifestations, relations among LINKS BETWEEN
specific sets of individuals, artistic productions, COMMUNITY,
cultural canons, narratives of exclusion and
MENTAL HEALTH
practices of inclusion and care, and, more
inherently to MHPSS work: AND PSYCHOSOCIAL
• Rituals, liturgies, commemorations and
WELL‑BEING
celebrations; Community is a fundamental aspect of mental
• Spiritual and healing practices, aetiologies health, as enshrined in the relevant World Health
and explanatory models of diseases; Organization (WHO) definition, which identifies
good mental health as:
• Legends and myths, novels and poems,
proverbs and jokes; A state of well‑being in which every individual
realizes his or her own potential, can cope with
• Memories and oral histories; normal stresses of life, can work productively and
• Emotional expressions, social customs and fruitfully and is able to make a contribution to her
or his community (WHO, 2012).
courtesy etiquettes;
• Visual and plastic arts, songs and Likewise, community is central to the definition
dances, theatre, drama, storytelling and of the adjective “psychosocial”, which refers
performance; to the interrelations between mind and
society (OED), since communities are a pillar
• Handcrafts, dressing and ornaments, of the larger society, and its more concrete
cooking and hospitality; manifestations.
• Sport and play;
In humanitarian action, the composite term
• Learning. “mental health and psychosocial support” has
been used since 2007 to define “any type of
These elements will be tackled in more
local or outside support that aims to protect or
programmatic terms in the following chapters.
promote psychosocial well‑being and/or prevent
or treat mental disorder”.
Community is central to this construct as well.

19
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

Indeed, war and disasters, forced migration Emergency-affected people are first and
and displacement are not only disruptive to foremost to be viewed as active participants in
the individual, but they lead to shared injuries improving individual and collective well‑being,
to a community’s social and physical ecologies, rather than as passive recipients of services that
which affect psychosocial well‑being. As Erikson are designed for them by others. Thus, using
(1976:154) wrote, they represent: community-based MHPSS approaches facilitates
families, groups and communities to support and
[A] blow to the basic tissues of social life
that damages the bonds attaching people care for others in ways that encourage recovery
together and impairs the prevailing sense of and resilience. These approaches also contribute
communality… a gradual realization that the to restoring and/or strengthening those collective
community no longer exists as an effective source structures and systems essential to daily life
of support and that an important part of the self
and well‑being. An understanding of systems
has disappeared...“I” continue to exist, though
damaged and maybe even permanently changed. should inform community-based approaches to
“You” continue to exist, though distant and hard to MHPSS programmes for both individuals and
relate to. But “we” no longer exist as a connected communities. (IASC, 2019a)
pair or as linked cells in a larger communal body.
On the other side, a superficial understanding
These injuries require not only individual but also of a community-based approach could be
collective responses to promote psychosocial summarized in the slogan “Communities know it
recovery and well‑being, which often involve the all”. Yet, disruptions and displacement can create
restoration of moral, social and political agency situations where the sense of a community
through the creation of shared meaning and is under question, and the networks and
narratives. interrelations that usually bring communities
In 2019, the IASC Reference Group on MHPSS together are severed, while values and cultures
issued Community-Based Approaches to MHPSS are under redefinition. Disasters often pull
Programmes: A Guidance Note (IASC, 2019a) communities apart (including creating fault lines
available in Arabic, French, Portuguese, and divisions between national humanitarian
Spanish and Urdu, to respond to a widely workers). Strengthening the resilience of the
perceived need to better define principles of community is a crucial factor in recovering from
MHPSS work based, as already mentioned, on adversity, and in preventing long-term mental
the understanding: health and social difficulties. (Norris et al., 2008;
Padgett, 2002).
In other cases, different communities are brought
Box 7
by the emergency to cohabit in one geographical
Migration and the definition of Mental location, without sharing the other, more
Health constructivist elements that build a community.
The simple definition of good mental health This Manual tries to operationalize this
is challenged by the specific situations created understanding within a model of work, derived
by migration and displacement. Find additional and designed mainly for the MHPSS activities of
information here. IOM in humanitarian settings, but that could be
applied to other programmes by other agencies.
This work is based on the following models.
...that communities can be drivers for their own
care and change and should be meaningfully
involved in all stages of MHPSS responses.

20
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

1.3. MODELS

1.3.1 The model of a psychosocial approach to programming in emergency and

displacement
This model lies in the fundamental interrelation of biopsychological, socioeconomic/sociorelational
and cultural factors in defining the needs of migrants, displaced and crisis-affected populations, as well
as the responses to these needs, as illustrated in Figure 3.

Figure 3:
The model of a psychosocial approach to programming in emergencies and displacement

MIND SOCIETY
SOCIORELATIONAL
SOCIOECONOMIC

BIOPSYCHOLOGICAL CULTURAL

Source: Schininà (2012).

The three spheres are equally important, interdependent and mutually influencing in defining
psychosocial needs, resources and responses.
The biopsychological factor encompasses emotions, feelings, thoughts, behaviours, memories,
stress and stress reactions. Psychological coping skills are related to this sphere. Body and mind are
considered a unique system in this model.
The sociorelational/socioeconomic sphere focuses on the interactions and the interdependence
between the individual and communities he/she belongs to. It consists of two complementary
aspects: The socioeconomic aspect has to do with the availability of and access to resources,
such as, for example, livelihood, health care or information technology. The sociorelational aspect
brings up the quality of relations between an individual and their family, wider social systems and
communities.

21
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

The cultural sphere regards, as already Keeping this interrelation in mind will make any
mentioned, a system of shared material and humanitarian programme more psychosocially
immaterial elements that members of a society informed, and more community-based. A part
use to signify their world and relate with one of this Manual is about what the managers of an
another, which are extremely important in how MHPSS programme should do to make sure that
they make sense of adversities. a psychosocial approach is used in humanitarian
programmes organized by the same organization,
This scheme should inform the understanding or existing support mechanisms within the
of all humanitarian needs in a community in its community that are not labelled as MHPSS
interrelatedness. Therefore, biopsychological programmes.
needs should be understood as being related to
sociorelational and socioeconomic determinants,
and their manifestations read based on culture. 1.3.2 The model of CB MHPSS
Likewise, socioeconomic and sociorelational programming in emergency and
needs should be understood as being displacement
interrelated to the biopsychological and cultural
disruptions they derive from and generate. To schematize the approach to dedicated CB
MHPSS programming of the organization, IOM
Similarly, humanitarian responses should always has for almost two decades used an adaptation
be mindful of these interrelations. Needs must of Renos Papadopoulos’ grid of outcomes of
be prioritized, and agencies may respond to disruptive events, applying it to programming.
one set of needs rather than another. Yet, this This model is in line with a socioecological
interconnectedness should always be considered, model and with a community-based approach
for instance, by the following: to MHPSS, as advocated by the relevant IASC
• Providing psychiatric support, one should Guidance Note.
be mindful of cultural explanatory systems To know more of the informing principles of
and adapt culturally the diagnostic tools. the model, here is an original contribution
One should also be mindful of how the Papadopoulos wrote specifically for this Manual.
provision of services can be understood by In the chapter, the model is called Framework for
the community and how this can affect the dedicated MHPSS programming, and is presented
well‑being of the client and can’t be detached as it is used for IOM programming and therefore
from the consideration of the socioeconomic adapted from its original elaboration.
possibilities the family has to provide for the
care.
• Distributing food, one should be mindful
of the cultural elements of the distribution,
such as which food is appropriate for that
community and, for instance, how receiving
in-kind charity can be perceived in the
environment, to mitigate possible stigma. On
the other side, one should also consider the
emotions that the modality of the distribution
can generate: such as shame and a sense of
disempowerment, among others.

22
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

Figure 4: Framework for dedicated MHPSS programming

Negative psychosocial Neutral psychosocial Positive psychosocial

responses responses and resilience responses or adversity
factors activated developments
INDIVIDUAL
FAMILY
SIGNIFICANT GROUPS
COMMUNITIES
Source: Adapted from Papadopoulos (2007).

A CB MHPSS programme will assess and respond to needs with a systemic and comprehensive approach
that attends to:
• The suffering and the negative psychosocial consequences that the emergency and the displacement
have provoked at the individual, family, group and community levels, and how they interrelate: It will
therefore devise activities that respond to these different levels of suffering, which can include:
- Ordinary human suffering due to mental disorders at the individual level;
- Family violence, separation and roles readaptations at the family level;
- Disruptions or polarizations of significant groups;
- Community fractures such as stigmatization, conflict, divides, lack of sense of trust in institutions, and
a lack of sense of trust in others, among others.
The tendency of MHPSS in emergencies is to focus, almost exclusively, on the negative individual responses
to adversity: In a CB MHPSS paradigm, these will instead be attended and responded to at all levels, always
connecting the negative to the other two categories of responses.
• The neutral responses and resilience factors – that is, what makes people, groups and communities
able to go on after a crisis counting on their pre-existing resources, qualities, skills, networks and coping
mechanisms: A CB MHPSS programme will try to identify existing neutral responses and resilience
factors, and strengthen them to mitigate the negative reactions. Resilience, as defined by Panter-Brick
and Leckman (2013), “is the process of harnessing biological, psychosocial, structural and cultural
resources to sustain well‑being”.
- An emphasis on strengths, resources and capacities, rather than deficits;
- Anticipation of actions that reduce the impact of adversity;
- Attention to multiple levels of influence, ranging from the structural and cultural through to the
community and the individual;
- Mapping influences within ecologically nested systems (Ager et al., 2010). Resilience applies not
only to individuals, but also to families, groups and communities. Thus, family resilience factors,
for instance, can be used to respond to individual suffering, alone or in combination with tailored
individual responses. Or, pre-existing support groups can be reactivated and trained to respond to
the new challenges.
• The positive responses to adversity: In addition to the negative and unchanged responses to
adversity, every person, family, group and community exposed to adversity also gains something to
some degree from these experiences. There are endless examples of positive responses to adversity
in real life: for example, altering previous individualistic style of life by appreciating the importance of

23
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

social networks, volunteerism, widening and • Identifying and empowering positive

deepening the scope of previous life goals, responses to adversity through skills-building,
new community preparedness or learning capacity-building, mentoring, in-kind support,
new skills. A CB MHPSS will identify and give mobilization and engagement, volunteerism,
space for the presentation of these positive and fostering civic participation.
responses.
To do these, CB MHPSS programmes should
The original grid can be used in rapid assessments or have:
any other form of assessment where the intention • A specific focus; and
is to map out the entire range of effects following
an emergency. Here it is presented as a model • Core teams that reflect a variety of needed
of the various components that should inform a background and expertise.
community-based psychosocial programme, which
includes:
1.3.2.1 The focus of a CB MHPSS
• Mental health care for people with severe programme
mental disorders, pre-existing or magnified by
the circumstances of the crisis. MHPSS in emergencies is defined as:
• Counselling to help individuals and groups to “any type of local or outside support that aims to
protect and promote psychosocial well‑being and/
cope with their predicaments, focusing on
or prevent or treat mental disorders”.
their existing resilience.
• Family counselling, parental skills trainings and Within this definition, in a CB MHPSS
family mediation, to help families to overcome programme, the focus is on strengthening local
their predicaments. supports, and on looking at psychosocial
well‑being from a relational perspective.
• Support to marginalized and affected groups, The “client” of a community-based MHPSS
including minorities, and specific categories programme is therefore the social system, and
of survivors, in the form of counselling and the focus is on strengths, resources, continuity
integrated protection services. and adaptation to changes. The activities
• Community messaging addressing the supported by such an approach are often those
identified root causes of community that community members are already engaged in,
suffering, as well as conflict mediation and but not solely. The focus is less on direct services,
transformation to respond to the chain of and more on offering a structure that promotes
violence that can characterize these situations. positive connection and social processes. Most
often, this involves helping to reactivate old and
• Promotion of activities that are known
build new connections between constituencies,
to alleviate individual, family, group and
and helping people recognize and enhance
community suffering in a given community,
existing resources for recovery. On the other
strengthening the social fabric, and promoting
side, CB MHPSS programmes recognize the
and mobilizing the agency of individuals and
changes and difficulties that war, disasters and
groups who have skills and prosocial attitudes
displacement bring to the social and symbolic
in a community. This includes fostering the
fabric of a community, which create gaps in
creation of self-support, creative and cultural
interactions and services that will need to be
groups, and sport and learning activities; and
addressed.
re-establishing livelihoods, as well as those
rituals and celebrations that are part of the
natural ways people respond to adversity.

24
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

1.3.2.2 The background and expertise of the core team

The disciplines and competencies that a CB MHPSS programme should have include:

• Clinical psychology; • Anthropology;

• Counselling psychology; • Humanities;
• Social psychology; • Sociology;
• Community psychology; • Applied arts;
• Social work; • Education.
• Linguistics;
Professional staff in the programme, experts and supervisors will possess a combination of those
backgrounds, or competencies will be prioritized according to the specific MHPSS components the
programme focuses on.

Figure 5. IASC pyramid of MHPSS in emergency (IASC, 2007)

(each layer is described in Box 8)

Specialized
services

Focused supports

Community and
family supports

Basic services and security

Source: IASC (2007).

25
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

Box 8
The IASC pyramid of MHPSS intervention
The Inter-Agency Standing Committee (IASC) Guidelines on MHPSS in Emergency Settings (IASC, 2007)
structure MHPSS activities in a pyramid, which has become extremely popular in MHPSS interventions
in emergencies around the globe. The pyramid calls for a layered system of complementary supports
that meet the needs of different groups (see Figure 5). These include basic services and security,
community and family supports, focused services and specialized services. These layers are not
hierarchical and should ideally be implemented concurrently.
The first layer of the pyramid refers to the protection of the well‑being of all people through ensuring
psychosocial and/or social considerations in the (re)establishment of basic services and security are
taken. Security, adequate governance, and services that address basic needs, such as “food, shelter,
water, basic health care and control of communicable diseases”, should be provided in “participatory,
safe and socially appropriate ways that protect local people’s dignity, strengthen local social supports
and mobilise community networks.” MHPSS responses in this level could include advocating for these
services to be “put in place with responsible actors; documenting their impact on mental health and
psychosocial well‑being; and influencing humanitarian actors to deliver them in a way that promotes
mental health and psychosocial well‑being” (IASC, 2007).
The second layer refers to “Community and family supports”, and draws attention to the importance
of the role community plays in enabling the maintenance and improvement of the affected persons’
mental health, specifying activities such as “family tracing and reunification, assisted mourning and
communal healing ceremonies, mass communication on constructive coping methods, supportive
parenting programmes, formal and non-formal educational activities, livelihood activities and the
activation of social networks, such as through women’s groups and youth” (IASC, 2007). More
specifically, the Guidelines recommend the facilitation of “conditions for community mobilization,
ownership and control of emergency response in all sectors… community self-help and social
support… conditions for appropriate communal cultural, spiritual and religious healing practices”
The third layer, focused supports, refers to support provided to people who “require more focused
individual, family or group interventions by trained and supervised workers” (IASC, 2007).
The fourth layer, specialized services, refers to services provided to people who experience significant
difficulties in basic daily functioning due to intolerable suffering, and to those who have severe mental
disorders (IASC, 2007). Assistance should include psychological or psychiatric supports, “referrals to
specialised services if they exist, or the initiation of longer-term training and supervision of primary/
general health care providers” (IASC, 2007).
Most of the activities identified by the Guidelines at the community and family support level will be
presented in this Manual following a different framework. Yet, wherever possible, the Manual will
signal at what level of the pyramid of psychosocial intervention a certain proposed activity should be
categorized. This is done to allow programme managers to present results within the IASC groups and
frameworks in a way that can be understood by partners. On the other side, as it will become evident
in the Manual, often the various layers of the intervention pyramid are more interconnected than a
rigid categorization would allow, which will be also highlighted.

26
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

1.4. CHALLENGES AND CONSIDERATIONS

Although community is a system that comprises different subgroups, levels of individual
interiorizations and counternarratives, and is constantly transforming, it risks in certain instances to
be perceived and performed as atemporal, normative and prescriptive by its actors as well as by
external observers. This brings several consequences:
• CB MHPSS activities might consolidate negative stereotypes and bring about harmful practices as
a reaction to the emergency (for example, early marriages, segregation of girls and persons with
mental disorders, and aggressive behaviours).
• Psychosocial managers may tend to generalize community characteristics to all assisted individuals
and consider them immutable. By contrast, they should always understand the dynamic and
evolving nature of community.
• Competing discourses inform most functions of communities: a dominant discourse, which is
responsible for forming the main position of the system; and subjugated discourses, which are
different if not contrary to the dominant one. The key dimension that distinguishes these two
types of discourses is power. All discourses should be listened to and validated in a CB MHPSS
programme, as necessary and appropriate.
• When community is identified with its dominant and hegemonic discourse, this risks exacerbating
the marginalization/discrimination/stigmatization of subcultural and subjugated groups, reinforcing
power imbalances or subverting existing power balances in a way that creates tensions and
further oppression.
• Furthermore, communities are transformed due to emergencies. People might react and adapt
to adversities in peculiar and different ways. Some of the community members might become
more conservative, while others might become more explorative (or even negative) towards their
cultural belonging than they were before the crisis. The same person might swing between these
polarities at different stages of her/his journey-in-the-making. Therefore, community, in its cultural
and identity aspects, needs to be contextualized in the present while an intervention is planned.
• Humanitarian workers can have an impact on the affected communities in terms of:
- The human relationships that are developed between them and their clients;
- The range of expectations and hopes that are raised;
- The idealizations that emerge;
- The identities that are formed as a result of the CB MHPSS programme;
- The impact of the “beneficiary” identity;
- The dependency that is created;
- Focusing on a specific group of the population.
An MHPSS manager needs to be mindful of how all these impacts interact.

27
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
1. CONCEPTS AND MODELS OF WORK

FURTHER READING
Bateson, G.
1979 Mind and Nature. A Necessary Unity. E.P. Dutton, New York.
Erikson, K.
1991 Notes on Trauma and Community. American Imago, 48(4):455–472.
Papadopoulos, R.K.
2007 Refugees, trauma and adversity-activated development. European Journal of Psychotherapy and
Counselling, 9(3):301–312.
For other references, find the full bibliography here.

28
 2.
ENGAGING WITH COMMUNITIES

Coffee ceremony in Ethiopia. © IOM 2018

29
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

- Assures better access to the most

2.1. WHAT MHPSS vulnerable populations.
PROGRAMME MANAGERS • In terms of results, engaging communities
SHOULD KNOW effectively brings a series of direct outcomes
to well‑being:
Community engagement is considered a - Facilitates recovery: Through engagement,
cornerstone of all humanitarian responses, and organizations can support communities’
can be summarized as an operational approach long-term recovery rather than only
that involves the affected communities in the providing for immediate needs.
different phases of the programme and the - Grants agency and protect resilience:
provision of services, not only as users, clients or The use of existing resources within the
beneficiaries, but to varying extents as agents of community is an element of stability
their own individual and collective well‑being. and limits the negative effect of the
Community engagement can therefore be non-participatory approach of many
considered as both a process and a result of an emergency humanitarian interventions and
MHPSS programme in emergencies. the creation of victim identities.
- Increases local ownership and empowers
• In terms of process, The Inter-Agency Standing people: Being a part of the decision-making
Committee (IASC) Guidelines on MHPSS in process, affected communities are more
Emergency Settings (IASC, 2007) guide likely to own the intervention, and to learn
humanitarians on how to facilitate the and be empowered by this process.
conditions for community engagement. In - Strengthens social cohesion: Different
addition, the IASC Reference Group on components of a community, and all
MHPSS’ Community-Based Approaches to different communities coexisting in a
MHPSS Programmes: A Guidance Note (IASC, territory, should be engaged. Sharing
2019a) further emphasizes meaningful activities and decisions enhances social
participation of communities in the provision cohesion between these communities
of MHPSS in emergencies. As previously and groups. And social cohesion enhances
mentioned, communities are composite, well‑being.
and encompass different groups and social - Helps mend the social fabric where
systems. All different components of a disruptions have torn it.
community, and all different communities
coexisting in a territory, should be engaged, This chapter covers the objectives and
not only the mainstream one. For instance, stages of community engagement in an
in the case of IOM, the host community, MHPSS programme, and describes a process
various migrant communities and socially of engagement suitable for IOM MHPSS
and culturally diverse subgroups should programmes.
all be engaged. As a process, engaging
communities:
- Reduces conflicts and enhances trust: 2.1.1 The three main areas of
Engaging and informing communities engagement
helps to manage expectations, and Community engagement can have a lot of
avoid misunderstandings between the positive effects, and is an essential feature of
management of the programme and the the process of implementing a CB MHPSS
affected communities. programme. Its objectives can be organized in
- Brings to more effective programming: three main clusters:
Builds on existing knowledge, resources,
networks and concepts.
30
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

a) Informing decisions: Providing opportunities 2.1.2 Gradations of community

to the community to contribute to decision- engagement
making processes. This is important but
at times difficult to achieve in emergency Community engagement can have different
MHPSS programming, where at times the gradation and scales, as summarized below:
main activities of a programme are decided • Passive: Information is shared with
even before meeting the communities. And communities, but they have no authority on
yet, a certain level of contribution to decision- decisions and actions taken.
making can always be achieved. • Information transfer: Information is gathered
b) Building capacity: Enhancing MHPSS capacities from communities, but they are not taking
and competencies in a community. part in discussions leading to decision-making.
c) Strengthening relationships: Improving • Consultation: Communities are asked for their
relationships between the agency and the opinions, but they don’t decide on what to do
community, and between some components and the way to accomplish it.
of the community. • Functional: Communities are involved in the
The three objectives are interrelated and should planning of one or more activities, but they
be pursued at the same time, but the timing of have limited decision-making power.
the programme and the nature of the emergency • Interactive: Communities are completely
may bring a prioritization of one objective over involved in decision-making with the agency
another. For example, building and strengthening implementing the programme.
relationships becomes the primary objective when
• Ownership: Communities control decision-
the MHPSS intervention was designed without
making and agencies act only as facilitators
community engagement, to fit with the requests
(funders, supervisors and trainers).
and timing of donors. Informing decisions is
instead the primary objective of an agency that • Empowerment: Communities are empowered
has money to spend but no preconceived ideas in the provision of MHPSS, so that they can
of existing needs and resources. Building capacity ultimately be able to respond to existing
will be the primary objective of an agency that needs with limited external support.
has a very technical profile (Capire Consulting
The aim should always be to strive for as much
Group, 2015). In an IOM CB MHPSS programme,
community engagement as possible, putting
for instance, engaging communities of concern
the bar at the functional level, aspiring to
is a way to build relationships with and between
reach ownership and empowerment levels. In
migrant and non-migrant communities. It is a
IOM MHPSS programmes, different levels of
way to inform decisions about the programme
engagement will be used with different actors
(objectives, indicators and priorities, among
within a community. For instance:
others), and it is mainly a way to create capacity in
communities, as it will be explained in this Manual. • Empowerment: Professional categories and
practitioners active in various domains of
From a programmatic point of view, engaging MHPSS will be empowered through academic
communities in MHPSS happens in a continuum level trainings, designed with local academia and
that invests all phases of the MHPSS programme experts as partners (see chapter on Training).
cycle, from assessment to monitoring and
evaluation, taking into account the three objectives • Functional and ownership: Psychosocial
of community engagement in the process. teams are fully a part of the decision-making
process of MHPSS programmes. They

31
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

come from both the host and the displaced a proper mapping, one can engage with the
communities, and they engage and interact leaders of those structures already known by the
with others in the community (see chapters organization, or the most relevant and visible.
on Psychosocial mobile teams and on
Technical Supervision). Finally, it is important to identify community
gatekeepers who are able to help the manager
• Functional and interactive: The activities that engage with the affected communities or their
are proposed by the teams are both service- subgroups. Gatekeepers are people with social
oriented and mobilization-oriented, therefore functions in their community, in particular
granting a balance between responding to leaders, due to their influence and access to
needs and allowing a meaningful participation the community. For instance, civic and local
of volunteers, professionals, survivors, government leaders, religious and spiritual
stakeholders and other actors (see chapter on leaders, leaders of other community-based
Sociorelational and cultural activities and organizations, teachers, artists and intellectuals,
on Creative and art-based activities). members of relevant departments at local
All this will be explored in the following chapters. universities, youth activists, elderly and female
leaders and many others can be engaged as
gatekeepers.
2.2. WHAT MHPSS Both the MHPSS professional community and
PROGRAMME MANAGERS the other gatekeepers can help the manager
SHOULD DO in assessing needs; mapping resources
with a snowball approach; and learning about
local concepts and idioms of distress and grief,
2.2.1 Whom to engage frustration and fear, happiness and hope, as well
Engaging communities means engaging people, as the local customs and beliefs important for
social functions and institutions through a the implementation of an MHPSS programme.
process, and specific actions that allow them to The time taken to meet and listen will often pay
actively participate in decision-making, to the off with appreciation and collaboration. However,
different degrees mentioned above. Whom to in engaging with gatekeepers and members of
engage in an MHPSS programme is set in the different professional and administrative–political
objectives of the programme itself. groups, managers should maintain a critical
approach. Organizations, local governments
and social groups have their own agendas and,
2.2.1.1 Individuals without recognition of these strategies, wrong
operational decisions are easily taken (IASC,
The first point of contact for IOM MHPSS 2007).
managers should be MHPSS professionals and
resources. Even in complex emergencies, national 2.2.1.2 Families
and local MHPSS professionals can effectively
contribute to informing and shaping psychosocial Families are important social systems, and
support programmes. need to be engaged as such. In an emergency
context, particularly in cases of displacement
Secondarily, many social, administrative, political and forced migration, families are the cultural
and religious structures that are relevant to and social spaces where individuals express
mental health care and psychosocial support their stress, fears and grievances, and receive
might be still in place. Even before starting with

32
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

basic care, emotional support and protection. During the assessment phase, samples of families
Although families are usually part of larger social should be interviewed as a whole (allowing for
and territorial groups formally represented active participation of all members, not only the
by cultural, administrative or political leaders heads or the most vocal), to understand MHPSS
(see above), it is important to establish direct needs, and coverage and quality of delivered
operational engagement with extended services. According to local cultural norms and
families or clusters of families (camp’s sections, emergency settings, representatives of extended
neighbourhoods in urban settings, and villages in or clustered families can be supported to
rural areas). establish projects’ or parents’ committees in
support of the programme.
Families of primary concern for community
engagement in MHPSS should be those whose
members are: 2.2.1.3 Groups
• Affected by disabilities, including cognitive Community engagement involves the inclusion
disabilities; of diverse groups in the community; men, youth,
• Affected by pre-existing or crisis-generated disability and women’s associations, professional
mental, neurological and substance abuse associations and clubs, activists and self-help
disorders; groups, community-based organizations, groups
• Survivors of violence and/or witnesses of of interest, and groups that gather around a
violence that occurred during the crisis; specific activity or interest (sports, fan clubs,
choirs). In an emergency situation, these groups
• Single-headed families with a large number of might be weakened by conflict, displacement,
dependants (children, elders, relatives); or logistical or political restrictions. Financial and
• Associated with or from minority ethno- technical resources should be earmarked to
religious groups. revitalize, strengthen or even re-establish
these groups. Particularly relevant is the
creation of networks and digital platforms where
Box 9 local NGOs and community-based organizations
Engaging with families can share best practices, information and
coordination, and promote campaigns of mutual
Engaging with families can include the interest.
establishment or an early warning system for
cases of suicidal attempts, segregation of girls
Box 10
and persons with disabilities, early marriages,
child abuse and domestic violence. For the Engaging with persons with disabilities
purposes of such an informative system, youth Accessible and inclusive MHPSS community-
and women are usually the best community based activities ensure: people with disabilities are
members to engage with in monitoring family part of decision-making and leadership processes;
dynamics and hidden cases of abuse. Trust and information on MHPSS is accessible and inclusive;
confidentiality between community members MHPSS facilities are accessible; and MHPSS
and MHPSS staff are the core of this system, activities are designed in an accessible and
which can’t be established at the very inception inclusive way and encourage active participation.
of the emergency response, but at a later stage. Furthermore, MHPSS programmes should
specifically identify and invite people with diverse
disabilities to attend MHPSS activities.

33
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

2.2.1.3.1 Religious groups A project committee can be created with people

who are a true representation of the different
Working with religious groups retains strategic facets of the community. Regular meetings can
consideration during the engagement process, be organized with them, building trust in the
because religion plays a relevant role in the value programme and in the process. The committees
set and emotional and social life of many in the will include MHPSS experts, community leaders,
communities. Endorsement from religious groups religious leaders, and representatives from the
and their involvement in the programme are thus various communities and groups. Consistent
important factors of community legitimation with the objective of the engagement and
and ownership of the project. In fact, during an the gradation of engagement required by the
emergency, it is likely that religious organizations programme, the meetings can be:
would already be conducting CB MHPSS
activities, in which case the possible engagement • Information-sharing on the update of the
can be extended to partnership. programme (passive);

It is also important to look at inclusion through • Sessions where new information is shared
the lens of religion. Local faith communities with and gathered from the committee
are usually able to stand close to people in based on technical and managerial needs
emergencies and offer an interpretation of the (information transfer);
experience that might prove to be meaningful to • Meetings where the opinion of the committee
many. Therefore, religious and spiritual leaders members on issues pre-identified by the
can have a positive influence in channelling manager is collected (consultation);
negative psychosocial reactions and promoting • Planning meetings where output indicators are
peaceful coexistence and participation. However, evaluated together and important programme
the involvement of religious and spiritual groups decisions are taken (functional–interactive)
must be carefully considered and balanced in (Capire Consulting Group, 2016).
contexts with more than one group, or when a
specific religious, ethnic, or social subgroup might In addition:
be subject to open or covert discrimination • Psychosocial mobile team (PMT) members
by religious groups. For additional guidance on are a part of the community (see chapter on
integration of faith, faith groups and leaders in Psychosocial mobile teams).
CB MHPSS programmes, see here. For a more
• Each IOM PMT includes a community
structural approach, please see the guidelines
mobilizer (as above).
on A Faith-Sensitive Approach in Humanitarian
Response: Guidance on Mental Health and • Relevant local professionals are hired as
Psychosocial Programming (IASC, 2018a). consultants or in specific training and technical
positions.
2.2.2 How to engage • Local experts and academics are part of the
supervision team (see section 4.4 of this
There are several ways to keep communities chapter).
engaged during the various phases of a MHPSS
programme. The engagement process requires • Artists, activists and promoters can be given
transparency and accountability, accessible in-kind support to organize activities for the
and timely information, and clarity about the community (see Figure 9).
structures, processes, policies, capacities and • Existing networks, services and traditional
limitations in human and material resources. practices can be supported in kind, or by
training or network-building, to act as referrals
or service providers.

34
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

• Structured forms of feedback collection from the project’s affected populations, decision makers
and the rest of the communities are implemented. These should take into account the
Accountability to Affected Populations framework and Communication with
Communities mechanisms.
• The engagement of migrants’ communities can additionally require cultural mediation, adequate
interpretation, and cultural competence trainings for the members of the committees.
• Religious and cultural activities, such as fasting season and seasonal work, should always be
considered – negatively, as they may affect participation; and positively, to be used in support of
the communities’ engagement with the programme.
• Capacity-building can be offered to community members.

Box 11
Engagement and partnership with local organizations
IOM has successfully implemented in Colombia, Lebanon, Libya, Turkey, Serbia and Iraq, just to mention
a few, structured forms of engagement and partnership with local organizations providing MHPSS.
These intensive training programmes (usually a weekly session over three to four months covering
theoretical and operational topics) helped not only in capacitating the organizations but also in establishing
coordination and consolidating civil society networks. This was usually followed up by the delivery of
practical in-kind support, and supervision and mentoring, to develop small-scale MHPSS activities.
These organizations represent several ideologies, motivations, operational capacities and concerns,
including faith-based, humanitarian, educational, women and children support, elderly, persons with
disabilities, minorities, migrants, and gender-based violence (GBV) and torture survivors. IOM’s initiative
helped these organizations to increase their capacity to:
• Intervene and coordinate themselves during the acute phases of the crisis on the basis of
territorial and operational proximity to the affected populations and host communities;
• Pool professional resources and share best practices to ensure compliance with community-
based methodologies and quality standards of MHPSS;
• Lobby as a unified group for funding, capacity-building and administrative procedures
towards local authorities, the private sector and public service providers;
• Advocate for recognition, protection and care of affected populations by international
organizations, national governments and humanitarian systems (United Nations agencies,
donors and embassies);
• Interact with IOM as an international partner in assessing and jointly implementing
emergency MHPSS interventions.
The resulting community-based organization coordination groups and NGO networks proved to be
crucial in the provision of CB MHPSS in Libya in the immediate aftermath of the resurgent civil war in
the summer of 2014.

35
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

Box 12
Local committees 2.3. CASE STUDY
National staff members working for the
organization could be in part biased by the LINC Community Resilience based
fact of receiving salary or compensation, on Transitional Family Therapy
and could be preoccupied with adapting (Landau, 2018)
what they know about their cultures to the A LINC Community Resilience Intervention
new organizational culture in which they are involves an entire community or its
embedded. Local programme committees representatives in assessing a situation and
can be formed to steer MHPSS programmes designing its own intervention (Landau,
and engage on regular basis (Sliep, 2011). 2007). This type of intervention can be used
The local committees should be involved within a community or by governments and
throughout the project cycle. They can help organizations as a way to prepare for and/
in prioritizing assessment questions and or resolve the consequences of mass disasters
advising on the appropriateness of the means (Landau, 2004, 2007, 2012, 2018; Landau et
of verification used. In the planning phase, al., 2008; Landau and Saul 2004; Landau and
the committee decides how to prioritize Weaver, 2006). The intervention uses a series
the findings of the assessments and help in of maps to assess demographics, attitudes,
developing mutually agreed upon action plans customs, family structures and important events
that facilitate ownership and control by the in the community. Following this assessment,
communities involved (IASC, 2007). These community forums are organized, each
plans should clarify how decisions will be representing a comprehensive cross-section of
made, define common values, and negotiate the population. In larger communities (more
rights and responsibilities for each stage in the than 6,000 people), LINC Community Resilience
process (who, what, where, when, why and Interventions begin with consultants who train
how). During implementation, the committee local professionals to assist in facilitating the
will provide regular feedback on the results interventions so that the entire community may
of the programme and vet training plans. The be reached.
committee will also validate the tools of and
participate in the evaluation of the programme. Following LINC guidelines, members of the
The committee members can also act as community are divided into small discussion
focal points for their subgroups (academic, groups, each representing a cross-section of the
professional, ethno-religious, geographical, community. The groups identify the strengths,
gender, age, subcommunities). They are the themes, scripts and resources that are available
ones to inform their community or specific within the community, and discuss what the
group, and are the ones who try to involve concept of resilience means to them individually,
them in the programme. MHPSS managers as well as to their families and community. Each
should support the committee members and group then develops overarching goals for the
gatekeepers to their own strengths through future. Groups usually embrace the goals set by
specific training sessions and active involvement the collective, but they also usually add several
in the activities. Local committees should of their own. They discuss ways in which their
include gatekeepers and experts for both available resources can be applied to each small
the displaced and the host communities, and easily achievable task that is derived from
as well as subcommunities. one of the goals. The groups then work as
collaborative teams to select their community
“Links”, or people from within their own group

36
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

whom they trust and with whom they can communicate easily. Links are identified as people who
would make good leaders and who are able to bridge the gap between the community and outside
professionals. Members of the collaborative teams then identify practical tasks from their goals and
arrange work groups to achieve them. The number of Links depends in part on the size of the
community. Medium-sized communities (populations of 6,000–50,000 people) select, on average,
3 to 5 Links; larger cities (50,000–1 million people) select 8 to 10 Links, each of whom coordinates
multiple projects. This model has been applied in Argentina, Australia, Brazil, Finland, Japan, South
Africa, the United States, Kosovo1 and elsewhere.

2.4. CHALLENGES AND CONSIDERATIONS

Community engagement is not an easy process, especially not with refugees, or displaced and migrant
communities. Displaced communities are often fragmented, scattered and pervaded by a generalized
lack of trust due to their experiences. In addition, at times they cannot fulfil their cultural and social
roles and traditions. The host community can feel threatened and not receptive.
There might be struggles between different community organizations and NGOs (including
international NGOs), lack of funding, corruption, lack of well-functioning (governmental) institutions,
exploitation and a challenging existing power structure, fed by a non-participatory humanitarian
system (Saul, 2017).
Sometimes humanitarian organizations or workers are not engaging communities throughout their
programmes’ cycle for various reasons (Health Communication Capacity Collective (HC3),
2017; OCHA, 2017):
• Fear of the negative: Humanitarian workers might be afraid of negative feedback or that people
see them as accountable for issues they have little or no control over.
• Lack of resources: Providing coherent and useful information and listening meaningfully to
communities may be seen as tasks that require additional budget and dedicated human resources.
As resources are strained in most emergencies around the world, community engagement often
is not considered a priority investment.
• Competing priorities: In any emergency, time is always of the essence. Life-saving assistance needs
to be provided quickly, and taking the time to consult with people may seem counterproductive.
Food, water, shelter and health often are considered as the only or most pressing priorities in a
crisis.
• Coordination: Organizations might also have conflicting or competing approaches or messages.
Not all international organizations easily work with different local groups, such as the local media.
Harmonizing this can be an ongoing challenge.
• Inclusion of different groups: It is often not easy to include all the different groups due to power
relations and dominant sociocultural behaviour and narratives. In conflict situations, there is a risk
that there is a mingling of perpetrators and victims. Because of cultural sensitivity, certain issues
are not easily discussed by the various groups.
• Language barriers (see chapter on Counselling).

1 References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).

37
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
2. ENGAGING WITH COMMUNITIES

Access to communities and the available methods for community engagement may be altered
during health emergencies such as the COVID-19 pandemic. Although not exhaustive, conducting
continuous assessments, awareness campaigns, and remote support can be useful engagement
strategies during health crises.
Additionally, the IASC Thematic Group on Community-Based Approaches to MHPSS held an online
exchange discussing challenges and ways forward for community engagement.

FURTHER READING
Ager, J., E. Fiddian-Qasmiyeh and A. Ager
2015 Local Faith Communities and the Promotion of Resilience in Contexts of Humanitarian Crisis.
Journal of Refugee Studies, 28(2):202–221.
Regional Psychosocial Support Initiative (REPPSI)
2010 Mainstreaming Psychosocial Care and Support - Facilitating Community Support Structures. REPPSI,
Johannesburg, South Africa.
United Nations Office for the Coordination of Humanitarian Affairs (OCHA)
2015 Community Engagement. OCHA, New York.
For other references, find the full bibliography here.

Cooking activity for Syrian and Turkish women,

Turkey. © IOM 2020
38
 3.
ASSESSMENT AND MAPPING

Focus group discussion with male youths in Jolla, Nigeria © IOM 2015
39
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

• How to custom-design participatory

3.1. WHAT MHPSS assessments;
PROGRAMME MANAGERS • How to select existing tools based on their
SHOULD KNOW participatory nature.

Assessing the MHPSS needs and resources of This chapter regards general initial MHPSS
people affected by an emergency, and mapping assessments. Once activities are set and the
existing MHPSS services, or resources that teams established, other assessments may
could be easily reactivated, are essential parts of be needed that are specific to the activities
community-based MHPSS programmes. MHPSS performed. For instance, (a) a livelihood
assessments and mappings in emergencies programme that includes MHPSS components
should not only aim at listing problems, they requires a market analysis; (b) the organization
should also help managers in analysing how of creative activities requires a creative mapping
individual, familial, cultural, social and political of the community; and (c) in certain situations,
factors are intertwined in emergency responses, a conflict analysis will be necessary to inform
and how these connections affect the mental MHPSS activities in certain areas. These
health and psychosocial well‑being of crisis- assessments are related to specific activities and
affected populations and migrants. It therefore are presented in the relevant chapters of this
becomes essential that the MHPSS needs of Manual.
affected populations are assessed in ways that
involve community members. This is clearly
defined in The Inter-Agency Standing Committee Figure 6: Assessment steps
(IASC) Guidelines on MHPSS in Emergency Settings
(IASC, 2007:38–45 – Action Sheet 2.1, Conduct Coordinate with other actors
assessments of mental health and psychosocial
issues).
Collect existing information
If assessment is aimed, among other goals, to
get insights into the collective tensions that lie Mapping of existing actors
behind individual and family psychosocial problems and resources
and the way to respond to these problems,
communities need to be engaged to the extent Formulate objectives
possible in all the steps of the assessment, as
illustrated in Figure 6.
Prepare assessment
Since literature on how to design and conduct
an assessment is copious, this chapter does not
Data collection
present an assessment method or a specific tool,
but rather focuses on how to engage communities
in MHPSS assessment and mapping, and make Data analysis and discussion
with relevant stakeholders
them more community-based, referring to existing
tools. This will include: Programme recommendation
• How to include community members in the and dissemination
assessment team;
Source: Adapted from WHO and UNHCR (2012).
• How to validate and discuss the assessment’s
objectives, methods and priorities with key
community members;

40
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

The initial assessment should address three main

questions: 3.2. WHAT MHPSS
• What are the existing resources and capacities PROGRAMME MANAGERS
in the communities (both affected and host SHOULD DO
communities) to cope with adversities and
provide MHPSS services?
3.2.1 Coordinate assessment with other
• What are the most urgent needs objectively actors
identified by the project’s staff and
stakeholders, and subjectively perceived by Assessment and mapping should be coordinated
the affected populations themselves? with other concerned agencies and actors in the
field. This includes (a) other agencies involved in
• Who are the most vulnerable individuals, MHPSS activities; (b) other humanitarian actors,
groups and subgroups in need of MHPSS in including the cluster system; (c) local authorities;
the affected community? and (d) communities:
The answers to these questions will help the (a) Other agencies involved in MHPSS activities
PMTs reach the aims of the assessment, listed in in a given context can be contacted through
Box 13. the IASC field-based technical MHPSS group,
if one exists (see Annex 1). To the extent
possible, assessment and mapping efforts
Box 13 should be coordinated among different
Main aims of MHPSS assessments agencies to avoid overlapping and enhance
complementarity.
• To learn about the MHPSS concerns
created by the emergency and how (b) Other humanitarian actors shall be contacted,
they are being addressed, with special especially within the cluster system, to
attention to those most vulnerable; explore whether part of the information
has been or is being collected through other
• To identify social, cultural and assessments, and whether some items of
professional resources that exist in the MHPSS assessment could be included in
the affected community to address other ongoing humanitarian assessments. In
psychosocial issues and reactivate self- addition, they can be contacted for facilitation,
confidence, resilience and agency; coordination and clearances. For IOM,
• To identify existing structures that could MHPSS items could be included in Camp
serve as referral, particularly for those Coordination and Camp Management cluster
affected by severe mental, neurological mappings and in Displacement Tracking
and substance use disorders; Matrix assessments (see Box 14), through
coordination with the responsible officers.
• To identify and provide special
(c) Local authorities should be informed about
protection to groups excluded from or
the plans and made aware of what exactly is
stigmatized by the community;
meant by a participatory MHPSS community-
• To obtain the baseline data against based assessment and its implications.
which the programme’s strategies, (d) Communities should be engaged, not only as
activities, outputs and outcomes can be participants, but as decision makers in the
measured later. assessment. A way for engaging communities
in the assessment is by establishing a

41
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

community committee when the assessment 3.2.2 Collect existing information

is being planned. The membership can be
enlarged during the assessment based on A desk review can be done remotely and in loco,
the results of the mapping, with the task searching for, reading and analysing academic
of providing inputs and feedback into the studies and grey literature, including scientific
assessment’s topic and methodology (and articles, field reports, books and materials
later, analysis and results). For the formation produced by humanitarian agencies.
and dynamics of a community committee, If resources allow, or if a strong partnership
see the chapter on Engaging with with relevant faculties exists, academic centres
communities. could support the desk review, mobilizing their
students and experts. IOM, or the IASC MHPSS
group, would identify and partner with a relevant
Box 14
academic institution and commission a review. A
MHPSS questions in the Displacement best practice of this approach was seen in Haiti,
Tracking Matrix soon after the earthquake of 2010, when WHO
Two questions pertaining only to the realm of commissioned a review by McGill University of
MHPSS could be included in Displacement existing information on mental health concepts
Tracking Matrix protocols: and services in the country, which was ready
within weeks after the catastrophe.
(a) Are there psychiatrists, psychologists
or doctors able to treat people with For the methodology used in such reviews, see
mental disorders in your community? this article.

(b) Are there services or individuals that To read the report produced by McGill
people in your community can refer to, University on Haiti, see here.
when they do not feel psychologically To read a similar report produced by IASC after
well? In case psychology is not the earthquake in Nepal see here.
understood, local idioms or the formula
“do not feel well at heart” can be used. The desk review analyses existing information
about cultural, social, political and religious
background of the affected communities that

Focus group discussion in Bentiu, South Sudan. © IOM 2018

42
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

are relevant to an MHPSS intervention in the are doing or plan to do, thus missing pre-existing
context. It helps in having precious information community-based resources that are currently
at the inception of programmes, and in focusing inactive (but could be easily reactivated), or
subsequent assessments and mappings. active but unknown to the humanitarian system.
Also, agencies that receive funding from the
humanitarian system are the most motivated
3.2.3 Mapping of existing actors and to participate in such mapping exercises,
resources which may be unknown to community-based
Mapping of existing services, capacities actors that receive their funding from other
and resources, and needs assessments, sources, or operate according to different
are complementary exercises. Focusing on paradigms (pre-existing governmental services,
the presence or absence of services the churches and traditional resources, spontaneous
humanitarian system deems necessary might volunteer groups, professional groups, and so
give an idea on what is available or missing, but on). It is therefore important that IOM fully
it might not clarify if what is available responds engages with the inter-agency 4Ws exercise,
to what affected populations and community while also enlarging the scope of the mapping
members perceive as the most needed, risking to community-based resources that may be
to underplay communities’ perceptions of their unknown to the humanitarian system, and foster
own needs. On the contrary, an assessment ways in which these resources can be included
without a mapping of services and resources and represented in the mapping.
might give an idea of what people perceive as
needed, but it might not describe if these needs Box 15
can be addressed with local resources, potentially
overlooking the community’s capacity to cope Resources
and respond to the situation. Some hints on where to look for information:
•https://publications.iom.int/–platform;
3.2.3.1 Inter-agency mapping
• www.mhpss.net;
The IASC Reference Group on MHPSS in • www.reliefweb.org;
emergencies has elaborated a “4Ws” mapping
tool, which is a helpful matrix aimed at providing • www.who.int/hinari/fr;
an overview of the existing MHPSS responses • www.academia.edu;
within the humanitarian system. The 4Ws
mapping focuses on “Who is Where, When and • www.apa.org/pubs/databases/psycinfo/
doing What”, to get insight into the provision of index.aspx;
related resources, capacities and services along • www.ncbi.nlm.nih.gov/pubmed/;
the four tiers of the IASC MHPSS intervention
pyramid (IASC, 2012). • https://scholar.google.com/;

The IASC 4Ws was designed to serve the • www.humanitarianresponse.info/;

humanitarian intervention. As such, it is a • www.interventionjournal.org;
powerful tool to identify geographical and
thematic gaps, avoid duplications and foster • www.migrationhealthresearch.iom.int
coordination among humanitarian actors involved In loco: In the field one could consult academic
in MHPSS. However, in some instances, it risks archives, repositories of theses of relevant
focusing primarily on what humanitarian agencies faculties, local libraries, among others.

43
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

At the beginning of an emergency, mapping often happens through a snowball approach (an actor
will refer the mapper to another, who will refer the mapper to a third, and so on). It is therefore
important to consider the mapping as an ongoing exercise to expand throughout the life cycle of a
programme. In addition, while in the flowchart mapping is presented as step 3, in practice it can also
be conducted at the same time as the needs assessment or after the needs assessment.

Box 16
Assessment and mapping of specialized services for those with severe mental
disorders
When designing and delivering interventions targeting those with mental disorders, mapping should
focus on:
• Existing “informal” sources of care available for people with severe mental disorders at the
community level;
• Knowledge around the different sources of available care;
• Attitudes towards the different sources of care;
• Health-seeking behaviour of people with severe mental disorders;
• Existing coping mechanisms, including social, cultural and spiritual outlets, which could be
usefully strengthened;
• Any current or previous community plans to address the needs of people with severe
mental disorders, including capacities, gaps and requests for additional support;
• Resource persons from different community subgroups (for example, women’s groups,
youth organizations, cultural and religious associations) who could potentially be recruited
and trained to support individuals with severe mental disorders.
This information should facilitate IOM MHPSS managers to identify:
• Services for immediate referral of those in need;
• Services IOM should partner with, with the objective to gradually build their capacity to
receive referrals;
• Possible obstacles created by perceptions and health-seeking behaviour of affected
individuals, families and communities.
However, this mapping should always be accompanied by quality control and human rights
compliances of the mapped services (See Chapter on Community-based support for people
with severe mental disorders).

44
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

3.2.4 Formulate objectives achieve the required output (ICRC and IFRC,
2008:25–39).
The objectives of the assessment are highly
dependent on the results of the desk review, the
organizations’ mandate and actual possibilities to 3.2.5 Prepare
respond to the current crisis, and the discussion
and inputs received from the members of the In this phase, several decisions and actions
project’s committee, if already established, or related to the assessment must be taken. They
the first community gatekeepers met during are addressed briefly below.
the process. In general, as identified in the
IASC Community-Based Approaches to MHPSS 3.2.5.1 Select methodology and tools
Programmes: A Guidance Note (IASC, 2019a):
The methodology should be based on:
A CB MHPSS assessment should identify mental
health and psychosocial problems as well as safe • Objectives;
and quality resources and strengths; including • Scope of the programme;
individual, family, community, traditional, religious • Availability of time;
and cultural coping mechanisms, social support • Availability of financial resources;
mechanisms, community action and government • Availability of human resources;
and NGOs capacities. • Informing logic of the intervention.

An important distinction is whether the primary In general, assessment methodology determines

aim of the assessment is of advocacy or to plan a the degree to which participants and therefore
direct intervention. Another important factor is the communities can freely express ideas, which is
nature of the programme. If the programme can an essential aspect of community-based and
respond to different emerging needs with a flexible participatory approaches. The existing tools vary
approach, the goal can be broader. If the scope in the way they allow the expression of and/or
of the programme is limited – for instance, it can emergence of participants’ opinions. In this regard, a
only provide urgent clinical services to people with distinction needs to be made between at least four
severe mental disorders – then the goal should be methodological approaches:
restricted in identifying issues around this subject. • A nomothetic approach based on types or
Doing otherwise would not only be ineffective, but categories: A nomothetic approach brings an
also tiring for the community, risking assessment assessment constructed around categories that
fatigue and raising false expectations. are predefined. For instance, how many people fit
For IOM, typically, the first MHPSS assessment in a certain category or need that the assessment
is broader, aiming at understanding people’s aims to identify?
psychological reactions – their own perception • An ideographic approach that aims at
of what causes these reactions, and people’s understanding meaning and perceptions of
existing coping strategies, at the individual, family cultural or subjective phenomena: This approach
and community levels – and their understanding lets participants express what matters most to
of needed services. them and then places these inputs in a coherent
structure. Results can be categorized, but
For agencies or IOM missions whose
categories are not predetermined. They emerge
programmes are limited in scope, the objective
from the assessment.
of the assessment should be as specific as
possible; realistically considering a minimum • Quantitative methodology that will result in
amount of information needed, timing and prevalence data, number of people in need of a
resources available (staff, logistics, access) to certain service, among others.

45
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

• Qualitative methodology that will result in insights on the issues at stake, a grasp of participants’
perceptions of various issues, among others.
Checklists and closed-ended questions with binary answers (yes or no) are quantitative
measures, part of a nomothetic approach. Semi-structured interviews with open-ended
questions, case studies, group discussions and art-based assessments are all qualitative
measures, part of an ideographic approach. While a qualitative and ideographic approach could
be considered more community-based, in that it lets participants express more freely their
concerns, and grasp what is more accessible in their narratives, it may bring data that are more
difficult to analyse or whose analyses are more dependent on the researcher’s point of view. It
may also bring results that are not strictly related to the sort of programme the organization
has the capacity to run. Table 1 presents a series of complementary information addressed by
different methodological perspectives.

