In the tumultuous landscape of conflict, where every headline screams of violence and destruction, there exists a quieter, yet equally devastating reality—the silent struggles of those grappling with the invisible wounds of war. It is a reality that often goes unnoticed amidst the chaos, overshadowed by the urgent demands of immediate physical humanitarian relief. However, it is important to understand that impact of conflict on mental health is profound and pervasive. From the haunting echoes of trauma to the relentless grip of anxiety, the psychological scars left by war run deep, affecting individuals and communities long after the guns fall silent. In this blog post, we delve into the critical importance of mental health interventions in conflict zones, exploring the complexities and challenges of addressing this often-neglected aspect of humanitarian response.
Introducing conflict-affected communities
To begin, it is important to highlight what defines a conflict-affected community. This describes a community of people who live under the threat of violence, mobility restrictions, and other types of repression by armed groups (Drange & Binningsbø, 2019). People living through this type of repression also face specific victimizing events such as forced recruitment, forced disappearances, forced killings, displacement, torture, and sexual violence (Drange & Binningsbø, 2019). The circumstances that these communities live under serve as a breeding ground for a host of mental health issues; specifically trauma-related issues (Shoib et al., 2022). Therefore, it is crucial to take special care when conducting any humanitarian work in these communities, especially when conducting a mental health intervention. The first part of this blog will discuss important considerations to make in the planning and implementation of