A quantitative, nomothetic approach is more likely to bring valid and precise results, but also
to be based on categories of needs that may not be what matter the most for communities,
grasping what is available in participants’ cognition but not necessarily what is most accessible
and therefore relevant for them, and to limit the scope of the assessment to narrow,
predetermined elements.
In any approach chosen, questions should be limited to collect exclusively the information
needed to plan a successful project. The focus should be on the quality of the information, not
the quantity, to avoid exposing communities to lengthy assessments and maximize resources.
WHO and UNHCR have developed a toolkit that includes several MHPSS assessment methods
and tools that can be used in an emergency, which are for the most part quantitative and
nomothetic, but with notable exceptions, such as the last three, tools 10, 11 and 12 (WHO
and UNHCR, 2012:63–77).
Another relevant source of useful procedures and tools for MHPSS assessments is the IASC
Reference Group Mental Health and Psychosocial Support Assessment Guide (IASC, 2013).
Relevant for the aims of this Manual on CB MHPSS are the two annexes on
participatory assessments (ibid.:15–26).
A useful compendium of assessment tools to be used in a community engagement perspective
(see also Chapter on Engaging with Communities) is proposed by the Capire Consulting Group
in the Inclusive Community Engagement Toolkit (Capire Consulting Group, 2016).
Figure 7, retrieved from the Capire Consulting Group’s The Engagement Triangle (Capire
Consulting Group, 2015), presents different assessment tools that can be used in
humanitarian emergencies: interviews, intercept surveys, vox pop, briefings, meetings, focus
groups, consultative groups, citizen juries, kitchen table discussions, workshops, field trips and
deliberative forums. It details which tools are recommended () or highly recommended ()
for each assessment purpose.

46
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

Figure 7: Capire Consulting Group’s scheme of selection of tools per assessment objective

A range of tools and techniques have been

mapped on the Engagement Triangle, based on Small group
the intent of the community engagement.
One-to-one Large group
These tools and techniques are just mediums
to facilitate the community engagement. The
content and delivery needs to be tailored on a

Kitchen table discussion

project by project basis.

Deliberative Forum
Consultative group
Intercept Survey
Note: This sample of tools and techniques
are drawn from Capire’s recent projects and

Focus group

Citizen jury

Workshop
experiences. Interviews

Field trip
Vox pop

Meeting
Briefing
1 To inform decisions
        

2 To primarily inform decisions and

secondly build capacity          

3 To primarily inform decisions and

secondly strengthen relationships           

4 To build capacity
 

5 To primarily build capacity and

secondly inform decisions         

6 To primarily build capacity and

secondly develop relationships 

7 To strengthen relationships
 

8 To primarily strengthen
relationships and secondly build    
capacity

9 To primarily strengthen
relationships and secondly inform       
decisions

10 To inform decisions, build capacity

and strenghten relationships        

Source: Adapted from Capire Consulting Group (2015).

47
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

Table 1: Nomothetic/ideographic – Practical differences

NOMOTHETIC – QUANTITATIVE IDEOGRAPHIC – QUALITATIVE

Topic: Incidence of people who define themselves as Topic: Identification by affected populations of the main
psychologically stressed or very stressed and rank “anger” emotions and states of mind felt during the crisis, risky
as the most recurrent feeling in the last 2 weeks. journey, forced movement, displacement and confinement
(if any).
Key Question: How much would you define yourself Key Question: Can you describe your prevalent feelings
psychologically stressed on a scale from 1 to 5, and how and emotions over the different periods: when the crisis
many times have you felt anger as the most relevant started, during the journey to the camp/centre, now that
emotion in the last two weeks? you are settled in a safer space?
Topic: List of mental health and psychosocial support Topic: Identification by affected populations of the main
resources (practitioners, clinics, hospitals) available in the providers of affective support, emotional and spiritual
camps, centres and host communities. care, medical and religious services in the communities.
Key Question: Who are the available psychologists and Key Question: To whom in your family and
psychiatrists and which health posts can you refer to if neighbourhood do you refer when you need emotional
you need medical care? support, you want to share your bad feelings and you are
searching for medical treatments?
Topic: Number of individuals who show mild Topic: Description of the occurrences that make people
to moderate symptoms of depression related to living in camps and transit centres feel sad, melancholic,
displacement situation and irregular migration. apathetic or hopeless.
Key Question: How many persons have developed Key Question: Could you recall situations, places, people
symptoms of depression (ideas, attitudes and behaviours) or discourses that make you feel bad, sad or concerned
due to crisis, journey or displacement in this service? about your emotional balance in the camp/centre?
Topic: Number of survivors of torture, GBV and Topic: Identification by affected populations of
domestic violence living in the camps and host vulnerability factors, aggressive communication and
communities. negative social codes that affect survivors, women and
children in displacement.
Key Question: How many persons are survivors of Key Question: Which do you think are the most
violence or (actual and potential) survivors of abuse in offensive behaviours, words and attitudes for persons
their families in the camp/centre who have been survivors of abuse and violence, and might
threaten their sense of safety and protection?
Topic: Number of families who have one or more Topic: Description of barriers and enablers experienced
members with disabilities who experience barriers in by people with disabilities to accessing support services.
participating in their family and community life.
Key Questions: How many families have one or more Key Questions: What are the support services available
members with a disability? What barriers do members to you? What are the challenges and enablers you
with a disability experience? experience to accessing these services?
Topic: List of the most important religious rituals, civic Topic: Identification by affected populations of collective
celebrations and family activities usually performed by and family practices that offer a sense of belonging and
affected communities and/or their subgroups. homeness to people who share cultural practices such as
spiritual beliefs, aesthetics, arts and crafts, and cooking.
Key Question: What are the most relevant religious Key Question: Which kind of religious festivals and
festivals and public ceremonies for the affected community rituals, public ceremonies or social meetings, creative
or for specific subgroups/families? activities or domestic chores do you most like to attend
and perform, and why?

48
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

In emergencies, IOM normally uses an Box 17

MHPSS Rapid Appraisal Procedure Assessing prevalence of mental disorders:
toolkit that contains quantitative elements Cautions
(surveys), qualitative elements (interviews) and
Differentiating between what is abnormal
observations. The protocol and methodology
“pathology” and what is a normal emotional
can be:
response to an abnormal event is a global
• Very simple, in case of assessments taking challenge. Large-scale epidemiological surveys,
place in the immediate aftermath of a especially those that have not been culturally
disruptive event or a displacement in under- validated, may not be able to differentiate
resourced realities (see, for example, IOM, between the two – for example, sleeping
2014). poorly can be a “symptom” or an expected
• More elaborate, for instance in situations of response to an adversity or stressor. This can
protracted displacement, or situations where mean rates of disorders could be overestimated
expert interviewers can be identified (see, when local expressions of adaptive distress
for example, IOM, 2010c). reactions are confused with psychopathology.
Any study into the prevalence of mental
All in all, the best way to proceed is for an disorders needs to begin with ethnographic
MHPSS manager and their team to tailor understanding of people’s lived experiences
context-specific assessment methods and and different social and cultural expressions of
tools that take into consideration the above- distress in order to find holistic and accurate
mentioned resources, or others, and pick descriptions. These include:
those that are suitable for the context, more
• Cultural frameworks for mental disorders
community-based, doable in the time and
and associated belief systems;
with the resources available, and pertinent
to the scope and the kind of programme the • Community attitudes towards mental
agency can actually run. In addition, the tools, disorders and their impact;
especially the ones that are ideographic, can • Relevant information on social, cultural,
be transformed, adding or deleting certain religious, economic and political
items. For instance, each of the tools of the structures and dynamics (for example,
IOM MHPSS assessment toolkit is not to be conflict issues, ethnic/class divisions,
considered as final, but as a list of questions individualistic/collectivistic);
and items that can be reduced, expanded or • Ethnographic information on relevant
prioritized upon need. In addition, whatever sociocultural norms and practices;
method and tools are used, they should be • Understanding the impact of the
contextualized and adapted to the specific emergency context on the above.
languages of participants, cultural context
and stage of the emergency. This should be In addition, diagnostic (mental health)
a collaborative process between the IOM questionnaires need to be validated, and clinical
international team, the IOM national team interviews are better predictors than checklists
involved in the assessment, and the project and self-reports. In fact, if surveys are just
committee or community anchors identified translated but not validated and administered
at that stage. A context analysis can be by interviewers who are not (mental health)
planned to better understand social, political, professionals, results could be misleading. It
cultural and economic aspects of the changing should be noted that assessments are not
environment in which the affected population the same as epidemiological research, and
lives. the collection of prevalence data on mental
disorders is rarely feasible or useful as part of
an initial assessment.

49
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

3.2.5.2 Select target groups and Box 18

interviewees Purposive sampling
Participatory assessments are conducted “Purposive sampling (also known as judgment,
with different members of the population to selective or subjective sampling) is a sampling
understand specific needs, resources, capacities technique in which a researcher relies on
and proposals, and to test the validity of the his or her own judgment when choosing
existing set of information. members of a population to participate in
The IOM toolkit includes specific batteries of the study… The purposive sampling method
questions for national stakeholders, international may prove to be effective when only limited
stakeholders, local/community stakeholders and numbers of people can serve as primary data
affected families. Other tools in the WHO– sources due to the nature of research design
UNHCR toolkit (WHO and UNHCR, 2012) and aims and objectives. For example, for
can be addressed to affected individuals only, research analysing effects of personal tragedy
or to groups. In any situation, participants can such as family bereavement on performance
be randomly selected and, depending on the of senior level managers, the researcher may
objective, there should be relevant participation use their own judgment in order to choose
of men and women, and people of different ages, senior level managers who could particulate
ethno-religious, socioeconomic and culturally in in-depth interviews.”
diverse groups, including different migrant Definition taken from the website Research
groups, if relevant. In order to have relevant Methodology, available here.
communities and subgroups represented,
purposive sampling can also be adopted (see Box
18). A mixed approach that remains random in Language and culture should be considered.
the selection of participants but fixes minimum There may be a need to develop a lexicon of
and maximum quotas of people to interview for words, phrases and expressions according to
each representative group is always preferred. affected populations’ understanding, cultural
practices and belief systems. For instance,
when talking about feelings without knowing
that “feeling” in a language means only physical
sensations, there is a risk to misjudge the
collected information, generating far-reaching
effects on the intervention.

MHPSS assessment in Cox’s Bazar, Bangladesh. © IOM 2020

50
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

3.2.5.3 Selection of interviewers • Ethical principles, confidentiality and informed

consent;
A team that will carry out the assessments
needs to be selected. The size of the team • Psychological first aid (PFA) to support the
should be decided upon in relation to the interviewees if needed;
number and distance of the sites, the sample • Administrating the specific tools that will
to be interviewed, their location, and the be used for the assessment including using
time frame and budget. The following points Washington Group Questions to disaggregate
should be considered when identifying staff for data by disability. See How to ask the
assessments: Washington Group Questions.
• Technical expertise: Ensure that the team In emergency situations, where the protocols are
or individuals engaged in the assessment prepared in a hurry, the training can contain a
have the appropriate or the most relatable workshop to discuss and transform the assessment
expertise and capacities. protocols based on feedback received by the trainees
• Personal qualities: Good communication, in terms of suitability, lexicon, cultural elements and
compassionate ability of good listening, basic possibly stigmatizing elements of the protocol. At
reporting skills. times, some items will need to be deleted because
• Context: Ideally, the assessment team is they may not be comprehended by the team.
comprised of members of both the host and An important element of the training is ongoing
the displaced communities, or at least by supervision and support during data collection
professionals familiar with the local context (see chapter on Technical supervision). The
and the language used in the area where training should ideally take no less than three and
the assessment will take place. If this is not no more than five days.
possible, at least a cultural mediator or
translator should accompany the interviews.
• Communities’ involvement: Make sure to 3.2.6 Data collection
involve and engage communities and include The methodology for carrying on a good data
members in the assessment team. Further collection exercise should include the following
information about team selection can be found points when possible:
in the Psychosocial mobile teams chapter.
• Reading situational analyses from at least
Depending on the context, one could expect each three viewpoints, including external and
member of the team to conduct 3 to 4 individual community ones (triangulation of information),
interviews, or 2 to 3 focus groups per day, plus while interviewing key informants and direct
reporting. observations on the ground;
• Meetings with community and religious leaders,
3.2.5.4 Training of interviewers stakeholders, teachers, health workers, focusing
group discussions with members of the
Before the assessment starts, all interviewers community affected by mental, neurological
need to be trained in: and substance use disorders, persons with
• Interviewing and communication skills; disabilities, their family members and relatives;

• Documentation skills; • Using different visual (photos, drawings,

emoticons) and interactive (participatory
• Analytic and problem-solving skills; ranking, voting, walks) exercises to also allow
• Understanding of basic mental health and children and individuals with low levels of
psychosocial issues; formal education to actively contribute;

51
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

• Community consultations, which should be MHPSS in Emergency Settings (IASC, 2007:8). In

carried out by means of semi-structured this regard, it is mandatory to ensure that data
interviews that allow for a full range of collection would be confidential, grant anonymity
qualitative data; and be based on voluntary participation and
• Participatory mapping exercises aimed at informed consent. It will be condensed in a short
identifying existing MHPSS services for referral period of time, given the high volatility of the
and human resources (displaced health environment of an emergency and in order to
workers, teachers, trainers), which should inform programming in a timely manner.
be carried on at this stage, as well as social Interviewers will usually be divided by camp
networks diagrams, which should be drawn sector or neighbourhood, and each team
in camps, transit centres and neighbourhoods will comprise of different genders, allowing
hosting internally displaced persons, refugees participants to choose the gender of the
and migrants; assessor.
It is important to inform discussants and Interpretation and cultural mediation should be
leaders that data collection is part of a learning provided, if needed.
exercise, and might be repeated at later
stages. Data collection will vary according to Given the fact that participants may have
the methodology adopted. It is important conflicting needs, lengthy interviews should be
to consider that data collection will first avoided. In some context, it is preferable to have
and foremost follow ethical principles and multiple interview sessions, rather than a very
participatory standards based on The Inter- long one-off one.
Agency Standing Committee (IASC) Guidelines on

Clinical assessment, IDP centre, Sana’a, Yemen. @ IOM 2014

52
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

Especially when an assessment includes clinical

components, a referral system should be put in Box 19
place before the assessment takes place. Power structure
In addition, data collection should be conflict- Working in a community-based approach,
sensitive and limited to the minimum disruption the acknowledgement of the role that power
to the community fabric that may derive from structures play in a community is vital, so
the ways in which data are collected. Those parallel interviews or focus groups with
modalities are best assessed and reviewed with individuals or small groups should be promoted,
the project committee and the project team, because it may be inappropriate to talk about
as well as camp managers and other local certain issues in a larger group. It is essential
authorities. to create a space in which people can openly
Key points to be considered in terms of talk. Dividing groups according to gender and
community-based approaches include: age can be useful for the assessment, but a
consideration of the social, religious and cultural
• Cultural sensitivity, gender diversity and dynamics of the specific emergency context
inclusiveness: For example, discussing sexual ensures that all voices are heard and that
violence with a woman in a mixed group everyone can identify their needs, problems and
can cause punishment or exclusion for the resources, which can lead to richer results, such
women afterwards. On a different level, if as in this example:
the tool is addressed to families as a group,
the male head of household may have a Ask the young men what they see as the most
prominent role and focus groups with women important issue to the women in their community.
The women are, at the same time, in a small group
and younger people may become necessary discussing what is important to them. When
to balance information. everyone comes together again, the men are given the
opportunity to share their thoughts on what women
• Power relations: People with power can
consider important at this moment and time in their
exercise control on what is being publicly said, lives, with the group. They usually get it wrong and this
or participants might exercise self-censorship creates a lot of laughter. The roles are then reversed,
in their presence. so that everyone has a chance to get it wrong, and to
laugh, so we feel that we laugh with the people and
• All the actors involved in the assessment not at the people (Sliep, 2009:16).
retain a degree of preconceived knowledge,
which might marginalize alternative views of a Such a reflective exercise should only be done
specific group. Therefore, constant attention early in a meeting and by workers who have
for stigma and biases about and within experience. It may be totally inappropriate or
certain groups, including the humanitarian ineffective in communities where women are
community, should be exercised. not allowed or used to judging men.
• A focus group is not always representative
of the most compelling needs of the whole
affected population, as some individuals
might monopolize focus group discussions,
particularly related to sensitive topics. It might
be helpful to take that person out of the
group dynamic and proceed with an individual
interview because they have such clear
information and opinions.

53
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

3.2.7 Data analysis and discussion with relevant stakeholders

The procedures of data analysis will also largely depend on the methodology adopted to engage
communities and collect information. Ideographic and qualitative tools are typically more difficult
to read than nomothetic quantitative tools. The procedures through which data are going to be
analysed and the needed capacity should be considered from the very beginning of designing the
assessment (see figure 8).

Figure 8: Data analysis

Data analysis of a quantitative nomothetic tool: Social network analysis, cluster analysis, trend analysis,
descriptive statistical analysis, incidence and prevalence
analysis, regressions and correlations analysis.
Data analysis of a qualitative ideographic tool: Discourse analysis, narrative analysis, content analysis,
grounded analysis (themes, categories and codes),
framework analysis.
Data analysis of a mixed method tool: Complementary analysis, comparative analysis, context
analysis, inferential analysis.

Preliminary analysis and clustered findings should be shared and discussed with community
representatives, to the extent possible and using visual representations such as graphics, diagrams,
drawings and pictures. These meetings can include:
• The assessment team, which includes experts or activists from the affected communities;
• The project committee or relevant stakeholders (including at least those who were interviewed);
• Local leaders and representatives of affected populations, including representatives of the most
vulnerable categories.
This ensures that interpretations are made more in line with community perceptions and avoid
misunderstandings. This analytical process in a community engagement perspective is also aimed at
identifying local resources to be mobilized during the implementation phase and monitoring and evaluation
exercises.
In IOM rapid MHPSS assessments, results are presented based on Renos Papadopoulos’ systemic grid of
outcome of consequences. See here.
For contextualization, see the full study here. For a more recent study, using a similar but simplified
model, see a MHPSS assessment conducted in South Sudan in 2014, here.

54
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

3.2.8 Discussion and dissemination status, ethno-religious, political) are represented

on the assessment team, as well as in the
Findings and data analysis should be discussed interviewed populations (including the elderly,
with all involved: NGOs, government, community women, men, youths, children and persons with
and subcommunity representatives. After this mental problems and/or disabilities). Community
discussion, findings and data analysis should clarify engagement and working with partners can help
needs and available resources, and bring actual alleviate this concern.
programmatic recommendations, including an
evaluation of obstacles, misperceptions or any • Assessments can raise false expectations in the
issues of credibility related to the assessment. communities. It is important to inform them on
Findings (for example, report, summary and/ the objectives of the assessment in advance, and
or presentation) should be shared in the local be honest about goals.
language and in culturally appropriate ways, when • It can be challenging to train people from the
possible. For the purpose of this Manual, the community to ensure high-quality, safe, culturally
assessment findings and recommendations need sensitive and ethical data collection, as there are
to be shared with the IASC system, especially if also time limits.
there are recommendations for other sectors to
mainstream MHPSS, and the academic partners, • Analysis of data is often challenging because of
and through the identified gatekeepers and the lack of statistical expertise in the MHPSS
members of the project committee. Gatekeepers teams. It is important to choose assessment
and members of the project committee can objectives as well as methodology based on the
describe findings and recommendations to existing capacity of analysis; otherwise, a lot of
their specific communities and subgroups in efforts will be nullified by the impossibility to
the perspective to (re)activate individual and meaningfully analyse the gathered data.
collective resources, reducing the risk of “learned • It can be challenging to gather sensitive data, such
helplessness” generated by the range of problems as human rights violations, and make sure the
detected by the assessment. data collection is confidential (UNFPA, 2014).
• Tools have limitations, as described throughout
the chapter.
3.3. CHALLENGES AND
CONSIDERATIONS Reasons for not doing an assessment include:
• When conducting a needs assessment will put
There are multiple challenges associated with the data collectors or interviewees in danger or are
assessment phase in emergencies: harmful;
• It can be problematic to reach remote areas • When a population feels over-assessed and
that are heavily affected by the emergency, possibly hostile to additional needs assessments.
ensuring that all community subgroups (social

PMTs’ MHPSS assessment, Lebanon. © IOM 2015

55
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
3. ASSESSMENT AND MAPPING

Table 2: Dos and don’ts

Dos Don’ts
Respect ethical principles and heed protection concerns Don’t do harm
Only collect information that will be used to design Don’t collect information that will not influence
interventions programme decisions
Coordinate assessments with all relevant stakeholders Don’t collect information without involving others
Include the affected communities in the design, analysis Don’t neglect the perspectives of those affected by
and decision-making humanitarian crisis
Assess problems and resources Don’t focus on the problems only
Ensure that the assessment tools are culturally appropriate Don’t use assessment methods across cultures blindly
Tailor each assessment to the particular situation and Don’t employ a standardized assessment package
phase of the crisis
Check beforehand what is already known in the area Don’t immediately start collecting new information
Include different sections, age groups, gender, ethnic and Don’t forget the “silent” groups
religious groups
Be attentive for conflict and tensions Don’t put people at risk by asking questions
Ensure that assessment teams are trained and
knowledgeable of the local context, balanced in terms of
gender, and include members of the populations
Make sure that the assessment is timely and tailored to
the phase of the humanitarian crisis
Source: Based on Ventevogel and Schininà (2009).

The IASC Thematic Group on Community-Based Approaches to MHPSS held an online exchange
discussing challenges to assessment, monitoring and evaluation, of which a video can be found here.

FURTHER READING
International Medical Corps (IMC)
2016 Rapid Mental Health and Psychosocial Support Assessment: Needs, Services, and Recommendations
for Support to Individuals Affected by the Mosul Emergency. IMC, Erbil, Iraq.
2017 Ethnographic Assessment of Psychosocial Needs of Children at Vasilika Camp. IMC, Athens.
International Organization for Migration (IOM)
2011 Who am I? Assessment of Psychosocial Needs and Suicide Risk Factors Among Bhutanese Refugees in
Nepal and After the Third Country Resettlement. IOM, Kathmandu, Nepal.

For other references see the full bibliography here.

56
 4.
PSYCHOSOCIAL MOBILE TEAMS

Home visit at Protection of Civilian site in Malakal,

South Sudan. © IOM 2017
57
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

This chapter of the Manual illustrates the process of

4.1. WHAT MHPSS establishing and maintaining a PMT, more in terms
PROGRAMME MANAGERS of teamwork than taskwork. The actual activities
SHOULD KNOW and services offered by the teams are in fact
described in subsequent parts of the Manual. This
IOM CB MHPSS programmes in the aftermath of chapter mainly illustrates the experiences of IOM’s
an emergency usually make use of a standardized PMTs, but its overarching principles and recruitment
approach: the psychosocial mobile teams (PMTs). methods can be applied to any MHPSS team.
PMTs are multidisciplinary psychosocial support
teams that offer services not in a facility-based but
in a community-based fashion, which is why they 4.1.1 The composition of IOM PMTs and
are called mobile. They have been engaged by what the team members do
IOM to respond to the MHPSS needs of displaced Each PMT is composed by up to six team
populations in many emergency situations over two members with the following qualifications/roles:
decades, including in Chad, Haiti, Lebanon, Libya,
Nepal, Nigeria, Serbia, South Sudan, Sri Lanka, • A team leader, coordinating the activities
Kosovo1 and many others. While many elements of of the teams, linking the necessities of the
the work of the teams depend on the dimension, teams with those of the project management,
quality, characteristics, cultural context and existing identifying training gaps, supporting the teams
MHPSS capacities of each emergency, a series of in designing activities based on assessed needs,
common standards and suggested processes have and attending to output-level monitoring (see
been identified. chapter on Monitoring and evaluation) and
reporting: If properly trained, team leaders
The key strengths of PMTs have proved to be: can also act as supervisors for the teams (see
• Their multidisciplinary composition: The chapter on Technical supervision).
combined expertise of a range of team • A member tasked with directly attending or
members is used to deliver community-based organizing provision of individual and group
comprehensive care to individuals, families and psychological counselling and support: Ideally,
groups (IOM, 2016). this team member would be a clinical or
• Their participatory approach: Teams include counselling psychologist or a counsellor. In
members of the concerned communities with situations in which this profile is not available,
various types of educational backgrounds, the functions can be carried out by a social
cultural competencies and professional skills. worker, or a health counsellor, a pastoral
counsellor, a midwife or a traditional resource,
• They allow for flexibility of programming (sites, who will be supervised and trained for the
responses, timing), which is an essential factor scope of the team’s activities.
when dealing with emergencies.
• A member tasked with social support,
• Their mobile nature allows outreach and including referral to additional services and
proximity to the communities over time and social support organizations, as well as family
displacement phases. mediation and case management: Ideally, this
• They render services more accessible for will be a social worker. If social workers are
women, persons with disabilities, older people, not available, the function can be performed
large families and others who may experience by a counsellor, or a social activist, and
limitations in travelling to facilities. training and supervision will be adapted
accordingly.
1 References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).

58
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

• A member tasked with the organization of See relevant terms of reference here.
sensitization sessions, psychoeducation sessions,
awareness sessions and informal educational Box 20
activities for the community: This professional
Selection of PMTs
will be an educator or a trainer.
• A member tasked with the organization In some contexts, one or more of these
and promotion of cultural, socializing, sport profiles may not exist or are not represented
and recreational activities, both in terms of in the sites of displacement. In these cases,
structured activities that they facilitate directly; based on mapping of capacities, teams are
and mobilizing, supporting, framing and selected among the most relatable professionals
putting in a network already existing activities: or activists. The frequency and scope of
This professional will usually be an artist, an supervision, as well as training, are therefore
anthropologist, a sports coach or a cultural and strictly connected to the existing capacities
social mobilizer (activist, journalist, animator), within the teams, the nature of the needs that
who is named an artist-animator. the team respond to, and the type/context of
the emergency (see chapters on Training and
• A community mobilizer, who understands Technical supervision).
the community very well and assists in the
mobilization of its various sectors: This can
be either part of the core team, or someone The PMTs start their engagement with communities
who acts as a community focal point for the by assessing the needs of specific sites and/or
teams. The community focal point differs from groups, based on IOM and other assessment and
the mobilizer because their function is mainly mapping tools (see chapter 3 on Assessment and
of support and does not require full-time Mapping).
engagement. Moreover, the focal point is not
mobile but is bound to a specific camp sector They then provide psychosocial support based
or neighbourhood. on the multitiered approach suggested by the
pyramid of MHPSS intervention covering tier
Other team members may include: one (basic services and security, mainly in terms
• A member tasked with small-scale conflict of information, field coordination, advocacy and
mediation (see chapter on Integration of referral to services); tier two (community and
MHPSS in conflict transformation and family support); and tier three (focused services),
mediation). establishing referrals to the teams in charge of
• A health worker (typically a nurse) in case no clinical referral and follow-up, or the services or
one else is providing medical services, and just agencies providing clinical care for people with
for the time necessary to cover the gap. mental disorders. See box 22.

59
Individual counselling session in Malakal PoC site © IOM 2021/Liatile PUTSOA
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

Their approach is twofold. Most often the expression through artistic means, either directly
mobile teams provide support through: or by mobilizing existing creative resources.
• Direct provisions of services and activities; The counsellors in the team offer (lay) individual
and or group counselling to people they directly
• Mobilization of and support to community- identify, who seek assistance or who are referred
based resources. by other members of the teams and train other
key people in the community in buddy-to-buddy
In general, each one of the team members has systems and PFA.
his or her own function, but they all collaborate
on needs assessment and the design of the Conflict mediators intervene to mediate small-
interventions. They refer clients (individuals and scale family and community conflicts, while
groups) to each other, and when they think their nurses or other health professionals attend
internal support is not sufficient, they seek help to the referral to health services and help the
and supervision from international or senior educators to design health awareness inductions.
national experts within the programme (manager The community mobilizer or community focal
and supervisor). point supports the team, sharing with them
Each of them is able to provide psychological relevant information about the security and
first aid (PFA). social situation in the sites on a daily basis, as well
as linking with local authorities and actors, and
The educators produce and disseminate keeping the community informed and reminded
messages related to psychosocial well‑being and of the activities of the teams.
health promotion. They provide or organize the
provision of informal education to children and The specificities of all sectors of involvement of
adolescents, and organize safe spaces and child- the teams are explained in more details in the
friendly spaces. They additionally organize adult forthcoming chapters.
non-formal education classes and support the
educational and awareness activities organized by
Box 21
other members of the teams.
Local partners
The social workers attend to vulnerable social
cases and make referrals to service providers In some contexts, IOM might be unable to
that are previously mapped and mobilized. directly recruit people to set up a mobile
Moreover, they support the rejuvenation of team, or similar multifunctional community
community support and safety networks, and structures already exist. In these situations, the
attend to family mediations. manager should work through identified local
partners. A mapping analysis (see chapter on
The artist or community animators engage the Assessment and mapping) helps to identify
communities in some of their traditional, cultural local stakeholders and available resources, and
and religious activities, which help them maintain IOM will provide complementary programmes
a sense of identity. This includes traditional such as trainings, technical supervision and
arts and crafts workshops that are used as other capacity-building initiatives (see chapter
income-generating activities as well as a form on Technical supervision and Training).
of psychosocial support (Babcock et al., 2016).
They can also organize and propose specific
structured cultural and artistic activities in forms
of workshops and or events that promote

60
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

that the PMTs receive extensive supervision

4.2. WHAT MHPSS and training, members of the teams can also be
PROGRAMME MANAGERS appointed from the staffs of university faculties,
SHOULD DO ministries, and existing professional and civil society
groups. These engagements can take the form
of secondments, extra-time volunteer work, or
4.2.1 How PMT members are selected part-time engagements, through agreement with
the respective employers. This will allow the
IOM, like any other agency, considers a well-
concerned institutions, universities and civil society
established set of practices, from recruitment to
organizations to acquire knowledge and trained
deployment, that will need to be administratively
staff over the longer term, ensuring sustainability. In
followed in those cases. This chapter does not
addition to the core team, other members can be
dwell on administrative procedures and types of
attached to the teams and included in the trainings
contracts, but the general scope of the selection.
based on identified needs, or for determined
PMTs, in IOM and other agencies, are built through
periods of time, with a capacity-building objective in
active mobilization of communities, in order to reach
mind. Starting the programme with advocacy and
people in camps, transit centres, and urban and rural
sensitization actions can give the programme higher
areas. How teams are selected therefore becomes
chances to be successful. The community should
of paramount importance. Applying a community-
be informed on the roles and functions of the
based approach to team selection and composition
teams before MHPSS activities begin to be better
requires a good understanding and engagement of:
accepted.
• Communities and subgroups and their
dynamics;
Box 22
• Economic, social and political contexts and
their actors (stakeholders, leaders, influential Care for people with severe mental
individuals); disorders
• Conflict and conflict sensitivity; PMTs do not deal directly with clinical support
to people with severe mental disorders. Usually,
• MHPSS concepts and needs.
their work is complemented by dedicated
Ideally, after the adoption of terms of reference, smaller referral teams, comprised of health
the various positions will be advertised through counsellors and, when possible, psychiatric
ministries, local authorities, relevant faculties of nurses. They usually receive referrals by the
local universities, interest groups, professional PMT and other actors after informed consent is
and civil society organizations, websites and social signed, and arrange, after consultation with the
media. The PMTs will then be composed taking manager or the supervisor, the appointment
into consideration their language skills, expertise, and transportation of the person in need to
references, ethnicity, nationality, gender balance the nearest mental health care or health-care
and educational backgrounds and, ideally, balance facility; attend to the psychoeducation and
between members of both host and displaced support of the family; and provide follow-up
migrant communities, noting that this may not be care, including making sure that the prescription
always the case due to bureaucratic impediments, is followed, and inclusion of the clients and
work permits, and other obstacles. their families in the activities promoted by the
PMTs. For more information, see chapter on
Considering the necessary emergency development Community-based supports to people
nexus, the fact that often professional resources with severe mental disorders.
are few in emergency situations, and the fact

61
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

Box 23 Induction and core training modules must be

Engaging academia standardized and institutionalized as much as
possible. For more information, see chapter on
An example of engagement of university Training.
students come from post-earthquake Haiti,
where the entire university’s infrastructures
were destroyed and fourth-year psychology 4.2.3 The role of hubs as anchors of the
students were able to achieve their last year, work of the teams
supporting the IOM’s PMT and being involved
in their trainings and supervision sessions, which Hubs are temporary structures run by the PMT
were recognized by the university as part of that can vary in form and size according to needs,
their curriculum for the year. This brought to but they are usually constructed with the same
an entire generation of psychology students the material used for the other units in the camps or
experience of being exposed to post-disaster displacement site (tents, caravans, prefabricates,
practical provision of psychosocial support, and shadings structures), or created in existing rooms
helped the university to adapt its psychology or flats in neighbourhoods. They ideally comprise
curriculum based on trainings they received. a small office for management and counselling
purposes, a big room for larger events, and two
rooms for workshops and classes, one of which
4.2.2 How the PMTs are trained and can also be used for counselling. Hubs are better
supervised located close to schools and sports grounds if
available, or they might include:
Supervision and training of PMTs are crucial, and they
receive continuous training though different modalities: • Playgrounds for children (also to support
caregivers to attend courses and psychosocial
• Induction training predeployment, sessions);
covering basic MHPSS topics: This
includes an introduction to the IASC • Volleyball/mini-soccer grounds to facilitate
Guidelines, community-based MHPSS, PFA, sports activities for youths, particularly girls, in
communication skills, ethical considerations, safe and protected spaces.
self-care and other relevant topics.
They should be safe and protected spaces (choose
• Monthly training sessions, which address the location and eventual protective measures in
more specialized topics: The supervisor and coordination with the security unit), and close to
manager decide on the topics to be presented, latrines for males and females, water points or
based on emerging needs identified in the hand-washing stations.
field: for instance, peer-to-peer support, case
management, counselling, GBV, work with Hub structures are usually decorated internally,
children, work with people with disabilities, art- and externally if appropriate, in order to create a
based interventions, conflict mediation, and the welcoming atmosphere for affected populations.
subjects of the chapters of this Manual. PMTs are mobile by definition, in the sense that
they cover different camps and neighbourhoods,
• On-the-job training and supervision: Team and adapt to the movements of the populations
members receive on-the-job training and they serve, with an aim to grant continuity to the
supervision though regular meetings or field intervention. In some situations, however, it has
visits. The manager and supervisor may also proved useful to create these hubs in different
organize on-the-job training delivered by sections of camps, transit or community centres,
external experts, based on specific identified hosting neighbourhoods that can be used by the
training needs.

62
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

Community mobilization in IDPs sites. Psychosocial Mobile Teams,

Ethiopia. © IOM 2018

teams to organize and implement activities. The vulnerable individuals, who were returning home
hubs can be used to host activities organized or returning to transitional shelters.
by the teams, and also activities organized by
members of the communities mobilized by the When the population stabilizes in one place
teams, including meetings, workshops, classes and due to relocation, return or because the
events. Activities should always follow a schedule displacement becomes protracted, the work of
(daily, weekly) and should be well communicated the teams consolidates in two ways:
through boards and visual/verbal announcements • From the one side, if the affected population
(for those who cannot read). The schedule will be and authorities consider that there is still a
up to the team leader, and the daily operations of need for regular MHPSS, recreational and
the centre could be included within the functions counselling centres for families are established.
of the community mobilizer, as appropriate. These centres expand their functions over
emergency interventions and thus are not
The hubs are not long-term centres, but included in this Manual.
temporary facilities that help the logistical
part of the work of the teams, and provide • On the other side, the training provided to
suitable spaces for activities that require higher the teams is evaluated and consolidated in
confidentiality (counselling, group discussions on a national curriculum, which can take the
sensitive topics), and in ritualizing the work done form of a master programme, an academic
by attaching it to a physical space. The work of diploma, creating preparedness in the country
the team, however, remains highly mobile, with for the next emergency to come, as it is
regular outreach activities. better explained in the chapter on Training.

4.2.4 What is next 4.3 CASE STUDY

Usually, the PMTs, or at least their members For an example of the work of the PMTs, see
that come from the displaced communities, this video on how PMTs were utilized in north-
follow the populations in their movements. est Nigeria. Since then the project has expanded
For example, in Haiti, two years after the and some teams have accompanied the displaced
earthquake, MHPSS teams were fully engaged populations in their return home.
in the return process of returning from camps
to communities, offering MHPSS, referral, and
supporting persons with disabilities and other

63
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

• Likewise, when teams operate with a

4.4. CHALLENGES AND mobilization approach, the difference
CONSIDERATIONS between the team member, who is paid,
and the mobilized community resource
There are also challenges associated with a who conducts an activity usually for free,
community-based approach to team selection: can create a grey area. In these cases, it
• Different languages spoken by the host and is important to find forms of gratification
displaced communities can create challenges for the community resource (training, in-
in recruiting and training the most adequate kind compensation, public recognition), and
staff. In these cases, consider adding cultural identify time and engagement limits between
mediators to the teams (see chapter on volunteer and paid functions.
Counselling). • Finally, conflicts might occur within and
• In some countries, it is challenging to recruit between teams or between the teams
both females and males within the same and other providers or some community
team with the same level of education, skills members, due to different reasons, including
and professional levels, because of cultural personalities, cultural and political attitudes,
considerations on gender. In those situations, and stressful working conditions, which
the number of team members could be tend to exacerbate over time. These can
expanded, to allow gender balance. be addressed in supervision, and time and
resources should be dedicated for staff care.
• Balance in ethnicity of the team members with
the same level of education and skills might
Box 24
also be difficult to achieve in some contexts.
Expanding the number of members to include How many teams for how many
different ethnicities can also be considered. services?
• The competition among relief agencies during There is not a unique formula to calculate
a humanitarian operation can sometimes how many teams are necessary to serve
interfere with the recruitment of candidates or a certain number of people. This ratio is
the retention of team members after training highly dependent on the service the teams
is provided to them. This can be mitigated are providing, their expertise, the size of the
by establishing inter-agency agreements and problems, the other services and support
including actors from other agencies in the networks available, and the general population
trainings provided to the teams. to serve. In general, a team of 5 should be able
• While different contracts are offered to to provide around 4,000 services per month.
different team members based on their level This figure includes individuals participating in
of expertise and prior engagements, teams one-off events and psychoeducation sessions,
may allow volunteers to join them to achieve several sessions of a workshop with multiple
flexibility and sustainability. The different affected populations, sporting events and
contracts among team members can create others, both facilitated by the team members
dissatisfaction and tensions within the team, (500 to 800 max.) or by other facilitators or
which need to be addressed in a participatory community members mobilized and supervised
way, through supervision and clearly set and by the team members (up to 3,500), and
transparent differentiations. should not be considered as the total number
of individuals receiving counselling or case
management, which cannot be more than 30
per month per dedicated team member.

64
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
4. PSYCHOSOCIAL MOBILE TEAMS

FURTHER READING
Bjerneld, M.
2009 Images, Motives and Challenges for Western Health Workers in Humanitarian Aid. Digital
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine (453).
Kutash, K., M. Acri, M. Pollock, K. Armusewicz, S.S. Olin and K.E. Hoagwood
2014 Quality Indicators for Multidisciplinary Team Functioning in Community-Based Children’s
Mental Health Services. Administration and Policy in Mental Health and Mental Health Services
Research, 41(1):55–68.
Schininà, G., M. Aboul Hosn, A. Ataya, G. Dieuveut and M. Salem
2010 Psychosocial Response to the Haiti Earthquake: The Experiences of International Organization
for Migration. Intervention, 8(2):158–164.
Schininà, G., N. Nunes, P. Birot, L. Giardinelli and G. Kios
2016 Mainstreaming Mental Health and Psychosocial Support in Camp Coordination and Camp
Management. The Experience of the International Organization for Migration in the North
East of Nigeria and South Sudan. Intervention, 14(3), 232–244.
Yeboah-Antwi, K., G. Snetro-Plewman, K.Z. Waltensperger, D.H. Hamer, C. Kambikambi, W. MacLeod,
S. Filumba, B. Sichamba and D. Marsh
2013 Measuring Teamwork and Taskwork of Community-Based Teams Delivering Life-Saving
Health Intervention in Rural Zambia: The Qualitative Study. BMC Medical Research
Methodology, 13:84.
For other references, see the full bibliography here.

65
 5.
SOCIORELATIONAL AND CULTURAL
ACTIVITIES

Sociocultural workshops. Recreational and Social Centre for Families,

Moultakana-Abu Sliem, Tripoli, Lybia. © IOM 2013/Stefano SPESSA
66
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

Sociorelational and cultural dimensions regard

5.1. WHAT MHPSS the full spectrum of a community-based mental
PROGRAMME MANAGERS health and psychosocial support programme
SHOULD KNOW in emergencies, including specialized mental
health care and focused counselling services.
The sociorelational and cultural aspects of those
Box 25 services are discussed in the respective chapters
Chapter Video (Counseling and Community-based support
for people with severe mental disorders). The
The following chapter is explained in this
following chapters present dedicated sociorelational
video which was developed as a complement
and cultural activities that can be mainly included in
to the Manual. For a visual explanation of the
MHPSS programming at the second and third layer
information presented in this chapter, please
of the pyramid of MHPSS in emergencies.
watch before or after reading the material.
The Inter-Agency Standing Committee (IASC)
Guidelines on MHPSS in Emergency Settings (IASC,
In the first chapter, a series of MHPSS operational 2007), point out the relevance of cultural, spiritual
models were presented. The first model and religious practices, both as forms of community
gives centrality to sociorelational, cultural and engagement and in the provision of mental health-
biopsychological factors and how they influence care services, respectively, in Action Sheets
each other, both in determining psychosocial 5.3 and 6.4. These paragraphs are concise and
well‑being and in the provision of effective MHPSS. comprehensive, and they should be considered for
The section of the Manual encompassing chapters complementary reading.
on Sociorelational and cultural activities,
Creative and art-based activities, Rituals and Specific to children and families, the UNICEF
celebrations, Sport and play and Non-formal Operational Guidelines: Community-based mental
education and informal learning describes health and psychosocial support in humanitarian
activities that work mainly at the cultural and settings: Three-tiered support for children and families
sociorelational levels, and that can have a profound (UNICEF, 2018), and the UNICEF Compendium
impact on the biopsychological well‑being of of Community Based MHPSS Resources
crisis-affected individuals. These activities can help (UNICEF, 2021) provides guidance on activating
bridge tradition with the necessity to change, and in or restoring community structures that strengthen
turn, transform what individuals and communities social networks and protect and support children
face after a crisis, helping them maintain a sense and families, and should be used as reference.
of identity. Considering the model of MHPSS
programming, these activities respond to the
suffering of individuals and groups, focusing on Box 26
enhancing resilience factors and activities that Safeguards for children
traditionally mitigate distress, while giving evidence
As soon as children are involved, safeguards
to the positive outcomes of the emergency in
against abuse should be put into place. They
terms of skills, creativity and reflections. Culture
include behavioural protocols for the staff,
has a significant impact on an individual’s well‑being
training and complaint systems. This regards
because it strengthens the social fabric, and
not only sociorelational and cultural activites,
provides individuals and communities with a sense
but also Creative and art-based interventions,
of belonging and of being supported.
Sport and play, Non formal education and
informal learning. For advices on the practical
implementation of the principles see here.

67
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

Games for youth with and without disabilities. Recreational and Social Centre for Families,
Moultakana-Abu Sliem, Tripoli, Lybia. © IOM 2013/Stefano SPESSA

Box 27 These activities very often build on existing

Selection of activities practices. In any community and in any group,
people have their ways to relate to and support
The selection of the activities described in each other. In some cultures, men may meet
this and the following chapters is embedded to play chess or backgammon at the end of
in the IOM operational framework and past the working day in the main square; in others,
experiences and is, in this sense, partial. In women may meet to cook together. These
particular, the sociorelational and cultural sociorelational and cultural activities and
relevance of social media and other web-based groupings, after emergencies, should be restored,
tools should not be underestimated in how it facilitated and supported. For instance, during
shapes bodies and their perceptions, minds, the Balkan wars, it was noted that traditionally
values, sense of community, value of memories, women, especially those who were married and
group building and socialization practices, as in rural areas, would gather at certain hours of
well as reactions to the emergency. Affected the afternoon to crochet and knit together. This
communities, particularly youth and those was an occasion for them to share resources and
on the move, are usually connected among skills, to relate and socialize, and to receive social
themselves and to external networks through support. During and after the various Balkan
smartphones and computers, searching for wars, many organizations started supporting
information, entertainment and guidance. How women to re-establish these practices in camps,
and when these connections have an impact on refugee centres and affected neighbourhoods.
their mental health and psychosocial well‑being The support varied from context to context,
should also be taken into consideration by and could include outreach, provision of a
programmes. While some examples of best safe space, provision of materials and tools,
practices are presented, this version of the provision of access to markets and fairs, and
Manual won’t provide a complete overview and in some cases facilitators, animators and even
reflection on these possibilities. psychologists, who could help the women use
these venues to discuss in more structured
and non-stigmatizing ways their psychosocial
Apart from the activities that will be presented problems and negative feelings, or could provide
in the following chapters, which are based on psychoeducation. Another example is the
specific mediums, MHPSS programmes should coffee ceremony in Ethiopia. Coffee ceremonies
support a series of spontaneous or induced – such as gatherings in which women usually
groupings of affected populations, with an aim to roast, grind and brew coffee beans for family,
foster social cohesion and social supports. friends and neighbours – play a strong social
68
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

support role and provide an occasion for positive church or the shrine for the weekly or
socialization. After displacement, the affected daily celebrations. In South Sudan, for
population could no longer participate in such instance, women’s groups were supported
ceremonies and reported that this was affecting that gathered each week for tailoring and
their coping capacity. The MHPSS programme crocheting the decorations and textiles for
thus provided material support (cups, coffee, pots, the Sunday mass.
among others) to enable the resuming of such • Problem-based group: A group that gathers
ceremonies. Not only were the coffee ceremonies around a problem, for instance female
strengthening the social fabric and support heads of household, men who can’t find
network, they also became an easy avenue for a job. In both Iraq and South Sudan, IOM
MHPSS team members to engage with the facilitated support groups for women who
community. lost their husbands due to conflict. They
These kinds of activities are socializing, not entirely gather regularly to do social activities, such as
structured, and possibly non-validated. They sit knitting, sewing or sweets baking, and connect
between discussion groups, livelihood support, with other women in the same situation.
group psychological intervention and counselling, The PMTs supported these groups with
without following entirely the standards of any of complementary sessions on loss, grief, life
these activities. Yet, in a community-based MHPSS skills or parenting skills.
approach, they are a fundamental tool to support • Traditional Group: elderly, congregation
communities, starting from their resilience meetings, traditional spontaneous dance
and traditions. Another difficulty with these groups, religious/inter-faith groups, among
activities is that they are very context-specific, others. Healing ceremonies were facilitated
while humanitarian interventions tend to favour in Cox’s Bazar in Bangladesh with Rohingya
interventions that are duplicable and scalable. community members, who were able to
IOM MHPSS programmes have found, intuitively, reconnect with different aspects of their
ways to support groups to hold spontaneous and culture. The ceremonies consisted of three
traditional social gatherings, with specific MHPSS parts: music, to express emotions and
objectives in mind. experiences; art and paintings, to preserve
culture, history, and share individual and
These groups can largely be categorized by: collective stories; and the third part consisted
• Interest group: A group that gathers around of each participant choosing a symbol of
a specific interest, a preoccupation, or an strength, that represented their culture,
affiliation. IOM Iraq works with displaced unity and resilience. These three ceremony
people in urban settings, who want to be elements had a strong intergenerational
active members of their new communities. component, in that older generations were
Neighbour groups gather regularly to discuss able to pass down aspects of their history
issues of concern for the neighbours around and culture to the younger generation. The
hygiene, decorations and others, and propose healing ceremonies allowed participants to
initiatives for improvement, such as launching engage with their historical narratives, cultural
cleaning campaigns. and community identities, and promoted
positive coping mechanisms and a sense of
• Activity group: A group that gathers around social support.
an activity, for instance watching television,
playing chess, crocheting, preparing the • Structured group: Scout groups, organized
youth groups, students’ associations.

69
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

Often, groups can fall under more than and the organization of assessments and
one category. For instance, in Cox’s Bazar, focus groups;
Bangladesh, IOM organized communal kitchens (ii) Fostering community mobilization and
where refugee women from different parts agency;
of a camp could gather to cook together. This (iv) Facilitating identification and support
has created a group that is at the same time an for particularly vulnerable individuals or
interest group, based on the preoccupation of groups;
being able to feed the family; an activity group, (d) Foster the creation of additional groups
revolving around cooking; and a problem-based that are not spontaneous but project-
group, because these are mainly vulnerable generated. These can be useful in supporting
women. particularly vulnerable individuals or to
Regardless of their nature, all of them can respond to identified problems: for instance,
function as peer-support groups, if empowered the communal cooking groups in Cox’s
to do so. For instance, the communal kitchens Bazar, or the men’s groups in South Sudan.
groups helped to identify women particularly at (e) If the group can have a specific MHPSS
need and refer them, and to provide basic forms outcome, or is designed to have an MHPSS
of MHPSS, since IOM psychologists spend time objective, it is important to:
with the groups of women while cooking. (i) Identify a leader or facilitator for the
group, and train him or her in peer
support and mentoring techniques (see
5.2 WHAT MHPSS 5.2.1); or
PROGRAMME MANAGERS (ii) Provide a skilful facilitator to the group,
SHOULD DO from the MHPSS programme team.
(f) Create a network between relatable
Managers should envisage and design groups, through exchanges and events, or
programmes that allow for supporting mobilizing the groups for support in the
spontaneous and traditional forms of gatherings organizations of rituals and celebrations,
that can have specific MHPSS objectives and sporting activities, and so on. In South Sudan,
outcomes. While they are not going to run these an IOM-supported cultural dance group
activities directly, they should be aware of the became well known and was often called
process that needs to be involved in supporting in to participate in important community
them: ceremonies: weddings, birth celebrations and
(a) Assess which traditional ways of gathering memorials. While the group was important
exist in a community, with a gender and age for the participants’ own coping strategies, it
differential approach, as in the example of also had an impact at the community level.
crocheting groups in the Balkans. In Iraq, participants in hairdressing, baking,
(b) Identify what kind of support may be needed sewing and makeup courses would often
to reactivate or maintain these groups. This support community activities with their skills:
can include in-kind support, transportation, for example, offering free haircuts before
or the establishment of a space where people important celebrations, baking sweets for
can meet as they are used to. the community, making toys for children,
offering hairdressing and makeup services for
(c) Identify the value that these groups and ways weddings, among others.
of gathering can have for the objectives of the
programme, for instance: (g) Monitor and evaluate how the activities
(i) Facilitating entry points to communities, of the group have helped to achieve the
intended MHPSS outcome.

70
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

5.2.1 How to identify and support • Supporting them in their emotional needs;
the group facilitators towards MHPSS • Evaluating the system on a regular basis.
objectives
Mentoring and peer support is based on a
supportive relationship between peers with 5.2.2 Informal groups as peer-support
similar experiences. They are empowering lay groups
forms of psychosocial support learned through In some cases, the gatherings of these groups
organized training activities. can become forms of group peer support, in
The mentor is a volunteer, the spontaneous which individuals having similar life experiences
leader of a sociocultural group, who is available interact and form helping connections. In this
to support their group, but is not a counsellor. sense, peer support groups provide social,
The mentor’s role is to help their peers in emotional, physical and tangible support, and
the group through identifying problems, and can help the participants to overcome feelings
giving information about services, networks of social isolation and build a bridge towards the
and resources. The mentor should be sensitive, community. A structured peer support group
empathic and available. would consist of:
(a) One initial meeting.
The mentor should receive a training, covering
aspects such as: (b) Ideally 8 to 20 participants: Newcomers
should not be included in existing groups, but
• The types of activities that they can do with form new ones. This can be kept flexible due
the group; to geographical distances, and pre-existing
• How to listen effectively; bonds considerations.
• How to manage and adapt expectations; (c) A trained facilitator: For instance, the mentor.
• How to encourage equal and respectful (d) During the first meeting, explanation of the
relationships; purposes, agreement on the calendar, and
• How to refer others to services; choosing the topics to discuss: Participants
learn how important it is to listen to each
• How to provide PFA; other’s story, without forcing a disclosure
• How to end the group; and without being intrusive. They learn how
beneficial from an emotional point of view it
• The specific needs of children and families
is to find out that not only predicaments but
(see here for more information and guidance
also resources are common among them.
on resources for training).
(e) Follow-up sessions organized based on the
The programme can set up an effective interest and availability of the group.
mentoring system by:
This guide shows more about how to organize
• Identifying mentors;
these groups.
• Organizing formal trainings, covering the
above described topics, which usually should To finalize plans and organize trainings for the
entail a five-day initial training and refreshers; facilitators, one can refer to IOM’s MHPSS
Section at contactpss@iom.int.
• Organizing regular technical supervisions (see
chapter 15 on Technical Supervision and
Training);

71
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

5.3. CASE STUDIES 5.4. CHALLENGES AND

CONSIDERATIONS
5.3.1 South Sudan
One of the main challenges is establishing who
An example comes from South Sudan, where is part of the group. Some groups may be
spontaneous groups have been supported by the spontaneously established, which can create
programme through a process of facilitation of challenges. For instance, the group composition
conditions for the groups to meet, and training for could create difficult dynamics if all group members
their leaders and facilitators. are from the same ethnicity (in a context with
ethnic tensions). Groups including several members
In this video can be found the genesis and evolution of the same family may affect participants’ ability
of a gathering of female-headed households to share in a confidential manner. However,
(problem-based group) which started as a support spontaneous groups can also prove very useful:
group, and which quickly became a peer-support they are rooted in the community’s own support
group, an activity group, and finally, a livelihood structures system and have a good understanding
activity. on how to navigate those. Group members may
This publication highlights the voices of the group feel more comfortable, as they know each other
facilitators who provided peer-support to the other and trust each other’s motivations.
members of the same interest and problem groups. Establishing groups may make it easier to influence
group dynamics: members can be selected to
ensure a helpful balance.
5.3.2 Ethiopia
Yet how to select group members can also be
Another example comes from Ethiopia, where
challenging. It must be decided if the group is
a youth group was formed over an activity,
heterogeneous or homogenous. Membership
and which facilitated social cohesion amongst
will be influenced by the objectives of the
youths form different backgrounds. The youth
group. For instance, if the group aims to
came from both IDP and host communities, its
provide a safe forum of socialization to women-
members were both male and female, and was
headed households, the group may wish to
supported by two MHPSS team members who
exclude men from this specific group. Factors
varied in age. Wanting to engage in an activity
to consider when establishing membership
that would benefit the group and the greater
criteria could include: age, sex, clan/tribe,
community, the youths decided to engage in
interest, commitments, areas of origin, social
honey farming, and with the support of IOM
status, IDPs/host community members and
who provided material support, built traditional
religious affiliation, among others. This is not
beehive spaces. This process allowed the group
say that there should be segregation based on
to interact with others in the community, broke
those factors, but rather that it is important to
down negative stereotypes community members
recognize that these factors will have an impact
had about youth and eventually led to other
on the group dynamics internally and also on
initiatives, in which members of the group began
how the group will be perceived by the rest of
volunteering in the community to build shelters
the community, which in turn can also affect the
and help run errands for others. The group’s
groups’ own self-perception.
impact went beyond its direct activities and
promoted positive social interaction between Another consideration to take into account is
communities differing in age and migration whether the group will be open, welcoming
background. newcomers, or closed. In order to address this, it is

72
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
5. SOCIORELATIONAL AND CULTURAL ACTIVITIES

important to look at different criteria: It is also important to evaluate the use of cost-
• The size of the group: If the group gets too big, effective ideas vs. having a variety of activities,
it may be more challenging to ensure it reaches prioritizing which option is appropriate depending
its objectives. on the situation. The most popular activities will
reach a wider sector of the affected population but
• The structure of the group: If is it a more might risk leaving individuals out of the programme
informal group focusing on social activities, or or leave specific needs unmet.
a more structured group with defined roles
for its members and a psychosocial objective. Keeping the groups going can be challenging,
In the latter case, it may be more difficult to especially in protracted displacement situations.
incorporate newcomers. The dynamics of a group may change over time:
for example, it could change focus in terms of
• The journey of the group: As the group topic and membership. Groups can also give birth
evolves, and members have gone through the to new groups or subgroups, depending on the
life cycle of the group, newcomers may find it need to recognize new “groups” as they arise. For
complicated to fit in. example, mothers’ support groups were organized
Handling of difficult support group members and in the Primary Health Care Clinics in Wau, South
their unintended impact of activities must be taken Sudan, as part of a nutrition programme. Teenage
into account. MHPSS teams should be aware of and young mothers were usually quiet during the
any potential negative effects of difficult group meetings. When asked why by the facilitator, they
members in social and cultural activities, and adopt shared that they were not comfortable discussing
mitigation measures. For instance: or speaking about certain issues related to their
status in front of older women, including relatives.
• People with mental health issues may feel
Eventually, this led to the formation of a new
worse and become more withdrawn if they
subgroup within the mothers’ group.
try something that is too challenging for them,
affecting the group environment. Groups can also eventually end, and may end for
• Highly disruptive individuals can interfere in the different reasons: members may choose to end
participation of other group members. the group as they have achieved their objectives,
or are displaced again by the conflict. As the group
• There can be negative health impacts for some evolves, and especially as emotional investments are
people with health issues while taking part in made by its members, it becomes more crucial to
certain activities. prepare for such a possibility. The possible ending
• The possibility of violent behaviour and fights of the group could also influence how groups
must be prevented. are formed: for instance, in Nigeria, some groups
created themselves with members who came from
• Members who attend and don’t participate, or
the same locations so that in the event of return,
experience communication problems, might
they could continue the group at their location of
affect the group environment.
origin.
• More dominant group members might try to
impose their values. For references, see full bibliography here.

• It is important to create boundaries and manage

expectations so that people will know what is
appropriate and what they can expect. If people
have a bad experience, it can prevent them
from engaging in activities in the future.

73
 6.
CREATIVE AND ART-BASED ACTIVITIES

GBV awareness-raising mural workshop in Guyana © IOM 2020 74

 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

They are central to the model of CB MHPSS

6.1. WHAT MHPSS programming, since:
PROGRAMME MANAGERS • The arts, with their capacity to transform
SHOULD KNOW suffering, negative experiences and collective
wounds in artistic production of aesthetic,
Box 28 social and cultural significance, work at the
Chapter Video interconnection of the individual, collective
and societal dimensions, and the intersection
The following chapter is explained in this
between suffering, resilience capacities and
video which was developed as a complement
practices, and the positive outcomes of the
to the Manual. For a visual explanation of the
adversity.
information presented in this chapter, please
watch before or after reading the material. • They also connect individuals with their
families, subgroups and larger segments of
society, possibly including new narratives in
This chapter will introduce the use of expressive the public discourse.
art-based and creative activities, such as music, • With their metaphorical yet recognizable
theatre and drama, storytelling, poetry and language, they can at times voice the
creative writing, dance, painting, sculpting, unspeakable, and link the unlinkable.
photography and video-making within MHPSS
programmes. The aim is to inform MHPSS They represent an important dimension of
managers on how to design and monitor identities in that they are a fundamental feature
MHPSS programmes that include these of collective identities and can also give a voice to
fundamental cultural components, facilitating subcultural identities, while promoting individual
expression, relaxation, symbolic re-elaboration agency.
and transformation of painful predicaments,
agency, relationships, problem-solving and
Box 29
peaceful discussions through metaphors, social
communication and documentation. These Effects of art-based and creative activities
activities can activate processes that are at Art-based and creative activities can have
the same time healing, educational, social and a positive effect on social and cultural
cultural, and that are rooted in structured and determinants of health, such as social capital,
recognizable (and therefore safe) forms, but literacy, life skills and auto-efficacy. Furthermore,
allow for individual, subcultural and collective recent neuroscientific and psychological,
changes and transformations. neuroendocrine and immunological studies
Art-based and creative activities are strictly have claimed that participation in cultural
connected with the paradigms presented in and artistic activities can have a positive
the chapter on Models of work. Artistic impact at the organic level, containing the
interventions work on the connection negative outcomes of protracted distress and
between the three spheres of the model of empowering the immune responses. According
a psychosocial approach to programming to the most recent studies of neuroaesthetics,
in emergency and displacement, since they the vision and creation of artistic forms solicit
link body and mind in a creative action that is the mirror neurons and stimulate empathy and
relational, rooted in culture, and creates cultural “atunement”.
“objects”, such as songs, sculptures, paintings,
plays, videos, etc.

75
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

Theater activity for children’s day in Izmir,

Turkey. © IOM 2019

The relations of these activities with the IASC of meaning, the psychosocial programme
MHPSS pyramid of intervention will be explained should purposely create occasions to link these
in the following section. experiences between them and, in the case of
displacement, to link similar artistic experiences
First, the chapter will look at common between the host and displaced communities.
programmatic indications to consider when This means creating or supporting spaces, such
including creative activities within an MHPSS as festivals, events, contests and art exhibitions
programme. Then it will describe programmatic on a given theme. It also includes common
steps that should allow this integration. Finally, it productions and dedicated multidisciplinary
will describe in more detail some processes and spaces, where integration is easier than other
models of work that regard only one of the arts, domains, being based on agency and a common
such as theatre and drama. Theatre and drama artistic language, rather than vulnerability
are specifically used as an example for reasons and services. These activities are defined as
that will be better explained later in the chapter. programme-facilitated.
In addition, and most inherently to its objectives,
6.1.1 Programmatic indications an MHPSS programme should try to mobilize
Art-based and creative activities are rooted and capacitate artists and people who like
in the agency of populations and exist in any using various forms of arts in the facilitation of
community. An MHPSS programme should workshops and processes with more precise
provide so that these practices can be protected MHPSS (relaxation, self-esteem, social cohesion,
or reactivated after the emergency and/or the community development, peaceful discussion,
displacement, allowing theatre ensembles, dance documentation) focus for more vulnerable
troupes, music groups, individual artists, among populations. This is not only about supporting
others, to continue producing their artistic existing practices, but engaging with different
creations. This can include in-kind support and artistic communities and individual artists,
distributions of materials, or equip a psychosocial proposing that they put their wisdom and
hub or a community centre with musical skills at the service of others in need in their
instruments, for example. These are called communities, with a more direct healing and
community-generated activities. reparative objective. Most of these artistic forms
have indeed been used with different social and
Since these activities create social capital, psychological aims in developed countries, as well
occasions for collective discussions and making as in the psychosocial domain in humanitarian

76
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

action for decades (Schininà, 2009), and best • Peaceful discussion and identification of
practices have been identified throughout the problems within the group (for example,
years. These workshops and activities are defined theatre forums, setting the programme
as programme-generated. for a concert, among others);
Finally, creative and art-based interventions can be • Social communication from the group
used as an entry point to the community and also to the community (for example, theatre
as an assessment tool to inform programme design. plays, concerts, exhibitions, videos).
Notable differences exist between different
Box 30 forms of art in the prominence they give to
Three categories of activities these levels. For instance, figurative art activates
the level of individual artistic expression, and
• Community-generated activities protect, of social communication through the “objects”
support and reactivate existing creative it produces. Theatre and dance give more
and art-based resources; importance to the relational aspects and group
building because they are often ensemble
• Programme-facilitated activities build on
works and need an audience, which is a
existing creative and art-based activities,
relation with an out-group, to take place. Video
creating occasions for networking,
documentary productions and art exhibits of
mobilization and sound communication;
photos usually focus on social communication.
• Programme-generated activities mobilize An MHPSS programme will mainly engage with
art-based and creative resources in existing resources and practices, but it should
specific activities and workshops with a consider the pertinence of the used medium
clear psychosocial support aim, targeting when assigning psychosocial support-related
specific problems or vulnerable groups. objectives to the activity.
Art-based and creative activities encompass a
series of practices that act at the four levels of
Art-based and creative activities act the pyramid of psychosocial interventions, with
simultaneously on various levels: most practices positioned at levels 2 and 3.
• Individual expression (for example, The scheme in Figure 9 categorizes a few of
painting, singing, dancing); the possible activities, without aiming at being
exhaustive.
• Group building (for example, choirs,
music ensembles and groups, dance and
drama groups);

Group painting. Dohuk, Iraq. © IOM 2018

77
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

Figure 9: Creative activities along the MHPSS pyramid

Specialized services:
psychodrama,
dramatherapy,
dance-movement
therapy, music therapy,
art therapy.

Focussed services:
workshops in few sessions,
based on social problems or
identified vulnerabilities, using
techniques of dramatherapy,
play-therapy, music therapy, dance
movement therapy, art therapy,
autobiographical and narrative theatre,
educational videomaking.
These are all programme-generated.

Community and family supports:

Community generated: Choirs, painting classes, music groups,
traditional and other dances groups, storytelling, poetry readings,
theatre groups and plays, circus and acrobatics, clownery, puppetry.
These can be both professionals or amateurial. Amateurs theatre is
typically called community-based theatre.
Programme-facilitated: events, festivals, contests, caravans, exhibitions on a
given theme, displays.
Programme-generated: social theatre, forum theatre and theatre of the oppressed,
theatre/music/dance animation, theatre in education, oral history and archives of
memory, educational puppetry.

Basic services and security: programme generated videos, small educational

plays, artistic ads, social media messaging of artistic nature that give info
and facilitate access to services and basic protection and security, like mine
awareness and others. Theatre for education about life saving skills can be also
included at this level.

78
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

However, in an emergency context: activities that are in fact not what they are called,
• Art-based therapies as a form of treatment but just the use of creative tools in an MHPSS
of mental disorders (fourth level) will be programme. However, when actual art-based
used only if certified experts exist in the therapies are used, they need to be accompanied
given context; otherwise, the programme by technical supervision, safeguards and
should not engage in creating such an methodologies that these disciplines adhere to.
expertise.
• Application of these practices for problem- 6.2. WHAT MHPSS
based focused support (third level) can be a PROGRAMME MANAGERS
part of the MHPSS programme, and training
can be provided to artists and activists in this SHOULD DO
respect, but it should always be accompanied MHPSS programme managers most likely
by supervision of the facilitators or be won’t conduct art-based and creative activities
conducted and facilitated by mixed teams of by themselves, but they should make sure
artists and psychologists/counsellors. their programmes allow for the use of such
• Community-based uses of art and creativity methodologies and practices as follows:
can be performed and facilitated by anyone (a) Mapping of existing and pre-existing arts-
who has a skill in the specific art medium. based and creative practices and resources,
These can be divided in two: those that are and assessing perceptions in the community,
generated by the community and that the including:
programme just mobilizes or supports, and (i) Individual artists or amateurs;
those that are generated by the project to (ii) Teachers of related disciplines;
respond to specific socialization needs of a (iii) Ensembles, groups and companies, both
community. They include the recreational use formal and informal;
of arts. (iv) Spaces and venues where these activities
• At the basic services level, arts are engaged take place, if any;
to inform people creatively about existing (v) Art-based and creative activities more
services and life-saving measures through recognized by the communities at large,
performances, simulations, radio ads or songs including the traditions linked to the
with this specific purpose. cultural and artistic heritage of that culture.
The categorization of these practices for (b) Reactivating and protecting the existing or
levels of intervention may be fluid, yet it is pre-existing practices and resources: These
important, since very often in humanitarian can happen in many ways and need to be
MHPSS programmes, terms and concepts contextualized. Support can be material or
related to the psychosocial application of artistic immaterial, in network or in training, and
disciplines are not used consistently. In many include barters. For instance, the project
cases, games with an educational purpose could provide in-kind support to individual
offered at the community support level are artists and groups using arts, as materials,
labelled psychodrama, which creates both the instruments, equipment and safe venues.
wrong impression that these are a possible This support can be subject to a barter (see
treatment for mental disorders, and a bias that (d) mobilizing the arts, below) and is better
they can harm. The same often happens with provided to:
the definitions of dramatherapy, art therapy (i) Collective rather than individual initiatives
and others that are erroneously used to define (for example, a choir rather than a singer);

79
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

(ii) Initiatives addressed to vulnerable or specific psychosocial support functions.

groups, if already existing (for example, This can be prompted in different ways, which
a theatre class in a disadvantaged school include:
or neighbourhood, or minority cultural (i) Campaigns calling people who have an
centres); artistic skill that they want to put to the
(iii) Artistic processes with a wider social services of their communities to come out
impact (for example, traditional dance (see, for example, Box 32).
groups involved in Sunday masses or other (ii) Organizing trainings in using arts as a form
civic celebrations, radio shows); of social action, like in social theatre, art
(iv) Dedicated spaces, such as psychosocial in education, adaptation of art and drama
support hubs (see chapter on Psychosocial therapies adapted to social mobilization,
mobile teams), or collective centres. and problem-based groups (see, for
example, Box 33).
Since these practices have strong subcultural (iii) Offering incentives or grants for small-
values, understanding that practices and scale interventions involving vulnerable
perceptions can differ for different groups in communities in artistic activities with a
the same community is necessary. Conflict and social aim: These may be linked to training.
context sensitivity should be adopted in selecting (iv) Barters, which are related with the
activities to support, as well as the “do no harm” support given: For instance, if the
principle. programme equips one of the psychosocial
(c) Catalysing these initiatives and bringing them hubs with instruments for a musical band
in a network: This is usually programme- and gives access to the instruments to the
facilitated and is done by: bands in the neighbourhood in shifts, the
(i) Reactivating past festivals, contests and bands can be requested to give back to
celebrations; the community. The giving back can take
(ii) Finding ways to foster the inclusion of different forms:
displaced people’s artistic production in 0 A concert, either stand-alone or during
events, exhibitions and festivals happening an event or a celebration.
in the host community; 0 A course in playing a particular
(iii) Calling for contests, festivals, events and instrument for displaced youth.
campaigns with a given theme, exhibitions, 0 If artists wish to be trained and feel
readings, regular or mobile cinema such a drive and/or have the right
caravans and tours, in order to facilitate a attitude, a workshop in the use of music
network; and rhythm as a form of expression
(iv) These can be based on specific media (for and relaxation can be given.
example, a film or video festival, a day of 0 What is important is not to force
theatre shows, dance contests), or making anyone to perform psychosocial
them neighbourhood-based (see a possible support functions that they are not
model in Box 31); ready or willing to perform because
(v) Informing local authorities and linking with of the barter, but to find the best
them. barter that can fit anyone’s attitudes
(d) Mobilizing the arts: These capacities and and engagements with an MHPSS
energies should be mobilized to respond to programme.
specific problems the communities are facing This is just one example, and similar options
or to facilitate the inclusion of specific groups can be given to painters, performers, poets and
or to create social cohesion, attributing direct writers, among others.

80
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

Art workshop in Gubio IDP camp, Maiduguri, Nigeria.

© IOM 2018

The mobilization can bring a series of activities involving specific groups of community members in
theatre, dance, music, video and creative writing workshops, among others, which involve the group
in a creative process where the dynamic and the well‑being of participants are more important than
the aesthetics of an artistic product. In case there is a product and it is displayed, the relevant show,
exhibition, projection, etc., will be opened only to the proximal community, such as friends, family and
caregivers.

Box 31
Mobilization of artistic and creative resources
The social and community-based theatre research group attached to the University of Turin has
adopted a model to mobilize artistic and creative resources in marginalized neighbourhoods and
camps. They create moments of artistic barters, in the form of community events, where the most
creative part of the population is invited to perform and the other to attend. These should happen in
locations that are safe, ample enough and yet can have a symbolic value for that community, including
IOM’s psychosocial support hubs and centres. They include parades, concerts, readings, and displaying
of arts and crafts, and can become a ritual/repeatable event.

(e) Including in the plan of support groups, community-based interventions for people with severe
mental health disorders and focused support with art-based workshops and processes: These
activities, due to their psychosocial objectives, which can be diverse (from relaxation and stress
management to social cohesion), are usually structured with a series of safeguards and boundaries.
The MHPSS programme manager is not supposed to be an expert in all these applied forms of the
arts, and should rely on national, regional and international capacity in the design phase. However,
most techniques and processes have a few elements in common:

81
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

(i) Graduality: There is no rush towards a themselves, but also to search together
product, but time is allowed for individual the most effective ways to communicate.
expression, relationship-building, creation The research of quality in the relationships,
of a safe space, trust-building, explorations, and in the realization of the products,
contracting and feedback. allow participants to activate self-efficacy
(ii) Resource-based: The work focuses on strategies and resources, and to develop
resources. People may be grouped, based an aesthetic satisfaction, important for the
on their needs, but within the group of development of well‑being.
work, their resources (relative to the media (viii) Multidisciplinarity: Usually, the workshops
of the workshop) are the focus of the work. will be jointly facilitated by artists and a
(iii) Agency-based: Art-based psychosocial psychologist or counsellor.
support activities are neither top-down
nor didactic, but are facilitation and valuing Typically, these workshops engage in a process
processes built with the participants. that starts with individual empowerment, then
Activities ownership is a condition and an creates trust and a safe space for people to
objective of the activities themselves. express freely and enter into a relation though
(iv) Diversity-focused: Activities allow each their expressions. When the group is consolidated
participant to express his or her own enough, it can start tackling problems through
personal and cultural identity, and metaphoric and artistic means, and finally goes on
to pacifically and respectfully find an to produce an artistic object for an audience that
encounter with others’ identities, through is usually preselected and consists of proximity
the development of inclusive behaviours. groups (families, friends, neighbours, caregivers
Socialization of differences is allowed by and stakeholders with decision-making powers on
the fact that, in creative processes, more the issues at stake). Engaging artists in these forms
diversity leads to more interesting creative of support should come with a solid training
outcomes. programme for them, which will be specific to the
(v) Group-building: Participants are stimulated technique and the medium involved.
through training exercises, games and
artistic processes to discover their Box 32
diversities, similarities and communalities at “I can do”
the physical, psychological and cultural levels.
Theatre expression and artistic creation In the Bekaa Valley, one of the Lebanese regions
help in developing group communication most affected by the war with Israel of 2006,
and group cooperation, often without the after the war was over and people returned
use of words, which especially in conflict home, IOM and UNICEF launched a campaign
situations can be the most divisive. called “I can do”, to mobilize individuals and
(vi) Metaphor-based: Most of these activities, groups with artistic and creative skills to create
especially those engaging theatre, art and interventions of social utility for the most
music, are metaphorical in nature. The affected communities. (See the English version
problems and the expression of personal of the campaign materials.) The campaign
feelings and experiences are mediated by attracted a large number of people who
a so-called transitional object – a song, a proposed activities that were implemented
character, a puppet or a sculpture – that to start up the IOM-run recreational and
allows one to express, but at the same counselling centre for families. Twelve years
time, take a distance from the expression of on, the centre is still running, operated by a
personal issues. local NGO, and some of the people who
(vii) Quality of processes and products: Activities responded to the call at the time are still among
stimulate participants not only to express its facilitators.

82
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

regulation and physical expression of

6.3. EXAMPLES OF emotions, role-play and creative discussions.
THEATRE AND DRAMA It works on re-elaborating personal
ACTIVITIES THAT experiences, in a safe fashion, thanks to the
use of transitional objects (puppets, stories,
ARE PROGRAMME- characters) and metaphors. There are two
GENERATED main non-exclusive practices in dramatherapy:
one that brings participants to work on
The artistic techniques and processes that can be
existing plays, characters, stories, myths and
used for programme-generated MHPSS activities
legends that can resonate with experiences
are various and can’t be exhausted in this
of their own lives; and one that stages the
chapter. As an example, a series of techniques
lived traumatic experiences from participants’
linked to theatre and drama are presented in the
pasts. Dramatherapy could be used in IOM
following paragraphs. Theatre and performance
MHPSS programmes in emergencies with
art are indeed the arts that have enjoyed more
people with severe mental disorders only
declinations in the community development,
if the practice is pre-existing in the context
psychosocial support and mental health fields.
and dramatherapists are trained. Otherwise,
This may be due to the fact that theatre
some dramatherapy practices can be taught
and drama are usually based on physical and
and used as focused, problem-based support
emotional expression and their interrelation,
activities, especially those using pre-existing
improvisation, and relations with a team. Their
creative materials. For applications of
products are relational in nature because they
dramatherapy practices in focused support
need the co-presence of at least two persons,
activities, see Jennings (2005, 2009, 2017,
the performer and the spectator, to exist, and
2018).
can work on catharsis (emotional release thanks
to the identification with the experience lived (b) Psychodrama: Similar to dramatherapy,
by the character), or metaxis (the ability to psychodrama is a certified therapy that entails
understand a problem in its fundamental points a process bringing the restaging of a traumatic
thanks to the staged action). event from the past with a group of peers,
which will allow the protagonist to change
(a) Dramatherapy: This is a certified form of
elements of their own behaviour in the
therapy based on the links between body and
situation, or ask others to do the same, to reach
mind, memories and expression, emotional
catharsis. It can be used only when certified

83
Band practice in Cox’s Bazar Cultural Memory
Centre, Bangladesh © IOM 2020
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

psychodramatists are already present in the (d) Social theatre (applied theatre): At the
context. It is otherwise not recommended due beginning of the 1990s, a new form of theatre
to skills, time, setting required. See Moreno – taking inspiration and methodologies from
(1987) and here, and also here. theatre animation and community-based
(c) Playback theatre: Similar to psychodrama, but theatre, new theatre and art and theatre
less emotionally charged, Playback theatre therapy – found its way into direct interaction
implies a group of actors or trained individuals with the problems of individuals and groups
who are able to stage impromptu the in specific areas. It was a theatre based upon
storytelling of someone from the group or the body and relationships, but distanced
the audience, giving it a visible form. It is widely from purely therapeutic approaches, and
used in situations of human rights violations. without solely aesthetic and artistic goals.
See Dennis (2004) and here. It was, in fact, less self-centred and was
ready to become an instrument of social
action through laboratories, workshops and
Box 33 performances, with a goal of healing and of
IOM training in the Syrian Arab Republic heightening the quality of social interactions.
It was a theatre that linked the experience
In Damascus, in 2014/2015, IOM organized within the group to the sociocultural,
a one-year ongoing training course for artists economic, and historical context the group
and activists who were facilitating artistic emerged from and remained a part of. This
workshops in the context of psychosocial was and is called social theatre. As Bernardi
support programmes for displaced and stresses, social theatre is part of the current
crisis-affected women, youths and children involvement of anthropology in society and
in the country. Participants included painters, facilitates: the social construction of the
actors, musicians and animators working for individual; the dynamization of interpersonal
20 different organizations, volunteer groups relations and inter-subjective comprehension;
and churches, and the training consisted of and the structuring of the entire community
5 residential modules of 24 hours each plus and of the smaller social institutions of
distant supervision. The modules included which the community is compromised, such
dramatherapy and art-therapeutic techniques, as schools, hospitals, villages. See Schininà
social theatre, puppetry for social intervention, (2004c) in further reading, and Pitruzzella
and Theatre of the Oppressed. These (2006). For practices and examples on the
techniques were found particularly useful in the differential use of dramatherapy and social
context, because they allowed practitioners theatre, see Jennings (2009), here. For
to express their issues through metaphors, practices and examples of the use of social
granting privacy and safety that were missing theatre, in refugee settings, see Balfour (2013)
in other more talk-based interventions, due to in further reading).
the specific nature of the crisis. An 18-month
evaluation showed that participants benefited (e) Theatre of the Oppressed: This encompasses
greatly from the trainings, both in terms of a series of techniques and practices of
professional skills and through the personal the theatre to use for social, political and
empowerment that came from the interactive well‑being purposes. The most famous
and experiential parts of the modules. Modules techniques are its games, Image Theatre and
can be obtained from contactpss@iom.int. Forum Theater, which are both described
in annexes to this chapter. See Boal (1995,
2002, 2008).

84
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

(f) Theatre in education/theatre for development: in Uganda, Burundi and eastern Democratic
Theatre in education consists of the Republic of the Congo. This model explores
preparation of theatre play with educational the effects of disruptive events or situations
goals, which are designed to be interactive on community life and grassroots, theatrical
and accompanied by a series of warm-up means of responding. This approach has
games. The play is presented in front of been influenced by the ideas and practices
an audience (typically of students), twice. of Narrative Therapy and Forum Theatre
The second time, the play is interrupted at (Sliep, 2005, 2009). This can be used at the
different significant points and a discussion is community support and focused levels.
solicited with the students on emerged topics. (c) Theatre Forum: Another example of staging
See here. stories can be inspired by the Theatre
Forum, a technique created by Augusto
Boal (Sullivan and Lloyd, 2006), whose
6.4. CASE STUDIES characteristic is the active engagement of
OF ART-BASED AND spectators with the performance. A problem
CREATIVE ACTIVITIES IN that oppresses an individual is presented
PROGRAMMES unsolved in a theatre scene. The scene is
repeated twice and, during the replay, which
Examples include: is facilitated by a presenter or joker, who is
also expert in moderating the interactions,
(a) Art-based workshops with a group: The
each member of the audience can stop the
objectives and subobjectives are based
scene at any given moment, step forward
on the typology of participants, needs
and take the place of the oppressed
assessed and media used. It has a variable
character, showing how he/she could
duration (minimum five meetings of two
change the situation to allow a different
hours each) and can host from 5 to 30
outcome. Breaking the barriers between the
participants. The document in hyperlink is
performers and the audience, the dynamic
the report of a training module Guglielmo
engagement on stage is powerful and has
Schininà conducted with the students of
transformative effects on all the spectators.
one generation of the Summer School
In addition, practical and shared solutions to
Psychosocial Interventions in Migration,
general problems are sought in the process.
Emergency and Displacement on social
Usually, the scene is the result of a workshop
theatre workshops of this kind whose
of a few days with a group of people sharing
structural elements can be applied to other
similar situations. Find an example on how
media. These are typically community
IOM has used Forum Theatre in post-
support or focused activities, depending
earthquake Haiti, with a process illustrated in
on the composition of the group or the
the attached article (Schininà et al., 2011).
objective.
While the Forum is a community support
(b) Narrative theatre: This is a narrative activity, depending on its process, it can also
approach to working with communities be a focused support one.
affected by trauma, conflict and war. The
(d) Circus arts: This can be used as a way
approach was initially tried in villages within
of expression with different age groups.
rural Malawi in relation to issues of HIV/
Clowns’ organizations have been involved
AIDS. It has been developed further over
in emergency settings in different countries,
the last 10 years in different parts of the
working especially with children and families.
world, and is currently being engaged with

85
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

For instance, Clown Science Dreams, in both community support and focused
collaboration with Jesuit Refugee Services, support, based on scope and objectives.
worked on enhancing resilience, self- (g) Visual arts: In various settings, visual arts
development skills and self-confidence have been used in the provision of MHPSS
through art-based interventions, theatre at the community level, from communal
and clown activities in Iraq. mural painting to representing people’s daily
(e) Community events with narration or lives and experiences though images. It is a
other artistic activities (music, dance, valuable tool to express realities and ideas
among others): These events are properly without words, frequently used with children
structured and developed based on artists’, and youth. It can include painting, drawing,
professionals’ or dilettantes’ competencies. ceramics, textile art, photography, video
They can be developed with a small group and other expressions, depending on the
of stakeholders and community members, cultural context. Visual arts can be combined
can involve traditional arts, and can consist with other interventions. For instance,
of a single performance or concerts, IOM Nigeria uses portrait painting and
or storytelling, or require the active storytelling as tools to facilitate self-
participation of those attending. These are empowerment among affected populations.
full community support activities. See the IOM South Sudan used theatre and
example on the use of choirs. moviemaking, working with youths affected
(f) Collective narrative practice, honouring and by conflict.
building on local skills, stories and knowledge: (h) Storytelling events: Storytelling is an
In many cultural contexts, talking in the first effective tool for mobilizing communities
person about hardships is not culturally and promoting social cohesion towards
resonant. Collective narrative methodologies integration and healing. Stories that relate
such as the Tree of Life and Team of Life experiences can create understanding, and
approaches enable meaning to be conveyed have the power to unite people while they
through metaphor in culturally diverse are being told. They play on a deep emotional
and resonant ways. These folk cultural level, benefiting all participants: it is not only
methodologies can be engaged with, not the listener who learns, but also the teller
only by highly trained professionals, but also who becomes aware of the value of their own
by key community and family leaders, who unique experiences and background, and the
may not have had the privilege of extensive solidarity that can come from a recognition
schooling or education (Denborough, 2008, of mutual or similar feelings and experiences.
2012, 2014; and Ncube, 2006). These are Storytelling can be verbal, in the form of a

Playing the Odissey with a Group of Syrian refugees and psychosocial workers in Ankara,
Turkey. © IOM 2017
86
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

video or a reading. A facilitator can help the (j) Youth workshops: An example of a youth
returnees to combine their stories in different workshop is titled “Piece of Art to Arts for
narratives to share in public. Peace”. This was an interactive intervention
A new form of storytelling is possible with designed to facilitate increased connections
the help of technology. Digital media have among group members in South Sudan. It
been playing an increasingly influential role in intended to bring together multiethnic groups
shaping both the perceptions and outcomes of of displaced children and young people who
emergencies. The combination of words and met regularly in the psychosocial support
images can magnify the impact of stories. An resource centres, either during sports,
example of audience engagement with visual craft activities or group discussions. In this
storytelling is given here by IOM. These are workshop series, they learned about growing
community support activities that can derive and fostering relationships, without relying on
from focused interventions. sophisticated verbal abilities. Specific techniques
encouraged the expression of feelings and
(i) Archives of Memory: In many places, from thoughts and interpersonal dynamics that
Kosovo1 to Colombia, IOM has used an cannot be easily translated into words. The
approach that links creative activities, rituals, interactive nature of the art projects creates
oral history and documentation. Facilitating a context where interpersonal disconnections
communities in creating Archives of Memory, can be explored and understood, and
which are physical and/or digital archives connections can be celebrated, both by talking
collecting personal, creative, photographic, and by making art.
diarist memories of the experience of
displacement, they can then be used as a (k) Often programmes and workshops
cultural testimony and a living memorial for mix various practices and objectives. By
generations to come. The booklet based instance, in Lebanon, in 2013 a group of
on the experiences in Kosovo1 is in further Syrian displaced female teenagers that
reading. The development of new media, was already involved in various activities at
which allow storage and dissemination of one of IOM recreational and counselling
memories that are not bound to a physical centres, subscribed for a workshop aiming at
space, has changed the way archives are developing a video animation. The workshop
conceived. In 2017, IOM Indonesia organized was run by a psychologist and an artist-
a digital storytelling room for refugees and videomaker and mixed artistic, technical and
stranded migrants hosted in a migrant centre. autobiographical elements. After an initial
This consisted of a room equipped to create period, the participants decided to focus
short autobiographical videos using pictures the workshop to the autobiographical
and voice-overs, and a short tutorial for the element, maintaining only a small animation
interested migrants on how to create these component. This brought to the video
videos. In 2010, IOM Jordan, in coordination Letter from a Refugee that went on to win
with the River Jordan Foundation, created human rights awards at video competitions
an online Archive of Memories of Iraqi and to be translated in several languages,
refugee children enrolled in Jordanian schools. in order to be used as educational and
A profile was created for each child, in antistigmatization tool, including in
which were included photos, drawings and countries where Syrians were about to be
memories under the supervision of an expert resettled. See the video here.
facilitator. The archive was online for five
years.

1 References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).

87
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

Box 34 MHPSS programmes can have two roles in

Art-based interventions in academic engaging with art-based practices. One is
programmes supporting the reactivation of existing cultural
and artistic practices, for which conflict
IOM includes components of art-based sensitivity and inclusion always need to be taken
interventions and culture in its Master and into account. The other is to initiate specific
other academic programmes on MHPSS in psychosocial support activities with well‑being
emergency and post-emergency settings, and objectives based on artistic practices. This will
includes artists among those who can attend require dedicated expertise in the MHPSS team
those trainings. See, for instance, the special or in the supervisory team, and trainings for the
section of the Journal Intervention, containing facilitators, who may be skilful artists but lack the
the fieldwork of some of the students to necessary psychosocial skills or be psychosocial
the IOM Diploma in Psychosocial Support workers with no specific skills on the media and
and Conflict Transformation, organized in the arts engaged, which are equally important.
collaboration with the University of Ankara.
Continuity is key for these interventions to be
successful. One-off recreational sessions can be
entertaining, but can hardly reach the intended
6.5. CHALLENGES AND psychosocial objectives. Yet timing and continuity,
CONSIDERATIONS due to volatility of the security situation, are
often a challenge in these contexts.
The most validated adaptations of arts-
based practices into healing and social
support programmes – such as, for example,
dramatherapy, art therapy, playback theatre
and the Theatre of the Oppressed – are
largely based on Western artistic practices and
traditions. Their adaptation to each and every
culture can’t be taken for granted, and should be
attentively discussed with local practitioners and
communities.
Activities should always be tailored to the
needs and preferences of the target population,
knowing that creativity expresses in different
form in different cultures, but is present in all
cultures. Adult males may not meaningfully
engage in ludic activities and performances in
some cultures. However, other artistic media
– such as singing, playing music, and oral and
written poetry – can be considered a fit.
Likewise, while in the West bodily training is
the first step of theatre-based workshops and
practices, women in certain cultures find it
difficult to engage in bodily expression.

88
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
6. CREATIVE AND ART-BASED ACTIVITIES

FURTHER READING
Armaghanyan, S.
2018 Theatre as Psychosocial Approach in Humanitarian Settings. (Unpublished masters’ thesis).
Balfour, M. (ed.)
2013 Refugee Performance, Practical Encounters. Intellect, Bristol, United Kingdom.
International Organization for Migration (IOM)
2001 Archives of Memory: Supporting Traumatized Communities Through Narration and Remembrance.
Schininà, G.
2004 Here we are. Social Theatre and Some Open Question on its Development. The Drama
Review, 48(3):17–31.
For references see the full bibliography here.

Community theater in Benin City, Nigeria. © IOM 2019 89

 7.
RITUALS AND CELEBRATIONS

90
Whirling Dervishes at an Iftar dinner in Izmir, Turkey. © IOM 2019/Lanna WALSH
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

In the aftermath of an emergency, rituals and

7.1. WHAT MHPSS celebrations can perform several functions.
PROGRAMME MANAGERS Through codified rules and scenarios, ritualized
SHOULD KNOW movements, learned narratives and symbolic
images and practices:
Box 35 • They offer occasions for codified expression
Chapter Video of individual negative emotions and positive
emotional reactions.
The following chapter is explained in this
video which was developed as a complement • They help to overcome isolation, and help
to the Manual. For a visual explanation of the people to socialize and share.
information presented in this chapter, please • Making use of metaphors, images, characters
watch before or after reading the material. rooted in traditions, they allow people to
communicate negative experiences in a safer,
indirect way.
This chapter concerns the inclusion and
• Being learned and repeated for generations,
promotion of collective rituals and celebrations
they help in contextualizing the current
in a CB MHPSS programme. After a brief
suffering in history and heritage, providing
introduction to the functions rituals and
continuity and a perspective.
celebrations can have in a CB MHPSS
programme, the chapter will provide practical • They can provide interpretative frameworks
information to MHPSS programme managers on to personal and collective predicaments.
how to include rituals and celebrations in MHPSS Tales, legends, staged ritual dramas, songs,
programming. While the restoration of individual proverbs and scriptures all contain elements
and family rituals has an important role to play of reflection on the human condition that can
in terms of self-care and psychosocial well‑being, also shed light on the current problems.
this chapter concerns collective and community- • They help people to feel reconnected with
based rituals and celebrations only. themselves, their families, communities of
origin and host communities.
Box 36 • Rituals can represent, validate and accompany
Complementary information transformations. The transformative function
is inherent to rituals, which often are rituals
The UNICEF Operational Guidelines: Community- of passage – such as marriages, seasonal
based mental health and psychosocial support celebrations, initiations and funerals – which
in humanitarian settings: Three-tiered support all reflect the social recognition of the change
for children and families (UNICEF, 2018) in a personal state.
provides guidance on support to communities
• In addition, in situations characterized by
to re-establish rituals or cultural events (for
disruptions that have fractured communities,
example, commemoration events to foster
they can ritualize the experiences of violence,
communal healing, cultural festivals or religious
displacement and relocation, and celebrate
celebrations), along with traditional healers
the resilience of communities. Celebrating
or leaders as appropriate. The information
arrivals in the camps, and their closure, new
contained in this chapter complements
intercultural rituals – along with the host
the information contained in the UNICEF
communities – can all contribute to the
Guidelines from a programmatic point of view.
well‑being of affected populations.

91
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

Box 37
Example from the Yazidi community in Iraq
In 2015–2016, the Yazidi community in the northern part of Iraq welcomed back those Yazidi women
who had been kidnapped into sexual slavery by ISIS, using traditional cleansing rituals, which allowed
them to be fully reintegrated into their families, using a traditional form. This is an example of collective
ritual of transition used to respond to war-related adversity (for more information, click here and
here).

7.2. WHAT MHPSS PROGRAMME MANAGERS SHOULD DO

Psychosocial programme managers are not going to perform or organize rituals and celebrations
themselves. Yet they should design and implement programmes that allow for support to rituals and
celebrations in various forms, which will be described below.

7.2.1 Facilitate existing or reactivate interrupted practices

7.2.1.1 Map types of rituals and celebrations with community leaders and informants
Rituals and celebrations can be religious or non-religious. Both religious and non-religious rituals and
celebrations can be daily (for example, Muslim daily prayers or flag-raising), weekly (for example,
Sunday masses or elderly gatherings), yearly (for example, Eid, Christmas, Labour Day, Independence
Day), occasional (for example, weddings, funerals), periodic (for example, initiations, coming-of-age
processes). It is important, at the very beginning of a psychosocial support programme, to create
a calendar of the rituals and celebrations that can be calendarized, to understand the scope of the
necessary financial and manpower commitments. To note:
• Movements (but in some cases, also public gatherings) of refugees, IDPs and migrants outside
camps and centres require authorizations and coordination with security forces that might take
time and efforts to be obtained.
• Rituals and celebrations should be reviewed with community leaders, in order to identify potential
human rights violations and be clear about what the programme can support or not and why.

92
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

Table 3: Examples of rituals

Examples of rituals
Personal rituals • Coffee in the morning.
• Bedtime routines, like storytelling or prayers.
• Personal religious practices.
• Comfort rituals/stress management.
Social rituals • Hospitality: Coffee ceremonies, meals, “good manners”,
greetings and farewells, relations with guests.
• Activities with friends: Tea and chess, bar hopping,
dancing, sports.
• Celebration of holidays, birthdays, name days.
• Memorialization of events.
• Presentation of “self” such as attitude, posture,
approach to others.
• Family relationships and activities.
Religious rituals • Prayers and preparation for prayer.
• Rituals of devotion: Fasting, abstaining from X,
seclusion, paying alms, worship, special food.
• Celebration of holy days, festivals.
• Memorialization.
• Preaching/worship.
• Creation of shrines/altars/places of devotion.
• Elevation of persons having certain gifts or training to
be leaders for others.
Cultural rituals • Initiation/membership rituals.
• Group membership rituals: Political groups, gang
behaviour.
• Symbolic behaviour.
• Clothing/hairstyle as reflective of group identification.
• Citizenship or ethnic membership.
• Development of arts, including song, dance, visual, crafts.
• Sharing of history/narratives of group.
• Passing of traditions across generations.
Rites/rituals of life events (cultural, traditional or religious) • Recognition that a person has changed, therefore
social position/relationships change.
• Rites of passage from one state to another. Sometimes
include survivorship or disaster recovery.
• Births and naming.
• Puberty and initiation to adulthood.
• Marriage.
Rituals of grief, loss, disasters • Gathering of people to mourn.
• Support for friends and family of the bereaved.
• Public ceremony, public demonstration of feeling,
processions.
• Prayers.
• Lighting of candles, bringing of flowers.
• Food, communal meals.
• Rituals of honouring ancestors.

93
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

Box 38 traditional instruments, stationery, chairs or

Religious rituals necessary seating arrangements, lights and
candles – might greatly support the execution of
At the early stages of an emergency, religious religious rituals and public gatherings in a warm
rituals, such as public prayers and rituals and conducive atmosphere. It is important that
connected with the life cycle – coming of all religious and ethnic/cultural groups present
age, marriages and, most importantly, grieving in a camp or a community be represented,
rituals – should take place. Click here for more always using a conflict-sensitive approach (see
information, and see this video highlighting chapter on Integration of mental health
ways MHPSS programmes adapted to the and psychosocial support in conflict
COVID-19 pandemic when working with transformation and mediation).
communities processing grief and loss.

7.2.1.2 Identify and refurbish (or prepare 7.2.1.3 Mapping and involving faith-based,
new) sites and locations civic and cultural organizations
and their leaders
This includes, for example, mosques, churches,
temples, meeting rooms, town halls, schools, Religious leaders, artists and cultural activists, within
museums, cinemas and theatres, where religious and outside the groups of concern, who are willing
rituals and civic collective gatherings can be held to collaborate with the psychosocial project in
in safe and welcoming premises. If such locations organizing rituals and gatherings, and promoting
are not available in a close range, the project participation, based on agreed procedures and
might consider the establishment of temporary aims, should be identified. If available, programme
dedicated spaces (rub halls, tents, caravans, managers should actively search for collaboration
shadings) or renting/rehabilitating available with religious congregations, cultural centres, and
structures for the purpose. It is important to faith-based and civic-based organizations to provide
recreate a symbolic enclosure to these spaces, training on MHPSS to their staff and volunteers.
even with simple objects such as fences, These include both among the displaced and
pathways, boards, images, plants and decorations. the host communities. If deemed appropriate,
Usually, provision of ad hoc equipment – such partnerships should be established with them to
as data projectors, screens, sound systems, jointly carry out these activities.

Eid Mubarak, Dari-Recreational and Counselling Centre for Families, Baalbeck,

Lebanon. © IOM 2016

94
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

7.2.1.4 Facilitate inclusion Box 39

Programme managers should facilitate inclusion Safety and protection

of individuals and families who might experience Participants may need to be reassured of
difficulties accessing public gatherings and their safety and protection, vis-à-vis the risk of
religious places. Examples include: internal and external provocations. Not only
• Providing or subsidizing transportation; should safety and security be provided, but
participants should be made aware that these
• Arranging translators (and sign interpreters if measures are in place.
required);
• Using accessible venues;
7.2.1.6 Engage staff appropriately
• Enabling participants to attend with a support
person; Ideally among the multidisciplinary PMTs,
• Explicitly inviting marginalized groups of there is a member that is tasked to learn from
people to attend. communities’ religious and spiritual beliefs,
traditional narratives and iconography, ritual
On the occasion of civic commemorations, and civic calendars (for example, cultural
public campaigns or ceremonial exchanges and media activists, teachers, scholars and
of gifts, a mixed attendance and inclusion of artists). PMTs are likely to be composed of
different subgroups should always be pursued. professionals with different ethno-religious
backgrounds and social status, along with
Rituals and celebrations can also be used
gender, age and political differences. Therefore,
to divide and exclude, and this needs to be
it is important as a preliminary to discuss
evaluated at the inception of the programme.
modalities of their engagement in rituals and
celebrations. Particularly for religious rituals
7.2.1.5 Mobilize stakeholders and partners and public gatherings, which might require the
full mobilization of the team, it is important to
Local authorities, camp managers, section coordinate roles and functions according to
leaders, teachers, journalists, artists and professional skills, social attitudes and cultural
media activists should be involved from the proximity to the affected populations. Staff
inception of the activity. Appropriateness members who do not feel comfortable, or
of the activities, designing and implementing perceive their presence as potentially obstructive
steps, available financial and material resources, to the smooth implementation of the activity,
logistics support and authorizations should should be left free not to facilitate or attend.
be discussed and coordinated with them. If Discussions with and within the teams after
deemed necessary, ad hoc committees can be the implementation of rituals and celebration
established for the organization of both civic activities should be encouraged by psychosocial
and religious rituals, but religious ones may supervisors as a good managerial practice and
have to follow their established procedures, lessons learned exercise.
particularly on the subject of inclusion. It is good
practice to mobilize groups and individuals in
the organization of these events (for example,
youths, scouts, heads of families, women’s leaders
and religious actors).

95
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

Healing Ceremony with Rohingya women in Cox’ Bazar,

Bangladesh. © IOM 2018

7.2.2 Promoting additional activities and 7.2.2.2 Promoting new celebrations

new rituals and celebrations
In strict dialogue with religious leaders and
civic activists, new ritual celebrations could be
7.2.2.1 Promoting the reactivation of promoted by the MHPSS programme, including:
rituals and celebrations • The anniversary of the day of displacement;
After a preliminary assessment on the most • The opening, anniversary or closing of a camp
appropriate religious rituals and civic celebrations or transit area;
recognized by the community, according to the • A day celebrating the relations between the
specific goals, stages of the emergency and target displaced and the host community;
groups, different sets of activities should be
identified (for example, public prayers, candlelit • Interfaith celebrations based on the
march, pilgrimages and visits to symbolical religious composition of the camp, displaced
places, funerals, weddings, annual celebrations community and host community.
and commemoration, storytelling and poetry
contests, radio talks and social media events) 7.2.3 Links with sports, cultural creative
that the project aims to support directly, either activities and informal education
because they are missing, or because they
are deemed particularly important. Special Preparation of the main celebrations and rituals
attention should be paid to testing some of can be linked to sporting events or activities,
the assumptions on the positive effects of the such as tournaments and contests. The ritual
specific activity on the well‑being of participants and the celebration can be linked to the other
through discussions with religious leaders, cultural creative activities supported or connected to
activists and selected members of communities. the programme. For example, one can organize
See example on community-led Iftar dinners in seminars, drama, music, traditional and other
Turkey. dances shows, poem readings and storytelling,
and photo and art exhibitions, during or around
the celebrations. Moreover, the rituals and
celebrations can be used to promote support
groups and other programme activities.

96
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

7.2.4 Documentation
7.4. CHALLENGES AND
Many of these events might assume historical
CONSIDERATIONS
relevance and should be properly documented
by the project. It is important to archive: When public celebrations and religious rituals
• Photos and videos produced by participants, are associated with painful memories, deep
PMT members and media; resentment and contested meanings, their
inclusion in a psychosocial support programme
• Printed materials such as brochures and
should be carefully planned, to prevent their
posters;
close association with psychosocial interventions
• Professional documentaries. to antagonistic, partisan and politicized stances.
Particularly sensitive in emergencies can be
Some of these documents will properly fill
martyrs and veterans’ celebrations, as well as
Archives of Memory.
commemorations of battles, exoduses and
genocides.
7.3. CASE STUDY Religious rituals and celebrations can be a source
of conflict in some context, and this risk must be
In the aftermath of the 2010 earthquake in Haiti, evaluated. The engagement of traditional healers
during masses, some Christian priests were and ritualists should also be done with utmost
blaming the earthquake on the prior behaviour caution.
of their faithfuls, characterized by a non-strict
adherence to the prescriptions of the religion. Participants might not feel comfortable having
By contrast, the cosmological vision of the world their rituals documented. As in any activity, they
connected with Voodoo helped individuals should be consulted before taking pictures or
and communities give a transcendental value recording the event.
to the earthquake, making it easier for them
Often, rituals are used to divide and exclude,
to attribute a meaning to its consequences.
especially in conflict situations. A careful
Many families believing in Voodoo were quite
evaluation of the possible instrumental use of
distressed about the impossibility to bury the
rituals for exacerbating conflict and exclusion
roughly 80,000 corpses that could not be found,
needs to be carried out within an MHPSS
since in Voodoo, funerary rituals are extremely
programme before engaging with these specific
important in determining the well‑being of
celebrations. For further guidance, see here.
the person in the afterlife, but also his or her
possibility to still relate to the world of the living. Assessing the impact of rituals and celebrations
For this reason, IOM, first alone and then under can be challenging. Evaluation and feedback
the umbrella of the IASC Working Group on mechanisms can be used to ensure that the
MHPSS, promoted an interconfessional forum of activity has a positive impact on the well‑being of
religious leaders. The forum brought sensitization people of concern.
on the psychological consequences of blame
towards priests in the country, the creation and
dissemination of common supportive messaging
and especially the elaboration of a guide, agreed
by all, to perform funerary rituals in the absence
of corpses, and to the organization of such
collective rituals in several camps.

97
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
7. RITUALS AND CELEBRATIONS

FURTHER READING
International Organization for Migration (IOM)
2018c Psychosocial Support and Dialogue in the Syrian Arab Republic and Lebanon. IOM, Geneva.
Schininà, G.
2004a Cursed Communities, Rituals of Separation and Communication as Vengeance. A Redefinition
of Artistic Interventions in War and War-Torn Societies. In: War Theatres and Actions for Peace
(C. Bernardi, M. Dragone and G. Schininà, eds.). Euresis, Milan.
University of Oxford Refugee Studies Centre
2013 Local faith communities and the promotion of resilience in humanitarian situations: A scoping
study (E. Fiddian-Qasmiyeh and A. Ager, eds.). Working Paper No. 90.
For other references see the full bilbiography here.

Integration day celebration, Paraguay © IOM 2020

98
 8.
SPORT AND PLAY

Indoor Games for children at the Protection of Civilians site in Bor,

South Sudan. © IOM 2017
99
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

8.1. WHAT MHPSS PROGRAMME MANAGERS SHOULD

KNOW
Sport and play are fully part of the cultural and relational experience of a community, and can
contribute to protecting and promoting the mental health and psychosocial well‑being of individuals
and groups, across genders, ages and social statuses.
Sport can be defined as an organized and usually competitive form of physical activity, while play can
be described as engaging in a recreational activity for the purpose of enjoying oneself. Play can be
both physically passive or active, and within the context of this chapter, play will be referred to in its
active form. It is important to distinguish between sport, play, physical activity and exercise. Physical
activity can be described as any bodily movement, while exercise is a subset of physical activity which
is structured and deliberate. Sport, play and exercise can thus all be forms of physical activity. For
further information and recommendations on physical activity and health outcomes, please see here.
The importance of physical activity on mental health and psychosocial well‑being can be seen in
the bidirectional and causative relationship between physical and mental health and through the
preventative and protective effects physical activity can have on psychosocial distress. Additionally,
people experiencing poor mental health are at a significantly increased risk of cardiometabolic disease
and can experience higher than average premature mortality rates.
Sport and play are deeply rooted activities that are always present, in some form, in any community.
As they are a part of learned interactions and behaviours, and easy to reproduce, they are often
spontaneously reproduced even in emergency and displacement settings. They are therefore a
powerful means to support interactions among community members in emergencies, as well as an
entry to engage communities and their subgroups in MHPSS programmes.
Sport and play are essential for the physical and psychological development of children since, through
playing, children express and externalize in a safe environment, learn how to connect and cooperate
with others, and can give a symbolic structure to their experiences. Games are also spaces for
exploration and problem-solving, and educational tools for adults. In this sense, sport and play can
help individuals to develop their resilience. More information can be found here.

100
Sporting Activities in Gujba, Nigeria. © IOM 2018
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

Outdoor games. Dari Recreational and Social Centre,

Misrata, Libya. © IOM 2013/Stefano SPESSA

Outdoor games. Dari Recreational and Social Centre,

Misrata, Libya. © IOM 2013/Stefano SPESSA

Box 40
Children’s well‑being and resilience
Well‑being describes the positive state of being when a person thrives. In children, it results from the
interplay of physical, psychological, cognitive, emotional, social and spiritual aspects that influence a
child’s ability to grow, learn and develop to their full potential. In MHPSS work, well‑being is commonly
understood in terms of three domains:
• Personal well‑being: Positive thoughts and emotions, such as hopefulness, calmness, self-
esteem and self-confidence;
• Interpersonal well‑being: Nurturing relationships, a sense of belonging, the ability to be close
to others;
• Skills and knowledge: Skills to effectively interact with others, cope with distress and seek
information.
Source: Children’s Resilience Programme (IFRC and Save the Children).

For additional information on child development, well‑being and resilience, not only in relation to sport
activities, please see here.

At the community level, in the humanitarian domain, evidence shows that sport and play, and other
recreational and structured activities, can be powerful tools for social inclusion, social cohesion,
conflict transformation and creating a strong sense of community and togetherness. They can also
contribute to restoring a sense of normalcy, helping to maintain the developmental process.
From a psychosocial point of view, sport and play are able to work organically on several
components of mental health and psychosocial well‑being, since they engage the physical,
psychological, social and cultural dimensions in the same actions.
In the IASC pyramid of MHPSS interventions in emergencies, sport and play are usually considered
at the second level of intervention (family and community support). Most spontaneous and generic
sport and play activities will in fact be offered to all community members. Yet, sport and play can
also be focused activities at the third level of intervention by, for instance, problem-focused play
therapy workshops centred on psychological problems, or by conducting sport activities which aim

101
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

to facilitate physical and psychological rehabilitation of vulnerable categories, for instance of

people with amputations, among others. In some cases, sport and play can be used as a part or a
complement of different forms of psychotherapy at the fourth level of intervention (which is true for
mindfulness, as well as cognitive behavioural therapy, art therapy and others).

Box 41
Attention points
To increase the possibility of reaching MHPSS and protection outcomes, it is essential to have in mind,
from the initial stage, several attention points, such as:
• How are sport and play perceived by the community? By children and youth? By women and men?
• Which activities used to be implemented in the past? Were these activities gender-, age- and
disability-inclusive?
• Who were the main actors involved in promoting and supporting sport and playing activities
(NGOs, schools, youth clubs, mosques, churches, sport and cultural centres, private
institutions and/or sport federations)?
• Are there potential risks linked with supporting and stimulating games and sports (such as
cultural divisions, human rights violations, gender issues, among others)?
• Are there social norms prohibiting certain groups from participating?
• Can sport and games be a possible answer to a specific community’s needs?
• What are the existing resources?
• How is the emergency impacting the set-up and implementation of the planned activity (for
example, see chapter on Integration of mental health and psychosocial support in
conflict transformation and mediation)?
For more information, see here.

Sport and play are strictly interconnected with rituals and cultural activities, since:
• Sport and play can be used to celebrate rituals.
• Rituals have their codified protocols that usually include play and games or representations.
• Sporting events can become rituals in their own capacity.
They are also interconnected with informal education, since:
• Informal education can regard psychomotricity and different forms of sport.
• Games and play can reinforce life skills.
• Games and play can be used as a learning method.

102
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

Finally, the relation between sport and play, and theatre and other arts-based activities, is clear-
cut, since they all refer to the action of playing, of which they represent different forms and
manifestations. Additional information, including the definition and operational framework for the use
of sports in post-disaster settings, can be found here.

8.1.1 Basic principles in organizing sport and play activities

In the design and implementation of sport activities that are structured and have specific psychosocial
objectives, the MHPSS manager should embed principles found in Table 4.

Table 4: Sport and play in MHPSS principles

Meaningful From a psychosocial perspective, to make participation in sport and play even more
participation meaningful, it is important to organize before and after discussions about the changes activities
have promoted at the level of the individual (self-esteem, sense of power, frustrations) and of
the community (sense of playing together, exploring new rules and meanings to antagonism
and cooperation). Non-meaningful participation, especially in emergency situations, would be
the one that derives from focusing on antagonism.
Skills to facilitate sport processes, in a psychosocial programme include:
Capacity • Personal skills;
development • Social skills (communication, listening; negotiation, conflict management; teamwork,
empathy; motivational approaches);
• Methodological skills, which encompass:
- Knowledge of specific sport techniques;
- MHPSS skills;
- Pedagogical skills.
In emergency situations, these skills may need to be refreshed or taught, since the challenges
of the emergency context bring the need for new personal, social and technical capacities, as
well as new sport practices.
Context sensitivity Sport activities should be sensitive to the cultural and spiritual dimensions of individuals and
families, the socioeconomic and political contexts of the emergency, and to subcultural and
conflict dynamics.
Inclusion In sports, inclusion is programmatically translated in a series of practices aiming at “increasing
access to, participation within, and reducing exclusion from, any arena that provides sport and
physical activity”. Therefore, proactive initiatives should be taken to ensure the participation
of marginalized or segregated individuals to participate alongside their peers. Groups at risk
of being left out include adults and children of all populations of disabilities, including cognitive
disabilities, women and girls; and elders and youths belonging to different subgroups. A viable
methodology to grant inclusion in sport activities can be found here.
Sustainability This is mainly measured by the degree to which the MHPSS understanding and skills have
been embedded in the sport practices of a community.

8.1.2 Categories of sport and play

There are different ways to classify sport and play activities, including structured versus unstructured
activities. Regardless of how one chooses to classify them, it is critical that sports and activities aim to
support psychosocial well‑being, and are selected and implemented in ways that consider all ranges of

103
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

motions and abilities, and include considerations and adding links to relevant tools.
of age, gender, economic situation and culture,
among other factors. As for creative and art-based activities, sport
activities supported and promoted by an MHPSS
Games and sport training need to be organized programme can be divided into “community-
in a programme and sessions. A suggested plan generated”, “programme-facilitated” and
is the one that envisages a main goal for each “programme-generated”. For an explanation of
session. In each session, the goal is discussed these terms, click here.
and agreed, then there will be a warm-up, core
exercises and trainings, a cool-down, and a Practical steps to include sport and play activities in
debate/discussion. a MHPSS programme will include:
(a) Mapping existing sport and play activities
Activities may be: among the displaced and affected community,
• Individual/group; including activities they used to do but are
• Outdoor/indoor; currently unable to do due to the emergency
displacement.
• Aerobic/non-aerobic;
(b) Mapping existing sport and play activities
• Technology-based. among the host community, including those
Which sports activities to select should be that could easily involve the displaced,
primarily based on what is already existing within emergency-affected communities.
the community. However, sport and play should (c) Identifying and selecting sport and play activities
also be seen as an opportunity to innovate and to support and engage people of concern
listen to the needs and requests coming from in the programme: Support to community-
the community. For example, skateboarding generated sport and play activities can include:
in Afghanistan has been used in a particularly (i) Sport materials;
innovative programme for girls’ empowerment. (ii) Sport equipment;
(iii) Other in-kind support;
(iv) Training;
8.2. WHAT MHPSS (v) Securing facilities and their access;
PROGRAMME MANAGERS (vi) Including the sport activity in a referral
SHOULD DO mechanism;
(vii)Creating occasions for networking between
MHPSS managers are not going to directly conduct sport activities, such as leagues, common
sport activities, but rather design, supervise and trainings and forums.
manage programmes that should create a space for (d) Disseminate information on the physical and
the use of sport and play to reach psychosocially- mental health impacts of sedentary behaviour.
related objectives at various levels of intervention. Sedentary behaviour can be associated
The activities will be mainly implemented by with negative mental health outcomes, and
the PMT. The UNICEF Operational Guidelines: informing communities of the consequences of
Community-based mental health and psychosocial sedentary behaviour can lead to improvements.
support in humanitarian settings: Three-tiered support
for children and families (UNICEF, 2018) envisages (e) Implementing additional programme-facilitated
practices for inclusion and participation of children sport activities within the programme,
and their families in sport activities and events. enhancing the capacity of existing realities, with
The suggestions below aim at complementing the the specific objective to respond to identified
information from a programmatic point of view psychosocial needs (high levels of distress, lack

104
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

of social cohesion): In this case, clearly defined 8.2.1 Capacity-building

programme objectives will be influenced by,
and will in turn influence, the type of sport/ Designing and organizing capacity-building for
interventions selected. the identified coaches, organizers and volunteers
are key steps for managers that should be
(f) Group sport activities that are not part of implemented to support the setting up of
the usual sport and play activities used in activities, and also to maintain quality of activities,
a community, but that respond to specific by providing ongoing support to trainees. These
psychosocial objectives or emergency can be introductory or specialized, based on
generated needs: In this case, objectives should needs and pre-existing capacity. Training should
reflect and be reflected in the type of sport, always be accompanied by ongoing support and
the local context, the stage of emergency, supervision. Table 5 is a reinterpretation of the
and the psychosocial needs that have one that can be found here.
been identified and prioritized through the
assessments. They should be determined with Coaches’ technical skills should be developed
a participatory approach. in parallel with their MHPSS skills. The latter
represent a prerequisite to reinforce the skills of
(g) Taking barriers experienced by persons with others. In addition, training can vary for levels of
disabilities into consideration when planning complexity, according to the existing capacity.
sport and play activities to make them inclusive.
(h) Including people of concern in the selection of
activities and development of a schedule.

105
Volleyball game at the IOM MHPSS Centre in
Malakal, South Sudan. © IOM 2020
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

Table 5: Key steps for managers to support the setting up of activities

Enrolment - Make a list of existing and required skills for coaches and facilitators.
- Develop a recruitment strategy for staff involving the community.
- Select coaches from the local community whenever possible.
- Engage equal numbers of female and male coaches where possible.
Training/ongoing - Train all coaches/facilitators on basic MHPSS (for instance, using this tool), PFA,
support motivational approaches and small-scale conflict mediation (see chapter Integration
of mental health and psychosocial support in conflict transformation and
mediation).
- Complement with sports-skills and game-skills training.
- Facilitate coach/volunteers/organizers exchange platforms.
- Provide mentoring and psychosocial support for coaches, volunteers and organizers during
training and throughout implementation, by the dedicated resource in the PMT.
- Conduct on-the-job trainings with frequent follow-up rather than one-off longer trainings.
- Provide training on how to include persons with disabilities in mainstream sport activities.
- As part of training and ongoing support, ensure there is a functional referral mechanism
in place for children who need other types of support, including non-MHPSS services and
specialized MHPSS.
Retention - Increase coaches’ and facilitators’ motivation and volunteerism by providing recognized
training and certification in specific coaching/animation competencies and appropriate
coaching kits.
- Encourage coaches and facilitators to form peer-to-peer groups as part of ongoing sup-
port to the coaches and the activities they are implementing with the community.

8.3. CASE STUDY

Egypt is home to many refugees from the Syrian Arab Republic, the Sudan, Eritrea and Iraq. These
refugees live in precarious conditions, and their children suffer the effects of forced displacement.
Tensions between refugees and host communities are common.
In years past, Terre des Hommes developed and implemented a methodology called “Movement,
Games and Sports”, which aims at improving young people’s well‑being and protection. Since
October 2017, a new project called “Sport for community-based protection and social inclusion”
has been implemented and aims at providing sustainable sport as well as psychosocial and life skills
activities that increase social inclusion and community-based protection for vulnerable children and
youth.

8.3.1 Helping young people get back on their feet

Animators use football as a tool to support the children. “When they lose, refugees in particular feel as if
they’ve lost everything. In their real lives, they feel they may never recover. We use activities to show them
that they can get back on their feet and still make something of the situation. This applies to football and real
life”, explains Pasant Aly Mokhtar, who is in charge of those running the activities.

106
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

8.3.2 Teaching key skills Sport is a tool to reach a variety of objectives but,
as a stand-alone practice, its MHPSS potential has
One of the coaches explains: “I don’t want its limitations.
the children just to play. I’d like them to learn
something new every day. I’d like to teach them While sports are important, it is essential
new life skills and encourage social integration.” to consider food and other basic needs of
participants. If food insecurity is a grave issue,
one should consider delaying the start of sport
8.3.3 Promoting integration programmes and partnering with those who are
Noor, a Sudanese mother, came alone with her able to engage in mitigating food insecurity.
children to Cairo five years ago. She is afraid of Coaches are in a unique position to be role
making friends with strangers. To ease life for models and mentors for young participants,
children in this situation, they can create their but there are also stories of coaches misusing
teams in advance for each training, but are not their influence and power, harassing, bullying,
allowed to separate them by nationality. This manipulating and neglecting participants’ safety. It
promotes integration. is widely recognized that safeguards are necessary,
and this includes putting into place safeguard
policies.
8.3.4 Building self-confidence
Sport and play do not always nor automatically
Some individuals suffer the consequences of war
have a positive impact. Careful consideration
or the loss of a family member. Some no longer
should be given to potential negative effects of the
remember their homes, but still have trouble
intervention:
adjusting to their new culture. The first time
they take part in the activities, they’re shy. It’s the • Creating risks by empowering women or
coaches’ goal to support individuals to regain vulnerable categories in highly conservative
elements of positive self-recognition and strengths cultures.
to promote self-confidence and resilience. • Fostering negative and aggressive competition,
which can validate or reactivate community
tensions: Sport can be associated with political
8.4. CHALLENGES AND divides in conflict areas, and used as a divisive
CONSIDERATIONS element. It is therefore important to associate
planning of sport activity with a conflict-
Gender and disability inclusion should be sensitive approach.
mainstreamed. Activities should be culturally
appropriate and respect non-discriminatory • Potentially creating new emotional stressors
principles. For instance, girls may be at risk of due to competition associated with the physical
bullying by taking part in a certain activity or activities, and in turn having an adverse
sports that imply force and physical confrontation. impact on mental health outcomes.
It is important to offer different kinds of sports • Fostering women, girls and child abuse and
and to adapt rules and practices to make games intimidation.
and sports, even highly physical ones, accessible.
• As sport and play are tools to reach
Communicating the objectives of the programmes psychosocial and protection outcomes, they
to the community is essential, and illusions or should not be conceived as isolated activities
disproportionate expectations should not be but integrated into larger programmes.
created to stay realistic. • In specific cultures, participation of women can
be very hard to encourage.

107
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
8. SPORT AND PLAY

FURTHER READING
Alexandria University Theories and Applications the International Edition (TAIE)
2011 Sport as an Instrument for People Development and Peace Promotion. TAIE. Faculty of Physical
Education, Abu Qir, Alexandria University, Alexandria.
Clemens Ley, C. and M. Rato Barrio
2010 Movement, Games and Sport in Psychosocial Intervention: A Critical Discussion of its
Potential and Limitations within Cooperation for Development. Intervention, 8(2):106–120.
Harknett, S.
2013 Sport and Play for All: A Manual on Including Children and Youth with Disabilities. Handicap
International, Colombo, Sri Lanka.
Huizinga, J.
1949 Homo Ludens. Routledge, London.
PYKKA and United Nations Children’s Fund (UNICEF)
2010 Changing Life Through the Power of Sports. PYKKA and UNICEF, New Delhi.
Sport Inclusion Network
2012 Inclusion of Migrants in and through Sports: A Guide to Good Practice. Sport Inclusion Network,
Vienna.
sportanddev.org
n.d. Sport as a Psychosocial Intervention.
For other references see the full bibliography here.

108
 9.
NON-FORMAL EDUCATION
AND INFORMAL LEARNING

Fuad, a migrant child participating in a computer class at Keçiören Municipality Community Centre,
Turkey. © IOM 2018/Emrah ÖZESEN
109
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

9.1. WHAT MHPSS PROGRAMME MANAGERS SHOULD

KNOW
In the immediate aftermath of a crisis, restoring the functioning of formal educational institutions
can be difficult for both local governments and humanitarian actors. In situations of forced or mass
displacement, the integration of newly arrived communities in the formal education system of the
country of destination can be hampered by logistical and administrative constraints. Moreover, in
displacement and migration, students, even if integrated in the education system of the host country,
can struggle in adapting to different curricula and pedagogical models from the ones they were used
to. Therefore, such contexts call for programmes facilitating either non-formal education and/or
informal learning responses as a bridge towards, or as a complement to, formal education. Formal
education, non-formal education and informal learning are all fundamental cultural activities which
contribute to organic community integration. They are also an important venue to create relations
and to learn how to relate to others.
It is important to understand the various definitions and differences. The Inter-Agency Network for
Education in Emergencies (INEE), provides a common framework to refer to (see Table 6).

Table 6: Common framework for education in emergencies

Education in - Quality of learning opportunities for all ages in situations of crisis, including early childhood
emergencies development, primary, secondary, non-formal, technical, vocational, higher and adult
education.
- Provides physical, psychosocial and cognitive protection that can sustain and save lives.
Formal education - Usually refers to educational institutions that follow a specific curriculum developed and
approved by a government with one or more final graded examination(s).
Non-formal - Takes place both within and outside educational institutions, and caters to people of all
education ages.
- Does not always lead to certification.
- Non-formal education programmes are characterized by their variety, flexibility and ability
to respond quickly to new educational needs of children or adults.
- Often designed for specific groups of learners, such as those who are too old for their
grade level, those who do not attend formal school, or adults.
- Curricula may be based on formal education or on new approaches.
- Examples include accelerated “catch-up” learning, after-school programmes, literacy and
numeracy.
- Non-formal education may lead to late entry into formal education programmes, which
are sometimes called “second-chance education”.
Informal learning - “Forms of learning that are intentional or deliberate but are not institutionalized are known
as informal learning. It is consequently less organized and structured than either formal or
non-formal education. Informal learning may include learning activities that occur in the
family, workplace, local community, and daily life, on a self-directed, family-directed, or
socially-directed basis ” (United Nations Educational, Scientific and Cultural Orga-
nization (UNESCO)).

110
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

Non-formal education can target different populations, and can be implemented in a specific
space or not. Curricula are more or less formalized, but with no certification process nor
diploma at the end. These can include language classes, uncertified literacy and numeracy
courses for adults, computer literacy and psychoeducation sessions.
Informal learning is less structured than formal and non-formal education, but what
differentiates it the most from other forms of education in an emergency is not the structure,
but the objective. A structured sport session, for example, has objectives. A specific set of
games and exercises solicits brain/muscles and is categorized as informal learning, even though it
is a very structured activity. In basketball training, one has to learn how to play, and to practice a
lot in order to do so. He/she will engage mind–body circuits through learning positions, targets,
how to throw the ball, how to collaborate with others and how to follow rules, for example.
Yet the final objective is not the learning but the actual playing. The same happens during
cultural, creative, artistic and theatrical activities illustrated in this Manual, which are not aimed
specifically at education, but can have objectives related to learning (skills, attitudes, processes).
The non-formal learning potential of several activities can be spontaneous or well thought out,
in the sense that activities can be redesigned and structured to reach their full potential.
Non-formal education and informal learning contributes to MHPSS outcomes for different
reasons (see Table 7).

Table 7: Non-formal education and informal learning as they contribute to MHPSS

- Safe schools and non-formal learning spaces are some of the most beneficial environments for children and youths
during a period of uncertainty.
- Intentional investment in education-based psychosocial support has proven to protect children and youths against the
negative effects of disasters by creating stable routines, providing opportunities for friendship and play, fostering hope,
reducing stress, encouraging self-expression and promoting collaborative behaviour (Alexander et. al., 2010; Masten
et. al., 2013).
MHPSS

- Psychosocial well‑being is a significant precursor to learning, and is essential for academic achievement; it thus
has an important bearing on the future prospects of both individuals and societies.

- The psychosocial support approach works best when integrated into the different spheres of young people’s
lives. Since education settings bring children, youths and their peers, parents, families, and communities together,
they can help create a supportive environment that promotes improved psychosocial well‑being.
- Ideally, the education and community settings that surround each child work together to ensure that they
receive the best possible care and follow-up; this includes communication between teachers and parents, and
counsellors, if needed.

111
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

assure access (transport, payment of fees if

9.2. WHAT MHPSS suitable) and inclusion.
PROGRAMME MANAGERS (c) Identify people with skills they can teach
SHOULD DO to the others in the displaced community
and mobilize them in organizing non-
MHPSS managers are not providing non- formal education for defined groups.
formal education and non-formal training Support these activities in kind, training and
by themselves, but they need to design eventually stipends for the facilitators.
programmes that envisage actions and
resources to promote non-formal education (d) Analyse the non-formal education potential
and informal learning. They will also have to of other support activities organized by
select and supervise educators and teachers the programme (theatre and drama, sport),
who are core members of the PMTs, and and create spaces for exchanges between
agree on their action plans following the steps the facilitators of those activities and the
below. educators on the team to emphasize this
potential through structuring, pedagogical
(a) Foster the involvement of the community: hints, and pre- and post-workshop
Community members should be especially discussions.
engaged in these activities, not only as
participants but to understand priorities, (e) Finalize a plan of non-formal education
identify teachers and trainers, select activities, dividing them in:
activities and monitor outcomes. The (i) Inductions and information sessions (a
selection and prioritization of the activities few hours);
are based on three factors: (ii) Workshops (a few days or a week);
(i) Needs-based: Identification of needs in (iii)Actual educational activities (school
the community (school help, hygiene support, language classes, numeracy
awareness, psychoeducation); classes) that should be given a set
(ii) Resource-based: The identification of duration, number of sessions and
community resources whose agency can a closure in order to maximize
be empowered by organizing non-formal participation and inclusion.
education activities for others (computer, (f ) Provide training to volunteers, teachers
languages, arts and crafts, music); and facilitators on interactive methods to
(iii)The possibility of the programme to facilitate sessions and basic MHPSS:
cater for the needed materials, venues, (i) Promote, wherever possible, ad hoc
security, among others. non-formal education activities for
Design and implementation, adaptation, people with severe mental disorders or
location and identification of involved disabilities.
persons as well as linkages with other (ii) Organize service evaluations, at the end
programmes should be discussed, defined of each cycle of non-formal education
and addressed with key actors of the activities.
affected community.
(b) Wherever possible, support pre-existing
facilities in the host community (music
schools, sport schools, dance schools,
computer schools, language schools)
rather than creating parallel structures, and

112
Outdoor Games at the Dari Recreational and Counselling Centre for Families,
Baalbeck, Lebanon. © IOM 2015 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

Table 8: Examples of activities (non-exhaustive)

Health education Any combination of learning experiences designed to help individuals and communities
(WHO definition) improve their health, by increasing their knowledge or influencing their attitudes.
Hygiene promotion Hygiene promotion is a planned, systematic approach that enables people to take action to
(SPHERE definition) prevent and/or mitigate water, sanitation and hygiene-related diseases. It can also provide a
practical way to facilitate community participation, accountability and monitoring in WASH
programmes.
Life skills WHO in 1999 identified five core cross-cultural areas of life skills: decision-making
(WHO definition) and problem-solving; creative thinking (see also lateral thinking) and critical thinking;
communication and interpersonal skills; self-awareness and empathy; and coping with
emotions and stress.
Sport education Many life skills can be taught through sport activities that contribute to development:
concentration, collaboration with others, self-confidence, strategic thinking. Specifically,
games and play can foster a sense of safety and contribute to children’s well‑being.
Moreover, they constitute tools for social inclusion that contribute to the sense of
community and togetherness.
Literacy and Proficiency in literacy and numeracy is essential if young people are to fully develop their
numeracy courses potential as effective members of their community and for migrants to integrate. Where
(UNESCO) there are low levels of literacy and numeracy in the adult population, it is an indication of
low basic skills and low employment levels.
Those courses can be part of a broader catch-up plan.
Arts and crafts Non-formal education in arts and crafts can make people relax, connect with others
through an action, enhance self-esteem and, in some cases, act as an income-generating
activity (see challenges).
Mine risk education Refers to “activities which seek to reduce the risk of injury from mines and explosive
(international mine remnants of war by raising awareness and promoting behavioural change, including public
action standards) information dissemination, education and training, and community mine action liaison”.

Non-formal education requires a close linkage with communities and a strong involvement from
the beginning to ensure that non-formal education activities are adapted to the population’s needs.
Lack of involvement by the affected populations and the community could negatively impact non-
formal education interventions by fostering limited interest in the programme or delivering messages
that are not contextualized nor adapted to the population. The contents and material should be
checked and approved by community members, who acknowledge the purpose and necessity of the
programme to support it.

113
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

9.3.1 A new way of targeting youths, a

9.3. CASE STUDY: hard-to-reach demographic
FABLAB INITIATIVE
In crisis-affected areas, teenagers and youths
FOR EMERGENCY experience significant protection risks, including
AND HUMANITARIAN but not limited to early marriage, school
CONTEXTS dropout, child labour, conflict or contact with
the law, violence associated with the crisis, and
Globally, a FabLab is defined as a technical association with armed conflict, including forced
prototyping platform for innovation and recruitment, and juvenile justice issues.
invention, providing stimulus for local
entrepreneurship. For Terre des hommes (TdH), Despite being very frequently at risk, teenagers
the adaptation of this initiative to development and youths are often extremely difficult to reach.
and humanitarian contexts complements and There are few standardized approaches for
heightens the impact of existing programming engaging with teenagers and youths, and little
by providing an entry point to a broader consensus around basic issues, including what
package of services available within different TdH ages precisely constitute the term “youth” itself.
interventions adapted to needs and context. Attractive places for youths:
It consists of a physical space equipped with • Focus on cutting-edge yet easily accessible
tools (for example, 3D printers, laser cutters digital technologies, as youths have higher
and circuit-makers), software (to programme levels of engagement and interest in
the tools and support access to networks), digital technologies compared with other
and educational approaches and processes (for demographic groups.
example, adapted training courses, management • Support creativity in a flexible and adaptable
systems to open the space to innovators and manner, which is key for a group that has
peer-to-peer learning models). It is not simply fluctuating interests, capacities and needs, and
piece(s) of equipment – rather, it is a way of whose needs are currently not sufficiently
engaging with children, youths and communities. met by humanitarian responders.
• Organize time of activities considering issues
such as child labour and school attendance.

Educational activities. Psychosocial mobile teams. Bassaryiha, 114

Lebanon. © Timon KOCH 2017
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

English classes at Haj Ali IOM Community Centre in Iraq.

© IOM 2017/Sandra BLACK

Table 9: Impact opportunities

Education - Provides a good basis for provision of non-formal education, particularly in STEM
(science, technology, engineering and mathematics), for the most vulnerable youths.
- Enables the transfer of youths from non-formal education into formal education
(university, high school or vocational training).
- The safe space stimulates both learning and opportunities.
Affected - Allow youth to lead and more actively participate in the development and
populations-led implementation of projects and generate a tangible output.
participation and - People using FabLabs drive their own development, which gives affected populations
design the flexibility and the tools to design their own solutions while linking users to share
experiences.
Child protection - Provides an open, safe space for youths and communities in which they can build trust,
work together to define their own priorities, and identify innovative solutions to their
problems.
- Aims to empower children and their communities to engage more effectively in dialogue
and action to support child rights, leveraging digital tools and networks.
- Privileged space for delivering MHPSS services and, when necessary, identifying and
referring youths to TdH’s other services (such as those provided by social workers and
community mobilizers, among others).
Livelihood - The hardware component represents an aspect of the digital economy to which few
opportunities conflict-affected communities have access.
- Can support vulnerable communities to engage in small-scale production and meet
immediate needs in a more cost-effective and tailored fashion.
- Tdh FabLabs represent a valuable resource and access to livelihood for those who
develop skills through the TdH FabLabs.
- For the broader economy within the community, as it provides new models and a
method for enhancing existing tech (and other) industries.

In conclusion, FabLab was a great opportunity of learning for youths and community members, and
in the meantime to ensure high participation and involvement in the implementation to make the
FabLab sustainable. It helps provide a safe place, to deliver adapted learning, to take sufficient time
with youths for them to learn, to have fun, and finally to learn something around new technologies,
together with other education contents (vocational training, basic reading and numeracy courses).

115
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

(c) Non-formal education and vocational and

9.4. CHALLENGES AND professional training need to be kept distinct.
CONSIDERATIONS While people can be informally educated
in an art or a craft, for their own interest,
The differentiation between the various forms vocational trainings aiming at employability
of education in emergency within MHPSS and income generation based on the
programmes is very important in terms of same skills are part of a livelihood support
programming and community dynamics since, protocol, and need to be designed with that
especially in emergencies, confusion often arises aim in mind. Not doing so can create future
between formal and informal education, informal frustrations in participants. The chapter
education and informal learning, and vocational on Integrated MHPSS and livelihood
and professional trainings. This leads to four support will better describe how this
series of problems: integration can happen in vocational trainings
(a) Creative or socializing MHPSS workshops without creating confusion.
(informal learning) are often misinterpreted (d) Formal education is always a primary need
as non-formal education activities. For and should be favoured. At times, however,
instance, a tailoring or crocheting group for in emergency situations, non-formal
women, primarily aimed at helping them education risks being used as a substitute
gather together and express themselves, can for formal education even when formal
be considered by the affected populations education is available but is (a) in remote
and at times by the project management as a locations, and (b) perceived as too difficult.
non-formal course in tailoring. This can give In those situations, if resources are scarce,
rise to false expectations among participants transportation to formal educational facilities
and create an ambiguity in the planning of the should be prioritized as a response, vis-à-
activity, the necessary expertise of the trainer, vis the organization of informal educational
and other things. Clarity on the nature and activities. In addition, while informal education
scope of activities needs to always be adopted can keep on being offered, sensitization on
in planning. the importance of formal education needs
(b) MHPSS programmes tend to certify non- to always be organized and mainstreamed,
formal educational activities. This is also done and schools in need of help for children and
for very short inductions or information youths to adapt to the new curricula favoured
sessions. While this is often at the request of vis-à-vis other forms of non-formal education.
participants, and can represent an incentive
for participation and boost their self-esteem,
it can also bring two problems. On the one
hand, participants may feel these certificates
add to their professional capacities. On
the other hand, in a humanitarian context
characterized by the necessity to hire staff in
a haste, certificates can be misinterpreted in
their training value. Finally, the proliferation
of certifications can devalue the legitimate
certifications of those who followed an
official curriculum in the country, affecting
community dynamics.

116
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
9. NON-FORMAL EDUCATION AND INFORMAL LEARNING

FURTHER READING
Finn Church Aid (FCA)
2018 Improving Well‑being Through Education – Integrating Community Based Psychosocial
Support into Education in Emergencies. FCA, Helsinki.
International Network for Education in Emergency (INEE)
2010 Minimum Standards for Education: Preparedness, Response, Recovery (2nd ed.). INEE, Geneva.
2016 Background Paper on Psychosocial Support and Social and Emotional Learning. INEE, Geneva.
2018 Guidance Note on Psychosocial Support. INEE, Geneva.
For other references see the full bibliography here.

Young woman comes to the IOM MHPSS Centre to learn English in 117
Malakal, South Sudan © IOM 2021/Liatile PUTSOA
 10.
INTEGRATION OF MENTAL HEALTH
AND PSYCHOSOCIAL SUPPORT
IN CONFLICT TRANSFORMATION
AND MEDIATION

Support Group Session at the Protection of Civilians site in Bentiu,

South Sudan. © IOM 2017
118
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

10.1. WHAT MHPSS PROGRAMME MANAGERS SHOULD KNOW

One of the challenges that MHPSS teams frequently encounter in humanitarian emergencies is the
pervasiveness and complexity of interpersonal and intercommunal conflicts. It is thus essential for
MHPSS workers to acquire basic skills in managing and resolving conflicts. This chapter will discuss
practical ways in which MHPSS workers can use their skills, resources and networks to respond
to interpersonal and community-based conflicts. To this end, a brief introduction to concepts on
conflict assessment is provided.
Conflict is a contradiction. It is a state of human relationships in which one side’s attempt to achieve
its goals stands in the way of the other side’s. The following link provides a more detailed description
of conflict as well as other related concepts.
Conflict in and of itself is neither destructive nor constructive. When parties in conflict lack the
capacities and means to transform their conflict, the resulting frustration and enmity can turn the
conflict into a destructive experience. When the parties have the capacity and means to see their
conflict as a shared challenge to be overcome, the conflict becomes an opportunity for creative
problem-solving and relationship-building.
According to pioneering peace researcher Johan Galtung, a social conflict at all levels, from
interpersonal to international, has three dimensions: attitude (A), behaviour (B) and contradiction (C),
as summarized in Figure 10.
Figure 10: ABC triangle

BEHAVIOUR
Relates to:
Manifest expressions and actions
Examples of conflict behaviour:
Shooting, hitting, stabbing, shouting, making public
statements, crying, shaking hands, embracing, taking
collaborative action
Behaviour conducive to conflict transformation:
Non-violence

ATTITUDE CONTRADICTION
Relates to: The functions and dynamics of Relates to: A state of relationship in
the human mind which one party’s goal-seeking behaviour
stands in the way of the other’s
Examples of conflict-related attitudes:
Fear, anger, frustration, fulfilment, value Example: A conflict-affected relationship
commitment, desire for self-actualization, between two or more parties
respect for social identity
Quality of thinking conducive to
Attitude conducive to conflict conflict transformation: Creativity
transformation: Empathy

Source: Based on Galtung (1958).

119
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

The ABC triangle is a useful framework to help starting point, and could be used as a list for
MHPSS programme managers examine the trainings that could be offered.
interconnected nature of attitude, behaviour
and contradiction. Their practice in counselling, Box 43
for example, can help individuals and groups to
Resources
restore empathy, therefore facilitating attitudinal
changes, which can in turn encourage them to Additional resources on conflict transformation
adopt non-violent behaviours. Furthermore, may be found at the following sites (all sites
their attitudinal and behavioural changes can accessed 17 April 2019):
contribute to building constructive relationships,
and exercise the creative thinking skills necessary • African Centre for the Constructive
to resolve the incompatibility of their goals. Resolution of Disputes (ACCORD)
(www.accord.org.za);
Humanitarian emergencies such as natural
disasters, armed conflicts and migration crises • Alliance for Peacebuilding (www.
make it difficult for individuals and communities allianceforpeacebuilding.org);
to exercise empathy, non-violence and creativity. • Beyond Intractability
This is particularly true in cases of displacement, (www.beyondintractability.org);
which often result in tensions between the
displaced and host communities. MHPSS can • CDA Collaborative Learning Projects
help affected individuals and communities restore (www.cdacollaborative.org);
empathy with one another, promote non-violent • Conciliation Resources (www.c-r.org);
behaviour, humanize their relationships, and
encourage creative problem-solving. • Peace Insight (www.peaceinsight.org);
Conflict transformation consists of finding a • United Nations Mediation Resources
mutually acceptable solution to the underlying (https://peacemaker.un.org/resources).
contradiction that strains human relationships,
• Building Bridges in Conflict
while promoting empathetic attitudes and
Areas (https://en.unesco.org/
non-violent behaviour. Conflict transformation
interculturaldialogue/resources/546)
contributes to building a secure and reassuring
social environment in which individuals
and communities affected by humanitarian
10.2. WHAT MHPSS
emergencies can regain or develop their
capacities to self-reflect, restore relationships, PROGRAMME MANAGERS
and seek and receive MHPSS effectively. The SHOULD DO
processes of MHPSS and conflict transformation
• Be sensitive to conflict at all stages of an
are thus complementary and mutually
MHPSS programme.
reinforcing. For these reasons, MHPSS workers
will find it useful to gain basic skills in conflict • Use MHPSS activities in conflict
analysis and transformation, in order to deliver transformation efforts or programmes.
MHPSS services effectively. • Introduce conflict mediation and social cohesion
Conflict transformation skills useful for as a component of MHPSS programmes.
MHPSS professionals working in humanitarian A prerequisite to these tasks above is conducting
emergencies vary significantly depending on a conflict analysis and feasibility analysis,
the circumstance in which they work. The summarized in Box 44.
skills summarized in this link suggest a possible

120
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

Box 44
Conflict and feasibility analysis
1. Conflict analysis
Conflict analysis is an analytical process through which to identify the sources and nature of
a given social conflict systematically. Suggested steps to perform a conflict analysis include
the following:
• Identify parties in conflict, defined as individuals and/or groups capable of exercising agency
to develop and pursue goals.
• Learn and articulate the goals of each of the parties.
• Describe their relationships (for example, collaborating, opposing, or having no
relationships).
See examples of conflict analysis. The first example addresses a simple two-party conflict;
the second example analyses a more complex multiparty conflict. These examples of
conflict analysis suggest opportunities for conflict transformation.
2. Feasibility analysis
This refers to an initial inquiry into the feasibility of intervention. Depending on the context
of their work, MHPSS workers conducting a feasibility analysis may ask questions about the
security, legal, political and institutional circumstances of the intervention. They must also
examine the programme objectives, time frames, resources, expertise, availability of local
partners, and other factors essential for making informed decisions about the desirability,
ethicality and possible methods of intervention.

Conflict mediation training, Baalbeck, Lebanon. © IOM 2016

121
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

Findings from conflict analyses and feasibility analyses can help establish a well-informed basis for
implementing each of the three suggested tasks:
(a) Be sensitive to conflict at all stages of MHPSS programmes: Incorporating conflict sensitivity
into all stages of an MHPSS programme is essential when working in conflict-affected societies.
Conflict sensitivity refers to the process of (i) understanding the social context of the conflict
in which an MHPSS programme is implemented, (ii) monitoring the interaction between the
programme and its context, and (iii) proactively taking actions to minimize the programme’s
negative effects on the conflict and to maximize its positive impacts. The possible actions to be
taken include a suspension of the programme where its continuation is likely to exacerbate the
conflict. For more information on conflict sensitivity, as well as on the “do no harm” principle
closely related to conflict sensitivity, please visit this link.
Conflict sensitivity is particularly important in the selection of MHPSS programme sites,
objectives, expected outcomes, staffing, and affected populations. With respect to staffing, the
selection of PMT members requires attention to conflict sensitivity. Conflict analysis is especially
important in this context, because the conflict-affected communities they serve will find it
important that the team is balanced, representative and accessible to all affected populations
without prejudice. For more information on the selection of PMT members, please see chapter
on Psychosocial mobile teams.

Box 45
Livelihood support for women
With respect to the application of conflict sensitivity to the development of programme
outcomes and affected populations, livelihood support for women presents a useful example.
While support for women’s empowerment in family and community life is an important
programme objective, its possible consequences include an increase in men’s resistance and in
domestic violence. Considering these challenges, MHPSS workers must consult not only the
participating women but also a broader scope of stakeholders who can either support or hinder
the women’s activities for economic empowerment. MHPSS workers must also inform the
participating women of the possible adverse consequences of their participation, as well as of the
choices the women can make to continue, discontinue or seek help. The example of women’s
livelihood development illustrates the complexity and difficulty of activities designed to tackle
deeply structural and cultural contexts of programme design. It also illustrates the role of conflict
sensitivity, not only about programme effectiveness but also in terms of ethics.

(b) Use MHPSS activities in conflict transformation efforts and programmes: MHPSS programmes, as
described in the models of work, address the interrelation of biopsychological, sociorelational and
cultural factors of experiences. These programmes make use of recreational and social, ritualistic,
artistic, sport and educational activities, capable of bringing people together and fostering social
cohesion. Creative activities can stimulate imaginative thinking useful for creative problem-solving.
In addition, individual and group counselling, as well as psychoeducation, can help conflict-affected
individuals and communities develop empathy, promote non-violence and facilitate relationship-building.
Three aspects of an MHPSS programme – counselling, psychoeducation, and social and recreational
activities – can make an especially important contribution.

122
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

(i) Counselling as a contribution to conflict together. The social and recreational activities
transformation: MHPSS activities, which focus offered at the centre enable the previously
primarily on the attitudinal and behavioural divided community members to get to know
dimensions of conflict, can be carried out in each other, build relationships, and a shared
such a way as to help affected communities sense of community.
address the underlying contradictions in While each of the above three types of MHPSS
conflict-affected relationships. Counselling is activities can make a significant contribution to
an especially useful method for this purpose. conflict transformation, their effectiveness can
In north-eastern Nigeria, for example, the be enhanced further by institutional partnership
MHPSS staff support the reintegration and collaboration. Specifically, MHPSS workers
of former Boko Haram members into can reach out to IOM’s Transition and
their home communities. The staff offers Recovery Divisions or Stabilization Units, whose
counselling to the returnees whose MHPSS activities are more closely aligned with conflict
needs are inseparably linked to long- transformation. If these units are not readily
standing challenges about their livelihood available, MHPSS workers can identify and
development, self-worth, education and need partner with other actors with expertise and
for social justice. While their counselling does experience in conflict transformation. For more
not aim to resolve these and other social information on forming these partnerships,
issues that contributed to the rise of Boko reach out to contactpss@iom.int.
Haram’s insurgency, it can nevertheless help
former Boko Haram members reflect on (c) Introduce conflict mediation in MHPSS
these issues and explore ways to face them programmes: One of the most practical
constructively. methods of conflict transformation that
(ii) Psychoeducation as a contribution to conflict PMTs can learn and practice as part of their
transformation: MHPSS education enables daily activities is conflict mediation. MHPSS
conflict-affected communities and individuals managers can explore alternative means by
to understand how the human mind works which to introduce conflict mediation into their
under stress, grief and loss, what actions day-to-day activities. The alternative means
can be taken to manage these, and how described below are mutually supportive
communication can be positive in nature. and complementary. They may be combined
In order to address the psychosocial effects or sequenced in such a way as to maximize
of the war and the migration crisis in the programme effectiveness:
Syrian Arab Republic, IOM produced Self- (i) Hire an experienced conflict mediator:
Help for Men Facing Crisis and Displacement, a An MHPSS programme manager can hire
guide for adult men seeking basic knowledge an experienced conflict analyst, if funding
on the sources of stress and the practical permits. The MHPSS programme in Iraq,
measures they can take to mitigate the stress. for example, hired a conflict specialist as a
The guide is available at this link. member of the MHPSS team. The specialist
(iii) Social and recreational activities as a monitors the conflict dynamics at MHPSS
contribution to conflict transformation: Social centres implemented within the programme,
and recreational activities can bring together and ensures their conflict sensitivity and
members of divided communities through programme effectiveness.
mutual humanization and building social (ii) Identify and appoint a conflict mediator, as
cohesion. In Libya, for example, the MHPSS a core member of each PMT: A PMT may
staff is using a community centre to bring include a qualified team member to play
displaced people, migrants and local residents the role of a conflict analyst and mediator,

123
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

whose responsibility is to monitor and community members with conflict mediation

work on conflict-related issues. This is to skills, and support them to become focal
be done while being aware of the context’s points who can partner with the PMT.
conflict dynamics, as engaging in mediation, These local focal points may receive
even at the local level and informally, can be customized skill-building training. In addition,
perceived on a sociopolitical level and give or alternatively, they can be included in the
the perception that the entire PMT is not trainings for the PMT described in points
neutral in a conflict situation. (iii) and (iv) above. In Iraq, for example,
(iii) Provide basic conflict mediation training IOM’s MHPSS activities provide community
to the whole of an MHPSS team: MHPSS members with intensive conflict mediation
workers equipped with basic conflict trainings, facilitate community members’
mediation skills can carry out MHPSS participation in dialogue and leadership
activities with greater conflict sensitivity, groups, and carry out youth peacebuilding
contributing to the management and activities. Through these IOM-sponsored
prevention of violent conflicts, and granting activities, trained and qualified Iraqis have
effective service delivery when relationships come to serve as conflict mediation focal
between stakeholders are tense. The PMTs points working side by side with the PMTs.
working in the aftermath of Boko Haram’s
insurgency in north-eastern Nigeria received 10.2.1 PMT members as mediators
trainings in the analysis and transformation of
interpersonal and intercommunal conflicts. PMT members and MHPSS workers in general
The training materials and curricula they used can serve as conflict mediators in humanitarian
can be obtained by writing to contactpss@ emergencies. In many contexts of MHPSS activities
iom.int. in which MHPSS workers perform mediation,
(iv) Provide advanced trainings to selected they do not hold the title of a mediator, nor do
PMT members to enable them to become community members recognize MHPSS workers
conflict mediation focal points: Some of the as mediators. Under these circumstances, MHPSS
PMT members may receive more advanced workers practice emergent mediation, defined
mediation trainings, gain practical experiences as an informal, spontaneous process of assisted
and become mediation focal points. The negotiation and problem-solving for which there is
MHPSS staff in South Sudan adapted this no formal mediation contract expected.
strategy to its distinct programme needs. Emergent mediation can be initiated by casual
Together with selected community members, conversations with clients of MHPSS services.
South Sudan’s MHPSS staff members Questions such as “Is there anything I can do to
received advanced conflict mediation training. help you think through this relationship challenge
Based on the training, they became conflict together?” and “Would you mind telling me
mediation focal points in IDP camps. The why you and the other person are refusing to
training increased their capacity to address communicate?” can serve as an invitation to
community conflicts on their own. The skills emergent mediation.
they gained contributed to creating both
formal and informal structures of conflict Defining emergent mediation broadly, MHPSS
management. The training materials and workers can perform mediation in the following
curricula can be obtained by writing to: ways:
contactpss@iom.int. (a) One-on-one dialogues: in addition to what is
(v) Identify and empower qualified community presented here, the chapter on Counselling
members to become conflict mediation offers useful insights into one-on-one dialogues.
focal points: MHPSS teams can find trusted

124
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

(b) Mediation between two or more parties.

(c) Support for social, ritual, educational, recreational and artistic activities that promote relationship-
building and problem-solving (See Box 46).
The three methods are usually applied to regular MHPSS activities in which relationship-building is important.
They are complementary and mutually supportive. Two or more methods can be combined and performed
simultaneously or sequentially, depending on the needs and contexts of the MHPSS activities.

Box 46
Linkages with prior chapters
Social, ritual, educational, recreational, artistic community-based activities, described in prior chapters,
refer to a broad range of familiar community practices that can bring a larger number of people
together to meet the community’s shared needs and purposes. The people brought together for
community-based activities may come from the same community or from different communities.
When organized purposefully, community-based activities can help people from different sides of a
conflict to humanize each other and build trust, and encourage them to overcome the underlying
reasons for the conflict. MHPSS workers can offer community leaders the support they need to
effectively utilize community-based activities in such a way as to address conflict issues and relationship
challenges constructively. Illustrative examples of such community-based activities include:
• Traditional healing and reconciliation rituals;
• Wedding, funeral and naming ceremonies;
• Religious services and religious study sessions;
• Interfaith prayers for a common cause;
• Intercommunal markets and trade;
• Intercommunal collaboration for farming, animal rearing, fishing and forestry use;
• Cooperatives for intercommunal livelihood development;
• Community festivals;
• Intercommunal sports activities;
• Community theatre;
• Intercommunal disaster relief;
• Intercommunal neighbourhood clean-up, tree planting and environmental protection;
• Purposeful use of the media and social media for community-building;
• Curriculum development, teacher training and language instruction that promote community
cohesion and intercommunal coexistence;
• Intercommunity dialogue sessions or meetings;
• Group support sessions.
For information on how to organize these activities, please see the prior chapters.

125
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
Peace Ambassadors’ Training at the10.
MoYINTEGRATION OF2018
centre in Iraq. © IOM MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

Box 47
Application of conflict analysis and 10.3. CHALLENGES AND
transformation skills CONSIDERATIONS
Click here for case studies on how to apply While an analysis of the relational, cultural
skills in conflict analysis and transformation and structural dimensions of conflict require
to real-world contexts of humanitarian highly abstract thinking, recognition of conflict
emergency. behaviour does not require much abstraction,
because behaviour is usually visible and
tangible. When faced with violence and human
10.2.2 MHPSS workers’ training needs suffering, the rational thinking necessary to
in conflict transformation and grasp the complexity of conflict is at times
mediation compromised, and fundamental elements of
The concepts, skills and methods of practice the conflict, such as its history, the root causes
outlined in the preceding sections of this chapter of the violence, and other factors, are set
suggest a range of topics that MHPSS workers aside. In the face of violence and humanitarian
can study to expand their capacity to address emergency, people may distance themselves
interpersonal and community-based conflicts in from the kind of abstract thinking necessary
humanitarian emergencies. For information about to analyse, understand, and process complex
what training curricula different IOM missions conflict situations that led to an outbreak of
have used, please contact the IOM MHPSS violence, and may instead focus on an immediate
Section at contactpss@iom.int. A concise evaluation of violent behaviors. Keeping the
summary of suggested topics can be found here. attitude–behaviour–contradiction (ABC) triangle
in mind, MHPSS workers can support individuals
and communities in conflict restore a holistic,

126
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
10. INTEGRATION OF MHPSS IN CONFLICT TRANSFORMATION AND MEDIATION

multidimensional image of Self and Other. Through such a process of sustained public education and
dialogue, MHPSS workers can help parties in conflict and stakeholders regain a self-reflective capacity
and psychosocial readiness to analyse conflict and prevent violence.
Violence makes parties in conflict pessimistic about their future possibilities. It discourages them
from believing and investing in creative problem-solving. Under such circumstances of pessimism
and hopelessness, MHPSS workers can help parties in conflict and community members restore
creativity. Concretely, MHPSS workers can introduce successful examples and best practices of
creative problem-solving from the parties’ own communities, as well as from other credible sources.
MHPSS workers can also share with the parties such skills and methods of conflict transformation
and mediation as the ones described in this chapter, so they can expand their toolbox to tackle their
conflicts constructively and creatively.

FURTHER READING
Arai, T.
2009 Creativity and Conflict Resolution: Alternative Pathways to Peace. Routledge, London.
2017 Promoting Interreligious Harmony in Myanmar: A Guide to Training and Dialogue. Peaceful
Myanmar Initiatives, Yangon, Myanmar.
Barsky, A.E.
2014 Conflict Resolution for the Helping Professions. Oxford University Press, New York.
Beer, J.E. and C.C. Packard, with E. Stief
2012 The Mediator’s Handbook. New Society Publishers, Gabriola Island, B.C., Canada.
Conflict Sensitivity Consortium
2012 How to Guide to Conflict Sensitivity.
Galtung, J.
2000 Conflict Transformation by Peaceful Means (the Transcend Method). United Nations Disaster
Management Training Programme.
For other references see full bibliography here.

Small Scale Mediation Activities, Wau, South Sudan. © IOM 2015

127
 11.
INTEGRATED MENTAL HEALTH
AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

Informal group for sewing. Wau, South Sudan. © IOM 2014

128
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

11.1.2 Why to combine livelihoods

11.1. WHAT MHPSS programming with MHPSS
PROGRAMME MANAGERS
In emergency settings, people’s access to
SHOULD KNOW livelihoods is often disrupted. There may
be increased difficulties for the means of a
livelihood, with inherent stress. Moreover,
11.1.1 What is a livelihood? the loss of livelihood can often be one of the
Simply defined, a livelihood comprises the greatest impactors on both an individual’s sense
capabilities, assets and activities required for making of social status and their individual sense of
a living. This may include subsistence strategies, control. This can be particularly acute when a
income-earning activities, formal or informal household head becomes a net “recipient” of
employment, or a combination of all of these. aid support, rather than playing the breadwinner
role they played before the crisis. To learn more
Livelihoods represent much more than income about the relationships between access to
or employment. Livelihoods comprise individuals’ livelihoods and mental health and psychosocial
spiritual, humane, social, political, financial, natural well‑being, and better understand this chapter,
and physical capital or assets. What we do to earn see a series of short videos here, especially
a living often determines who we are in society, those from James Walsh, Guglielmo Schininà and
and the relationships we will have with others. It Elisabeth Babcock.
may define the opportunities we can access and
the quality of life we can expect. Understood in The rationale for including livelihood support
this way, livelihoods are a fundamental component within MHPSS programme centres on two
of overall psychosocial well‑being. points. First, by promoting economic security,
livelihood programming can help address the
In the humanitarian context, it is common stressor of financial and material insecurity in
to define a livelihood programming purely in emergency settings. This stressor is identified
terms of the economic reinforcement it offers consistently by populations in a diverse array
to help people weather a crisis. In order to be of settings. For example, rapid MHPSS needs
sustainable, livelihood support needs to help assessments undertaken by IOM in different
individuals, families and communities withstand countries all indicated that insecure access to
and recover from a shock with the same or livelihoods comprised one of the greatest causes
improved capabilities as before the shock/crisis, of distress and other negative feelings. Livelihood
without further threatening the natural resource programmes help alleviate this stress (Howe et
base. See Box 48. al., 2018; Jalal et al., 2015).
Second, access to secure livelihoods can
Box 48 strengthen the protective factors that buffer
Sustainable livelihoods against stress and promote agency. For example,
being able to provide for oneself and one’s family
• Do not undermine the long-term fosters a sense of self-efficacy. Livelihoods also
availability of natural resources; may offer opportunities for skill-building, which
can improve overall functioning and contribute
• Do not threaten the livelihoods of
to greater self-esteem. Quality employment can
others;
help reduce depression symptoms by fostering
• Are not dependent on outside a greater sense of agency (Butterworth et al.,
resources, such as external funding. 2011; van der Noordt et al., 2014). Additionally,
the social connection that livelihoods often offer

129
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
Learning baking at Hassan Sham Camp in Iraq. © IOM 2018/Aziz RABER
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

can contribute to a greater sense of belonging 11.1.3 What the evidence base tells us
and help counteract stigma.
Livelihood programming is not a panacea,
MHPSS interventions can also be integrated and practitioners should not expect that
into existing livelihood programmes with the simply adding a livelihood component to an
same benefits. It is particularly indicated when MHPSS programme will automatically enhance
people or communities have been severely outcomes, or vice versa.
affected by the crisis. They might experience
difficulties functioning and struggle to start or While there are volumes of literature on
maintain livelihood activities without appropriate livelihood programmes, the evidence base on
MHPSS. In this case, the existing programme programmes that combine livelihood support
should follow the presented structure, and an with MHPSS programming is quite limited,
assessment must be done on how to better because many livelihood programmes are not
integrate MHPSS aspects to support affected designed with mental health or psychosocial
people. well‑being impacts in mind, and/or are not
evaluated on these dimensions. Even fewer
have been implemented in emergency settings.
Box 49 A systematic review by Lund et al. (2012)
To learn more about the assessments, included only five evaluations of programmes
select any location below that included indicators for both livelihoods and
MHPSS outcomes, while that by Kumar and
• North-east Nigeria; Willman (2017) found eight, with none having
been done in situations considered emergencies.
• South Sudan;
Still, there is promising evidence from other
• Post-earthquake Haiti;
contexts to allow for identifying some guiding
• Urban areas of Lebanon with large principles to orient livelihood programming within
populations of Iraqi refugees. MHPSS programmes in emergency settings. These
are covered in the following section.

130
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

11.1.4 Guiding considerations for considerations. It builds on the Minimum

designing livelihood interventions Economic Recovery Standards of the
to boost MHPSS Small Enterprise Education and Promotion
Network, which presents minimum standards
Interventions claiming the title “livelihood support” to facilitate economic recovery in crisis situations,
vary enormously in their objectives, design providing guidance on what to consider when
and scope. They range from cash-transfer and planning livelihood activities.
social insurance programmes to job training,
entrepreneurship support and market facilitation Livelihood interventions that work to alleviate
activities. Even within particular categories of sources of stress and strengthen protective
livelihood programmes, there is great diversity. A factors have been most effective in boosting
cash-transfer programme might be aimed strictly mental health and psychosocial well‑being. For
at boosting incomes, or it may have broader social this, it is helpful to:
objectives, such as empowering women or youths, • Keep expectations realistic: Start small, and be
restoring a sense of normalcy, or even reducing honest with affected populations about the
violence. objectives and constraints.
Moreover, the type of livelihood intervention • Avoid adding more stress: Keep projects
options available will vary greatly with the degree simple and sensitive to the stresses people
of stability in a given context. In highly volatile already are facing.
situations, interventions are focused on saving lives:
for example, through distribution of food, seeds • Focus on building assets to enhance people’s
or tools such as grinding machines. In more stable ability to weather shocks over time.
environments, interventions can focus on building • Alleviate key stressors such as food insecurity
assets, employment support or entrepreneurship. or social tensions.
Ultimately, sustainability of livelihoods depends • Connect to social relationships where safe/
on people gaining access to markets so that they possible, to build on sources of resilience
no longer rely on external support, which is (existing support groups, local procurement
often beyond the reach of MHPSS programmes systems).
in emergency settings. Livelihood programmes
should be included from the onset of the • Match needs and capacities with markets to
emergency, but intervention options need to be set people up for success: Be sure to conduct
tailored to the specific contextual situation. a market systems assessment (see 11.2.3 for
details). Link the human capital identified in
There is no single design or “how to” guide the affected populations with the need for
that can cover the great diversity of livelihood financial capital in the market. Social capital
programming. Because livelihoods are defined and networks among people in the affected
by local conditions, the choice and design of population and host communities should be
programmes should emerge from knowledge of explored and taken into consideration to
the programme context. Camp contexts often develop an effective intervention.
present particular challenges for developing
• Consider sensitivities of targeting. Consult
livelihoods. In particular, livelihoods thrive on
with stakeholders to ensure that targeting
stability (commonly lacking in camps), and the
does not privilege certain groups, and that
close concentration of people with limited means
decisions are communicated clearly.
can limit opportunities.
For more information on the above-mentioned
This section is not intended to be comprehensive,
points check here):
but to serve as an orientation to some important

131
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

in-depth knowledge of the context and market,

11.2. WHAT MHPSS and some experience in conducting market
PROGRAMME MANAGERS system assessments and overseeing livelihood
SHOULD DO programmes. S/he should also be trained in basic
MHPSS concepts. At a minimum, s/he could take
this online training course and learn relevant
11.2.1 Assess whether the agency is chapters of The Inter-Agency Standing Committee
already running a livelihood (IASC) Guidelines on MHPSS in Emergency Settings
programme (IASC, 2007).
If the agency is already running a livelihood Local talent can often be recruited to support
programme, managers should provide their specific livelihood activities. For example, if the
assistance in: livelihood interventions linked with MHPSS
• Raising awareness among colleagues working will deliver trainings in trades such as tailoring
in livelihood support on the MHPSS aspects or carpentry, local tradespeople can help lead
of their work, using the following online trainings and mentor project participants.
training.
Livelihood staff and implementing partners
• Looking at possible synergies between – including trainers, instructors and facilitators –
the MHPSS programme and livelihood should be trained in (a) basic MHPSS
programmes, which can include: considerations, (b) the effect of toxic levels of
- Inclusion of MHPSS components stress on livelihood programmes, (c) how to
(discussion groups, group sessions, account for toxic levels of stress in the devising
individual counselling) in livelihood support and implementation of livelihood opportunities,
programmes; and (d) referral mechanisms and identification of
- Targeting the same communities with protection and MHPSS risks.
coordinated interventions;
- Sharing information on vulnerabilities and Such trainings can be derived from:
resources identified in the community. • Elizabeth Babcock’s video here;
• The comprehensive USIP training on
11.2.2 Include a livelihoods specialist livelihood and MHPSS;
as part of the team and train • Contacting contactpss@iom.int.
livelihood-related staff
Few people can be expected to be conversant 11.2.3 Assess market systems to match
in both the MHPSS and livelihood fields. For livelihood support with demand
this reason, in case livelihood experts are
not already present in their agency/mission, A market system is made up of the producers,
teams would contract a livelihoods specialist suppliers, traders and consumers that match
to design and deliver the activities as part of a the supply of goods and services with demand.
broader programme of MHPSS. They should These systems are critical in emergency settings
also be responsible for training short-term because they help people meet basic needs and
team members in these new areas. Ideally, this protect livelihoods. Markets can be particularly
person would be recruited locally in order to important to consider, given the variability of
have a strong knowledge of the context, but camp/non-camp settings. Camps often are
could be recruited internationally, depending on detached from local markets, but conversely
the scale of the programme. They should have offer unique opportunities of concentrated

132
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

demand. For more guidance on how to conduct Some important trade-offs to consider are:
a market assessment, see here. • Adding versus alleviating distress: All
From an MHPSS perspective, it is important interventions introduce some distress. It is
to match the information derived from the important to understand what this distress
market analysis, with the expectations of the might look like, and how/whether it can be
people involved in the programmes, their mitigated by the benefits of the intervention.
skills and objectives. It is indeed important to Will the distress of, say, a microcredit loan
respect people’s existing coping mechanisms and outweigh the potential benefits in savings/
expectations, while offering suitable marketable income? In an MHPSS programme, one
options. Programme design needs to balance would avoid any livelihood activity likely to
these two elements, as explained in the following add additional stress into the life of affected
section. populations.
• Targeting the most vulnerable versus more
likely to succeed: Because resources are
11.2.4 Explore trade-offs often limited and risks are high in emergency
Using the market systems assessment, it is settings, programmes can’t address everyone’s
possible to explore potential options and trade- needs all at once. An important trade-off
offs in order to decide what type of livelihood arises between targeting individuals who are
intervention may have the most MHPSS already doing well, such that they can then
impact. The trade-offs do not imply that the contribute more to local economies, versus
interventions are not worth pursuing; only that targeting the most vulnerable for more
mitigation measures might be needed to address potential social impact. This is important to
potential negative impacts. consider in MHPSS programmes addressed to
the most vulnerable populations.

Hairdressing class at the protection of Civilian site in Bor,

South Sudan. © IOM 2013 133
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

• Short-term versus long-term/systemic benefit: coordinate with other service providers

How will the programme balance the need to to ensure that this does not compete
respond to people’s urgent needs today with with or detract from other critical MHPSS
the importance of investing in more systemic interventions. This could involve coordinating
change? For example, a cash-for-work activity schedules accordingly to enable
programme could provide a needed boost to participants to attend both types of activities,
the local economy, but its sustainability will be or requiring participation as a prerequisite for
limited if people confront structural barriers, livelihood support.
such as exclusion from markets because of
migrant status or gender. 11.2.5 Continually assess risks, especially
• Targeting specific groups versus a territorial risks to personal safety
approach: Emergency settings are often
contexts of social instability and division. Bringing resources into a community can expose
Interventions that target a particular group people to new threats and risks. It can attract crime
– refugees or migrants – can improve the or increase household conflict by altering the balance
well‑being of that group, but may also risk of control over finances between men and women,
contributing to tensions with other groups, or across generations. Activities that challenge social
including host communities. Decisions need norms – for example, job training for women in non-
to be made about whether to prioritize traditional fields – can inadvertently increase risk for
the well‑being of a smaller group versus the people who access them (Women’s Refugee
interventions that serve a broader group Commission, 2014). Here is a useful framework
– for example, all those living in a defined for understanding and assessing risks in emergency
geographic area. settings.

• Boosting local economies versus distorting These risks need to be assessed initially and
markets: One of the critical questions in monitored throughout implementation.
many livelihood programmes – especially Managers should ask people what kinds of
cash-for-work and cash transfers – is how considerations could be helpful: for example,
big the stipend or transfer should be. If it is locating trainings or meetings nearer where
too small, its impact will be limited or even people live, holding events during daylight hours,
negligible. Too big, and it can create the or including meetings with families/households
wrong incentives – for example, hoarding to help partners feel included and see the
of food/goods bought with the cash, or benefits of the programme. This will reduce
dissuading people from other income-earning the risk of experiencing distress associated with
opportunities that are not dependent on taking part in livelihood activities such as those
external support. Likewise, programmes that related to walking to the venue at night or family
provide livestock run some risk of distorting disagreement regarding participation.
the market prices for that livestock simply by
increasing supply, though most programmes 11.2.6 Evaluate the advantages and
are too small-scale for this to be a key potential drawbacks of different
concern. types of programmes
• Detracting from other MHPSS interventions: Using the information gathered in the assessment
Livelihood initiatives are likely to offer great and the analysis of trade-offs, one can evaluate
appeal to certain groups, particularly if the suitability of different types of livelihood
cash or asset transfers are involved. When programmes. Table 10 presents some of the key
introducing such initiatives, it is critical to advantages and disadvantages of different types

134
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

Computer courses at Haj Ali Camp, Iraq. © IOM 2015/Aziz RABER

of interventions, which could also be combined as different activities of one programme. There is no
accepted rule on which interventions work better in camps or non-camp contexts. This is one of the
many variables that needs to be ascertained from the needs assessment. However, these examples
have been structured based on the likelihood of them being implemented in a camp context. This
table is not exhaustive of all the options, but gives examples of some of the trade-offs outlined
above:

Table 10: Advantages and drawbacks of different forms of livelihood support from an
MHPSS angle

Livelihood Description Advantages/drawbacks

Programme
Direct transfers
Social direct Cash – either directly, Livelihood advantages
cash transfers or as vouchers – is Where access to credit and capital is the main constraint to accessing
given to participants livelihoods, cash transfers can provide needed capital for investments
with few or no (materials, tools, training) to promote financial security and stimulate local
conditions. If the economies.
objective is to enable
people to buy basic MHPSS advantages
goods, transfer Allow people to self-prioritize their own needs and can target the most
amount is low. If the vulnerable.
objective is to promote
Potential drawbacks
economic security,
Limited impact where other barriers to financial security predominate (social
transfer amount is
norms or disrupted access to markets, for example). Can drive increased
typically much greater
inflation, or distort local markets and power relations if amount of the
than average.
transfer is too large and/or risk mitigation measures are inadequate. Can
reduce the sense of agency and be a source of social shame.

135
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

Food for Participants receive Livelihood advantages

work or cash food aid or cash in Promotes food security, helps prevent people selling off assets and helps
for work exchange for work, stimulate local economy.
usually on public works
projects (building or MHPSS advantages
restoring infrastructure, Food for work and cash for work can incorporate skill-building and can
trash pickup, among connect people to productive activities. Labour can be used to rehabilitate
others). community assets/infrastructure, which can boost communities’ sense of a
return to normalcy, as well as increase their sense of purpose.

Potential drawbacks
Estimating the appropriate amount of food or cash is critical to avoid
distorting markets and overly disturbing power dynamics. Can contribute to
dependency. Inexperienced programmes may not be inclusive due to lack
of understanding of how to address barriers experienced by persons with
disabilities. Work can be demeaning and short term, and therefore may not
help build sustainable livelihoods. Community infrastructure projects need
to be well thought out. For example, could the choice of public works to be
rehabilitated exacerbate tensions between individuals/groups?
Employment and job
training
Wage Identify opportunities Livelihood advantages
employment for employment Can mobilize people’s existing skills and provide opportunities for training and
within within the emergency additional skill acquisition. Can promote activated development and a sense
emergency response, from delivery of purpose and agency.
response of direct services to
affected population, MHPSS advantages
to the supportive Can provide meaning and purpose to affected populations and improve their
and administrative perception within the community. Promotes activated development and
structures. sense of agency. Can be combined with skill training. It is a common form of
livelihood support in MHPSS programmes.

Potential drawbacks
Can create resentment in socially complex contexts, and/or be complex
to implement in an egalitarian way. A market analysis is needed to avoid
it. Engaging underqualified individuals, who may be dealing with their own
stresses, can undermine the response and the psychosocial well‑being of
affected populations.
Job/skills Programmes that seek Livelihood advantages
training and to equip individuals for Creates portable assets. If training is matched to available labour market
placement waged jobs based on opportunities, can stimulate labour market and promote economic security.
market opportunities. Can promote activated development and sense of agency.
Provision of training in
basic job skills. MHPSS advantages
Can contribute to promoting self-esteem and self-efficacy. Can help establish
social networks.

Potential drawbacks
Few jobs (formal or informal) available in crisis contexts. Training without
placement may lead to raised expectations, or lack of applicability to real
world of work. May be difficult if training is not matched to available job
opportunities, or participants are not legally able to work. Can create
resentment if local labour is displaced.

136
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

Access to With potential to Livelihood advantages

information connect to wider In very high-capacity contexts, opportunity to earn income through
and MHPSS offerings, freelancing and connection to global markets.
communication information resource
technologies or IT centres can be MHPSS advantages
used to provide access Low risk. Allows individuals to get what they need and chart their own
to online courses, journey.
get information on Potential drawbacks
market prices or Unlikely to have significant impact on livelihoods in the short term, unless
demand, or even (in combined with other activities. High set-up costs unless integrated with other
rare cases) access camp interventions (for instance, safe spaces). It discriminates against persons
online employment
who are illiterate.
opportunities.
Assets for
generating income
Income- Grants or materials Livelihood advantages
generating (seeds, tools) are Can mobilize the skills people bring with them, produce needed goods,
activities provided to support/ stimulate local economy. Agricultural interventions can promote food
– group re-establish group security, stimulate local economy if people produce enough for sale.
agricultural business. This may be
support in agriculture – crop MHPSS advantages
production – but could Can build a sense of community between group members who have access
also exist in livestock/ to markets. Can incorporate training and skill-building. Favours group work,
fishing or non- which can build a sense of community.
agricultural businesses, Potential drawbacks
such as sewing clothes Inexperienced programmes may target persons without disabilities as
or bakeries. beneficiaries due to lack of understanding of how to address barriers
experienced by persons with disabilities. Potential to distort market
prices for assets or livestock provided by the programme. Can contribute
to competition for resources and degradation of environment. Asset
replacement projects can be hard to assess accurately, and may privilege
those who had more to start with. It can increase stress and anxieties and
bring frustration.
Income- Provision of livestock, Livelihood advantages
generating or materials to support Can contribute to income generation. Can promote food security, build
activities small business or assets and increase food security. The assets may be portable if affected
– individual income-generating people were displaced and return home.
livestock activities such as
or fishing livestock or fishing MHPSS advantages
support (water, food, veterinary Can incorporate training and skill-building. Can increase interaction with host
care, nets). Used communities as customers/vendors, allowing displaced people to extend their
to build assets and network. Can promote activated development and sense of agency.
income, and promote Potential drawbacks
food security. Can Inexperienced programmes may target persons without disabilities as
also involve asset beneficiaries due to lack of understanding of how to address barriers
replacement after a experienced by persons with disabilities. Potential to distort market
disaster. prices for assets or livestock provided by the programme. Can contribute
to competition for resources and degradation of environment. Asset
replacement projects can be hard to assess accurately and may privilege
those who had more to begin with. It can increase stress and anxieties and
bring frustrations.

137
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

Other common types of livelihood programmes, evolving changes in the market (which are likely
such as village savings and loans and microcredits, to experience significant flux, particularly in
are not considered in this chapter, as they are the early post-crisis period). An intervention
beyond the scope of MHPSS programmes. may need to be adapted to keep up with
market changes. Most importantly for MHPSS
programming, the intervention should always
11.2.7 Identify facilitative partners where be monitored and evaluated in relation to
possible the MHPSS objectives set by the programme,
Given the importance of connections to the for which people can refer to chapter on
market, programme managers should seek to Monitoring and evaluation. Given the trade-
identify market actors to partner with where offs outlined above, an M&E framework which
possible. Do seeds need to be given out, or also looks for risk of negative impacts on
can suppliers be invited to establish themselves other members of the community can also be
in the location or camp to distribute them in important. An example can be found here.
return for cash or vouchers? Can a financial
services provider be engaged to manage cash 11.2.10 Consider supplementing the “core”
transfers, which will convert into personal intervention with additional support
accounts after the intervention ends? This for certain groups
creates greater opportunity for sustainability and
long-term economic relationships to be built. Some subsets of the affected population may
Similarly, simply negotiating greater access to need additional support to benefit from the
local and regional markets for target populations, intervention. It could be that certain groups are
particularly those in camps, can function as a more illiterate, have roles within the community
major intervention in itself. Market actors can be that forbid them from certain activities, or
targeted with awareness of the MHPSS needs experience barriers to participating to livelihood
of affected populations, especially when working activities. This may require offering adapted
with groups with vulnerabilities. interventions, or supplementary supports, to
help them get the most out of the support. For
instance, addressing environmental, attitudinal
11.2.8 Develop clear transition strategies and policy barriers experienced by persons with
In engaging with communities, it is critical to set disabilities, raising awareness in the community
a clear end point for livelihood interventions, to facilitate access to specific activities, offering
so that affected populations are able to plan leadership courses to empower certain groups
for the future. This must be communicated or courses on specific skills required to have
clearly in community outreach, as well as part access to livelihoods. This could be language
of any trainings provided. Clear communication classes, literacy classes, learning how to navigate
prevents stress and supports affected people to in a new environment or how recruitment
gain self-reliance and recover their sense of hope. processes work in a new location.

11.2.9 Build integrated monitoring and 11.3. CASE STUDIES

evaluation processes
For examples of livelihood programmes adopting
Given the importance of market suitability, a MHPSS considerations, see Nigeria’s Community-
monitoring and evaluation (M&E) system needs Based Conflict Management and Cooperative
to continually monitor not only the impact of Use of Resources (CONCUR) here, and IOM
the interventions on the target group, but the Iraq’s integrated programming here.

138
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
11. INTEGRATED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT,
AND LIVELIHOOD SUPPORT

11.4. CHALLENGES AND CONSIDERATIONS

For the challenges and considerations associated with integrating MHPSS and livelihood support,
please refer to section 11.2.4 on trade-offs and section 11.2.6 on benefits and drawbacks.

FURTHER READING
Blattman, C., J. Jamison and M. Sheridan
2015 Reducing Crime and Violence: Experimental Evidence on Adult Non-Cognitive Investments
in Liberia. Working Paper No. 21204, National Bureau of Economic Research, Cambridge,
Massachusetts, United States.
Butterworth, P., L. Leach, L. Strazdins, S. Olesen, B. Rodgers and D. Broom
2011 The Psychosocial Quality of Work Determines Whether Employment Has Benefits for
Mental Health: Results from a Longitudinal National Household Panel Survey. Occupational and
Environmental Medicine, 68(11):806–812.
Jalal, C.S., E. Frongillo and A. Warren
2015 Food Insecurity Mediates the Effect of a Poverty Alleviation Programme on Psychosocial
Health Among the Ultra-Poor in Bangladesh. The Journal of Nutrition, 145:1934–1941,
doi:10.3945/jn.115.210799.
Mani, A., S. Mullainathan, E. Sharif and J. Zhao
2013 Poverty Impedes Cognitive Function. Science, 341:76–80.

For more references, see the full bibliography here.

IOM MHPSS works with communities inside the Malakal POC site 139
to make dignity kits © IOM 2021/Liatile PUTSOA
 12.
STRENGTHENING MENTAL HEALTH
AND PSYCHOSOCIAL SUPPORT
IN THE FRAMEWORK OF PROTECTION

Women’s support group for Rohingya refugees in Cox’s Bazar, Bangladesh. © IOM 2017
140
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

12.1. WHAT MHPSS PROGRAMME MANAGERS SHOULD KNOW

The Inter-Agency Standing Committee (IASC) defines protection as:
All activities aimed at obtaining full respect for the rights of the individual in accordance with the letter and the
spirit of the relevant bodies of law, i.e. human rights law (IHRL), international humanitarian law (IHL), international
refugee law (IRL) (IASC, 2016).

Protection is the responsibility of all actors intervening in a humanitarian setting (see Box 50 and
IASC, 2016), and it is particularly so for MHPSS actors, since “an intimate relationship exists between
the promotion of mental health and psychosocial well‑being and the protection and promotion
of human rights”, as stated in The Inter-Agency Standing Committee (IASC) Guidelines on MHPSS in
Emergency Settings (IASC, 2007). Accordingly, human rights and equity are the first core MHPSS
principles promoted by the Guidelines (see Box 51), and three action sheets (3.1, 3.2, 3.3) are
dedicated to the relation between MHPSS interventions and human rights violations and protection.

Box 50
The Centrality of Protection in Humanitarian Action – Statement by the IASC
Principals (IASC, 2013)
Protection of all persons affected and at risk must inform humanitarian decision-making and response,
including engagement with States and non-State parties to conflict. It must be central to our
preparedness efforts, as part of immediate and life-saving activities, and throughout the duration of
humanitarian response and beyond. In practical terms, this means identifying who is at risk, how and
why at the very outset of a crisis and thereafter, taking into account the specific vulnerabilities that
underlie these risks, including those experienced by men, women, girls and boys, and groups such as
internally displaced persons, older persons, persons with disabilities, and persons belonging to sexual
and other minorities.

Human rights are founded on the respect of the dignity and worth of each individual with their
unique characteristics, capacities and resilience. In emergencies, and resulting migration and
displacement, individuals are more likely to:
• Be at risk for their lives;
• Lose a sense of dignity;
• Be deliberately targeted or threatened with violence, abuse and exploitation;
• Be discriminated against in their access to food and water, shelter, health care and other basic
needs;
• Find obstacles in accessing education or civil documentation.
States are responsible for promoting, respecting and protecting human rights for all, without
discrimination as to “race, colour, sex, language, religion, political or other opinion, national or social
origin, property, birth or other status”, including migratory status. This is in compliance with the
humanitarian principles of humanity, neutrality, impartiality and independence.

141
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

More practically, four key elements of protection Although this evaluation of factors remains
mainstreaming into other sectors have been highly contextual and can’t always be generalized
identified to operationalize the protection in categories that fit all emergency situations,
principles of the Sphere Standards. These are: individuals who may require specialized
• Enhance the safety, dignity and rights of protective measures, especially in relation to
people, and avoid exposing them to harm. the protection of their mental and psychosocial
well‑being, could include:
• Ensure people’s access to assistance according
to need and without discrimination. • Survivors of GBV;

• Assist people to recover from the physical • Survivors of trafficking;

and psychological effects of threatened • Unaccompanied and separated children;
or actual violence, coercion or deliberate • Persons with disabilities;
deprivation.
• Individuals with mental, neurological and
• Help people claim their rights. substance use disorders;
• Chronically ill patients;
Box 51
IASC principles • Stranded or detained migrants;
• Other groups to be determined based
Principle 1: Human rights and equity
on context.
Humanitarian actors should promote the
The list is not exhaustive, but it offers a basis
human rights of all affected persons and protect
for prioritizing specific groups of people in
individuals and groups who are at heightened
relation to their vulnerability to specific threats.
risk of human rights violations. Humanitarian
More information on providing support to
actors should also promote equity and
these groups within the context of COVID-19
non-discrimination. That is, they should aim
can be found in this toolkit. As an annex to
to maximize fairness in the availability and
this chapter, IOM’s MHPSS and Protection HQ
accessibility of mental health and psychosocial
teams developed guidance on the specificities of
support among affected populations, across
addressing gender-based violence within MHPSS
gender, age groups, language groups, ethnic
programmes in conjunction with Protection
groups and localities, according to identified
actors. The annex’s training is available through
needs (IASC, 2007:9).
contacting contactpss@iom.int.

12.1.1 Who might be in need of

protection
In its Principles for Humanitarian Action,
IOM (2015b) identifies four interrelated
vulnerability factors that determine the need for
protection: (a) individual characteristics;
(b) pre-existing social, economic, environmental
and political conditions; (c) external disruptive
factors induced, or resulting from, forced
migration; (d) the specific situation of
displacement or migration (section IV.4).

142
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

Box 52 can contribute to the empowerment and increased

Protection in IOM resilience of affected individuals and communities
to reclaim their rights, participate actively in the
IOM is committed to mainstreaming decision-making processes of their communities,
protection in all its activities in humanitarian and resort to positive coping mechanisms when
settings, in ways that seek to do no faced with crises, thus contributing to increasing
harm, prioritize safety and dignity, foster their protection.
empowerment and participation, and are non-
discriminatory and based on needs. In addition, Synergies and coordinated actions should be
IOM works across all commonly accepted implemented throughout the whole project’s
dimensions of protection. cycles, as depicted in the following seven-step
operational framework.
IOM policy on humanitarian principles
formalizes the organization’s adherence to
the IASC humanitarian principles and can be 12.2.1 How to include protection
found here. concerns in MHPSS programming

IOM protection mainstreaming in emergencies

schematizes how IOM engages with protection 12.2.1.1 Context analysis
and can be found here.
MHPSS programme managers should have an
understanding of the general protection context
12.2. WHAT MHPSS and be aware of existing protection risk analysis
when devising responses to the actual and
PROGRAMME MANAGERS potential impact of violations and abuses on
SHOULD DO mental health and psychosocial well‑being of
vulnerable populations. In most humanitarian
MHPSS is understood to be a specialized and contexts, this information can be obtained from:
integral part of protection and complementary
activities, and close collaboration between MHPSS (a) The protection cluster and its Area of
programmes and protection programmes should Responsibilities (AoRs):
be the norm in the field. MHPSS programmes (i) Child protection;
should contribute to diminishing the protection (ii) GBV;
risks, strengthening existing capacities, and mitigating (iii) Housing land and property;
threats and vulnerabilities (see Box 54). They should (iv)Mine Action.
provide MHPSS for identified protection cases, (b) The MHPSS working group where there is
and refer to protection actors MHPSS clients who one.
are also in need of protection assistance. MHPSS
(c) The Health and Education Clusters.
practitioners should work hand in hand with
protection case managers when present to assess (d) The United Nations Country Team/
the protection risks and design case management Humanitarian Country Team strategy.
plans that cover treatment, risk assessments and (e) The Humanitarian Response Planning.
safety planning to help reduce or diminish these
risks. Follow-up and collaboration between MHPSS (f) The Humanitarian Need Overview.
and protection actors are crucial to achieve Thus, for an MHPSS manager, participation of
positive protection outcomes. MHPSS activities the protection cluster and relevant sub-clusters
can therefore contribute to different positive and regular exchanges with protection actors is
protection outcomes within the protection egg critical.
(see Figure 12), which extends to the fact that they

143
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

The understanding of the protection context (h) Joint projects and programmes can maximize
and risk analysis will feed into the MHPSS needs financial and human resources, and help to
assessments to guide a better response. advocate for unified messages.

12.2.1.2 Coordination and partnership 12.2.1.3 Capacity-building

Given the complementariness of their objectives MHPSS teams, including PMTs, should be trained
and principles, MHPSS and protection actors in:
should coordinate activities to ensure that (a) General protection.
they effectively and efficiently work towards (b) Operational standards and procedures used
protection outcomes and respect the rights by the protection actors in specific areas (for
of the affected populations. This implies that example, child protection, GBV or counter-
MHPSS programme managers should make sure trafficking).
that:
(c) Specific MHPSS needs and best practices for
(a) Protection referral pathways are known to response for specific protection cases of IOM
the MHPSS teams, which includes knowing concern:
and understanding the available services and (i) Survivors of GBV;
their nature. (ii) Displaced populations and vulnerable
(b) MHPSS is included in the referral pathways of migrants;
protection teams and actors. (iii) Survivors of trafficking;
(c) Both MHPSS teams and protection actors (iv) Migrants in detention;
are aware of their respective identification (v) Unaccompanied and separated children;
indicators for referral. (vi) The protection dimension of assisting
people with mental, neurological and
(d) There is an agreement on informed substance use disorders;
consent, data sharing, data protection and (vii)Elderly, especially if unaccompanied;
confidentiality principles and procedures for (viii)People living with disabilities.
mutual referral throughout the period of care.
(d) Psychoeducation of families.
(e) Referrals of MHPSS clients to protection
actors should be followed up and MHPSS managers should offer trainings to
documented, while respecting clients’ protection actors, as follows:
confidentiality. (a) General MHPSS and the IASC Guidelines
(f) An MHPSS staff member will be in charge of (IASC, 2007).
liaising with external organizations to ensure (b) MHPSS services available in the given
consistency of the referral pathways of emergency.
protection cases and timely communication
(c) Impact of violence on mental health and
among partners. In the PMTs, this will be the
psychosocial well‑being.
social worker.
(d) The protection dimension of assisting people
(g) Dissemination of information on existing
with mental, neurological and substance use
MHPSS referral pathways for protection
disorders.
cases is agreed upon with relevant protection
actors. (e) PFA and positive communication.
(f) Identifying people in need of MHPSS referral.

144
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

(g) Psychological consequences of: 12.2.1.4 Multi-layered response

(i) Displacement;
(ii) Trafficking; Cases referred to MHPSS programmes by
(iii) Administrative detention; protection actors should receive services at all
(iv) GBV; levels of the IASC pyramid of MHPSS. While
(v) Travelling unaccompanied and separated usually referral tends to happen only for those
children. with severe mental disorders or in need of more
focused counselling, PMTs should as much as
For further information on all the above- possible include clients in all activities that the
mentioned trainings, both for MHPSS teams programme proposes, including socializing and
and protection actors, please contact the IOM recreational activities, if and when appropriate
MHPSS Section at contactpss@iom.int. Some in terms of general and psychological safety.
of them can be offered jointly to MHPSS and In addition, services should not be segregated,
protection actors/teams, based on professional especially in the first stages of assistance. This
background and other determinants. Community means, for instance, that a counselling centre
members can be added to the trainings, since for survivors of GBV is to be avoided in a camp.
they have an essential function in granting By contrast, dedicated protocols and methods
and promoting protection and well‑being. can be used to provide counselling to survivors
This includes civil society and human rights of specific human rights violations, such as the
organizations. Solution-Focused Brief Therapy model for
survivors of GBV or torture. Existing staff
MHPSS staff, especially when working in close working in camps or displacement areas should
collaboration with protection actors, can be be trained in those methods, to be able to
included in protection-specific trainings on provide the necessary assistance when needed,
issues pertaining to their context, such as avoiding, however, the certainty of separate
child protection, GBV, human trafficking and facilities. Moreover, specific socializing activities,
detention. as well as peer-support or dedicated support
Similarly, protection actors often conduct groups, could be offered to specific categories
activities that need psychosocial competencies, of victims and survivors, based on their
such as building community-based protection identified common needs and resources (see,
networks or committees, launching awareness for example, the testimonial theater activities
campaigns, interviewing potential victims of proposed in chapter 6 on Creative and art-
human rights violations, and conducting focus based activities). Survivors of violence might
group discussions with various categories of the choose to engage in the community or in public
population. Moreover, they are often in direct debates, campaigns and sensitization activities as
communication with persons going through part of their personal resilient and restorative
distressing situations. They can be included in psychosocial path (for example, acceptance, self-
trainings in counselling skills, and community confidence, agency and activism).
mobilization, conflict sensitivity, mediation and
others usually offered to PMTs.
Box 53
Training is not the only way to reinforce GBV, MHPSS and Protection
partnership, and MHPSS programme managers For more detailed information on how
should be proactive in identifying manners to MHPSS and Protection actors can address
reinforce or complement current protection issues relating to GBV, see Annex 3.
activities.

145
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

Figure 12: MHPSS activities contributing not contain physical, verbal or symbolic cues
to different positive protection outcomes that could trigger negative emotions.
within the protection egg

12.2.1.6 Social, art-based and recreational

Levels of intervention
activities
- protection work
CB MHPSS programmes as explained in this
Manual include socializing, sport, theatre, and arts-
based and ritual activities. These can be important
Environment Building venues not only to promote psychosocial
well‑being of survivors of human rights violations:
Remedial Action they can also be considered ways to promote
human rights messages and concepts; for
Responsive Action identifying persons with specific protection needs
to be referred; and for understanding trends of
human rights violations or patterns linked to a
lack of respect or knowledge on human rights
Source: Based on ICRC (2001). topics, which can guide further awareness or
empowering activities. In some circumstances,
these activities can be purposively organized with
Box 54 a more explicit protection objective in mind,
Targeting subgroups involving protection actors. Such joint activities
that involve specific community leaders and
Avoid singling out or targeting specific members could reduce human rights violations
subgroups for assistance, unless this is critical and abusive behaviour, while increasing collective
and justified in the specific context to prevent awareness on rights and standards of protection.
further harm. Integrated support helps to See, for example:
reduce discrimination and may build social
connectedness. Consider, for example, (a) A booklet on domestic violence elaborated
providing women’s groups rather than groups by IOM Iraq;
for women who have been raped (IASC, (b) The Girl Effect programme, and
2007:61). its creative use of media for girls’
empowerment and protection in various
African countries.
12.2.1.5 Safe locations
While MHPSS activities in emergencies usually 12.2.1.7 Monitoring and evaluation
take place in a variety of settings, counselling indicators
of persons with protection needs should
happen in a setting that guarantees privacy, For monitoring and evaluation activities,
security, confidentiality and safety, and yet including those related to protection, see
is not stigmatizing. The space should be chapter 6 on Creative and art-based
accessible, and contain accessible information activities. The following indicators identified
with positive images or messages in local in IASC Common Monitoring and Evaluation
languages, and message boards with updated Framework for Mental Health and Psychosocial
information on referral systems, services and Support Programmes in Emergency Settings
useful contacts. The counselling space should (IASC, 2017), are related to protection:

146
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

(a) Number of reported human rights (f ) Percentage of target group members (such
violations, where possible and required; as the general population or at-risk groups)
(b) Percentage of target communities with who feel safe;
formal or informal mechanisms that (g) Number of protection mechanisms (such
engage in protection, monitoring and as social services or community protection
reporting of safety risks or at-risk groups networks) and/or number of people who
(for example, children, women and people receive help from formal and informal
with severe mental disorders); protection mechanisms;
(c) Percentage of target communities where (h) Number of people who have reported
representatives of target groups are human rights violations and perceptions
included in decision-making processes on about the responses of institutions
their safety; addressing their case.
(d) Percentage of target group members Indicators should be identified through
who, after training, use new skills and participatory exercises in the target
knowledge for prevention of risks and groups and subgroups. Indeed, a common
referral; understanding of abuses and threats should
(e) Number of members of at-risk groups be at the basis of this exercise and prior
(such as children or survivors of sexual work on language and culturally appropriate
violence) who use safe spaces; methodologies may be needed.

Box 55
IOM safe locations in South Sudan
In Wau, South Sudan, the counselling rooms are located inside IOM clinics. They provide a quiet
and private space for those who are seeking counselling, including caregivers, clients and people
referred from protection actors: for instance, survivors of sexual and gender-based violence
or people living with HIV/AIDS. Counsellors who work inside the clinics can receive those
needing support in collaboration with the health workers who have been trained in MHPSS.
In addition, an on-call counsellor and team leader are designated on shifts to ensure the timely
provision of support, whether they are at the clinic or in the vicinity of the community. There
is also at least a counselling space available in the psychosocial support resource centres. In the
centres, there are rooms that can be used for group activities or for counselling. When the
room is needed for counselling, the PMTs are alerted on the schedule. The counselling space is
prepared and maintained clean and available at all times. Often there are counselling sessions that
need follow-up after group activities; therefore, it is necessary to have a private space available for
use. Protective factors are also included in the design of the space. The spaces for activities are
free from possible hazards, ventilated and with semi-transparent parts on the walls, for people to
see that social activities are safely taking place (especially activities for children). The composition
of PMTs in each activity also matters; they should not dominate in numbers. If the activities
(individual or group) are done outside of the centre, the same principles about having safe
locations are applied. Consultations with communities on their concept of “safe places” are very
important when planning or designing activities, or when identifying venues or physical structures
to be constructed or rehabilitated.

147
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

12.3. CHALLENGES AND CONSIDERATIONS

(a) Project-based interventions, absence of integrated programming and siloed humanitarian
interventions are key challenges to improving protection outcomes and to promoting
psychological well‑being in situations of protracted crises. Without collective efforts from the
entire humanitarian community to systematically mainstream MHPSS as a cross-cutting issue, the
impact of MHPSS and protection interventions can face significant limitations.
(b) Humanitarian organizations and national institutions may operationally frame protective
interventions as individually centred and normative-based approaches, which make coordination
and joint programming with community-based MHPSS programmes either ineffective, or even
antagonistic. In this respect, capacity-building and mutual referral can be efficacious tools to find
common grounds.
(c) New protection measures and safety networks are at times introduced without properly
considering pre-existing ones. This can reduce the capacity of the affected communities to
protect themselves. The mainstreaming and collaboration of MHPSS programmes with protection
programmes will still be coordinated with the community programme steering committee,
and subject to community feedback. In addition, MHPSS assessments are usually able to identify
existing practices and networks, which need to be factored into these collaborations. The “do no
harm” principle must be considered in all interventions.
(d) People can cope with crises by resorting to pre-existing social or traditional harmful practices and/
or they can develop new crisis-induced negative coping mechanisms (female genital mutilation,
early marriage, child labour, marginalization of persons with disabilities, segregation or forced
institutionalization of persons with mental, neurological and substance use disorders). These might
not comply with human rights and humanitarian standards, and eradicating them may require
longer-term social, cultural and structural changes at the community level. MHPSS activities
should be inscribed within a multilayered, longer-term strategy, with increased coordination with
transition and development actors, whenever present.
(e) Human rights violations can also be perpetrated by humanitarian staff, and IOM has taken specific
measures to prevent sexual abuse by humanitarian staff in its policy on community Protection
against Sexual Exploitation and Abuse and staff standards of conduct, in line with the inter-
agency policies on the issue.
(f) There could be the tendency to overrefer “cases”, congesting some organizations and reducing
their capacities to provide quality services to the ones most in need. There are also often
challenges of overidentifying when there are no specific services available (for example, identifying
unaccompanied and separated children, or specifically street children, when no actor actually
provides alternative care, protection, access to health care or other services to them). The
identification of a group or individual at risk brings an ethical duty to provide care and follow-up.
This means that the MHPSS actor should refer to protection services and, where no services are
available, to inform responsible or relevant actors, or duty bearers, of the particular issue or the
cases, while respecting data protection, consent and confidentiality principles, and keeping the
security of the persons or group as the primary consideration. This should be done within the
protection cluster or/and its sub-clusters, or in liaison with protection actors.

148
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

Box 56
Reporting human rights and other violations
MHPSS staff will invariably witness the disclosure of abuses that could be classed as human
rights violations, while providing assistance to affected individuals. It is not the function of
MHPSS workers to investigate allegations of abuse, but they can certainly play a key role in
supporting survivors in accessing justice where possible.
Where a MHPSS worker is told about an abuse by a client, they should continue providing
care and not interrupting it and, upon receiving consent to do so, refer the case for additional
support to:
a) an IOM protection officer if they exist; OR
b) ask the manager to consult the Protection Cluster Coordinator for the appropriate
referral entry point, based on the survivor’s wishes, his or her immediate and long-term
needs, and the type of abuse. For example, the referral procedure for a case of suspected
child abuse will vary significantly from an allegation of torture made by an adult male in
detention. Referral options may include the provision of immediate medical or protection
assistance, or legal, livelihood and reintegration support. Referrals should not be made to
service providers, who are linked to alleged perpetrators.
Notwithstanding the advice provided by the Protection Cluster or other similar bodies, MHPSS
practitioners should at minimum be familiar with, and where existent and possible, integrate
into, the existing working groups and/or referral pathways for the following types of abuse:
• Sexual and gender-based violence (SGBV);
• Forced recruitment/trafficking;
• Child abuse;
• The six grave violations against children;
• Attacks on civilians;
• Torture and ill-treatment;
• Enforced disappearance.
All referrals should be made in line with respect for survivor autonomy, which means
respecting survivor choices, upholding full and informed consent, and respecting the principle
of confidentiality where possible. MHPSS staff should know that not all help professional
categories are protected from court-ordered requests to disclose information about survivors.
Before promising full confidentiality, staff should understand the limits of what they can
guarantee.

149
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
12. STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN THE FRAMEWORK OF PROTECTION

FURTHER READING
The Alliance for Child Protection in Humanitarian Settings
2018b Child Neglect in Humanitarian Settings. The Alliance for Child Protection in Humanitarian
Settings, Geneva.
Inter-Agency Standing Committee (IASC) Task Force on Humanitarian Action and Human Rights
2004 FAQ on IHL, IHRL and IRL. IASC, Geneva.
International Committee of the Red Cross (ICRC)
2004 Inter-Agency Guiding Principles on Unaccompanied and Seperated Children. ICRC, Geneva.
2018 Professional Standards for Protection Work (3rd ed.). ICRC, Geneva.
International Organization for Migration (IOM)
2009b Caring for Trafficked Persons: Guidance for Health Providers. IOM, Geneva.
2010b Data Protection Manual. IOM, Geneva.
2020 Mental Health and Psychosocial Support (MHPSS) in the COVID-19 Response: Guidance and
Toolkit for the use of IOM MHPSS Teams: Version III-Final. IOM, Geneva.
Office of the United Nations High Commissioner for Refugees (UNHCR)
2011 Age, Gender and Diversity Policy: Working with People for Equality and Protection. UNHCR,
Geneva.
2014a Child Protection Issue Brief: Mental Health and Psychosocial Well‑being of Children. UNHCR,
Geneva.
2014b Understanding Community-Based Protection. UNHCR, Geneva.
United Nations Office of the High Commissioner for Human Rights (OHCHR)
2011 International Legal Protection of Human Rights in Armed Conflict. OHCHR, Geneva
For other references see the full bibliography here.

150
 13.
COUNSELLING

Deebaga Stadium IDPs Camp, Iraq. © IOM 2016/Safa ALJANABI

151
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

13.1.2 Concepts
13.1. WHAT MHPSS
PROGRAMME MANAGERS 13.1.2.1 Counselling
SHOULD KNOW
Counselling is a supportive conversation. There are
Managers of MHPSS programmes are not many types of conversations that take place between
directly providing counselling services, but they community members that may have a therapeutic
design programmes and take implementation benefit. These can range from spontaneous, mutually
decisions that regard counselling. These have supportive conversations, to problem-solving
to do with selecting which counselling models associated with particular activities. In this Manual,
and tools to use in the programme, based counselling refers to those structured conversations
on contextual capacities and needs. MHPSS that may take place with individuals and groups, and
programme managers have to: that have a therapeutic outcome as their goal.
• Identify, alone or together with the technical Counselling is a rich and diverse field, which may
supervisor, training programmes that are also be practiced by other disciplines, such as social
suitable to enhance the existing counselling work and clinical psychology. The hallmark of
capacities in the given context. counselling is its particular emphasis on mobilizing
• Consider issues of scalability, and of suffering persons’ resilience (Fraenkel, 2014). Of
adaptation and training, when devising great importance in counselling is how to create and
counselling interventions in emergencies. maintain healing and ethically sound relationships
between the counsellor and those being counselled.
• Consider the issue of squared cultural and
linguistic differences and, at times, of working Features that stand out in a contextually sensitive
with interpreters when offering counselling to counselling approach are:
migrants. • Mobilizing suffering persons’ resilience, and
• Monitor adherence to adopted their psychological and relational strengths and
methodologies. Organizing and supervising resources, in order to solve their problems:
the technical supervision is also part of the This will often include facilitating the collective
manager’s duties. capacities for resilience that reside in family and
community relationships, and that are drawn
This chapter therefore serves as a guide to from cultural and religious traditions.
better understand the definition, practices and
modalities around the provision of counselling • Effective counselling: This involves teaching
services in an emergency, with particular important skills, such as active listening, respect
regard to those methods that better serve a and avoiding causing emotional harm. Effective
community-based approach, such as one that counselling is enhanced by the social–emotional
empowers and entitles communities in finding and relational intelligence of the practitioner
their own responses. In order to understand the and client, as well as other supportive
definitions of counselling, resilience and other members of the community.
terms used in the chapter, see here. • Counselling for many, and particularly for those
who have been displaced from home, family,
Box 57 and community, creates a space of “protected
Adaptations in Pandemic Response intimacy”: An important capacity for preventing
a sense of psychological homelessness (Saul,
For guidance on remote MHPSS service
2018).
delivery during the COVID-19 pandemic, see
this report developed by IOM Iraq.

152
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

A number of recent studies support the and communities. These approaches are aimed
importance of counselling in emergency settings at strengthening collective resilience and social
(Jordans et al., 2016; Patel, 2012; Murray et al., capital, and mobilizing the community’s engaged
2014; Ramaswamy et al., 2018; Tol, et al., 2011; action and response. Community-based
Watters, 2017). These MHPSS interventions can approaches aim at understanding the sociocultural
build healing connections that may both reduce and environmental parameters that both hinder
ongoing distress and prevent future mental health and promote the kinds of interactions and
difficulties. conversations that lead to well‑being. This includes
the relationships between people and between
At a most basic level, counselling helps re-establish groups; their culture; and existing structural
connections between people, so that one is not inequalities based on race, ethnicity, gender,
struggling with adversity in isolation – a serious class, and the physical, political and economic
risk factor for mental health difficulties. Since environment. This approach also includes a
humanitarian emergencies are so destabilizing and historical understanding of the narratives that
often unpredictable, the connection with others have shaped identities and the current situation or
can help in gaining perspective and composure, crisis.
and support the shoring up of resilience: for
example, recognizing and accessing resources A community-based approach is particularly
important for adaptation and problem-solving. relevant in crisis situations, where not only
individual clients, but their families and
Active and perceived social support has been communities, are affected, directly or indirectly,
found to be the most important protective by stressful and disruptive events. Counsellors,
factor in highly stressful situations, such as during too, are part of the system. They are affected by
and following emergencies, since both giving and their work, which includes reciprocal interactions
receiving help are adaptive activities (Hobfoll with clients, with their own work teams and
et al., 2007). Following a disaster, there is an organizations, and with their own families and
evolutionarily-based biological capacity for people communities. “Vulnerability” and “resilience” are
to come together and bond. This natural healing concepts that apply to counsellors as well as those
process may be supported through counselling they seek to help.
at the individual and communal levels, particularly
when its helps restore connections that may have Community-based approaches isolate problematic
been broken, as well as build new ones. behaviours or feelings not only in the individual,
but also in the web of relationships in which a
In the IASC pyramid of MHPSS intervention person is embedded. The problems will always
in emergencies, the counselling techniques and have both an individual and relational or collective
models described in this chapter are included at dimension. Counsellors will therefore understand
the third level (focused interventions), even though the context and meaning of counselling in
they require different levels of specialization. particular situations – for instance, does having a
counsellor from outside the family or community
13.1.2.2 Community-based counselling intervening to help solve the problems of children
in some way undermine the parents’ authority
Community-based counselling is one of the and competency? For example, does it send the
many approaches of counselling and has the message “You can’t do it yourself, we must help
advantage of addressing not only psychological you”? This problem often presents itself when
issues resulting from stress, grief, loss, depression counsellors work directly with children and ignore
and other individual mental health difficulties, the competencies of parents.
but also the psychosocial impacts and challenges
resulting from the collective injuries to families Table 11 clarifies principles for community-
based counselling. While many counselling

153
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

approaches focus primarily on the individual, and not every approach is reflective and responsive
to the community, a standard can be set in which any individual and group counselling approach
can be adapted to make it more community-based and contextualized.

Table 11: Community-based counselling approaches – minimum and optimal standards

Minimum standards Optimal standards

Programmes are often provider-driven, with Programmes engage the community’s participation at all stages
participation of community leaders and – planning, assessment, prioritizing, implementation, evaluation and
members to aid in programme implementation. dissemination. Programmes may fall along a continuum of outside
provider/inside community-driven programme development.
Primary focus on screening for and addressing There is an assessment of needs, challenges and priorities of the
multiple mental health problems as well as target population to determine the most effective and appropriate
specific diagnosable disorders. Symptomatology, counselling approach.
idioms and constricts are validated with the
community.
Primary focus is on treatment of individuals and Focus may be on addressing the particular challenges in families, in
reduction of psychological symptoms. Tools are the community as a whole, or groups and organizations within the
translated. community. The emphasis is on relational repair as much as symptom
relief.
Exploration of culture and context to An initial assessment is made of culture and context, to understand
understand how best to implement and scale individual and collective strengths, resources and coping capacities,
up interventions. as well as problems. Culture is central to determining local
understandings, priorities and meanings of potential interventions (see
IASC, 2007:38–48). Care is taken not to undermine local meanings,
resources and coping capacities at the levels of individual, family and
community.
Adapt evidence-based programmes developed Programme development is an iterative process based on ongoing
in other contexts to current context. The community input, revision and approval. Cultural meanings are
particularities of context and culture are central to determining priorities, available resources and preferred
explored to facilitate implementation. ways of addressing distress or challenges, using participatory methods
as above (Bragin, 2014).
Criteria for programme success are deter- The criteria for success in evaluating a programme are determined by
mined by established indicators developed in client-identified goals and in collaboration between outside providers
testing programmes, and in solution-focused and the community.
counselling in client-identified goal setting and
steps.

Some types of counselling approaches used in emergency situations – including cognitive

behavioural approaches, narrative exposure therapy, eye movement desensitization and
reprocessing, Rogerian approaches, some art therapy and dramatherapy techniques – tend not
to take into consideration the social and ecological context of the person(s) being counselled,
nor the context of the counsellors and the counselling situation itself. There are, however,
counselling approaches, such as strength-based solution therapy approaches, that are
grounded in a social ecological approach (see models of work). Furthermore, the above-
mentioned counselling approaches, although not being community-based in themselves, can
be integrated into a more socially and ecologically contextual approach and programme,
contributing to its overall objectives.
154
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Group counselling session, Lebanon. © IOM 2017

13.1.2.3 The counselling process

The counselling process is determined by the context in which therapeutic interactions take place, as
well as the particular theoretical model of the counselling approach, usually in structured multimeeting
programmes. Counselling may take place in professional spaces or MHPSS centres – such as IOM’s
recreational and counselling centres and hubs, other safe spaces, health centres, or in communal
or cultural spaces that have been identified – where an individual would go in need of guidance and
support – and during certain crises, counselling may take place remotely (Abramowitz, 2010; Chibanda
et al., 2016). Counselling may take the form of accompaniment: for instance, by a volunteer who helps
a client navigate to resources in new and unfamiliar situations – a popular approach in Latin America,
which builds on social work approaches to case management (Valdivieso and Andersson, 2017;
Pinheiro, 2017).
The process of counselling most often includes an initial stage of joining or gathering, and various forms
of listening and speaking:
• Some of these conversations may have particular culture-based guidelines about how to speak and
who can speak with whom and in what order.
• There may be cultural conventions or restrictions on the giving and receiving of advice (in traditional
communities, for example, married couples experiencing difficulty will meet with the in-laws to help
resolve marital conflict or solve problems).
• There may be cultural prohibitions on speaking to strangers outside of the family.
• Counselling may be directive or non-directive, and may focus primarily on providing emotional
support or giving advice.
• It may focus on solving problems or finding solutions, exploring painful feelings or strengthening the
coping capacities of individuals, families or groups.
• Many counselling approaches, especially in emergency situations, will involve some form of
strengthening of emotional regulation skills, through training in relaxation or mindfulness techniques,
or physical exercise and movement (Wessells, 2009).

155
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

The counselling process can vary due to the types of people who are meeting, whether the groups are
facilitated by professionals or trained paraprofessionals, or follow culturally prescribed ritual guidelines
around life transitions and crises.

Box 58
What distinguishes a systems or community-oriented approach to counselling from an
individual-oriented approach
• Rather than exclusively focusing on internal psychological processes, it attends to patterns
in relationships among people in families, couples, groups and in the community, through
community approaches.
• It attributes psychological and social dysfunction to problems lying not solely within the
individual, but also in larger systems.
• It pays attention to structural issues of race, ethnicity, religion, class and gender as social
determinants of mental health difficulties. It is structurally competent.
• It acknowledges that the problems of individuals and groups always occur within context, as do
the solutions, which must be meaningful and acceptable in the person’s social context – family,
friends, peer groups, faith-based groups and organizations.
• It sees the social context as not only sustaining problems, but also as the source for solutions.
To ignore both is to narrow the scope and potential effectiveness of counselling. For instance,
if a child who is exhibiting problem behaviour is removed from his social context to solve his
problem, when he is returned to that context he is also returning to the relational forces in the
family or school that may have sustained the problem in the first place.
• It can be more challenging with highly mobile populations – such as refugees and migrants, or
with displaced persons, whose sense of community has been fractured – and more difficult to
reproduce/scale up.

Group counselling session. © IOM 2015

156
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Male support Group, Erbil IDP site, Iraq. © IOM 2017

it is a part in order to identify the factors driving

13.2. WHAT MHPSS the situation, as well as to highlight the most useful
PROGRAMME MANAGERS points for intervention” (Green-Rennis et al., 2013).
SHOULD DO An important part of understanding the
complexity of the situation is to describe the
The decision about what kind of counselling
structural factors at play. These structural
programme(s) to implement in an emergency
factors could be at the level of community,
situation may be guided by the three core
neighbourhood, institution (housing, schools,
principles:
corrections, clinical services), and at the policy
level (state policy on housing, policies of
13.2.1 Understanding the complexity of international aid groups, the impact of war and
the situation in which counselling is political violence). Referred to as “structural
being provided competency”, this approach to clinical training
and practice addresses the social and political
The basic starting point for understanding the aspects of mental health and psychosocial
complexity of the situation is a descriptive account well‑being. Focusing on structure can promote
of the humanitarian emergency and of the a more collaborative approach that makes use
population affected (how many people, when of local resources. This is in lieu of an approach
did they arrive and where from, what has their that venerates individual behaviour change in the
journey been like, how many available health and face of overwhelming environmental adversity
mental health professionals are present, and so (Metzl and Hansen, 2014). This recognition of
on). This “thick description” (Geertz, 1973) may larger social forces is essential to understanding
serve as a first step on which a “situation analysis” the social disparities in global mental health.
can be made: that is, a tool for creating a detailed Inequalities based on race, ethnicity, gender and
understanding of an interpersonal episode or social class are major drivers of poor mental
complex state of affairs (the situation) in the health outcomes.
context of the larger narrative of which it is a part
(the embedding drama). “Situation analysis creates Other important questions to ask are: What
a detailed description of the situation and links that are the complexities of the stories? How
particular situation to the larger drama of which do narratives shape the experience of the

157
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

population, the providers and the developing families and communities exhibit resilience
collaboration – and the way the manager thinks themselves in response to stress and challenges.
about designing interventions? This may involve adjustments and adaptations
of subsystems within the community – that is,
13.2.2 Recognizing existing individual and individuals, groups and organizations – or it may
collective processes and resources involve the interactions of the entire community
for recovery with its environment, including other social,
economic and political entities (Kirmayer et al.,
Through interviews and observations, it is 2009).
important to understand the positive social
processes that have already been taking place Approaches to resource mapping have been
in the target population and the humanitarian presented in previous sections of this Manual.
environment, which may be considered forms Here we may add that, in developing resilience-
of counselling and may serve as the foundation based approaches to counselling, mapping sources
for the further development of counselling of resilience at different systemic levels will be
approaches for a community. The aim is not important in determining points of intervention. A
to undermine already-existing resources and variety of maps have been developed (see Landau
resilience processes important for recovery. An and Weaver (2006) later in this chapter) that will
understanding of these resources will provide be helpful to programme planners as a kind of
important information on the preferred help- checklist of the potential points of intervention.
seeking patterns in a population, and help
identify leadership capacities, skill sets and 13.2.3 Enhancing and building on what
motivated community members, who may be already exists
important collaborators in developing counselling
programmes. In collaboration with community representatives,
it is important to understand which existing
Resilience has now emerged as a new paradigm processes could benefit from support by
in the fields of development and mental health providers. For example, a group of volunteer
(Ager et al., 2013). What is distinctive about a parents running a sports programme for youths
resilience-based approach is: might request help from counsellors to address
• An emphasis on strengths, resources some of the MHPSS needs of programme
and capacities rather than deficits; participants that come up in the groups they
are facilitating. This non-stigmatizing site may
• Anticipation of actions that reduce the be an important place to offer information on
impact of adversity; understanding stress reactions and tools to cope
• Attention to multiple levels of influence, with stress, anger management and routes to
ranging from the structural and cultural other forms of counselling, if needed. The sports
through to the community, family and group itself may have the capacity to function as
the individual; a kind of peer support group with the aid of a
psychosocial counsellor.
• Mapping influences within ecologically
nested systems (ibid.). In trying to determine what types of counselling
may need to be added to what already exists,
Influences are bidirectional, in that an individual’s it will be important to understand the different
resilience is fostered by family, social and cultural effects or impacts of migration and displacement
resources embedded in one’s social ecology, at different levels. Often, when looking at a
as well as the collective capacities or ways that counselling approach, one can find his or her

158
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

approach to counselling in individual level • Provide preventive value – to the

factors (symptoms, mental health disorders), extent that the counselling approaches
but not the disruptions that take place at strengthen protective factors (such as
the level of the family and the level of the promoting social support and problem-
community. One needs to be able to consider solving).
interventions that not only strengthen family
and community supports, but address the • Address the most vulnerable and high-
impact that stress, grief, transition and loss can risk community members.
have on family and community interactions. • Promote social cohesion and be
Multilevel approaches to determining which effective in promoting cross-community
counselling methods to use do consider the communication and preventing
impacts of expressed community needs at communal fragmentation.
multiple systemic levels. • Acknowledge the diversity of needs
Family stress needs to be addressed at and determine which counselling
the family level, often with community interventions will most likely lead to
support. When determining what needs practical success and thus increase the
to be strengthened, enhanced or added to efficacy of the community.
the community’s counselling efforts, the • The development of the priority must
community’s desired goals and priorities for respect or take into consideration the
counselling must first be established with the power dynamics in the community.
community. Based on this vision of recovery, The issue of sharing and distributing
one can then explore with the community resources in a fair and equitable way
the different options for counselling as a part brings in a more ethical dimension for
of the process of developing a strategic plan how priorities are established.
for a set of counselling interventions that are
the most important for this early phase of • It is important for practitioners to
intervention. be both culturally and structurally
competent in facilitating this process of
What is the process for establishing the negotiation.
priorities and how are these priorities
negotiated among community members In the context of understanding the community
and with providers? That process may situation and broadly assessing its needs and
include a discussion of different types of resources, the goal is then to determine
counselling approaches that are traditionally which counselling approaches would be most
utilized or preferred by the community, desirable, feasible and viable in the situation. A
potential limitations of these approaches, framework is recommended here that is based
and what additional approaches are needed on relationally oriented design thinking adapted
to complement existing services in order to from IDEO U (2016) and Bava (2017).
address the unique challenges of the current The choice of particular counselling approaches
emergency situation. Available resources should be determined by the goals and
also need to be determined– trained priorities articulated by the community. Then
community members available for training as the community may explore with provider
paraprofessionals, for example. In the process organizations which counselling options may
of negotiating priorities, the following may be be available, feasible to implement and most
useful guiding principles: viable. The needs of the community do not

159
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

always coincide with the resources that are strategies they find most useful, so as not to
being offered by humanitarian organizations. interfere with or undermine a population’s
The community would benefit from knowing natural coping capacities. It will be important
about counselling programmes that most to wait before offering counselling that targets
closely fit their goals, so that trainers in these specific mental health difficulties that only
particular approaches may be sought. This become apparent months after an initial crisis.
determination is accomplished by interviewing However, in this initial stage, counselling that
community members, stakeholders and addresses the immediate impact of a crisis may
provider organizations. Some of the options for be useful, such as:
community-based counselling approaches at
different levels are presented below. • Practical problem solving and problem
management (see PM+, section 13.4.1
below);
13.3. OVERVIEW • Ambiguous loss groups (see section 13.6
OF COMMUNITY- below);
BASED COUNSELLING • LINC Community Resilience Model
INTERVENTIONS (Landau and Weaver, 2006);

Ideally, a counselling programme in emergencies • Sociotherapy (see section 13.3.3 below).

for IOM should not follow a precise and
At a second stage, more approaches can be
predetermined intervention protocol, but
used, including the ones above.
should be based on a solid foundation of
skills of the counsellors, and the sensitivities
and competencies described beforehand in 13.3.1 Individual level counselling
the chapter. A group of trained counsellors, approaches
constantly retrained and supervised, should
Problem Management Plus: PM+, in individual
be allowed to adopt flexible approaches in
and group format, is an innovative psychological
intervening with groups and individuals, while
intervention that provides clients with skills to
adhering to precise ethical principles and
improve their management of practical problems
overarching models of work.
(unemployment, interpersonal conflict, among
However, various community-based counselling others) and associated common mental health
interventions – or psychological interventions, problems, via the provision of four strategies:
as some call them – have been developed problem-solving counselling, stress management,
at the level of the individual, family, groups behavioural activation and strengthening social
and communities as a whole in humanitarian support.
settings. Others have been developed in a
variety of other settings, but have the potential
to be implemented in emergency humanitarian 13.3.2 Peer-support counselling
contexts. These are more structured and programmes
validated, and are therefore potentially easier to Friendship Bench Programme in Zimbabwe:
scale in case resources or capacity are scarce. Located in the grounds of health clinics around
During the initial months of a humanitarian Harare and other major cities in Zimbabwe, the
emergency, it is important to allow some time practitioners are lay health workers known as
for people to access on their own the coping community “Grandmothers”, trained to listen
to and support patients living with anxiety,

160
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Lay Counselling at the Protection of Civilians site in Malakal,

South Sudan. © IOM 2018

depression and other common mental disorders through other support systems, friends,
(see “Friendship Bench”). neighbours and colleagues, which would be
perceived as more effective and appropriate by
Being Buddies – IOM Nigeria: The buddy them.
system is an intervention similar to peer-to-peer
counselling, which consists of the identification, This methodology puts both participants in a
training and constant supervision by professional more equal position. In humanitarian settings,
counsellors of various community members very often, affected populations are seen as
who can provide support to their peers in the passive recipients of assistance. The buddy
neighbourhood, families, workplaces and groups. system approach allows for a different view and
It was originally developed in non-emergency promotes a different self-identification, because
contexts, in settings such as workplaces or affected individuals become both providers and
schools. In schools, programmes have been receivers of such services. Through the buddy
put in place to promote students’ psychosocial system approach, a positive sense of identity is
well‑being through buddy support, with the encouraged, providing affected individuals with an
idea that students would be more responsive opportunity to become positive role models.
to receiving support from their peers, to whom
they could relate to more, than from a school In emergency and displacement settings,
staff member. Such approaches have proved neighbourhood support structures are often
particularly relevant in some emergency settings, broken down, and the buddy system can help
such as north-eastern Nigeria. In this context, weave and strengthen the social fabric. By
counsellors and psychologists are scarce. encouraging interactions through “buddies”, groups
Moreover, seeking assistance from a counsellor can be created at the grassroots level to recreate
or psychologist is quite the exception, whereas neighbourhood or problem-based support.
most affected individuals would seek assistance

161
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Through the buddy systems approach, individuals among others), age groups (adolescent, adult and
are equipped with MHPSS skills in order to geriatric populations), settings (outpatient mental
provide effective support to their peers, and can health facilities, primary care, school-based clinics,
pair up with individuals needing more support. community settings, among others), and modalities
The MHPSS manager and supervisor’s role is to (for example, individual, group and telephone).
build capacity of the buddies, provide guidance
and ensure that they do no harm. Buddies There is a growing body of evidence showing
should be provided with supervision, to explore the effectiveness of IPT in low-resource regions
any challenges they may encounter, and reflect and settings. IPT was used in a group format,
on their practices and experiences. Finally, in was culturally adapted, and showed efficacy
emergency settings and particularly in protracted for depressed adults and adolescents in both
crises, populations can experience numerous southern and northern Ugandan communities;
displacements. With the buddy system approach, for depressed primary care patients in Goa,
the trained individuals will be moving with the India and Ethiopia; and with women with post-
affected population and still be able to provide partum depression in China and Kenya. The last
MHPSS, even in situations where humanitarian group was HIV positive and included survivors of
actors may not be able to reach the affected intimate partner violence. Group IPT was adapted
population. for global dissemination by WHO.
Sociotherapy is a therapeutic system with
strong theoretical and historical links to Sociology.
13.3.3 Group counselling This approach to therapy emphasizes social,
Group interpersonal therapy (IPT) was cultural, environmental and interpersonal factors,
originally developed in the United States as an taking into account the living environment of
individual treatment for unipolar, non-psychotic groups of clients to support their interpersonal
depression (Klerman et al., 1984). In treating adjustment and reach treatment objectives.
depression, IPT targets the connection between While psychotherapy is centred on the
the onset of symptoms and current interpersonal individual, sociotherapy considers that individual
problems. The IPT therapist begins with a psychological concerns frequently have social or
systematic diagnostic assessment, explains the environmental causes that limit the effectiveness
diagnosis, and works with the patient to identify of psychotherapy. Sociotherapy intends to
the problem areas associated with the onset provide substantial solutions to sociopsychological
of the current symptoms. Difficulties in four problems, helping clients to regain harmony with
interpersonal areas are considered triggers of their community.
depressive episodes and become the focus of Sociotherapy targets groups of clients, using
treatment: grief (due to death of a loved one), interaction and socialization as a way to collect
interpersonal disputes (disagreements with information on clients’ limitations and as a
important people in one’s life), role transitions therapeutic tool. Clients learn roles and adequate
(changes in life circumstances, negative as well interpersonal behaviour through experiencing
as positive) and deficits (persistent problems in social interactions (Whiteley, 1986); relearning
initiating or sustaining relationships). established roles and behaviours in a safe
IPT is specified in a manual, has been tested in environment. Thoughts and feelings on the
numerous randomized controlled trials, and is process are discussed with all group members
efficacious for a number of mood and non-mood and the sociotherapists, who support the group
disorders (depressive and bipolar disorder, post- to adjust to their daily lives in their specific social
traumatic stress disorder (PTSD), eating disorders, context.

162
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Richters (2010) states that “sociotherapy helps is particularly useful in developing programmes for
people regain self-respect, rebuild trust, feel safe families who have experienced social oppression
again, overcome unjustified self-blame, re-establish and who may have been reluctant to participate
a moral equilibrium, have hope, live without terror, in programmes created for them by professionals
forgive those who have harmed them, apologize to without their consultation. In contrast, when
those whom they have wronged, and regain their professionals adopt the stance of respectful
rightful place in the community”. This approach has learners, families respond by actively engaging in
been successfully used in different contexts, and for the programme development research and in the
more information, please see examples of its use programme created from it. This article describes
in Rwanda, where it has been used since 2005 to the nature and complexities of a collaborative
support communities after the war and the 1994 programme development stance (Fraenkel, 2006).
genocide (here and here).

13.3.5 Technological and social media-

13.3.4 Family counselling, Ambiguous based counselling approaches
loss – Working with families with
missing members Social media-based counselling approaches
are a new field of development. Although
Counselling approaches that work with families best reproducible practices could not be
struggling with ambiguous loss are important in identified at the moment, a series of readings
humanitarian emergencies. Boss (2004) defines is recommended for inspiration: Ungar et al.
ambiguous loss as “an unclear loss – a loved (2013), Ruzek et al. (2016), and Ruzek and
one missing either physically or psychologically. Yeager (2017).
It results from various situations of not knowing
if a person is dead or alive, absent or present,
permanently lost or coming back.” 13.3.6 Self help tools

The issues that families with a missing member(s) Often, in emergency situations, access to
must contend with are multiple, and need populations made most vulnerable is not
counsellors who understand the impact this possible. This lack of access can jeopardize the
kind of temporal dislocation and uncertainty possibility to offer direct counselling services,
can have on a family system. Counsellors will and to present and promote online mechanisms
need strategies for preventing and addressing of distant counselling. In these situations, IOM
the polarization and conflict that can occur in uses self-help printed and online tools that can
families when coping with a situation of a missing be included in distribution packages, or other
member(s). Family reunification programmes primary goods distributions. The process to
are also important in this phase and go hand in create these tools can be done in four ways/
hand with programmes that address ambiguous steps:
loss (Boss, 2018; IFRC, 2001, 2014; Killian, 2016; • Focus groups are conducted with relatable
Robbins, 2013). For practical guidance see here groups who are accessible to identify main
and here. stressors, concerns and viable solutions.
The collaborative family programme development • A mixed group of psychologists,
model is a collaborative research-based approach anthropologists and visual artists create self
to creating community-based programmes for help tools on the identified issues and building
families. In this approach, families are viewed as on identified resilience factors, that are
experts on the nature of their challenges and on conversational in tone and that include visuals.
what they desire in a programme. This approach

163
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

• The resulting messages and pictures are validated in new focus groups.
• The final booklets are printed and included in distribution packages, health facilities, educational
kits, and made available online.
See here the English version booklet Self Help for Men in Crises and Displacement, specifically tailored
in 2015 for Syrian men living in inaccessible areas in the Syrian Arab Republic. The booklet has since
been distributed, translated, adapted and used as supporting material in face to face and group
counselling sessions for men in several countries.

13.3.7 Other focused psychosocial supports

Other forms of focused psychosocial support are presented in this Manual, as follows:
• Problem-based, programme-generated support groups and peer support groups;
• Problem-based and programme-generated art-based interventions (dramatherapy, social theatre, art
therapy and others).
In addition, The Inter-Agency Standing Committee (IASC) Guidelines on MHPSS in Emergency Settings (IASC,
2007) include PFA as a third-level intervention. See Box 59 for the presentation and discussion of PFA.

13.4. ADAPTATION, TRANSLATION, TRAINING AND

CULTURAL COMPLEXITIES IN WORKING WITH MIGRANTS
The mentioned existing counselling interventions can be used within a CB MHPSS programme. Yet these
interventions, in order to be adapted and scaled up, will require:
• A meaningful selection of the best intervention for the context;
• The adaptation and translation of the relevant tools in the new language, if necessary;
• Training of the counsellors on the method and protocols.
For how to choose the best intervention for a specific setting and to adapt and translate the model
accordingly, please refer to the following chapters of the forthcoming WHO Psychological Interventions
Operational Manual: Integrating Psychological Interventions in Existing Services:
• Chapter 2 – Choosing the best intervention for a specific setting;
• Chapter 3 – Translation and adaptation of psychological interventions.
The forthcoming WHO manual will be found here in the online version of the present Manual, as soon
as it will be published.
When working with migrants and displaced populations and their host communities, the issues related
to adaptation and translation become more complex and three-tiered.
The translation of the tool in the mainstream language, which is well captured in the WHO operational
manual, may not be enough because migrants and displaced people come from other cultures and may
speak one or more different languages. One possible solution is to adapt and translate the protocols, tools,
training modules and supporting materials in more languages. But this is not always feasible, since several

164
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

languages can be at play, and the process can a structure to be put in place for initial and
become lengthy and costly. ongoing training, and ongoing monitoring and
supervision.
Increasingly, especially in sudden onsets of
emergencies but also in protracted situations, It is important to have a code of conduct that
such as the ones of the refugee camps in Greece include guidelines for maintaining professional
or in Kenya, it is necessary to envisage ways relationships. Wessells (2009), describes the
that allow the counsellors to work, with the following principles for maintaining a “do no
help of translators, with a client who does not harm” approach:
speak their same language and comes from a • Allow time for critical reflection on ethical
different culture. This is never a neutral process, issues before, during and after each
because all counselling models and psychological emergency response in order to mitigate or
interventions are based on a one-to-one minimize harm.
relationship or a one-to-a-group relationship, and
the presence of a third person in the equation • Develop and provide specific ethical guidelines
needs to be carefully planned and requires with regard to appropriate conduct in
special safeguards that include: international emergencies.
• Training the counsellors in providing • Document and improve efficacy of MHPSS
counselling through translation. interventions in emergency contexts.
• Training the identified translators, who often • Ensure preparedness of MHPSS workers in
are not professional translators, in how to international emergencies.
translate in a counselling setting, and on basic Limited resources, access and capacities will
confidentiality and active listening skills. determine the types of counselling programmes
• Providing for the salary or in-kind support of to be implemented, but in these situations a
the translator. great deal of creativity and ingenuity often takes
• Educating the counsellors in cultural diversity place, and sometimes even the most useful
management. This includes two kinds of resources and hidden capacities might emerge.
trainings, one more specific to the cultural This chapter provides a broader perspective
do’s and don’ts of the culture of the client, than is usually attributed to an individual model
and one more on how to address the key of counselling in its attention to situational and
issue of cultural diversity in the counselling contextual factors that need to be addressed
session. in a counselling situation, in the multiplicity of
To receive guidance in the organization of these spaces and interactions in which counselling may
trainings, please contact contactpss@iom.int. take place, and with the consideration that more
informal types of counselling are often taking
place spontaneously and on a regular basis. In
13.5. CHALLENGES AND communities, these natural processes should
not be harmed and the programme shall even
CONSIDERATIONS enhance the opportunities for these interactions
Some of the most common issues facing non- to take place when possible.
specialists working in such situations is that Providing support (for staff welfare) and technical
these community members often share the supervision to counsellors is important and
same kinds of challenges as those they may challenging. This is addressed in the chapter on
be counselling. Personal reactions may make it Technical supervision.
difficult to provide effective counselling, requiring

165
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

Box 59
Psychological first aid
Psychological first aid (PFA) is an evidence-based approach that involves humane, supportive and
practical help to fellow human beings suffering serious crisis events, provided by people in a position to
help others who have experienced a distressing event. PFA was conceived as an alternative to critical
incident psychological debriefing and other forms of one-off psychological interventions after disruptive
events that focused on trauma paradigms and retelling. These interventions have been proved to
be harmful in the medium term and are discouraged by several agencies, including IOM. PFA allows
providing emotional comfort and practical support, without leading people to tell what happened to
them.
It gives a framework to immediately support people in ways that respect their dignity, culture and
abilities. PFA is short one-off supportive intervention and cannot be considered a counselling method
or a service that can be offered several times to the same individual. If more than PFA is needed, it
should be addressed with referral.
PFA entails different components, including initial contact with the affected person, providing safety
and comfort, emotional stabilization, providing information and practical help, connecting the person
with their social network, connecting the person with available services, and providing information. The
PFA providers must always ensure protection from further harm for themselves and the supported
people, and be prepared for the intervention, analysing the situation and gathering information
beforehand.
Despite the fact that The Inter-Agency Standing Committee (IASC) Guidelines on MHPSS in Emergency
Settings (IASC, 2007) place this intervention on the third level of the intervention pyramid (focused
support), for IOM PFA should be used at all levels:
• First level of intervention – basic services and security: Camp coordination and camp management
(CCCM), Health and Emergency response staff, among others, should be trained in PFA, as they
are commonly the first respondents in an emergency. PFA allows them to provide information and
support the affected population in an effective way, preventing humanitarian intervention-induced
distress.
• Second level of intervention – community and family support: PFA can be used at the community
level. Groups of volunteers in the local population interested in supporting others can be trained in
PFA to support their peers experiencing highly distressful events.
• Third level of intervention – focused supports: PFA is usually the first intervention for people in need of
support after an emergency. MHPSS workers must be trained in PFA to help stabilize affected people
before determining if further counselling or social support is needed through referral.
• Fourth level of intervention – specialized services: PFA can, in certain circumstamces, be useful to offer
initial support to people with pre-existing or emerging mental disorders, and their families and caregivers.
All MHPSS workers must be trained in PFA. The most common tools used for training are WHO’s
Psychological first aid: Guide for field workers (WHO, 2011) and Psychological first aid: facilitator’s manual
for orienting field workers (WHO, 2013). Additional tools can be used depending on the context (here,
here and here).
Although no specific MHPSS background is needed to be trained on PFA, some basic skills are
necessary, such as active listening, compassion and flexibility. PFA tools contextualized to COVID-19
can be found here.

166
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
13. COUNSELLING

FURTHER READING
Betancourt, T. S., S.E. Meyers-Ohki, A.P. Charrow and W.A. Tol
2013 Interventions for Children Affected by War: An Ecological Perspective on Psychosocial
Support and Mental Health Care. Harvard Review of Psychiatry, 21(2):70–91.
Bragin, M.
2014 Clinical social work with survivors of disaster and terrorism: A social ecological approach.
In: Essentials of Clinical Social Work (2nd ed.) (J. Brandell, ed.). Sage, Thousand Oaks, CA, pp.
366–401.
International Organization for Migration (IOM)
2020 Mental Health and Psychosocial Support (MHPSS) in the COVID-19 Response: Guidance and
Toolkit for the use of IOM MHPSS Teams: Version III-Final. IOM, Geneva.
Nicolas, G., B. Schwartz and E. Pierre
2009 Weathering the Storms Like Bamboo: The Strengths of Haitians in Coping with Natural
Disasters. In: International Handbook of Emotional Healing: Rituals and Practices for Resilience
after Mass Trauma (A. Kalayjian, D. Eugene and G. Reyes, eds.). Greenwood Publishing Group,
Inc., Westport, CT, pp. 96–106.
Nordbrandt, M.S., J. Carlsson, L.G. Lindberg, H. Sandahl and E.L. Mortensen
2015 Treatment of Traumatised Refugees with Basic Body Awareness Therapy Versus Mixed
Physical Activity as Add-On Treatment: Study Protocol of a Randomised Controlled Trial.
Trials, 16(1).
Patel V. and C. Hanlon
2018 Where There is no Psychiatrist. Royal College of Psychiatrists.
Scholte, W. F. and A.K. Ager
2014 Social Capital and Mental Health. Intervention, 12(2):210–218.
For other references, see the full bibliography here.

Counselling activities at Al-Salam Camp in Iraq. © IOM 2018

167
 14.
COMMUNITY-BASED SUPPORT
FOR PEOPLE WITH SEVERE
MENTAL DISORDERS

Support group for persons with disabilities at the Protection of Civilians site in Wau,
South Sudan. © IOM 2018
168
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

• Risk behaviours commonly associated

14.1. WHAT MHPSS with mental disorder (such as suicidal
PROGRAMME MANAGERS feelings, self-harm).
SHOULD KNOW According to WHO (2018b), the determinants
of mental health and disorder include,
Mental disorders have a range of
“not only individual attributes such as the
manifestations, but are most commonly
ability to manage one’s thoughts, emotions,
characterized by a combination of distorted
behaviours and interactions with others, but
thoughts, perceptions, beliefs, emotions,
also social, cultural, economic, political and
behaviours and relationships with others
environmental factors such as national policies,
(WHO, 2018b). When these problems last
social protection, standards of living, working
for long and/or are very pronounced, they
conditions, and community support.”
strongly impact the life of affected persons
and significantly decrease their ability to During emergencies, the percentage of
function. These are termed “severe mental people with a severe mental disorder may
disorders” and require high levels of care. increase from a baseline of 2–3 per cent, to
3-4 per cent (WHO and UNHCR, 2012).
Typical examples of severe mental disorders
Emergencies not only lead to an increase in
are:
the number of people who are affected by a
• Psychotic disorders of all kinds (including severe mental disorder, but the conditions of
manic psychosis); those who already had such a disorder often
• Severely disabling presentations of mood deteriorate (see Weissbecker et al., 2019).
and anxiety disorders (including severely In addition to destabilizing existing health
disabling presentations of depression, and mental health services, the emergency
bipolar disorder and PTSD); situations can deprive people of social
supports and other means of coping that
• Severe clinical conditions due to the had previously sustained them. Families can
use of alcohol or other psychoactive be distressed by the burden of care, and be
substances; more stigmatized or alienated in their own
• See here for more information. communities than before the emergency. This
puts people with severe mental disorders at
The Inter-Agency Standing Committee (IASC) an elevated risk of abandonment or neglect
Guidelines on MHPSS in Emergency Settings during emergencies (Jones et al., 2009).
(IASC, 2007) also note that many of the
actions to be taken to protect and support People on the move face several stressors
persons with severe mental disorders apply that can cause high levels of distress and
for persons with other severe disorders and worsen their mental well‑being. Some
conditions, such as: reports and research suggest a very high
prevalence of mental disorder in migrants and
• Developmental disabilities with high
refugees, with some even assuming that most
support needs;
migrants and refugees have mental disorders.
• Neurological disorders and However, the evidence base for such claims is
neuropsychiatric conditions such as contested because of methodological limits,
epilepsy, delirium and dementia; and the tendency to conflate all emotional
• Locally defined severe mental health distress with mental disorder (Rodin et al.,
conditions; 2009; Schininà and Zanghellini, 2018).

169
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

In fact, critical and systematic research on in terms of access to clinical care, and in
the prevalence and incidence of mental other protection, such as strengthening
disorders among migrant and non-migrant protection measures.
populations in European studies did not find
substantial differences between migrants, The causes of most severe mental disorders
including refugees and non-migrants (Priebe are not known. Discussion on the complex
et al., 2016). Worldwide, research suggests interplay between biological factors and
a higher prevalence of psychotic disorders factors within the social environment in
in migrants, although the differences are determining severe mental disorders can
generally marginal (Hollander et al., 2016). be found at greater length in WHO (2014)
Public narratives on migration are certainly and Patel et al. (2018). As a consequence,
dominated by the discourse on migrants’ treatment and support of people with
vulnerability – how vulnerable migrants are, severe mental disorders typically includes
and how vulnerable they make societies – and a combination of biological, social and
such discourse may itself serve to compound psychological interventions. Even where
the psychological problems of migrants pharmacological medication is prescribed, this
(Schininà and Zanghellini, 2018). The should never be in isolation of other forms
United Nations special rapporteur on of individual and social support. Many people
the rights of everyone to the enjoyment of with mental disorders (depression, anxiety,
the highest attainable standard of physical PTSD) can be helped with psychological and
and mental health (2018) cautions against social interventions alone, without medication.
the use of “alarming statistics related to the During emergencies, there is a well-
scale of mental disorders of migrants since documented risk of both undertreating and/
this can route problems in a biomedical or overmedicalizing severe mental disorders.
model which may lead to less focus on policy, Those with severe mental disorders need
empowerment and investing in enabling to receive appropriate care, and this care is
conditions, and more on treating individual better offered in a community-based fashion,
conditions, leading to ineffective and such as:
potentially harmful outcomes”. • Avoiding hospitalization in dedicated
institutions;
IOM MHPSS programmes should not
reinforce unhelpful and incorrect ideas that • Providing mental health care that is integrated
all or most migrant and displaced populations in general and primary health care;
suffer from severe mental disorders or • Involving the family and other caregivers in
psychological problems. Words matter, the treatment;
and it is important for MHPSS programme
• Focusing on improving social and occupational
managers and teams not to use language that
functioning of the person, if possible.
pathologizes the psychosocial difficulties faced
by migrants and crisis-affected populations,
and erroneously labels a whole group as 14.1.1 Global developments and best
mentally ill. However, in situations of armed practices
conflicts, natural disasters, mass displacement
and migration crises, the relatively small A number of global guidelines strive to
number of people with severe mental improve care for people with severe mental
disorders are among the most vulnerable. disorders in emergencies, and these have
IOM MHPSS managers should therefore a primary focus on facility-based care for
prioritize the responses for this group, both individuals.

170
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

The Inter-Agency Standing Committee (IASC) pharmacological elements, including brief

Guidelines on MHPSS in Emergency Settings psychotherapies and strengthening social
(IASC, 2007) Action Sheet 6.2 includes: support. The emphasis is on providing both
• Ensuring essential psychotropic medications pharmacological and non-pharmacological
are in emergency medical kits; elements. One risk with mhGAP
implementation is that these psychosocial
• Enabling at least one member of the elements may be easily ignored – because
emergency primary health-care team to be staff has limited time or training to do these
able to provide frontline mental health care; interventions, leading to an overemphasis
• Training and supervising available primary on pharmacological approaches (Ventevogel,
health-care staff without overburdening 2014). The mhGAP package is facility-based;
them; however, trained community health workers
and other volunteers can have important roles,
• Establishing mental health care at logical
including:
points of access (in health facilities, but
this can also be through home visits or in • Community engagement activities, including
schools and child-friendly spaces); providing mental health awareness;
• Avoiding the creation of parallel structures; • Identification and referral of people with
mental health conditions;
• Informing populations about the availability
of mental health services; • Follow-up of people with severe mental
disorders through home visits and practical
• Working with local community structures
and emotional support;
to discover, visit and assist people with
severe mental disorders. • Organizing support groups: for example,
for people with epilepsy, parents of children
Action Sheet 6.2 advocates strongly for with intellectual disabilities, and people with
integration within existing health structures severe mental disorders;
and in order to do this well, community-based
approaches are important (these are flagged in • With adequate training and supervision:
bold in the list above). Providing scalable psychological
interventions, such as:
The WHO Mental Health Gap Action 0 Problem Management Plus (PM+);
Programme (mhGAP) aims at scaling 0 Thinking Healthy;
up services for mental, neurological and 0 Group Interpersonal Therapy.
substance use (MNS) disorders, especially
in low- and middle-income countries. The These scalable psychological interventions are
mhGAP Humanitarian Intervention reviewed in the chapter on Counselling.
Guide (mhGAP–HIG) contains first-
line management recommendations for
MNS conditions for use in humanitarian
emergencies (WHO and UNHCR, 2015). It
recommends that non-specialist health-care
providers in primary health facilities are trained
to identify and manage common mental
health conditions. The package is focused
on the use of pharmacological treatment for
certain disorders, but it also contains non-

171
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

Box 60 14.1.2 Why a community-based

Liaison with IOM emergency health approach
teams Global guidelines for severe mental disorders
IOM MHPSS programme managers in the tend to focus on facility-based health care
field should liaise with IOM emergency for individuals, with limited emphasis on
health teams to make sure that: community-based approaches. However,
communities are crucial to the care and
• IOM-run or partners’ emergency support for people with severe mental
primary health-care teams include a disorders and their caregivers. Two overarching
member able to provide mental health principles are important:
care;
• Person-focused: An individual is more than
• IOM-run or partners’ emergency their mental health condition or diagnosis,
primary health-care teams are trained and their individual needs and strengths
in PFA, and included in existing remain central. When taking a community-
mhGAP–HIG trainings; based approach, inputs from families and
the wider community are used to create
• Based on the existing national
effective change within individuals.
humanitarian mechanisms, IOM
pharmacies or identified pharmacies • Community-focused: It is also necessary
and facilities have enough essential to directly address the wider community
drugs for MNS conditions (see the full system in order to protect and promote
list here). well‑being, and to reduce stigma and the
severity of mental disorders.
These two concepts define community-based
The recently revised Mental Health approaches to supporting people with severe
standard in the Sphere Handbook mental disorders, which include the following:
(Sphere Association, 2018) refers to the
mhGAP–HIG, and emphasizes the training
of health workers, provision of essential 14.2. WHAT MHPSS
psychotropic medications and monitoring PROGRAMME MANAGERS
of human rights issues. The standards
also recommend working with community SHOULD DO
members, including marginalized people,
The approach and actions that need to be taken
to strengthen community self-help and
to promote community-based forms of support
social support, and to organize a referral
to people with severe mental disorders can be
mechanism between health-care providers
summarized in eight steps:
and community-based support.
(a) Meet lived realities at the community level
through participatory, culturally relevant
assessments;
(b) Map and build on existing community-based
knowledge and resources;
(c) Include people with severe mental disorders
and their families and caregivers in planning
and implementation of MHPSS programmes;

172
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

(d) Establish community-driven referrals and 14.2.2.1 Human rights and quality
follow-up (from community to health services standards
and vice versa);
People with severe mental disorders may
(e) Inform the wider population about the be at particularly high risk of human rights
availability of services; violations, through abuse and exploitation,
(f) Cover the full spectrum of MHPSS needs, especially in emergencies. It is the
including making sure that people with severe responsibility of all humanitarian actors to
mental disorders and their caregivers access intervene. Taking a community approach
basic needs and community-based supports; may reveal more of these violations, either in
institutions, facilities or within the community.
(g) Actively involve community members in At the same time, community approaches can
clinical intervention (including peer support, help key people better understand the human
caregiver interventions and civil society rights of people with severe mental disorders,
groups); and can reduce human rights violations.
(h) Promote recovery at the community level. Strategies can be found at the community
level to end discrimination, ill treatment or
These eight elements will be described through
violence, and promote the right to health,
the course of this chapter.
education and freedom from discrimination.
Assessment and mapping of existing services
14.2.1 Meet lived realities at the and resources must include a human
community level through rights lens and respect quality standards.
participatory, culturally relevant Before starting a referral system towards
assessments an institution or service, a WHO Quality
See chapter on Engaging with communities. Rights assessment is strongly recommended,
(see assessment toolkit here). IOM
does not promote or facilitate referrals to
14.2.2 Map and build on existing institutions or services that do not respect
community-based knowledge and basic quality criteria and human rights
resources standards.

For these items, see the dedicated section In addition, IOM MHPSS programmes do not
of chapter 2 on Engaging with communities, promote or facilitate referrals to institutions
here. or services using inhumane forms of
treatment and constriction, such as chaining
In addition, while conducting mapping, it patients. Electroconvulsive therapy has been
is important from the one side to look at harshly criticized by patients’ associations
traditional and religious systems, and on and human rights groups for years. In certain
the other to make sure that mapping is clinical contexts, it is accepted if provided
accompanied by an evaluation of the human under anaesthesia and after receiving full
rights compliance and quality of the existing consent from the clients. However, in many
clinical services. This will include working with places, these conditions are not met. In the
traditional and faith based systems. For more typical displacement and migration context, in
information, click here. addition, it is often challenging to obtain full
consent because of issues related to language
difficulties, cultural misunderstanding, lack of

173
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

Support Group Session with families of people with severe mental disorders at the Protection of Civilians site in Bentiu,
South Sudan. © IOM 2017

psychoeducation, referrals happening mainly 14.2.3 Include people with severe

in an emergency fashion, poor guardianship mental disorders and their
mechanisms, absence of families and the families and caregivers in the
power inequalities often inherent in health planning and implementation of
care for migrants. In practice, therefore, IOM MHPSS programmes
avoids referral of people with severe mental
disorders to health-care centres that practice It is necessary to continue to actively involve
electroconvulsive therapy. people with severe mental disorders and
their families and caregivers in the process
All the above-mentioned conditions need of designing and modifying interventions and
to be ascertained before the referrals start, programmes. This involvement should be
during mapping, through a quality-rights maintained throughout the project cycle and
and additional assessments. If a service or should be participatory in nature, and include
existing resource does not comply, IOM can mechanisms for ongoing dialogue already
start a series of capacity-building actions to identified in the chapter on Engaging with
bring the facility up to these standards, but communities, such as local programme
must not use it in the interim. Tools 4 and committees.
5 of the WHO and UNHCR Assessing
Mental Health and Psychosocial Needs
and Resources: Toolkit for Humanitarian 14.2.4 Establish community-driven
Settings (WHO and UNHCR, 2012) can referrals and follow-up
support processes for modifying practices to Many people with severe mental disorders
be in line with human rights principles. fail to come for formal treatment, or drop
out of treatment, because of isolation, stigma,

174
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

fear, self-neglect, disability, poor access or composed of a psychiatric nurse, a social

because services are perceived as socially worker and a driver, or similar professionals
or culturally inappropriate (IASC, 2007). or activists who are appropriately trained
Once existing attitudes, sources of care and and supervised. Team members are usually
resources are well understood, it is possible sourced from the affected communities and
for programmers to develop and agree on therefore can act as community catalysts
effective mechanisms to support people to for referrals. These teams may include
access care. translators or cultural mediators during
migration crises. They are tasked with:
Robust referral and follow-up mechanisms
can be established with identified community (a) Identifying people with severe mental
personnel, including resource persons, disorders;
traditional/hybrid and faith-based healers (b) Receiving referrals of people with severe
and other influential persons. Interventions mental disorders from the PMTs, families
may choose to establish more “formal” and/or other partners;
referral and follow-up mechanisms that are
community-based but act as an extension (c) Facilitating appointments for people with
of facility-based interventions: for example, severe mental disorders to the closest
health-care workers themselves, and trained care facility, avoiding institutionalization
community-based workers or volunteers to the extent possible, always preferring
providing home visits and/or supporting outpatient care, and limiting inpatient care
home-based care. to the minimum when the conditions of
the client or the logistics of the movement
Two-way referral pathways (for example, do not allow outpatient care;
community–facility and facility–community) (d) Following up with the client in the
can also be agreed upon with community- community, especially:
based resources, working with traditional (i) Checking on whether medication
and faith-based healing systems. Facility- protocols are being followed;
to-community referral pathways are a (ii) Supporting social needs through
necessary component of the mhGAP–HIG. referral;
Cross-cutting the treatment guidelines is the (iii) Supporting caregivers in their roles,
need to refer to community-based social or through psychoeducation and
protection services; shelter; food and non- counselling;
food items; community centres; self-help and (iv) Making sure that a continuum of care
support groups; income-generating activities is granted, linking the client and the
and other vocational activities; and formal/ caregivers with the various activities
informal education and child-friendly spaces offered by the PMTs at recreational,
or other structured activities (WHO and socialization, artistic and counselling
UNHCR, 2015). levels;
Families, peers, and the wider community (v) Organizing peer-support for caregivers
are also crucial points of referral, and are ((iii), (iv) and (v) are discussed further
necessary for effective follow-up for those below).
with severe mental disorders.
The IOM PMT model should include, when
resources allow, separate and dedicated
Referral Teams. Referral Teams are usually

175
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

Box 61
People living in institutions in emergencies
Emergency contexts can affect the integrity of existing institutions. As the IASC MHPSS Guidelines
highlight: “Some people with severe mental disorders living in institutions are (too) dependent on
institutionalised care to easily go elsewhere during an emergency.”
In emergencies, those previously living in institutions may find themselves in the community once again.
Key recommended steps from Action Sheet 6.3 include:
• Make sure one agency takes responsibility, ideally in supporting the government, for
supporting people living in institutions.
• If they remain open, protect the dignity and rights of the people there (see section 14.4.2.2)
and ensure that ongoing basic health and mental health care is available.
• If temporarily closed (because of, for example, an earthquake) or abandoned by health-
care workers, mobilize community resources by discussing with community leaders the
responsibilities of the community in providing a supportive and protective network, which
may include health-care workers, community health workers, informal health providers
(such as religious leaders, traditional healers), social workers, community groups and family
members.
• Provide these community networks with basic training and close ongoing supervision on, for
example, crisis management and ethical use of constraints.
In certain situations, psychiatric institutions may remain open, even if damaged, and people with severe
mental disorders, further excluded by long stays in these often-residential facilities, may remain to live
in the damaged premises. As such, they will be in need of shelter, food, water, sanitation, clothing and
essential medical and psychiatric care.
In Haiti, following the 2010 earthquake, residential psychiatric facilities physically collapsed, but a
sizeable number of residents remained inside living in the ruins. Most service providers could not
reach the facility for days. In such situations, IOM would consider the psychiatric facility area as a camp,
extending to the residents all services provided in priority camps under the Camp Coordination and
Camp Management Framework, until other more sustainable solutions are found.

14.2.5 Inform the wider population about the availability of services

For referrals, awareness must be raised with the wider community about the content and availability
of services.
Community resources may be used in the dissemination of this information, as information coming
from a trusted source is more likely to be believed and acted upon. In IOM, the dedicated Referral
Teams can organize sensitization and information workshops, the PMT will provide this information
during workshop and events, and clear information about existing mental health services for people
with severe mental disorders will always be visible at the MHPSS hubs. More information on raising
awareness and advocacy can be found in the WHO mhGAP Operations Manual (WHO, 2018e).

176
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

Box 62 • Advise about security issues when the person

Availability of services is not sufficiently aware of threats to security.

Sensitization around the availability of services (WHO and UNHCR, 2015).

should be carried out with consideration to People with severe mental disorders may also
“supply” meeting “demand”, to avoid frustration require additional help to access culturally
and, more importantly, inconsistent access appropriate community and family support,
to treatment. Community- and facility-based which is well covered in this chapter. Participation
approaches therefore complement each other. in mainstream programmes should be enabled,
and recreational activities, other sporting
14.2.6 Cover the full spectrum of MHPSS activities, and computer and literacy classes can
needs be provided (UNHCR, 2018a).

In humanitarian settings, basic services, social The above should be supported by IOM PMTs
structures, family life and security are often for people with severe mental disorders,
disrupted. People with severe mental disorders including through social work-oriented case
are often confronted with these extra challenges management and referral to other activities
to their daily routines and basic self-care. The organized by the PMTs. The IOM PMTs model
physical health needs of people with severe should be tasked with making sure that a
mental disorders can often be ignored, despite continuum of care is provided when linking client
evidence that they can live 10–20 years less and caregivers with the various activities offered
than the rest of the population (WHO, 2018a). by the PMTs at the recreational, socialization,
Therefore, all layers of the IASC MHPSS artistic and counselling level.
Guidelines (IASC, 2007) pyramid are crucial to
consider, and special considerations are likely 14.2.7 Actively involve community
necessary for the bottom layers – access to members in clinical intervention
and social considerations of basic services and
security, and strengthening family/community A number of intervention models for severe
supports (which are largely community-based in mental disorders are community-based,
approach) – to be adequately met. actively involve community members and are
appropriate for use in emergency settings. Three
The mhGAP–HIG highlights the need to support examples are given below with reference, where
people with severe mental disorders to safely possible, to useful toolkits for implementation.
access services necessary for survival and for a In addition, please click here to know more on
dignified way of living – such as water, sanitation, how to engage spiritual and traditional leaders
food aid, shelter, livelihood support – through in the provision of CB support for people with
the following actions: severe mental disorders.
• Advise about the availability and location of
basic services and security mechanisms;
14.2.7.1 Peer support
• Advise about basic self-care (nutrition,
physical); Peer support has been widely used in mental
• Actively refer and work with the social sector health, as it (a) creates a safe environment to freely
to connect people to social services (such as express and share emotions and thoughts about
social work-type case management); one’s current situation and challenges; (b) allows
one to learn from other similar situations;

177
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

(c) creates the occasion to build new relationships and reinforce social support networks; and (d) helps
group members to access resources and support (WHO, 2017a).
For peer support groups for people with severe mental disorders, see WHO, Creating peer
support groups in mental health and related areas (ibid.).
Individualized peer support is a form of one-to-one support provided by a peer with the experience of
having a mental health problem and of recovery, to another peer who would like to benefit from this
experience and support (ibid.). Guidelines for providing individualized peer support can be found here.
UNHCR (2017) describes engaging individual refugees as volunteers to support other refugees. With
adequate training, supervision and support, refugees can successfully provide culturally appropriate
support, given their deep knowledge of their communities. The guidelines describe how “the
engagement of refugees is also key to building their own self-esteem and dignity, and strengthens their
ability to cope with their own problem”, and can be found here.

Box 63
Cross-cutting issue – Stigma and discrimination
Community-level stigma and discrimination create additional barriers for people with severe mental
disorders, with negative effects on their mental health. This stigma at times includes biased discourses
that consider people with severe mental disorders evil, dangerous, criminal and so on. Since migrants
and refugees are often stigmatized as such, severe mental disorders in refugees and migrants can cause
stigmatization and prevent affected people and their caregivers from seeking help. One could have
several strategies to combat stigma.
For guidelines around managing stigma, The International Federation of Anti-Leprosy
Associations has developed a series of guides for managers, health workers and social workers,
which have been applied for use in mental health.
Other strategies involve:
• Ensuring that community members are actively involved: As described throughout this
chapter, this can increase understanding and produce more “mental health advocates”.
• Awareness-raising: The WHO campaigns on depression can be considered a valid tool
in this respect.
• Involving people with lived experience of severe mental disorders.
IOM PMTs should address the stigmatization of mental disorders through:
• Including people with severe mental disorders in their livelihood, sociocultural and
recreational and sport and play activities;
• Organizing anti-stigmatization campaigns and talks in the community, especially following
reports or incidents of stigmatization;
• Ad hoc events, such as the celebration of Mental Health Day in Nigeria.
Sourcing team members from both the host and the displaced community can help incorporate local
knowledge to address stigma and to avoid socially inappropriate discourses.

178
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

Box 64
Language and cultural considerations in specialized mental health care
Cultural considerations in globally recognized focused and specialized interventions must be
strengthened, especially when working with migrants and displaced populations who speak
different languages and come from very different cultural backgrounds. Models such as mhGAP,
when culturally adapted in a country (see the mhGAP Operations Manual (WHO, 2018e))
will usually be adapted to the mainstream culture of that country, not considering the heightened
cultural complications of working with minorities, subgroups and migrants who do not speak the
local language or share the local culture. Those delivering focused and specialized interventions may
not be equipped to appreciate that cultural expressions of mental disorder can vary and are easily
misinterpreted, especially during emergencies, or to work through an interpreter–translator.
MHPSS programme managers should consider the following activities based on needs:
• Including a module, in coordination with WHO and UNHCR on working with migrants and
in translation within the mhGAP–HIG trainings.
• Organizing short trainings in mental health and population mobility, and working with
translators for existing mental health services in the referral mechanism: For training content,
contact the IOM MHPSS Section at contactpss@iom.int.
• Training a group of migrants with knowledge of both the origin and the local language
as mental health mediators: For training content, contact the IOM MHPSS Section at
contactpss@iom.int.
• Adding a translator to the dedicated referral teams or directly seconded to mental health
services mostly used by certain populations of migrants.
• Working with translators is neither easy nor neutral, and requires preparation and
safeguards. For more information see here.

14.2.7.2 Caregiver interventions

Families and caregivers are crucial to the well‑being of individuals with severe mental disorders.
Considering this crucial role, there is space to build their capacity around providing support. For
reference, see WHO (2015b), Caregiver skills training for the management of developmental
disorders.
The UNICEF (2018) Operational Guidelines: Community-based mental health and psychosocial
support in humanitarian settings: Three-tiered support for children and families (field test version) and
the UNICEF (2021) Compendium of Community Based MHPSS Resources also offers guidance for
supporting parents and caregivers.
The tasks of dedicated referral teams within the IOM PMT model should include, when resources
allow:
• Supporting caregivers in their role, through psychoeducation, support groups and counselling;
• Organizing individual and peer support for caregivers themselves.

179
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

In terms of support directed at the caregivers themselves, the mhGAP–HIG recommends the
following steps:
• Ask the caregiver(s) about their concerns, capacities, physical and psychological well‑being, and
their own social support system.
• Give them information on relevant community services and supports, and discuss respite care
(another family member or a suitable person can take over the care of the person temporarily).
• Refer them to PMTs to offer basic stress management, and encourage them to access their social
support or, if needed, provide more focused support.
• Acknowledge that it is stressful to care for people, but stress to them that it is important to
continue doing so (WHO and UNHCR, 2015).

Box 65
Peer support in Kenyan refugee camps
Previous patients of the hospital’s mental health clinic signed up as “volunteer refugee workers”
to support follow-up of current patients. They were of special value when individuals and families
disengaged with treatment by making home visits to collect and address concerns, offer basic social
and emotional support, and act as a bridge between the health facility and the community. They also
served as a powerful “anti-stigma” tool by providing an example that individuals are more than their
mental health condition, and that working productively and living well is possible.

14.2.7.3 Multifamily psychoeducation groups

One of the most promising evidence-based counselling approaches is the multifamily
psychoeducational group. One example of this family and community resilience-based approach
was implemented in post-war Kosovo1 during the months following the cessation of conflict. The
Kosovo Family Professional Educational Collaborative, a team of mental health professionals from the
University of Pristina School of Medicine and the American Family Therapy Academy, developed a
multifamily psychoeducational approach focused on allowing people with severe mental disorders to
live in the community under the care and supervision of family members. The groups strengthened
the capacities of families to care for members with severe mental disorders by helping them
understand the nature of mental disorders and develop skills to provide home care. They also helped
the families develop a support system by meeting with other families who were faced with similar
challenges. The multifamily groups included presentations on psychiatric symptoms and the clinical
course of chronic mental disorders, medication use and side effects, the role of psychosocial factors
in precipitating or preventing relapse, responses to common problems and crises, and resilience-
building approaches to severe mental illness. See Weine et al. (2005) for further details on the
group process and session topics.

14.3.8 Promote recovery at the community level

The meaning of “recovery” from a mental disorder can vary among different people. For many, it is
not only about being “cured”, but about “regaining control of their identity and life, having hope for

1 References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).

180
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
14. COMMUNITY-BASED SUPPORT FOR PEOPLE WITH SEVERE MENTAL DISORDERS

their life, and living a life that has meaning for them, whether that be through work, relationships,
community engagement or some or all of these” (WHO, 2017).
Key components of recovery can include inclusion, relationships, meaning and purpose, dreams and
aspirations, control and choice, managing ups and downs, and positive risk-taking (WHO, 2015c).
Activities that promote recovery may be most effective when delivered at the community level. Two
examples are given below.

14.3.8.1 Vocational and economic inclusion

Different types of interventions that enhance vocational inclusion and employment are often labelled as
“recovery-orientated” (Slade et al. 2014). Livelihood interventions have also been used for people with
mental disorders.
WHO (2015c) concludes that recovery-oriented strategies enhancing vocational and economic inclusion
should be contextualized to their social and cultural environment. For more information, see here.

14.3.8.2 Independent living

People with psychotic disorders have a high risk of experiencing homelessness and housing instability (Fazel
et al., 2008). The facilitation of assisted living, independent living and supported housing can act as a base
from which people with severe mental disorders can achieve numerous recovery goals (Slade et al., 2014).
WHO (2015d) advises that interventions are culturally and contextually appropriate, consider local
resources and local cultural norms, and involve people, their families/caregivers and wider community
in their design and implementation. For more information, see link.

FURTHER READING
Jones, L., J.B. Asare, M. El Masri, A. Mohanraj, H. Sherief and M. Van Ommeren
2009 Severe mental disorders in complex emergencies. The Lancet, 374(9690):654–661.
Tungpunkom, P.
2012 Life skills programmes for chronic mental illnesses. Cochrane Database Systematic Review (1).
Weissbecker, I., F. Hanna, M. El Shazly, J. Gao and P. Ventevogel
2019 Integrative Mental Health and Psychosocial Support Interventions for Refugees in
Humanitarian Crisis Settings. In: Uncertain safety. Understanding and assisting the 21st century
refugees (T. Wenzel and B. Drozdek, eds.). Springer, New York, pp. 117–153.
World Health Organization (WHO)
2018b Mental Disorders. WHO, Geneva.
For other references, see the full bibliography here.

181
 15.
TECHNICAL SUPERVISION
AND TRAINING

Certificate course in Psychosocial Support and Conflict Transformation, Social Sciences

University of Ankara, Turkey. © IOM 2017
182
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

I. TECHNICAL SUPERVISION • Staff support: The MHPSS teams are given

the opportunity to talk about their difficulties
on the job. It is important to remember that,
15.1. WHAT MHPSS in emergencies, some MHPSS staff experience
a formal role of helper for the first time.
PROGRAMME MANAGERS Even when they are experienced helpers,
SHOULD KNOW they are confronted with new factors, and
are continually hearing stories of difficult
In IOM MHPSS programmes, “technical
experiences that are new to them.
supervision” refers to bringing skilled supervisors,
PMTs and other MHPSS teams together in
order to reflect upon the work. It is a process Box 66
of support and reflection, and is separate from
Staff care
managerial performance appraisal. It is about
empowerment and relationship, not control. Members of the MHPSS teams might be
In this sense, it is different from the way in survivors themselves or might face contextual
which “technical supervision” is understood in challenges similar to the ones their clients
other fields, where it includes a component of are experiencing. For personal support to
monitoring programme standards. the staff, supervisors should coordinate
with the managers and the Staff Care Unit
The overarching principle guiding technical
of the Organization. IOM staff can refer to
supervision in the field of CB MHPSS is that of
the Organization’s Occupational Health Unit
improving the quality of the offered services
at swo@iom.int. Technical supervision is
and preventing harm to affected individuals and
indeed an essential part of staff care, but it is
communities receiving those services, as well
not the only element of holistic staff care in
as to the staff involved. Technical supervision
emergencies, which is also based on human
addresses the intersection of the personal and
resources policies and personal support.
professional development of the supervised
staff. Technical supervision must be coordinated
and integrated with managerial supervision, in 15.1.2 Whom technical supervision is for
order to maintain a functional programme.
Technical supervision is necessary for both new
and experienced MHPSS staff, ideally at all levels
15.1.1 The objectives of technical (service providers and supervisors themselves).
supervision Many staff are living a double role, being helpers
(work life) as well as people affected by the
Technical supervision pursues two main objectives:
emergency (personal life). Providing supervision
• Professional standards: Supervisors assist the at all levels ensures support to MHPSS teams
PMTs and MHPSS teams to learn from their and improves skill levels, but it also demonstrates
experiences and to progress in expertise, as a culture of learning and self-reflection when
well as to ensure quality service provision to supervision is for everyone.
the individuals to whom they offer services.
This includes both skill development and
ethical accountability. This way of providing
technical supervision is linked to individual
staff well‑being, and can help ensure better
client outcomes.

183
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.1.3 What technical supervision is about

In practical terms, technical supervision consists of MHPSS teams meeting regularly with a
skilled supervisor to discuss individual clients, groups, community-based interventions and
any other MHPSS activities they perform, in a structured way. It also includes on-the-job
training. Supervision should be considered a mutual sharing of questions, observations and
speculation to aid in the selection of alternatives to apply in practice. The MHPSS teams
can bring up questions about the cases (which may be individual clients, families, groups or
communities), or activities they are having difficulties with, and about how the assistance they
are providing can be improved. Likewise, the supervisor can bring questions that can help
the MHPSS staff to critically review and analyse what they are doing in their practice, with an
aim to strengthen services. In addition, the supervisor will collaborate with the managers in
designing a training plan for the team that results from the gaps and problems that emerged
during the supervision.
More specifically, the supervision may focus on:
• The methods and modalities of the MHPSS work;
• Concerns the MHPSS teams have in relation to any aspect of an MHPSS activity;
• Lack of progress or difficulties with a case activity;
• Awareness of the potential impact of the MHPSS team members’ personal values on their
practice;
• Identification of any negative impact on the MHPSS teams from a case they are managing,
and self-care strategies;
• Issues related to establishing and maintaining appropriate boundaries with the affected
population;
• Issues related to team dynamics;
• Ethical and professional practice and compliance with codes of conduct;
• Professional identity and role development;
• Skill and knowledge development.
It is important to differentiate between technical support and personal support in the
supervision process. It can still be helpful for workers to seek their own personal support,
but it is important to be clear that the technical supervision process is related to work issues.
This is due to a number of reasons, including respecting the workers’ personal boundaries
and avoiding dual relationships; the power dynamics of potentially fearing losing one’s job due
to personal issues; and the fact that staff care should be considered an organizational duty
and not a responsibility of each project or programme, which may create an unequal offer of
personal support opportunities among staff members working for different programmes in
the same mission.

184
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.1.4 Technical supervision: What it is (b) Technical supervision provides a learning

and what it is not environment: It becomes by default a
way to educate staff on the job in a
Figure 13 shows what technical supervision is
participatory fashion. In addition, through
and what it is not.
the supervision, the technical supervisor
can identify gaps in knowledge or skills
15.1.5 Requirements of technical that the teams need to fill, and suggest
supervision that management organize additional
The requirements of technical supervision training or education accordingly.
include the following: (c) Technical supervision is a space to grant
(a) Technical supervision is embedded in fidelity and innovation to the model:
a culture of respect and support: It is Supervision can ensure that the MHPSS
important to clarify that the objective teams provide the intended interventions.
of supervision is grounded in the There are reasons that the intervention
organizational responsibility to support is structured the way it is, and it can be
the worker and the client in providing and important for the worker to provide the
receiving a service that is more likely to essential components in specific ways.
meet quality standards and avoid harm, This is a part of ensuring the quality
rather than serving as a way to criticize of services for the clients. However, it
or check somebody’s work. Technical is also often necessary and helpful to
supervision, as pointed out before, adapt the intervention based on the
inscribes itself in the broader context of client’s needs or the MHPSS staff skills.
staff care and staff development, which If there are new techniques that the
represent an organizational responsibility. MHPSS staff members have learned or
prefer implementing, or if there are

Figure 13: Yes and no of technical supervision

What technical supervision IS What technical supervision is NOT

It should aim to create a safe place, where MHPSS staff can feel comfortable It is NOT a performance management tool
to talk about the technical aspects of their jobs, discussing freely any that will be used to evaluate performance in
challenges they might be having. It should be a supportive and encouraging managerial terms.
space that facilitates growth and allows mistakes.
It should be entirely dedicated to the technical aspects of the work and It is NOT a space spent on administrative
how they affect the staff well‑being. issues and complaints such as pay raises, days
off, disciplinary actions or deadlines.

It is time spent discussing the difficulties associated with the role of It is NOT in itself a space to discuss personal
the MHPSS team members, especially for those cases where the issues that are unrelated to the cases or the
professional side cannot be easily separated from personal issues, such MHPSS activities.
as when a staff knows its clients privately outside of work. Technical
supervision diminishes the possibility that difficulties and dilemmas will
affect the personal well‑being of the MHPSS team member.

185
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

ways of acting within the community that they have been taught, technical supervision
helps to ascertain that the learned services are correctly incorporated into the service or
intervention. Additionally, technical supervision can serve as a place for feedback on the
intervention model itself. The model can be questioned as to whether it is a true reflection
of the needs encountered in the field, or if it is a best fit in the experience of the teams.
This is an ethical dilemma that, if emerged, needs to be addressed at different levels, and in
conjunction with feedback from the monitoring and evaluation system. The manager and
the supervisor should establish a mechanism for feedback that is responsive to potential
changes and can inform management decisions and future project development.

15.2 WHAT MHPSS PROGRAMME MANAGERS SHOULD DO

Programme managers should address the following:
(a) Accountability: Technical supervision should be kept distinct from management supervision.
This means that, while designing a project, a position should be created for a technical
supervisor. In IOM, the technical supervisor responds to but is distinct from the project
manager. For some other agencies, often for budgetary reasons, this can be a unique
professional covering the two roles. Supervisory sessions will also concern managerial
aspects and administrative issues.
(b) International or national supervisors? Depending on the size of the operation, the
supervisor can be a dedicated international professional or a dedicated national expert,
or a team of national experts. When the size of the project allows the hiring of an
international expert, it may be good to pair him or her with a national expert who can
bring a more culturally apt perspective to the supervision. Nevertheless, this cannot be the
standard approach, because in some contexts – such as situations of civil and tribal conflict,
conflictual community dynamics, or discrimination or mistrust within the community –
PMTs and MHPSS teams may perceive an international supervisor as more neutral and
trustworthy. In case the size and budget of the operations or other logistical constraints
do not allow the deployment of supervisors, the option of remote supervision (for
example, by Skype) should be considered ideally accompanied by an inception and closing
face-to-face meeting.
(c) One or more supervisors? The principal supervisor can coordinate other technical
supervisors who are more specifically competent in certain models or practices engaged by
the programme. As already mentioned, the supervisor will collaborate with the managers
in designing a training plan for the team that results from the gaps and problems emerged
during the supervision. In this sense, he or she will support and coordinate the identified
expert trainers in devising a contextualized plan.

186
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

Box 67
How to structure a technical supervision meeting
Plan and notify in advance the supervision meeting, inviting the participants according to the chosen model –
individual, group, peer – and the form, in person or remotely. In case of individual supervision, collect in advance
if possible all the information about the case the psychosocial support worker wants to discuss. In case of
group supervision, choose or verify that the location can be sufficiently spacious and free of distraction. Place a
number of chairs in circle according to the number of the participants. In case of peer supervision, decide who
is going to manage the flow of the meeting.
Physical set-up:
In case of individual supervision: A room, two chairs placed equally. In case of remote supervision, ask the
supervisee to limit all distractions, and provide PCs, connection to the Internet and a Skype-like programme.
In case of group supervision: A room, chairs, white papers, a clipboard. In case of remote supervision, a
widescreen PC, connection to the Internet and a Skype-like programme.
In case of peer supervision: It is the same as for groups.
Time required (approximately):
From a minimum of one hour to a maximum of two hours.
One time per week, or once every other week at a mutually scheduled, predetermined time.
Flow of the meeting:
The supervisor invites the participant or one of the participants to share the information about a work case
in a narrative form. He/she then invites the participants to comment on what has been heard and provides
comments on the roles and the actions performed, and the effectiveness of the choices that have been made,
and proposes alternatives in a non-judgemental way.
Important concepts to maintain throughout the technical supervision:
• “Do no harm”;
• Non-judgement;
• Empowerment;
• Self-care.
Sample of a supervision session breakdown:
• Brief introduction of the supervisor and of the supervisees;
• Brief check-ins or small talk to create the atmosphere;
• Link to the previous supervision session, if necessary;
• Invitation to bring up a question, dilemma or specific work case;
• Invitation for the participant/s to comment;
• Paraphrasing what has been told;
• Evaluation of the actions taken;
• Proposition of alternative views and actions;
• Invitation to ask questions and answer the questions, promoting interaction;
• Recap of the most important points;
• Closure of the supervision session;
• Planning of the following session.

187
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.2.1 Modalities of technical supervision

Technical supervision must be flexible in order to meet the needs of MHPSS teams, also considering the
different stages of their work experience. It can be provided mainly in individual or group settings:
(a) Individual supervision: It can be offered at a regularly scheduled time, or when a specific need
emerges for it. It gives full attention to the MHPSS worker and affords more time to discuss
specific issues, particularly how a specific case affects the worker.
(b) Group supervision: This is often offered at a regularly scheduled time. The entire supervised
group is present, and the supervision is offered to all members of the group or, conversely, teams
can be offered supervision being divided per location, or per role within the team (for example,
counsellors by themselves, or educators by themselves). This allows the MHPSS workers to know
what others besides themselves are also facing, and thus bring in the sense of confidence that he/
she is not alone. Supervision provided in a group promotes peer learning and support.

Box 68
Technical supervision of PMTs in IOM Nigeria
In north-eastern Nigeria, technical supervision is provided to IOM MHPSS mobile teams on a weekly
basis. Due to the large number of MHPSS teams, with 120 members deployed in three of the most
affected states – Borno, Adamawa and Yobe – technical supervision is provided by one international
and two national MHPSS specialists. Standardization and the quality of the supervision among the
supervisors are ensured by the international supervisor, who has the role of supervising the other
supervisors, with support from the MHPSS programme manager, who is an experienced MHPSS
expert. Technical supervision is also offered by IOM specialized staff or expert network on specific
themes or models of work, upon request of the MHPSS supervisor.
The supervision sessions are provided on a weekly basis (every Friday) for a period of two to three
hours, depending on the number of team members involved in the specific session, and the relevance
of the issues presented or raised for discussion by the teams or the supervisors. The location is
usually an IOM office meeting room, where flip charts, markers, paper and notebooks are available to
facilitate the discussion.
The supervisor starts the session by emphasizing self-care, confidentiality and “do no harm” principles
for the discussion. He or she then introduces and explores the main subject of the session, which can
be a case, an activity or a dynamic that emerged the prior week. The subject of the session is chosen
by the supervisor based on the written reports received the week before from each team. On some
occasions, the same subject can take up to three supervisory sessions. In this case, the team members
provide an update on how the issue is progressing, also based on changes implemented based on the
supervision. Staff members are asked to prepare the discussion of the cases–activities beforehand,
in order to maximize the support they can receive. The session has plenary and group work
components, and sensitive issues may be further discussed in smaller groups. This forum is important
for all teams to interact, learn, suggest alternative views and enhance their skills. A part of the session
is dedicated to feedback on main challenges faced in the field the current week. A recap of the main
points discussed and a few updates close the session. Skills gaps and training needs are identified by
the technical supervisors, discussed every third session with the teams, and then shared with the
programme manager to inform training plans.

188
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

(c) Peer supervision: This is a form of supervision termed “intervision” meetings. It is suggested
where the participants have the same role at least every second week. Duration: 1.5–2
and approximately the same expertise. The hours.
group is not directed by a supervisor and
so this kind of supervision works well with 15.2.3 Competencies of technical
“mature teams” that have worked together supervisors
for a certain period. It should never be
the first choice, as individual and group Becoming an effective and fully competent
supervision are to be preferred for the first technical supervisor is a developmental process.
stages. The competencies of supervisors must include:
(d) Remote supervision: Although face-to- • Skills:
face clinical supervision is the preferred 0 Demonstrated mastery of the intervention
method of delivery, other methods of clinical being provided;
supervision delivery – including email, video, 0 Communication;
audio recording or teleconferencing – may 0 Conflict resolution;
be employed where necessary. The use of 0 Group facilitation;
these alternative methods may be particularly 0 Supervision techniques;
necessary for MHPSS teams working in rural 0 Team-building;
and remote locations. The frequency of 0 Development of the supervisory
remote supervision sessions should be the relationship;
same as in the face-to-face modality. 0 Responsiveness to changing needs of
supervisees;
0 Compassion and supportiveness.
Box 69
• Knowledge:
Remote supervision 0 Group dynamics;
In case face-to-face supervision is logistically 0 Ethical regulatory issues;
impossible, or additional supervisors who 0 Evaluation tools and processes;
are located elsewhere need to be consulted, 0 Supervision methods;
remote supervision by Skype, phone, Zoom, or 0 Conflict resolution and facilitation;
other internet-based solutions, can be offered 0 Self-care competences.
as a viable alternative. • Attitudes:
0 “Do no harm” approach;
0 Non-judgmental;
15.2.2 Frequency of technical supervision 0 Empowering and strengths-based;
Technical supervision should be offered at the 0 Patient and empathetic;
following frequency: 0 Open to receiving feedback;
0 Open to improving skills.
(a) Individual supervision: At a regularly scheduled
interval, and/or every time a need emerges. More specifically, a technical supervisor in the
Duration: 1–1.5 hours. MHPSS field should know how to leverage
(b) Group supervision: Every week at the diversity to be able to create an inclusive
beginning and every second week after the environment, manage conflicts in order to keep
initial phase. Duration: 1.5–2 hours. people in dialogue as means to build trust and
unity, and balance between methodological
(c) Peer supervision: It is up to the group to adherence and emerging needs.
choose the frequency of what can also be

189
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.2.4 Supervision approaches • Supporting in finding a solution;

• Instructing and advising;
In the context of community-based projects, • Consulting and exploring.
two efficacious supervisory approaches are:
During the supervision session, space is given
(a) Systemic supervision is based on the system to sharing beliefs, feelings and thoughts of the
approach to supervision, which is derived supervisees, and to the search for practical
from social work models of supervision solutions to concrete issues. For a theoretical
in non-humanitarian settings. It identifies view of the system approach to supervision, see
different dimensions of supervision: the book Clinical Supervision Essentials.
• The supervisor;
• The supervisees; (b) Consensus methodologies build on the
• The organization; awareness that valuable knowledge is gained
• The affected population; by supporting the reflection process of
• The supervisor’s functions; professionals. It is based on experiential,
• The learning tasks of the supervisees. reflective learning as an important source for
developing professional expertise. This form
The model encourages supervisors to of supervision is valuable for more mature
recognize and to show the supervisees the groups, and is not the first option. See a case
importance of cultural factors, and draw study on best practice in care and protection
attention to how they interact with other of children in crisis-affected settings.
contextual factors. The supervisor’s main
tasks are:
• Technical counselling;
• Case conceptualization;

Certificate in Psychosocial Support and Conflict Transformation,

Social Science University of Ankara-Turkey @ IOM 2016
190
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.2.5 How are the supervisors trained and supervised

The supervision of supervisors assists technical supervisors to meet their learning, accountability
and support needs. It should be provided by one or more individuals who have a high level of
demonstrated competence in the contents of the programme as well as in the provision of practical
supervision. In IOM, technical supervisors are managerially accountable to the project managers of
the relevant MHPSS project, who are technically accountable to the global MHPSS Section, which will
provide supervision directly and through referral to its international expert network.
PMT leaders can be trained by technical supervisors to supervise the teams more closely at the field
level, especially in areas where access is limited. The technical supervisor tasks include the identification
of the training needs of team leaders and the organization of training sessions for them.

Box 70
Systems model of staff stress management
Humanitarian work presents an array of different stressors. There are inherent stressors reflecting
the content of the work, such as exposure to gruesome sites, onsite dangers, and powerlessness
in not being able to apply the level of help needed. Non-inherent stressors occur at the team and
managerial levels, including: lack of skills or training needed to do the job, poor role definitions/unclear
expectations, unnecessarily bureaucratic agency policies, and conflict and mistrust within the team.
Particularly, national staff commonly work at the intersection of these multilevel stressors, which often
remain overlooked by the organizational strategies. Thus, in order to address these various levels of
stressors, a non-traditional stress management model is needed that looks beyond individual self-
care. The systems model of staff stress management is both systematic and multisystemic, focusing
on building resilience across three dimensions. The first dimension builds a response across all the
stages of stress over time: prior to the stressor occurring, when it occurs, and after the stressor has
ended. This response may work to prevent or reduce the intensity of the stressors through decreasing
workloads, reduce the vulnerability through training workers or developing team cohesion, and
improve coping mechanisms. Second, the model works to build resilience across all socioecological
levels – individual, family, team, agency and the larger community – as a systemic policy, not just
a series of actions. The third dimension of stress and risk reduction applies to those working on
interventions at each phase of deployment, including careful staff selection, predeployment training,
in-field support, transitional support, technical supervision and follow-up support postdeployment.
Technical supervision is a part of a systems model of staff care, but only a part of it (Saul and Simon,
2016; Antares Foundation, 2005).

Figure 14: Systems model of staff stress management: Dimensions

1. Response across all stages of Prior to stressor, when it occurs

stress over time and after the stressor occurs

Systems model of staff stress 2. Building resilience across all Individual, family, team, agency and
management: Dimensions socioecological levels the larger community

3. Intervention in all phases of Selection, predeployment,

in-field support, transitional
deployment and postdeployment

191
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

II TRAINING Training can indeed play a double role in CB

MHPSS programmes. From one side it is
addressed to those working on the programme,
15.3. WHAT MHPSS being part of the organizational implementation
process; on the other, training addressed to
PROGRAMME MANAGERS external actors can be a programmatic activity
SHOULD KNOW or a specific deliverable of the programme.
The subjects of specific training programmes Process training that is part of the process of
related with each of the activities presented implementing a CB MHPSS programme include:
in this manual are discussed in the respective
• Training for the staff of the programme;
chapters. This chapter will instead describe the
process of designing trainings within a CB MHPSS • Training for other units of the organization,
programme in IOM. Training is a necessary whose job is connected with the CB MHPSS
component of a CB MHPSS programme in any one;
emergency situation. This is true on the short • Training for implementers and partners on
term, since people in emergency are usually how to (better) perform activities to deliver
asked to respond to situations that are novel to under the programme;
them, and that challenge their existing capacities.
In addition, in the specific field of MHPSS, the • Training for the sector under which the
emergency may catalyse needs and therefore programme is implemented;
may require capacities that were not present • Training for the technical supervisors;
altogether before the crisis took place. In order • Training for MHPSS programme managers.
to be able to respond with quality, helpers,
including those with MHPSS functions, often Training that is delivered as an activity or a
need training and technical support. deliverable of the programme, includes, for
example:
Training and capacity-building offered during
the emergency phase are a programmatic • The organization of Master’s, Diploma,
necessity on the short term, but they do provide Certificate programmes on MHPSS related
the nexus between emergency humanitarian disciplines and capacities for a wider
response, preparedness and long-term community of practice in a country;
development, because they create skills that can • The organization of trainings in a certain
be reactivated on the midterm, and contribute counselling method, in a psychological
to the overall resilience of a community, including intervention or an art-based MHPSS
long-term mental health system strengthening. technique, to enhance the general capacity of
Training indeed focusses on supporting the a community to respond to a situation;
agency of affected people. The success of an
international CB MHPSS intervention in an • MhGAP trainings for health workers in
emergency is determined by the quality and certain areas;
scope of technical knowledge and support the • PFA trainings for professional associations
relevant programme is able provide to local or humanitarian sectors not directly involved
formal and informal respondents, both those in the programme activities as agents;
employed or engaged by the organization’s • Transcultural trainings for psychiatrists in high
MHPSS programme, and those in the larger migration or high displacement areas.
community of practice.
This differentiation is not necessarily rigid.

192
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

Internal trainings for the staff of the programme aware while designing MHPSS programmes
can be opened to the staff of government of the relation between training objectives,
institutions, partner organizations, civil society methodology and duration. For instance, if
actors and activists, whenever this is appropriate, one works in a locality where no one has ever
reaching a wider impact. Likewise, trainings been trained in MHPSS-related disciplines and
implemented as an activity of the programme no foundation skills exist, and programme
can involve a defined number of internal resources allow to organize one day of training
MHPSS programme staff on top of the external only, then this can be a training on PFA, but
participants, enhancing the programme’s capacity not on counselling skills. Yet, if the programme
to respond. aims at providing counselling services in the
same situation, then proper, longer-term training
Process trainings tend to be focused on the should be included in the programme design.
capacity-building necessities of a programme as Moreover, trainings that aim at passing skills to be
it was designed, while trainings as programme duplicated or employed directly in the field need
activities are designed to reach a wider capacity- to always be organized in 3 steps:
building objective aimed at covering important
capacity gaps in the countrywide MHPSS (a) Passing of information-knowledge-procedure;
response systems, identified through needs (b) Testing the acquired skills in a protected
assessments and mapping. space, which can be done through simulations,
Of importance, a community-based approach role plays, intervision or others;
to training in MHPSS does not aim to impose (c) Testing the acquired skills in the real world,
hierarchical practices or ready-made tools, but to under supervision.
create new models of collaborative intervention
between the organization, the expert trainers This is valid for all trainings of the sort, no matter
and the students-practitioners, that need to how short/long and how focused/general they
be participatory and adapted to the specific are.
situation. Local, community-based ownership For IOM, trainings both for internal MHPSS staff
and a sustainable approach stem from this basic and for external students and experts follow
model of work. this logic, whereas point (b) is resolved with the
The range of what is usually included under the teaching methodology and point (c) by technical
vast definition of training goes from inductions supervision for internal staff, and mentoring and
lasting a few hours, aimed at passing essential supervised fieldwork for trainings offered to the
procedural, professional or academic information; wider community of practice.
to Executive Master programmes, that engage On-the-job training, due to the specificities of an
participants for several months on a subject emergency situation, can be the most efficacious
matter, building their skills, understanding and way to build capacity without slowing down
capacity to operate in a specific technical domain the response. This is a training that is provided
of MHPSS. during working hours, with the trainers joining
It is impossible to account for all the modalities the teams during field activities. Even on-the-job
of trainings one can employ in a MHPSS training, however, should encompass the three
programme in this manual. These will be largely steps to be efficacious and safe.
determined by a combination of various factors In terms of process training, such as training
including duration, scope, available resources, for the staff and functions of a CB MHPSS
existing skills on which the training builds on, programme, the scope of training will be
and others. In general, it is important to be inversely proportional to the foundation skills

193
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

existing in the given emergency context. As 15.4.2 Process training

mentioned, in some situations the programme
will need to create the foundation of certain 15.4.2.1 Training for the staff of the
skills in its staff, while in others, staff may be programme
already proficient and training will be mainly
dedicated to harmonization of practices, extra Based on the existing foundation skills of the
skills and emerging needs identified through staff members and the PMTs, a training plan will
technical supervision. be envisaged for the staff. In addition to weekly
technical supervision, the staff will be trained
The following chapter will give practical monthly, first on a core curriculum established
indications on how to organize both process at inception, and afterwards to respond to
training and activity training within a CB MHPSS emerging needs identified through the technical
programme. supervision sessions. The monthly trainings will
be provided either on the job or in the form of
a workshop, and will be delivered by national
15.4. WHAT MHPSS or international trainers, in coordination with
PROGRAMME MANAGERS the programme manager and the technical
SHOULD DO supervisor. Trainings will be organized for all the
staff, or with a differential approach, in which
members of the teams can be grouped and
15.4.1 Mapping and partnership trained by function (all counsellors, all community
mobilizers, etc.). More information on essential
Assessment and mapping should include an training can be found in the chapter on
evaluation of existing capacities and gaps, Psychosocial mobile teams. More information
including existing training needs and training on additional trainings on specific activities can be
resources in the country in the various facets of found in the respective chapters.
a MHPSS programme. The resulting analysis will
help in determining:
• The expectable capacities of the PMT 15.4.2.2 Training for other units of the
members, and their training needs; organization
• Existing training capacities in the country, This is specific to each organization. In IOM,
mapped versus needs; MHPSS programmes aim to train:
• Identify which training capacities are lacking in • Colleagues working in DTM in PFA;
the country; • Colleagues working in Livelihood,
• Budget the training accordingly in project Protection, and Conflict transformation
planning; in subjects identified in the relevant chapters;
• Identify trainers and supervisors. • Colleagues working in Health in subjects
identified in the chapter on Community-
based support to people with severe
mental disorders;
• For colleagues working in CCCM, see
paragraph 15.4.2.4.
The MHPSS programme managers will liaise with
their counterparts in other units to organize

194
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

these trainings, including resource mobilization. • MHPSS essential knowledge for CCCM
Trainings can be conducted by members of the actors, based on the booklet linked here.
MHPSS teams. For further guidance on contents,
contact contactpss@iom.int. IOM or other agencies may operate under
other sectors. Training packages and resources
can be found organized per sector in the IASC
15.4.2.3 Training for implementers and associated entity MHPSS RG and on mhpss.net,
implementing partners the online platform for MHPSS practitioners that
As already described in the chapter on PMTs, can be joined subscribing free of charge clicking
whenever institutions, civil society or professional here.
groups exist that can perform the functions
inherent to the work of PMTs, they should
implement the activities and IOM or other 15.4.2.5 Training for the technical
agencies should support their work. The support supervisors and the MHPSS
shall include technical supervision and training, programme managers
based on gaps in their capacity participatorily Technical supervisors and MHPSS programme
identified during the mapping, and training needs managers need also to be trained, at inception
emerging through the work and the technical and throughout implementation. As for
supervision. The process will be the same used inception trainings, IOM, in collaboration with
for the training of the PMTs, and logistics and the Scuola Sant’Anna di Studi Accademici e
priorities will be coordinated with the leaders of Perfezionamento in Pisa, Italy, has organized
these groups. a yearly Summer School in Psychosocial
Interventions in Migration, Emergency and
Displacement for the last nine years. The
15.4.2.4 Training for the sector under summer school includes 100 hours of teaching
which the programme is over 12 days, a final exam, and grants 5 academic
implemented credits. It is primarily meant to serve the IOM
In several emergencies, IOM leads the CCCM MHPSS programme managers and technical
cluster. Naturally, a MHPSS programme supervisors, but offers 20 seats to managers and
implemented by IOM will support the CCCM supervisors of other organizations as well. The
cluster actors and the sector in many ways, subjects of the training reflect the ones of this
including referral, exchange of information, liaison manual, with a more critical, research-oriented
between the CCCM cluster and the MHPSS and academic approach, although remaining quite
working group, and in training. In particular, the practical. The School has graduated 210 students
IOM MHPSS teams will train CCCM actors and from 45 different organizations.
camp managers in: The Psychosocial Training Institute in Cairo
• PFA. A special PFA training package has been organizes training courses more oriented
elaborated for CCCM actors and can be towards urban displacement and NGO work,
received from contactpss@iom.int; which can also be used by organizations to give
• Active listening, supportive communication solid inductions to their teams.
and non-violent communication and Other offered courses can be found on the
mediation. A relevant training module is dedicated section of mhpss.net.
included in the core CCCM training, and can
be received writing to contactpss@iom.int
or globalcccm@iom.int;

195
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.4.3 Trainings as deliverables of • When a critical number of people is identified.

programmes This will help not only to be cost effective,
but to focus on activities that are likely to be
Initial assessment and mapping should be more popular or more culturally meaningful
analysed to identify capacity gaps in country or in a specific context;
subcountry MHPSS systems, and trainings can
be envisaged as programmatic actions with an • When trainers and supervisors are available.
aim to cover these gaps and be able to provide a They will follow the usual organization in three
more quality response. In addition, a community- steps, and will include supervision.
based approach implies the mobilization of
existing formal and informal sociocultural activity For further information, see the chapters on
groups, artistic, interest and sport groups and Sociocultural activities, Creative and art-
individual artists, sportsmen, religious and based activities, Sport and play.
traditional leaders and activists to respond to
specific MHPSS problems, or to promote social 15.4.3.1 Counselling skills and
cohesion, with explicit psychosocial objectives. psychological interventions
In this case the programme should support training
trainings for the identified resources that could
support them in giving a new focus to their The assessment and mapping may indicate that
activities in a safe and quality fashion. there is a lack of qualified provision of counselling
or psychological therapy or psychological
In this second case, the approach will be a interventions. To respond to such a need, there
bottom- up one. Artistic, sociocultural and other could be two options, each presenting a trade-
resources will be identified. When a critical off.
number of committed professionals, activists
or artists is brought in, specific trainings can be One possibility is to train people in brief
organized for them in: psychological interventions, like PM+, so that a
sizeable number of responders can be deployed
• Facilitation of support groups or peer support
and mobilized in a relatively short-time to
groups.
provide an evidence-based service.
• More specific psychosocial skills related with
their own function-skills, such as: The other is to engage a number of individuals
0 Social theatre trainings for performance with the right attitude and ethics in a mid-
artists; term capacity-building in the foundation of
0 Elements of art-therapy for visual artists; counselling and psychological care. This will
0 Trainings in coaching skills, both technical allow professionals to be more versatile and
and psychosocial for animators of sport comprehensive in their provision of care, but
groups; their training will be completed in a much longer
0 And so on. period of time.
The trainings will be organized: IOM favours investing in foundation courses
that build broader skillsets, rather than focussing
• For people that are interested and have
on relatively shorter trainings focussing on
proved to have a sincere interest in helping
brief interventions or a precise model only, in
others and switching the focus of their
situations where foundation courses do not
activity;
exist. The counsellors in training will still be able
to provide services in a gradual fashion thanks
to on-the-job trainings and technical supervision,

196
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

while building a more solid and flexible base of

competences, likely to be more sustainable in 15.5. CASE STUDIES
the long term. For more information, see the
paragraphs on trainings and adaptation of the 15.5.1 Case study for process training:
chapter on Counselling. The experiences of the
Psychosocial Training Institute in
15.4.3.2 Academic professional courses Cairo (PSTIC) in urban settings.
One main feature of IOM CB MHPSS Models of MHPSS intervention are most effective
programmes has been the organization of when culturally and contextually designed
executive Master’s, Diploma or Certificate in response to the needs and problems of a
courses on psychosocial approaches to population population. PSTIC operates mainly in Cairo, in
mobility in low-resource or crisis-affected Egypt. Egypt is home to 240,000 refugees and
countries and communities. These courses have asylum seekers from 58 countries. Most live
taken place from the Balkans to the Middle East in Cairo, the capital city, intermixed in urban
and to South America, being adapted to the neighbourhoods alongside 22 million Egyptians.
specific needs emerged during the assessment Most refugees must support themselves. The
and mapping, and the cultural, social and political quality of life common to the poorest Egyptian
conditions of the context. They are designed in is amplified for refugees. Neighbourhoods
collaboration with national universities, respecting and public health and education facilities are
the requirements for accreditation. They are impoverished and overcrowded. The cost of
organized every second weekend, as they target living is higher than the daily wage. Refugees
professionals already providing critical services dream of resettlement yet few leave. Most live
in the field for governments, agencies, and civil for years in poverty, feeling unsafe with few
society groups. The courses are free of charge, future opportunities. PSTIC has crafted an
and students are selected through a competitive urban model in which a network of well-trained
process that evaluates, inter alia, the impact the refugees offer community and home based
applicants can have on shaping the provision MHPSS care 24 hours a day, 7 days a week.
of MHPSS. Pedagogically, they are organized in
The PSTIC team is a multilingual-multicultural-
lectures, participatory and interactive workshops,
multidisciplinary network of workers from
simulations and supervised fieldwork. The courses,
several countries; 90 per cent of them being
no matter their main MHPSS subjects, always
refugees. PSTIC targets the most vulnerable,
promote a systemic approach that will help
especially those who do not seek facility-
the students to comprehend and manage the
based care. No one is refused services and
complex interactions between the geopolitical,
all efforts are made to assist – refer to other
historical, inter- and intrapersonal, humanitarian,
organizations – or, when nothing is available, just
communitarian and cultural/subcultural systems.
encourage those in need. Supportive services
The courses are functioning as a space for dialogue
are offered at all layers of the Interagency (IASC)
between international experts identified by the
Standing Committee Guidelines for MHPSS in
IOM’s Mental Health, Psychosocial Response and
Emergency Settings intervention pyramid. This
Intercultural Communication Section, national
includes a 24 hours a day, 7 days a week helpline
academic experts brought on board by the
answered by a team available to give information
national university and field practitioners. They
and respond to any emergency; a roving
respond to an identified urgent capacity need,
multilingual team, which shares information daily
build on preparedness and development, and
in community sites; support to secure and safe
allow participants to keep on providing services in
housing; advocacy when seeking health care
the field and to be supervised in their fieldwork.

197
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

especially during emergencies; and advocacy 15.5.2 Case study of training as

for those detained. In addition, professionally programme activity. The executive
trained refugee Psychosocial Workers (PSW) Masters in Psychosocial Support
work alongside their communities to provide and Dialogue in Lebanon.
case management, individual, family and group
psychosocial support and counselling, problem In 2013, the organization devised a programme
solving and mediation; accompaniment and to respond to the psychosocial needs of Syrians
referral to other services. Finally, Egyptian residing in the Syrian Arab Republic and decided
psychiatrists work alongside the refugee team to focus the intervention on the capacity-
24 hours a day, 7 days a week to ensure the building of local psychosocial practitioners
combined psychiatric and psychosocial support responding to the crisis. Among different
needed for acute and chronic mental health care. initiatives IOM designed, a one-year Executive
Masters programme in “Psychosocial Support
Few PSW join PSTIC with prior MHPSS and Dialogue” for Syrians was developed at the
training. PSW are carefully selected from their Lebanese University after several consultations
communities based on personality traits and with Lebanese colleagues and groups of Syrian
their prior commitment to assisting others. practitioners. The programme was set up for
Before beginning to work, they complete 5 two generations of students. In 2017, a similar
weeks of daily training whose content starts but shorter course was organized in Turkey at
with ethics and includes essential psychological, the Social Sciences University of Ankara (ASBU)
social and health knowledge, practical for Syrian and Turkish professionals working with
development of helping skills, and work skills Syrian refugees in the country.
such as time management. After this, training
and skill enhancement continues weekly. PSW For the background and the structure of
also have individual and group supervision. the course, read the introduction of this
Each worker is part of a small multinational publication.
team lead by a senior refugee worker and a For the description of the modules and a sense
psychiatrist. The team meets weekly to review of the background and professional affiliations of
challenging cases and issues in an open and the participants, see this video.
safe learning environment. A few essentials
are necessary: Commitment to the care of For the description of the main themes of the
refugee workers includes ensuring they are fieldwork of the two editions of the programme
paid; a work environment that allows for open in Lebanon, read here.
sharing about the complicated dual allegiance To read the best 4 fieldworks of students of the
for community workers to their communities course in Ankara, read the dedicated section
and the organization; and continual activities that of the number of the review Intervention
encourage team building and self-care. hypelinked here.
To know more, find a webinar slideshow here.

198
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
15. TECHNICAL SUPERVISION AND TRAINING

15.6. CHALLENGES AND CONSIDERATIONS

For technical supervision, if the roles of the supervisor and the manager overlap, issues of power
and accountability can prevent a fully free supervisory process. It can help in facilitating matters to
establish a clear set of boundaries at the very beginning of the supervision process, and to tailor
contents of the supervisory sessions on the possible related shortcomings. However, as a best
practice, the two positions should be kept distinct.
The different roles of manager and technical supervisor, and their respective boundaries, need to
be clearly defined and communicated to avoid confusion and overlap.
For both technical supervision and training, programmes may not be funded, or not funded
enough, due to donors’ rules. Indeed, these are not considered as life saving emergency response
activities and therefore may be excluded from funding, no matter the size of the programme. This
creates a situation where an agency is asked to respond on a large scale, but will never be able
to grant quality and minimum standards of intervention. This problem can be solved by enlarging
the pool of donors and stressing the emergency-development nexus, while reducing the costs of
training and supervision mapping national and regional trainers.
Another challenge in training is posed by the short duration of emergency programmes and often,
the inability of the project manager to foresee incoming funds. This can bring to a fragmentation,
that if not probably accounted for in planning can lead to frustrations. It is therefore
recommended to plan trainings based on their maximum duration in relation to the life of the
progamme, and adapt training objectives accordingly.

FURTHER READING
Bragin, M.
2012 So that our dreams will not escape us: Learning to think together in time of war.
Psychoanalytic Inquiry: A Topical Journal for Mental Health Professionals, 32(2):115–135.
Haans, T., J. Lansen and H. Brummelhuis
2007 Clinical Supervision and Culture: A Challenge in the Treatment of Persons Traumatized by
Persecution and Violence. In: Voices of Trauma (B. Drožđek and J.P. Wilson, eds.). Springer,
Boston.
Sangath and London School of Hygiene and Tropical Medicine (LSHTM)
2013 The Premium Counselling Relationship Manual. LSHTM, London.
For other references, see the full bibliography here.

199
 16.
MONITORING AND EVALUATION

Community celebration in Iraq. © IOM 2018

200
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

Figure 15: Monitoring and evaluation

16.1. WHAT MHPSS
PROGRAMME MANAGERS
SHOULD KNOW
Evaluation
Monitoring and evaluation, currently conceptualized Monitoring is assesses specific
as monitoring, evaluation, accountability and Monitoring and information
the systematic
evaluation are at specific
learning (MEAL) (Sphere Project, 2015), are integral gathering of
two linked time points to
to any community-based MHPSS programme in information that
but separate
assesses progress determine if
emergencies. A community-based and participatory practices actions taken have
over time
MEAL process brings programme managers, staff, achieved intended
community leaders and programme participants results
and clients together to ensure effective programme
performance. It strengthens the ability of MHPSS
programme managers to reflect thoughtfully Source: IASC (2017).
on their work, to be sure that it is completed
Monitoring and evaluation is applied to the
as intended, and to be clear as to whether and
following project components:
how it met expectations to improve MHPSS in
affected communities. This process should allow for • Project inputs: Funds, materials,
changes in activities and programmes, and support equipment, staff and other resources
community learning about effective interventions “put in” to carry on project activities.
for MHPSS, during the emergency and afterwards.
Such a process creates additional opportunities • Project outputs: The activities achieved
for community ownership and accountability to or “put out” in the process of
accompany institutional learning at the design and implementing a project (such as training
implementation levels. session for staff or improved access
to services or facilities) that show that
The aim of this chapter is to introduce the concept operational plans are on track.
of community-based and participatory
monitoring and evaluation in MHPSS programming, • Project outcomes: What “comes about”
and clarify its essential role in reviewing needs, during the course of a project as a result
resources, socially and culturally adequate strategies of the achieved outputs.
of implementation, and objectives in the rapidly • Project impact: A lasting change in
changing environment of humanitarian emergencies, individuals, families and communities that
taking into account that communities are not results as a consequence of the project.
homogeneous.
Monitoring and evaluation are distinct but
16.1.1 What monitoring is
interrelated processes. In The Inter-Agency Standing
Committee (IASC) Guidelines on MHPSS in Emergency Monitoring is the systematic gathering of
Settings (IASC, 2007), they were identified as information that assesses programme progress
an essential part of MHPSS programming in over time (IASC, 2017). Monitoring compares
emergencies. Action Sheets 2.1 and 2.2 should be intention to results (Sphere Association, 2018).
read along with chapter 3 on Assessment and During a humanitarian emergency, even the
mapping of this Manual as an introduction to this best assessment and programme design cannot
chapter. perfectly predict emergency-related changes in
circumstance, the difficulties of implementation

201
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

in specific places, or any other complications in • Listening to programme participants about

programme actualization. Community-based and their experience of the programme in focus
participatory monitoring provides the mechanism group discussions;
for learning, contextualization and adapting • Engaging with community representatives in
programmes throughout the implementation focus group discussions;
(Sphere Association, 2018).
• Seeking out community representatives of
groups who may not be participating to be
16.1.1.2 Why monitor MHPSS check on inclusion and exclusion;
programmes
• Developing a monitoring “grid” complete with
We monitor for two things; process (are indicators for each project objective and and
we implementing correctly in the specific holding a meeting with beneficiaries at each
circumstances?) and results, (is what we are point to chart progress.
doing working?) In addition, people implementing
programmes will want others to witness and Click here for an example of one such chart.
recognize their work, and help make corrections After charting the results, the participants can
when needed. Programmes can then be modified evaluate for themselves whether the group is “on
to be sure that they do in fact address the issues at the right track.” Are the actions they are taking
hand, as experienced in the local context. really improving their sense of psychosocial
well‑being? Are these changes having any
negative effects on their well‑being? If so, can
16.1.1.3 When to monitor MHPSS they be corrected?
programmes
Monitoring is an ongoing process, but a good rule 16.1.1.5 Questions addressed by
of thumb can be to monitor after 30 days to learn community-based participatory
whether and how implementation is possible, monitoring
and what needs to be addressed; 60 days to see
if things have begun and again what issues need Community-based and participatory monitoring
addressing, and then at 90 days and every additional addresses the following questions:
90 days until the programme’s end. • Is the programme being implemented as
planned after the participatory assessment?
16.1.1.4 Community-based participatory 0 If not, what are the obstacles?
monitoring 0 How should they be addressed? Need the
programme be further contextualized?
Monitoring can occur through a method called • Are all of the intended affected populations
community-based participatory monitoring being reached?
and evaluation, which provides the mechanisms 0 Who is being excluded? Why?
for learning, contextualizing, and adapting 0 How can the programme bring in additional
programmes throughout implementation (Sphere marginalized populations?
Association, 2018). This process can include the
• Have the circumstances of any given population
following activities:
changed significantly?
• Discussions with project management and 0 What adaptations are needed to operate in
staff; these new circumstances?
• Observing the project activities while they are • Are the needs, resources and methodology of
happening; intervention identified at assessment still relevant
to the psychosocial well‑being of the affected

202
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

individuals and communities? They ask what happened to programme

0 Do the proposed activities still seem likely participants and how much of a difference
to improve their psychosocial well‑being and the programme made for them. They are
social relations? conducted at midterm and again at the end of
• What are the unintended negative a project of intervention.
consequences to date? • Impact evaluations attempt to measure if the
0 How do they affect the populations’ project promoted lasting positive changes in
well‑being? the participants’ mental health, psychosocial
0 How will the programme address these? well‑being, attitudes, behaviours and social
0 Is there a functioning and transparent relationships.
grievance mechanism?
• Is inter-agency coordination proceeding as Box 71
planned? Questions that IOM evaluations of
0 If not, what adjustments are necessary? MHPSS programmes try to answer
• Are staff members performing according to • How was the programme delivered? Which
standards, and are self-care programmes and processes contributed to positive and
measures available? negative effects?
0 If not, what adjustments are needed?
0 Recognize and support the positive efforts of • Which internal and external factors
staff, participants, and community members. intervened to affect (positively and negatively)
the impact of the project?
With these questions answered, monitoring
information can guide programme, project, or • Was the integration of specialized services
intervention revisions, verifying target criteria, provided by the project effective in
and confirm that the intervention is reaching the stabilizing, treating and preventing mental,
people who need it (Warner, 2017). neurological and substance use disorders?
• Did the project improve and activate
16.1.2 What evaluation is resilience, promote inclusion, facilitate
positive human connections, and restore
Evaluation is a systematic and objective agency, self and community efficacy,
assessment of the design, implementation and hopefulness to individuals, families
and results of an ongoing or completed and groups at each targeted level of the
intervention, project, programme or policy pyramid?
(Sphere Association, 2018). Evaluation refers
to the process of examining a programme • Did the project enhance the protection
at specific points in time, minimally at the of persons in institutions or segregated at
beginning, then at the middle (if possible), home, in tents or in camps?
and after completion to see if it achieved the • What are the most relevant good practices,
desired results as determined in the assessment. innovations and lessons learned in
Engaging community members and programme implementation, monitoring and evaluation
participants in the evaluation process of the project?
ensures their inclusion in learning. In MHPSS
programmes, IOM, from a technical perspective, • What structural and ongoing changes have
evaluates outcomes and, when possible, impact: been made to the lives of the individuals,
families and communities who participated
• Outcome evaluations assess the effectiveness in the project?
of a programme in producing change.

203
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

16.1.3 Understanding indicators 16.1.3.1 Goals and indicators supplied by

the common framework
Indicators are the measurable information used
to help, ask and answer the questions identified in The IASC Reference Group on Mental Health and
the monitoring and evaluation plan. The choice of Psychosocial Support in Emergency Settings has
indicators informs the rest of the monitoring and created the IASC Common Monitoring and Evaluation
evaluation plan, including methods, data analysis Framework for Mental Health and Psychosocial
and reporting. Indicators can be quantitative or Support Programmes in Emergency Settings (IASC,
qualitative. Participatory indicators are those that 2017). This document presents a consensus on
are developed together with stakeholders, especially the goals, objectives, indicators and actions for the
community members and participants, that help all monitoring and evaluation of MHPSS programmes
of those concerned to be precise about whether in emergencies. The full document can be found
the programmes are succeeding to improve here. Its key elements as they relate to CB MHPSS
mental health and psychosocial well‑being in the are summarized here. The document enumerates
community. Strong indicators are referred to as a five-step process for conducting monitoring and
SMART – specific, measurable, attainable, relevant evaluation on MHPSS programmes:
and time-bound. 1. Assessments of MHPSS proceed as usual. The
• Input indicators: These measure the beginning of an MHPSS programme design is
contributions necessary to enable the initiated to meet assessed needs (see chapter 3).
programme to be implemented (such as funding, 2. The organization considers its own programme
staff, key partners and infrastructure). outcomes and outputs as they relate to the
• Output indicators: Many programmes use output programme design. Each organization considers
indicators as their process indicators; that is, the how its project will contribute to the goal in
production of strong outputs is the sign that the the common framework.
programme’s activities have been implemented. 3. During the design phase, practitioners/
Others collect measures of the activities and implementers are encouraged to review the
separate output measures of the products/ common framework to see how it aligns with
deliverables produced by those activities. their own proposed intervention(s).
• Outcome indicators: Measure whether the 4. The programme takes (at least) one goal
programme is achieving the expected effects/ impact indicator and at least one outcome
changes in the short, intermediate, and long indicator from the common framework. The
term. programme also includes output indicators
• Impact indicators: Because outcome indicators unique to the programme design.
measure the changes that occur over time, 5. The organization explores possible means of
indicators should be measured at least at baseline verification to measure impact and outcome
(before the programme/project begins) and at indicators. These may be measures previously
the end of the project. Long-term outcomes used by them or other organizations.
are often difficult to measure and attribute to a
single programme. The common goal identified for MHPSS
For specific examples of how these questions programmes is “to reduce suffering and improve
can be addressed for CB MHPSS programs see mental health and psychosocial well‑being”. The
16.1.4 and the linked material in the section. framework describes two types of outcomes:
• Community-focused outcomes;
• Person-focused outcomes.

204
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

Box 72
How do monitoring and evaluation combine with accountability and learning to
complete a MEAL?
Accountability to affected populations (AAP) is an integral part of the humanitarian programme cycle,
which includes monitoring and evaluation, accountability and learning in its areas of concern.
AAP requires communities to be engaged in programme assessment, design, monitoring and
evaluation. AAP requires that, as programmes are amended and adapted based on community
feedback, there is a mechanism in place to report back to the community the changes being made
and how to make use of newly adapted services. As participatory monitoring is an ongoing process,
there are many opportunities to return to community members with the results of any adaptations. In
low-resource settings, this information can be disseminated in focus groups, community meetings and
activity groups, such as those mentioned earlier in this Manual. In higher resource and urban settings,
these methods of dissemination are also useful, but they will require the addition of social media and
radio communications in order to be effective.
The IASC toolkit on AAP provides detailed advice on how to implement this process and can be
found here.
Participatory monitoring and evaluation invite reflection and learning as managers, staff, community
leaders and programme participants work together to evaluate programme effectiveness. Learning
conferences that include evaluation reports allow participants – who have participated in the entire
process, from assessment and implementation to monitoring and evaluation – to consider next steps.
What about the evaluation was surprising? Anticipated? What experiences were pleasant but yielded
few results? Such learning conferences and, to the extent that resources allow, their publication on
interactive social media sites and through community organizations, ensure that there is a longer-term
effect that communities can use to improve well‑being going forward.
Some important questions to ask for reflective practice:
• What actions were taken during monitoring and evaluation to ensure that opportunities
were created for reflection and learning?
• To what degree did participant perspectives influence these activities?
• How were issues identified in the process documented, acted upon and reflected in the
evaluation?
To link these practices to AAP requirements, click here.

205
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

These reflect MHPSS programmatic activities at the community, group, family and individual levels.
The framework identifies five main common outcomes for any MHPSS project in an emergency, and
provides a set of 49 indicators to measure impact and achievements. The Guide also encourages,
along with the overall goal, to include at least one outcome and related set of indicators to monitor
and evaluate each MHPSS project. For easy reference, Table 12 highlights three key indicators for
each outcome, chosen among the ones that most relate to community-based MHPSS practices and
the IOM approach; however, it is highly recommended to refer to the publication in its entirety for
the full complement of indicators and details on implementation.

Table 12: Key indicators for community-focused and person-focused outcomes

Outcomes
Community-focused Emergency responses do People are safe and Family, community and
not cause harm and are protected, and human rights social structures promote
dignified, participatory, violations are addressed. the well‑being of all of their
community-owned, and members.
socially and culturally
acceptable.
Person-focused Communities and families People with mental health
support people with mental and psychosocial problems
health and psychosocial use appropriate focused
problems. care.
Source: Based on IASC (2017).

Table 13 provides a sample of key outcomes and indicators, again chosen among the ones that
better serve CB MHPSS programmes and the IOM approach.

Table 13: Key outcomes and indicators

Outcomes
1. Emergency responses do not • O1.1: Percentage of affected people who report that emergency
cause harm and are dignified, responses (a) fit with local values, (b) are appropriate and (c) are provided
participatory, community- respectfully.
owned and socially and culturally • O1.3: Percentage of target communities where local people have
acceptable. been enabled to design, organize and implement emergency responses
themselves.
• O1.4: Percentage of staff trained and following guidance (for example, the
IASC Guidelines) on how to avoid harm.
2. People are safe, protected, and • O2.1: Number of reported human rights violations.
human rights violations are • O2.2: Percentage of target communities with formal or informal
addressed. mechanisms that engage in protection, monitoring and reporting of safety
risks or at-risk groups (for example, children, women, people with severe
mental disorders).
• O2.6: Percentage of target group members (such as the general
population or at-risk groups) who feel safe.

206
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

3. Family, community and social • O3.2: Extent of parenting and child development knowledge and skills
structures promote the well‑being among caregivers.
and development of all their • O3.5: Level of social capital, both cognitive (level of trust and reciprocity
members. within communities) and structural (membership and participation in social
networks, civil or community groups).
• O3.6: Percentage of target communities where steps have been taken to
identify, activate or strengthen local resources that support psychosocial
well‑being and development.
4. Communities and families support • O4.1: Number of people with mental health and psychosocial problems
people with mental health and who report receiving adequate support from family members.
psychosocial problems. • O4.2: Abilities of caregivers to cope with problems (through, for example,
stress management skills, conflict management skills, problem-solving skills,
parenting skills, knowledge of where to seek help or information, and
resources needed to access care).
• O4.4: Perceptions, knowledge, attitudes (including stigma) and behaviours
of community members, families and/or service providers towards people
with mental health and psychosocial problems.
5. People with mental health and • O5.4: Number of women, men, girls and boys who receive focused
psychosocial problems use psychosocial and psychological care (such as psychological first aid,
appropriate focused care. linking people with psychosocial problems to resources and services,
case management, psychological counselling, psychotherapy or other
psychological interventions).
• O5.6: Number of people per at-risk group (for example, unaccompanied
and separated children, children associated with armed groups, survivors
of sexual violence) receiving focused care (case management, psychological
counselling, psychotherapy or clinical management of mental disorders).
• O5.8: Level of satisfaction of people with mental health and psychosocial
problems and/or their families regarding the care they received.
Source: Based on IASC (2017).

It should be noted that a group of IASC partners and Johns Hopkins University are currently
identifying recommended means of verification for each of the indicators. The resulting publication
will be added to the online version of this Manual once ready. A UNICEF manual on methods of
monitoring and evaluation particularly tailored to children can be found here.

16.1.3.2 Developing and using participatory indicators.

Many IOM MHPSS programmes, as described in this Manual, while providing a referral system
for people with psychological problems, focus on the re-establishment of community protective
systems, such as social cohesion and the activation of agency among groups within the population,
using terms defined by the participants themselves. These activities contribute to the same overall
goals as all other MHPSS programmes, but require specific indicators to represent results to be
evaluated, in addition to the ones reported in the IASC Guide. In a community-based approach,
it is fundamental to involve affected populations in the identification and development of the
indicators used in monitoring and evaluation.

207
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

16.1.4 The SEE_PET

The SEE_PET is a rapid participatory method that can be used to develop indicators of
psychosocial well‑being in a specific cultural context with concerned social groups. It can be used
to develop indicators of MHPSS programme effectiveness, against which staff and participants
can evaluate success and discard ineffective practices. Derived from the methodology of a three-
country study of conflict-affected women’s perceptions of psychosocial well‑being (Bragin et al.,
2014), it has been adapted for use with children and male adults, as well as IDP settings. The
SEE_PET is used to engage community members in defining and operationalizing the components
of psychosocial well‑being in their own language and thinking, turning those operational definitions
into SMART, contextual indicators. The method facilitates participants, community members
and programme staff in the use of these indicators to monitor and evaluate the psychosocial
components of emergency MHPSS programmes. It provides participants with a moment to reflect
on both needs and resources in the midst of crisis, enabling them to articulate and work toward
the life that they envision for themselves and their children, now and in the future. This method
has subsequently been used by IOM in emergencies in different low-resource contexts, such as in
South Sudan and Nigeria.
• For specific step-by-step instructions on how to use the SEE_PET, click here.
• To create and chart specific indicators for adults, click here.
• To create and chart specific indicators for children and adolescents, click here.
• For an illustrative IOM case study, click here.
• For the context and follow-up of the study, click here.
SEE_PET can be community-led but it is typically a process facilitated by trained experts.

Box 73
Developing participatory indicators supporting referral for treatment of mental,
neurological and substance use disorders
In some settings, IOM will be called upon to identify people with mental, neurological and substance
use disorders, who require specific referral and follow-up care. In some low-resource settings,
community members may not have ever had a proper system of locally available mental health care. In
those instances, recent studies show that community members are aware of symptoms they associate
with mental illness, neurological disorders and response to substance abuse. Such communities often
have ways of identifying and differentiating people whose behaviours represent the results of grief
and exposure to violence from those with ongoing issues requiring psychiatric care (Ventevogel et al.,
2013).
Organizing focus group discussions supplemented by meetings with key informants – such as
health-care providers, traditional healers, community leaders and psychiatric personnel who may be
available – can produce positive identifications of people requiring specialized referral.
In this case, rather than asking questions regarding psychosocial well‑being, focus group discussion
questions might ask about persons with behavioural and emotional problems and the optimal way to
care for them (Ventevogel et al., 2013). For case examples and a careful description of how to develop
and analyse the results of such focus groups, see the referenced article here.

208
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

16.2. WHAT MHPSS PROGRAMME MANAGERS SHOULD DO

Nine steps to start the monitoring and evaluation process are listed below. It is important to
note that each emergency is unique and that the steps may be omitted or modified based on
circumstances.
1. Sites and locations: Focus on three different sites (such as camp, transit centres and host
community), or three different locations in the same area (such as camp sections, nearby villages
and neighbourhoods).
2. Mapping: Carry on at least three different participatory exercises, such as transect and well‑being
walks, social networks diagrams (see INTRAC website) for resources and free online related
publications (here), and community scoring cards; and see MHPSS.net for an array of
downloadable and practical tools and instructions on how to use them.
3. Affected population: Purposive sample of approximately 30 informants for each site/location,
including men and women, GBV survivors, persons with disabilities, the elderly and people from
marginalized groups. If children are to be included in the programme, there should be separate
groups for children and adolescents.
4. Stakeholders and gatekeepers: Identification of four key informants for each site/location
– teachers, health-care workers, local and religious leaders, and camp managers – to be
interviewed.
5. Indicators: Identification of at least two SMART, qualitative and quantitative indicators for each
activity, output and outcome.
6. Tools: Selection of at least three tools – such as activity monitoring forms, participant satisfaction
questionnaires and focus group discussions – for each indicator.
7. Timing: According to the operational plans but as regularly as possible, including weekly activity
monitoring data, monthly participant satisfaction questionnaires and quarterly focus groups.
8. Staff: Identification of dedicated staff with appropriate language and cultural competence to be
trained in data collection and data management, including field team leaders, data entry assistants,
IT managers and project officers.
9. Data management: Identification of available platforms to store information (such as spreadsheets,
online databases and Word documents) and reporting forms to graphically share data (such as
monthly and quarterly).

16.3. CHALLENGES AND CONSIDERATIONS

Challenges include the following:
• Special care must be taken to ensure that all community subgroups are represented in the
monitoring and evaluation process. This requires a specific effort to prevent obstacles to
participation such as language, education, cultural norms, accessibility, social and gender
discrimination, power struggles, political interests and open conflicts.

209
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

• Cultural acceptance of methodologies and tools of community-based monitoring and evaluation

might not be taken seriously by stakeholders and affected populations themselves in emergency
contexts. It is important to make them part of a larger effort to engage communities.
• Subjective changes and self-perceptions of well‑being are also determined by external concurrent
factors, such as conflict dynamics, displacement stages, cultural interpretations of illness, social
conditions and political narratives that might rapidly change in a typical emergency scenario. This
all needs to be considered when analysing the results of monitoring and evaluation.
• Community-based activities – such as public gatherings, awareness campaigns, religious
celebrations, sport tournaments, skill training and livelihood promotion – require a set of
specific indicators and tools to measure the actual impact on psychosocial well‑being of affected
populations. These are signalled, when relevant, in the relevant chapters.
• Positive and lasting impact in MHPSS might require more time than the usual short operational
frame of an emergency intervention. Therefore, indicators and evaluation tools should be
accurate enough to measure trends and attitudes instead of consolidated achievements and
lasting changes.
• Budgets often fail to allocate sufficient resources for dedicated and qualified human resources
to attend to MEAL. When resources lack, they should be included in the job descriptions and
related competencies of core staff. These activities will therefore not represent added burdens,
but rather a part of regular duties.
Depending on the size and characteristics of the emergency, a full participatory identification of
indicators may be difficult to achieve in the very initial phase of the response. Communities and
the programme can achieve this capacity later in the process. In those cases, a SEE_PET or other
processes can also be initiated at a later stage, since they can still impact programme outcomes and
learning.

210
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
16. MONITORING AND EVALUATION

FURTHER READING
Ager, A., L. Stark, T. Sparling and W. Ager
2011 Rapid Appraisal in Humanitarian Emergencies Using Participatory Ranking Methodology (PRM).
Program on Forced Migration and Health, Columbia University Mailman School of Public
Health, New York.
Augustinavicius, J.L., M.C. Greene, D.P. Lakin and W.A. Tol
2018 Monitoring and evaluation of mental health and psychosocial support programmes in
humanitarian settings: a scoping review of terminology and focus. Conflict and health, 12(1):9.
Bragin, M., K. Onta, J. Taaka, D. Ntacobakinvuna, K. Adolphs, J. Bolen, N. Tammelleo and T. Eibs
2013 To be well at heart: Perceptions of psychosocial well‑being among conflict affected women in Nepal,
Burundi, and Uganda. CARE Österreich, Vienna.
Eggeman, M. and C. Panter-Brick
2011 Fieldwork and Research Process and Community Engagement: Experiences from the Gambia
and Afghanistan. In: Centralizing Fieldwork: Critical Perspectives from Primatology, Biological and
Social Anthropology. Studies of the Biosocial Society, (4). Berghahn, New York.
International Federation of Red Cross and Red Crescent Societies (IFRC)
2017 Monitoring and evaluation framework for mental health and psychosocial support in emergency
settings: Guidance and Overview. IFRC, Geneva.
International Organization for Migration (IOM)
2018b OIG Strategy for the Management of its Evaluation and Monitoring Functions, 2018–2020. Office
of the Inspector General, IOM, Geneva.
Rogers, P.
2014 Theory of Change: Methodological Briefs – Impact Evaluation No. 2. UNICEF Office of Research,
Florence.
For other references, see the full bibliography here.

211
 ANNEX 1
INTER-AGENCY COORDINATION

MHPSS Working Group meeting in Nigeria. © IOM 2018

212
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

1. INTRODUCTION
Coordination is an important component of successful MHPSS programme implementation.
It is included as an annex in this Manual not because it is deemed less important than other
programmatic aspects, but for the following reasons:
• Coordination and partnership with different actors, community members, civil society
organizations, stakeholders, affected populations and clients, leaders, religious leaders and
academia on the overall planning and implementation of an MHPSS programme, and with
other humanitarian organizations to optimize assessment efforts and define common
monitoring and evaluation frameworks, are already mainstreamed–described throughout the
Manual. This annex covers issues related to inter-agency coordination, which are essential
knowledge for managers, but are not necessarily a part of a community-based approach.
• The differential role that IOM plays or can play in inter-agency coordination of MHPSS
efforts is essential knowledge for IOM MHPSS managers, but not necessarily relevant for
readers from other organizations.
The chapter will discuss how IOM PMs should coordinate inter-agency MHPSS activities and
how to facilitate community engagement, to the possible extent, within country level MHPSS
working groups (MHPSS WGs).
Inter-agency coordination is an essential component of the emergency response at any stage of
its cycle – including preparedness and recovery – to ensure:
• Accurate information-sharing and reliable channels of communication;
• Identification of common strategies and priority of interventions;
• Even allocation of available resources according to needs, locations and partners’ operational
capacity;
• Adherence to humanitarian principles and minimum standards;
• Adherence to identified minimum technical and ethical standards;
• Promotion of joint training sessions and advocacy actions.
IOM’s Principles for Humanitarian Action (2015b) clearly commit the organization to the
IASC’s procedures and guidelines, along with other United Nations coordinating bodies. IOM’s
Migration Crisis Operational Framework (2012a) recognizes the importance of external
coordination with concerned States, IASC and United Nations agencies; particularly with
UNHCR.
A joint IOM–UNHCR letter addresses the coordination between the two agencies.

213
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

2. COORDINATION OF MHPSS IN EMERGENCIES

Globally, a Reference Group on Mental Health and Psychosocial Support in Emergency Settings
is an IASC-associated inter-agency entity. It was established in 2007, immediately after the
launch of The Inter-Agency Standing Committee (IASC) Guidelines on MHPSS in Emergency Settings,
(IASC, 2007), with the aim to:
(a) Facilitate integration of the core principles of the Guidelines into all sectors or clusters of
emergency response;
(b) Foster collaboration among agencies and diverse stakeholders (such as governments and
communities) for MHPSS in emergencies;
(c) Support inter-agency coordination and activities for MHPSS at the global, regional and
national levels;
(d) Develop relevant tools linked to the Guidelines and actively disseminate these with relevant
actors in the field;
(e) Encourage individual agencies to institutionalize the Guidelines;
(f ) Promote and support ongoing capacity development to enable effective use of the
Guidelines and related tools;
(g) Share experiences of implementation of the Guidelines among MHPSS actors;
(h) Interface with the United Nations Cluster System, refugee and migration coordination
systems to include MHPSS in policies, tools, capacity-building and planning processes;
(i) Facilitate language translations, printing and dissemination of the Guidelines.

214
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

Box 1
Actors and bodies of humanitarian coordination
IASC serves as the primary mechanism for inter-agency coordination, and acts in an action-oriented
manner on policy issues related to humanitarian assistance, and for formulating a coherent and timely
United Nations response to major and complex emergencies. IOM is among the 19 permanent
members (Principals) of IASC.
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA), at the global,
regional and country levels, convenes humanitarian partners for the coordinated, strategic and
accountable delivery of humanitarian action. OCHA is mandated to support humanitarian efforts
in complex crisis and internal displacement. UNHCR remains the lead agency with the mandate to
support refugee response and refugee coordination, with IOM leading on migration.
The Humanitarian Coordinator (HC) and the Humanitarian Country Team (HCT), made up
of the operational United Nations agencies involved in the emergency response, represent the
main coordinating body in countries affected by complex humanitarian crises related to internal
displacement (note not refugees and migrants).
Eleven Global Clusters coordinate the different sectors of any emergency:

• Camp Coordination and Camp • Logistics;

Management (CCCM); • Nutrition;
• Early Recovery; • Protection, which includes: Child
• Education; Protection, Mine Action, Housing
• Emergency Telecommunications; Land and Property and Gender-Based
Violence Areas of Responsibility (AoR);
• Food Security;
• Shelter;
• Health;
• Water, Sanitation and Hygiene (WASH).
For each cluster, IASC designated a lead agency (including WHO for Health, UNHCR for Protection,
and IOM for CCCM in displacement due to natural disasters) to be supported by co-lead
organizations, usually an international NGO (such as Save the Children and UNICEF as lead agencies of
the Global Education Cluster). The Global Clusters have a permanent nature and yearly plans, aiming
at setting and disseminating standards, practices and knowledge. When a humanitarian intervention
starts, the same clusters are established at country level, based on needs, number of actors and the
specific request from the host Government declaring which clusters should be activated. Sometimes
clusters merge (for example the Health and Nutrition Cluster in the NE Nigeria response) and
sometimes the clusters are labelled slightly differently based upon the host Government’s request.
MHPSS is cross-cutting in potentially all clusters, and is a particularly relevant theme in CCCM,
Education, Health, Nutrition, Protection (and its AoRs), Shelter and WASH.
The Humanitarian System-Wide Scale-Up seeks to reinforce focused collective and time-bound
emergency procedures. Scale-Up activation is time-bound and limited to six months, and can only be
extended once, for an additional three months, in exceptional circumstances.

215
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

The group has produced a wealth of additional operationally focused documents, tools and guidance
that have been quoted and referred to throughout the Manual. The entire list of publications can
be found here. Particularly relevant for this Manual is Community-Based Approaches to MHPSS
Programmes: A Guidance Note (IASC, 2019a).
Particularly relevant for IOM staff is the booklet IASC, Mental Health and Psychosocial Support in
Emergency Settings: What should Camp Coordinators and Camp Manager Actors Know? (IASC, 2014c),
because it is addressed to actors of the cluster that IOM co-leads globally and at the country level.
The MHPSS Reference Group has advocated for the establishment of MHPSS Working Groups at
the national and subnational levels, as the best way to coordinate the various actors engaged in the
different sectors of the response, particularly in order to avoid fragmentation among humanitarian
actors traditionally associated with the Health (clinical mental health) and Protection (community-
based psychosocial support) Clusters. The MHPSS Working Group should collaborate with the
relevant clusters and be proactive in mobilizing resources through the Consolidate Appeals Process,
drafting policies and promoting joint advocacy actions. What is at stake is not only the coordination
of the operational capacities of different service providers, but the coherence of the integrated
programme approach of MHPSS services (the four layers of the pyramid) throughout the whole
humanitarian response.
Preferably, the MHPSS Working Groups should be established at the national and subnational levels
at the early onset of the crisis. MHPSS WGs should never be attached to any single cluster, but
be kept inter-cluster (meaning a floating body that supports all relevant clusters – CCCM, health,
education, nutrition and protection). Each participating organization can then be tasked to link to the
cluster to which their organization is more related to in terms of programming.

Box 2
IOM and the IASC RG on MHPSS
IOM has been a member of the group since its inception, and has institutionalized the use of the
Guidelines in internal guidance notes; in its internal trainings for MHPSS, Protection, Health and
Emergency actors; external trainings for MHPSS actors; and in recruitment processes for MHPSS
staff.

216
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

Figure 16: Generic humanitarian response If a cross-sectoral MHPSS Working Group

mental health and psychosocial support cannot be established, it would still be
(MHPSS) coordination structure for large important that MHPSS’s focal points sit in
emergencies with numerous MHPSS actors the relevant clusters and sub-cluster working
- to be adapted locally - groups to ensure that the following minimum
coordinated actions still occur:
Humanitarian Coordinator • Share information on the context of
operations and documents, such as MHPSS
Inter-Cluster CoordinationGroup
needs assessments, indicators, data collection
tools, advocacy reports and plans of action.
Health Protection Other
Cluster Cluster Clusters • Create and constantly update a mailing
(includes AoRs) (e.g., Education, list of concerned organizations to quickly
CCCM, Nutrition)
disseminate information, materials and
MHPSS Cross-Cluster Technical Working Group schedules (meetings, workshops and events).
(typically co-facilited by a health and a protection afgency with focal
points in each of the Clusterrs and with accountability in Clusters)
• Conduct joint MHPSS needs assessments
and surveys.
• Provide regular updates on each
IOM is among the organizations that usually organization’s programme, highlighting
take the leadership in establishing and co- constraints and opportunities for
chairing the country-level MHPSS Working collaboration.
Groups. It has chaired or co-chaired the
groups in different countries and emergencies • Compile and regularly update MHPSS 4Ws
worldwide, including in Myanmar, Haiti, mapping of service providers (Who is
Nigeria, South Sudan, Libya, Iraq and many Where, When and doing What).
others. • Search for synergies and integration of
services with local organizations, including
When the size and scope of the project
State and private mental health providers,
allows, IOM appoints a full-time MHPSS inter-
schools, clubs, cultural centres, civil society
cluster coordinator (South Sudan, Nigeria,
organizations, women’s association and faith-
Haiti), which is the preferred option. The
based organizations.
coordinator is managerially attached to the
IOM MHPSS manager, but can technically refer • Promote local organizations’ participation in
to the global Co-Chairs of the IASC MHPSS cluster and inter-cluster working groups’ and
Reference Group for guidance. sub-working groups’ meetings.

If resources or the scope of the programme • Set-up an inter-agency referral system.

do not allow for a dedicated position, part • Address minimum standards, harmful
of the MHPSS programme manager’s and/ practices and codes of ethics through joint
or MHPSS officer’s working time will be monitoring exercises and reports.
dedicated towards supporting the MHPSS
• Mainstream MHPSS Guidelines in relevant
Working Groups, either co-chairing, or as
sectors of the emergency response.
active members. Typically, in this case, at the
minimum, IOM MHPSS staff will act as a link • Provide training sessions to humanitarian staff
between the MHPSS Working Group and the on MHPSS basic response (such as PFA) and
CCCM Cluster. on the MHPSS Guidelines.

217
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

• Promote joint advocacy campaigns on MHPSS in the affected groups and communities
of concern (such as posters, leaflets, brochures and radio programmes in the relevant
languages).
• Promote awareness on MHPSS’ needs and opportunities at OCHA, and the Humanitarian
Coordinator and Humanitarian Country Team level (such as funding requirements).
• Participate in the preparation of the annual Humanitarian Needs Overview (HNO) and
related Humanitarian Response Plan (HRP). Note that some HRPs may run for 2 years.
• Identify approximately 5 MHPSS related indicators (see Common Monitoring and
Evaluation Framework as a guide) that agencies can report against. These inter-agency
MHPSS indicators can also feed into the relevant cluster chapters of the HNO and HRPs.
• Support the regular update of humanitarian information systems (such as the Displacement
Tracking Matrix) and cluster database (for example, ActivityInfo) as far as MHPSS data are
concerned.
• Draft terms of reference for consultancies on specific topics (research, training, advocacy,
policies) jointly promoted by the MHPSS inter-cluster Working Group and other relevant
clusters/AoRs (such as Health, Child Protection, Mine Action and GBV).
• Support government and private mental health institutions with technical guidance and
ad hoc capacity-building initiatives (workshops, seminars, conferences, training sessions,
internships and scholarships).
• Support relevant government bodies at the national and local levels to draft emergency
strategies, operational plans and MHPSS policies.
In addition, when IOM chairs the country-level CCCM clusters, the MHPSS managers should
touch base with the CCCM team to support the following actions:
• Train CCCM actors in PFA and basic MHPSS.
• Teach the psychosocial modules of the core CCCM training.
• Disseminate the booklet IASC, Mental Health and Psychosocial Support in Emergency
Settings: What Should Camp Coordinators and Camp Manager Actors Know? (IASC, 2014c).
• Participate in the cluster meeting to identify MHPSS needed to refer to the MHPSS Working
Group, and report requests for support and troubleshooting from MHPSS actors operating
in camps.

218
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 1 INTER-AGENCY COORDINATION

Box 3
List of members of the IASC RG on MHPSS

ACT Alliance International Medical Corps

Action Aid International International Rescue Committee
Action Contra La Faim IOM/ UN Migration Agency
Africa Psychosocial Support Institute IsraAID
Americares Jesuit Refugee Service
American Red Cross Medair
Antares Foundation Medicin du Monde (France)
Care Austria Medicine du Mondo (Spain)
CBM International Mercy Corps
Centre for the Victims of Torture MERCY Malaysia
Child Fund MHPSS.net
Church of Sweden OCHA
COOPI Oxfam GB
DIGNITY Plan International
GIZ - Gesellschaft für Internationale Red-R
Zusammenarbeit Refugee Education Trust
Global Practice Group Save the Children International
Global Psychosocial Training Institute-Cairo Terre des Hommes
Health Right International TPO Nepal
Health Works TPO Uganda
Heartland Alliance International UNFPA
Hebrew Immigrant Aid Society (HIAS) UNHCR
Humanity & Inclusion Unicef
ICVA UNRWA
IFRC and ICRC (Special status - Standing Invitees War Child Holland
to the IASC) War Trauma Foundation
INEE WHO
InterAction World Vision International
International Catholic Migration Commission

219
 ANNEX 2
ETHICAL CONSIDERATIONS

Sensitization to promote safe migration in Benin City, Nigeria. © IOM 2018

220
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 2 ETHICAL CONSIDERATIONS

Applying ethical principles to Community-Based activity, they need to have the same
MHPSS is necessary to avoid risky practices level of trust as when MHPSS specialized
and grant communities’ safety. Generally, ethical services and be referred to further MHPSS
guidelines in MHPSS respond to two principles: resources when needed.
• Non-maleficence or “do no harm”.
• Quality and effectiveness of intervention. In addition
Ethical standards for humanitarian programmes • Be careful to avoid exacerbating
are defined and enshrined in a series of marginalization/discrimination/
guidelines, which apply to MHPSS programmes stigmatization
as well, including: There are many possible ways in which
• International Federation of Red Cross exclusion can take place within a community.
(IFRC), Code of Conduct in Principles of At times, paying close attention to one
Conduct for the International Red Cross group of concern can lead to the needs of
and Red Crescent Movement and NGOs another group of concern being overlooked
in Disaster Response Programmes, 2007. or neglected, potentially making people feel
• Core Humanitarian Standard on Quality discriminated against. Marginalization can also
and Accountability in The Sphere be caused by drawing attention to survivors
Handbook, CHS, 2018. in certain circumstances, especially when their
experiences are likely to attract social stigma.
• The 6 core principles of the IASC It is therefore important to be aware of
Guidelines on MHPSS in Emergency community dynamics and power structures, and
Settings, Core Principles, IASC (2007), to aim for an approach that is inclusive while
Geneva, 2007, p. 9. In particular, when also being responsive to the needs of different
promoting a CB approach to MHPSS it is subgroups. A gender analysis can also be a
paramount that: powerful tool to identify power dynamics in a
0 The needs, best interests and resources of community. Programme methodologies may
the emergency-affected population must have to change to reach different subgroups,
be of primary consideration when planning even if the outcome is the same. Examples
and implementing interventions, not only include conducting awareness-raising sessions
the agenda of the provider or donor. at household level and at a community centres,
0 Care must be taken that all those engaged to ensure that women, persons with disabilities
in any aspect of CB MHPSS are aware or others with movement limitations outside
of the ethical prohibition against sexual of the home also have access to information.
exploitation and abuse, sexual activity One should also be mindful of inadvertently
with programme participants or any other reinforcing power imbalances or subverting
potentially exploitative “dual” relationships. existing power balances in a way that creates
See the UN website on Preventing Sexual tensions and further oppression. Therefore,
Exploitation and Abuse (PSEA) here. when providing humanitarian relief and
0 Confidentiality must be maintained. This facilitating community participation, it is critical
includes providing services in such a way to understand the local power structures and
that vulnerable groups can receive services patterns of community conflict, to work with
without being specifically identified by different subgroups and to avoid privileging
their vulnerabilities (IASC, 2019a). If a particular groups.
person of concern discloses confidential
information during a community-based

221
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 2 ETHICAL CONSIDERATIONS

• Do No Harm programmes. People of concern must also be

informed of the practicalities of what will happen
When terrible things happen in a community, during the time they receive services in an adequate
particularly following mass violence or during armed way, in order to avoid misunderstandings.
conflict, the existence and espousal of different
narratives can intensify feelings of rage and hatred. • Recognize competence
Participatory needs assessments and tools can
invite the above-mentioned feelings. In turn, these Staff must recognize the limits of their professional
narratives can marginalize those with conflicting competence and not attempt to provide services
views or those who have family members on beyond their expertise. When a staff member
the “other side”; and may be used to organize does not have the required expertise to support
retaliatory violence. It is important to be mindful a person of concern, a referral should be made to
of group composition (e.g. differences in gender, other team members with the adequate knowledge
political affiliation) and the types of questions asked. or to local MHPSS resources.
The content of discussions needs consideration as
does the most suitable time to carry out a focus • Avoid conflict of interest
group discussion, separate discussions among
MHPSS staff must keep the best interest of
specific groups (for example women only) or one
people of concern in mind. When donor visits are
on one (key informant) interviews.
organized, staff must consider the impact of the
visits and receive consent from people of concern.
• Respect traditions and promoting change
This kind of exposure can be exploitative, people of
Cultural traditions and identities are in a constant concern might feel they are obliged to give consent,
evolution. Some traditions entrench unequal power and it might be a trigger for distress. Staff must
relations, are a source of rights violations, or incite think of power dynamics they might be recreating.
social violence. As important as it is to support Steps to eliminate conflict of interest situations
existing traditional support systems, community must be in place to follow when a situation arises.
based MHPSS should also include actions that can
shed light on harmful and exclusionary practices, • Avoid grossly unethical behaviour
thereby allowing positive traditional aspects to
Behaviours such as fraud, exploitation, abuse,
develop and negative ones to be left aside (Bragin,
criminal behaviour, etc., further amplify unbalanced
2014). In the case of specific vulnerabilities, a
power dynamics. A code of conduct must be
MHPSS worker should exercise extra caution in
signed by all staff. Both staff and people of concern
identifying the most fruitful community-based
should receive information on unethical behaviour
mechanisms to activate.
and safe reporting mechanisms.
• Obtain consent This annex has been partially copied from the
document Community-Based Approaches
In the case management system, informed consent
to MHPSS Programmes: A Guidance
should always be explained and signed by the
Note and the video Restoring Livelihoods
client. In the case of minors, a parent or guardian
with Psychosocial Support by Dr. Adeyinka
must receive information and sign on their behalf.
Akinsulure-Smith. For additional information
It is important that people of concern understand
on ethical considerations within IOM MHPSS
the limits of the programme from the start;
programmes you can contact the IOM MHPSS
knowing what the organization can do and cannot
and Intercultural Communication Global Section:
do for them. This will help to avoid unrealistic
contactpss@iom.int.
expectations, distress and distrust in future

222
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

ANNEX 3
GBV CONSIDERATIONS

Support centre for survivors of GBV in Cox’s Bazar, Bangladesh. © IOM 2018
223
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

• Forced marriage
INTRODUCTION
• Denial of resources, opportunities and
Gender-based violence (GBV) is a human right services
infringement rooted in gender inequalities While inequitable power dynamics and gender
and discrimination. All GBV survivors have the inequality lie at the root of GBV, there are many
right to receive high quality, compassionate factors that can make people more or less
care and support that addresses the harmful susceptible to experiencing it. Crisis settings in
consequences of violence, including MHPSS. general contribute to exacerbated risks.
MHPSS is a key component of referral pathways While the psychological and psychosocial impact
for survivors of GBV, but the capacity to address of GBV will differ among individuals; contexts,
the issues at stake remains limited, especially in types of violence, magnitude and duration of the
remote locations and in the immediate aftermath violent acts, and negative psychological and social
of an emergency. This annex tries to describe reactions are common among GBV survivors,
how the specific needs of GBV survivors can be to varying degrees of severity. In addition, the
addressed through IOM’s MHPSS interventions consequences of a GBV incident may lead to
in a safe manner, noting that GBV survivors will other harmful consequences, like the loss of
likely require the same level of support as other socioeconomic opportunities, which can add
members of the population suffering from distress to or reinforce the psychological burden of the
and other negative psychological reactions. As survivor, in a vicious cycle.
for other groups, some GBV survivors may be in
need of specialized mental health care for needs
either pre-existing and exacerbated, or resulting WHAT MHPSS
from, their experience of GBV.
PROGRAMME MANAGERS
SHOULD DO
WHAT MHPSS
A MHPSS manager should make sure that:
PROGRAMME MANAGERS
SHOULD KNOW a) MHPSS programmes adhere to the principle
of do no harm and aim to mitigate the risk of
What is Gender Based Violence (GBV)? GBV.

GBV is defined by the IASC as “any harmful act b) MHPSS programmes are inclusive of GBV
that is perpetrated against a person’s will, and that survivors in a safe manner.
is based on socially ascribed (gender) differences c) MHPSS teams are trained in safety measures,
between males and females.” and counsellors on specific therapeutic
approaches for GBV survivors.
GBV can affect everyone, but women and girls
are disproportionately impacted by this violence.
IOM categorizes GBV into six core types of 1. MHPSS programmes contribute
harmful acts: to GBV prevention programming
• Rape through coordinating with GBV actors

• Sexual assault GBV prevention programming is to be carried

out by GBV specialists to ensure appropriate
• Physical assault approaches, activities and messaging in a given
• Psychological/emotional abuse context. MHPSS programmes should therefore

224
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

coordinate with GBV actors when present, and improve safe access. For instance, having
both within and outside of IOM, in order to an open day, in which families can join and
contribute to GBV prevention programming. observe MHPSS activities, may mitigate
rumors and facilitate women’s ability to
Risk mitigation is the process of ensuring that all participate.
crisis programming interventions:
• Many MHPSS group activities, including
• Avoid any unintended negative effects which those related to creative expression, support
may result in an increased risk of GBV groups, discussion groups and others, may
occurring (e.g. through locating services in an elicit survivors to recount their experiences
unsafe location). of GBV. It is therefore important that
• Ensure women and girls are included relevant MHPSS staff is trained in managing
in a safe and meaningful manner in all those situations, so that the survivor does
interventions. not share identifying information or anything
• Ensure that all staff knows how to safely and that could put them at risk, while respecting
ethically respond if a survivor discloses an the survivor’s right to tell their own story.
incident of GBV, to avoid further harm. In creative expression workshops, it would
be essential that staff are trained in how to
Contributing to GBV risk mitigation efforts maintain the communication metaphorical
is the responsibility of all programmes, and and avoid asking any direct questions
MHPSS managers must commit to reducing related to GBV.
the risk and safeguarding survivors from harm
• Any individual referred by an agency known
through their programming.
to focus on GBV activities should not be
Examples of GBV Risk Mitigation efforts in directly asked if they are a survivor or
MHPSS programmes: asked to ‘tell their story’ as a way to access
the programme or initiate the help path.
• Ensuring safe and accessible locations of
Information on available services should be
MHPSS activities for women, girls, men and
provided together with assitance to access
boys. This may include facilitating women
the services, if requested by the survivor.
support groups in facilities or centres that
proved to be both accessible and safe for • MHPSS staff may be requested by a survivor
women. to accompany them to a health facility or
another type of response service. If possible
• Making sure that MHPSS activities do not
and safe, agency visibility should be limited to
put women and girls at unintended risk
the maximum extent and travelling in a non-
of intimate partner or family violence.
humanitarian vehicle considered the norm,
This can be resolved by including a risk
to mitigate the associated risks to survivors.
analysis in the initial assessment to guide
programme design. Assessment questions If survivors withdraw from the MHPSS activity,
on the prevalence of GBV incidents are unlike in other cases, they should not be sought
not recommended, and safety concerns out due to risks of being identified as a survivor
relating to specific interventions (e.g. income of GBV.
generating activities) should be obtained
through proxy questions if necessary. If
negative community perceptions of women
and girls engaging in such interventions exist,
proactive measures can be taken to promote

225
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

Box 1 • Make sure that MHPSS teams are diverse

Survivor-centred approach/client- in terms of gender composition to allow
centred approach survivors to choose the gender of the MHPSS
staff member they want to interact with.
MHPSS programmes are all informed by the Survivors of GBV may feel more safe talking
logic of a client-centred approach. This means to MHPSS support staff of their same gender,
that programmes grant respectful, safe, even though that is not always the case and
confidential, non-discriminatory support that the survivor, wherever possible, should be
is centered on the client’s agency. The same given a choice.
applies to GBV programming, in which the
same approach is called survivor-centred. In • Train staff of the GBV sector (caseworkers/
practice, the survivor/client-centred approach others) in basic MHPSS, including
places the survivor/client themselves as the communication skills and tools to identify
decision maker in all issues affecting them; which cases to prioritize for referral to
it is the survivor’s or client’s choice to seek MHPSS services and to which services.
medical, legal, psychosocial or other services
available to them. The survivor/client should
never be forced to report or seek services
Box 2
when they do not want to.
MHPSS for men and boys
While men and boys can also be survivors of
2. MHPSS programmes know how to be
GBV, fear of stigmatization and social norms
inclusive of GBV survivors in a safe
around masculinity might deter them from
manner
seeking support. Following a community-
It is important to notice that MHPSS based approach, it is the responsibility of all
programmes should never target ONLY GBV MHPSS actors to be aware of such gendered
survivors or seek them out in the community realities associated with GBV and ensure that
as this can lead to retaliation or stigmatization. service provision is inclusive.
However, MHPSS programs should be able to
Various resources provide more information
respond to the needs of GBV survivors. This can
on the need for MHPSS for male survivors of
be done as follows:
GBV, like this guidance note on Responding
• Establish specific activities for women and girls to Sexual Violence Against Males and Engaging
that can lead to the referral of survivors who Men and Boys in Preventing Sexual and Gender-
disclose a GBV incident to MHPSS teams. Based Violence, this report on Caring for
• Establish trusted mechanisms that can Boys Affected by Sexual Violence, another
enable survivors to self-disclose their need report on sexual violence against men and
for specific support in relation to their GBV boys in the Syria crisis, and this guidance
experiences if they wish. on Working with Men and Boy Survivors of
Sexual and Gender-Based Violence in Forced
• Since MHPSS is included in referral pathways Displacement.
for GBV support, communicate clearly with
the GBV sector on which capacity exists in
the MHPSS programme and in the country, to
avoid misunderstandings. See box 4.

226
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

it is ultimately the survivor’s decision whether

Box 3 they seek out medical support or not. Capacity
MHPSS for LGBTQI+ and procedures to do so should not be left to
the initiative of the individual staff member but
Marginalization of LGBTQI+ people is often programmed by the managers.
reinforced during a crisis and can extend to
exclusion from humanitarian response/aid. Likewise, it is vital to train a determined number
Given the lack of awareness over their needs, of counsellors who will act as focal points for
MHPSS programmes can tend to overlook GBV referrals (Bott et al, 2004). Counsellors
the risks and violence faced by them, must trust survivors’ experiences and normalize
especially in countries or communities where and validate their reactions, validate survivors
not adhering to traditional gender norms to make their own choices, and develop an
might be punished by law or is culturally action plan based on their personal needs. They
unacceptable, making them seem invisible. might use different approaches based on the
LGBTQI+ people might be at enhanced risk training they received and the situation of the
of GBV, including practices such as corrective client. Counselling might include the activation of
rape or conversion therapy. MHPSS teams survivors’ resources, strategies to rebuild self-
must therefore consider the barriers that esteem and self-efficacy, decisional balance, and
LGBTQI+ people face in accessing services relaxation techniques as well as other positive
and ensure that their support is non- coping strategies. It must be considered that
discriminatory and follows a survivor/client- GBV survivors might have additional concerns
centred approach, that does not expose during the emergency and displacement that
them to stigma or harm. might also require counselling and additional
support. Some approaches indicated for GBV
survivors include solution-focused brief
therapy (SFBT) and the stages of change
3. MHPSS teams are trained in safety approach, which considers precontemplation,
measures, and counsellors on specific contemplation, preparation, action and
therapeutic approaches for GBV maintenance phases to support clients.
survivors. Additional measures, such as peer support, can
It is vital to train all MHPSS teams in basic safety be considered as complementary services to
measures and disclosure management methods. support the well‑being of the client.
Survivors may disclose an incident to a trusted More information on recommended steps
MHPSS staff, or during activities conducive of for counsellors is available in this manual
emotional venting or storytelling. As such, it is and report, in these Standard Operating
important that all MHPSS staff are trained on Procedures on psychosocial services provision,
how to handle a disclosure in a safe and ethical this handbook on Counselling Asylum Seeking and
manner and have up to date information on Refugee Women Victims of Gender-Based Violence,
GBV and other services available. They should and in the Inter-Agency Minimum Standards on
use the referral pathways to inform survivors GBV in Emergencies Programming publication,
of available services and seek informed consent with particularly relevant guidance from points
to refer to GBV actors. In case of rape, it 4, 5 and 7. Please see also the chapter on
is important to inform the survivor of the counselling.
importance to seek medical treatment at their
earliest possible convenience and within 72 Counselling might also be indicated for
hours, and eventually facilitate access, noting that perpetrators as a tool to reduce harm,

227
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

especially in cases of IPV, focusing on building communication skills, expression and management of
emotions, problem solving and conflict resolution skills, and sessions could provide practical tools to
support healthier relationships.
It is important to develop tailored interventions for specific population groups such as adolescent
pregnant girls if the integration into the general MHPSS programme does not provide the
participants with the needed safe space to express themselves and to go through a process that
enhances their self-awareness and self-esteem.
It should be noted that facilitating discussions related to GBV and developing any kind of GBV-related
messaging requires the expertise of GBV specialists, and MHPSS actors should seek the guidance of
GBV actors where available.

Box 4
Referral Pathways
GBV actors, as all non MHPSS actors, tend to read psychosocial support programmes as the
provision of counselling, psychotherapy, psychiatric and clinical psychological care. It is therefore
extremely important to clarify the capacity existing in the MHPSS programme in terms of level
of intervention and depth of skills, to avoid ending up in a situation where survivors in need of
focused counselling are referred to programmes that offer only recreational activities, or survivors
with supportive counselling needs are referred to psychiatrists, or individuals in need of specific
forms of care are referred to programmes where counsellors are under training and can only
provide for generic and basic counselling. Accurate information should be included in multi-
sectoral referral pathways. Addressing the lack of access to services (like focused counselling
or specialized mental health care) should always be advocated for all and GBV actors can become
powerful allies in this advocacy work.
It is the survivor’s decision to be referred to services, including MHPSS at all levels once all the
information is clearly explained in advance. Information which must be provided to the survivor
before consent can include:
• Quality of the services – if no specialists are available this should be clearly explained to
inform the survivor’s decision on seeking services
• Availability of counsellors of preferred gender choice
• Average referral waiting times
• What information will be shared and how confidentiality will be maintained
• How MHPSS teams will contact survivors referred – if calling the survivor is not a safe
option, a specific time should be agreed on prior to the individual counselling session. Never
seek out the survivor if they do not attend an appointment.
This information should be provided by MHPSS managers to the GBV actors of concern.

228
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

Box 5 GBV is rooted in cultural and social norms.

Our referral system is overwhelmed, MHPSS interventions must acknowledge gender
should we prioritize GBV survivors? norms and attitudes of one or multiple affected
groups and host communities to provide
GBV survivors should be supported in effective support. MHPSS teams working closely
a timely, safe and confidential manner. with the community may be requested to
Prioritization will need to be adapted support some harmful practices or community
from context to context depending on response mechanisms which are not in line
programming, staffing and capacity. As with inter-agency guidelines and the survivor/
mentioned, supporting only GBV survivors client-centred approach. Some examples may
may draw unwanted attention and rumors, be requests to involve elders and chiefs or to
potentially identifying and exposing to further support traditional justice mechanisms which
risk of experiencing harm. Considering the draw much attention from community members
significant mental health and psychosocial and risks identifying the survivor. As always, it is
impacts survivors face after an incident of the survivor’s choice if they wish to participate.
GBV it is recommended they are included Humanitarian agencies, however, cannot engage
in any prioritization criteria, however, or support such practices, and may only facilitate
safeguards must be put in place to protect respectful conversation.
their confidentiality and not be identified as
survivors by virtue of participating in MHPSS
activities. MEDIATION
Family and couple counselling following
CHALLENGES AND interpersonal conflict, at times referred to as
CONSIDERATIONS mediation, represents a form of support that
counsellors can offer to individuals, couples or
Ensuring a survivor/client-centred approach families. If mediation seeks to address a GBV
in community-based MHPSS incident such as intimate partner violence,
While a community-based approach is counsellors should be aware that engaging the
considered critical for MHPSS, specific safeguards perpetrator may place the survivor at even
must be employed when working with survivors further risk, such as violent retaliation, threats
of GBV. It is not advised to have community led and ostracization from family and support
interventions when supporting survivors of GBV networks. Staff members could be harmed in the
due to the particular sensitivities around GBV process also, highlighting that the risks associated
cases and the risks faced by both the survivor with mediation need to be carefully considered
and community group members when handling even when survivors specifically request
such cases, unless community members are engagement with an abusive partner. For these
formally employed and trained. reasons, GBV specialists advise against mediation
interventions with survivors and perpetrators,
GBV survivors should not be sought out in only informing survivors of available information
the community as doing so may inadvertently on mediation and transitional justice mechanisms
identify them and in turn expose them to alongside any safety or security concerns they
further harm, including possible retaliation by may reserve. This information will enable the
their perpetrators and stigmatization in the survivor to seek out community mediation
community. services themselves if they still wish to, which is
always their choice.

229
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

In some scenarios mediation may be deemed as the only option remaining for practitioners
supporting a survivor due to a lack of alternatives. For example, a lack of safe houses for survivors
of domestic violence may result in a survivor requesting MHPSS to mediate with their abuser to
improve safety. Intervening in such a case through mediation risks worsening the situation for the
survivor as the goal of mediation is to restore relational harmony, which in a case of GBV where
the survivor and perpetrator do not have equal power in the mediation process, violence could be
normalized, tolerated and perpetuated in the long term; as mediation would involve a third party,
the perpetrator could become aggravated by the public nature of the intervention and violence
could increase; and as mediation within a violent context could jeopardize the safety and neutrality
of MHPSS staff and undermine survivors’ trust in staff and GBV service provision, resulting in less
GBV survivors coming forward to receive support subsequent to an incident. In these cases, the
counsellor should decline intervening in mediation, explaining the potential risks for the client and
the institutional reasoning behind it. The counsellor should, however, make clear that individual
counselling and other forms of support are still available as before. If the client decides to withdraw
from the counselling activity as a result, the counsellor should let the client know they can resume
the counselling and/or activity at any time.

GBV Information Management

GBV Information Management is afforded special protections and procedures due to the extremely
sensitive nature of the data. When GBV incident data is gathered, how it is stored and secured, and
how and why it is shared with other actors, demands thoughtful and careful practices. While it can
be challenging to meet the expected ethical and safety standards, IOM is committed to following
international guidelines and to mainstreaming this through all programme departments, which is
particularly pertinent for MHPSS programmes who often work directly with survivors and sensitive
information. MHPSS teams working with survivors must adhere to strict data protection policies and
information-sharing protocols when supporting GBV survivors. In practice, this encompasses coded
case forms when including any specific information related to GBV incidents; omitting any identifying
information alongside storing case forms in a secure location only accessible to relevant staff.

230
 MANUAL ON COMMUNITY-BASED MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES AND DISPLACEMENT
ANNEX 3 GBV CONSIDERATIONS

FURTHER READING
CIDA and SAT
2008 Counselling Guidelines on Domestic Violence. Southern African AIDS Training (SAT)
Programme & Canadian International Development Agency CIDA.
GBV Area of Responsibility (GBV AoR)
n.d Tools and Resources for Mental Health and Psychosocial Support Services
GBVIMS
n.d GBV Information Management System (GBVIMS). Podcasts.
Hillenbrand E, N. Karim, P. Mohanraj and D. Wu
2008 Measuring gender-transformative change A review of literature and promising practices. CARE USA.
Working Paper.
IASC
2015 Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action: Reducing
risk, promoting resilience and aiding recovery. (specific chapter for Health)
International Organization for Migration (IOM)
2018 Institutional Framework for Addressing Gender-Based Violence in Crises. (GBViC Framework). IOM,
Geneva.
Medina, M., V. Petra, R. Mimoso, A. Pauncz, G. Tóth, R. Hiiemäe, N. Harwin and S. Corgrove
2008 The Power to change: How to set up and run support groups for victims and survivors domestic
violence.
Raising Voices
n.d SASA, groundbreaking community mobilization approach developed by Raising Voices for
preventing violence against women and HIV.
The United Nations Population Fund (UNFPA) and GBV Area of Responsibility (GBV AoR)
2019 The Inter-Agency Minimum Standards for Gender-Based Violence in Emergencies Programming.
(Standard 4 – Health Care for GBV Survivors and Standard 5 – Psychosocial Support)
UNFPA
2008 Engaging Men and Boys in Gender Equality and Health. A global toolkit for action. Promundo,
UNFPA and MenEngage.
For other references, see the full bibliography here.

231
MANUAL ON
COMMUNITY-BASED
MENTAL HEALTH AND
PSYCHOSOCIAL SUPPORT
IN EMERGENCIES
AND DISPLACEMENT

SECOND EDITION

© IOM 2022

Some rights reserved. This work is made available under the Creative Commons Attribution-NonCommercial-
NoDerivs 3.0 IGO License (CC BY-NC-ND 3.0 IGO).*

For further specifications please see the Copyright and Terms of Use.

This publication should not be used, published or redistributed for purposes primarily intended for or directed
towards commercial advantage or monetary compensation, with the exception of educational purposes, e.g. to
be included in textbooks.

Permissions: Requests for commercial use or further rights and licensing should be submitted to publications@
iom.int.

* https://creativecommons.org/licenses/by-nc-nd/3.0/igo/legalcode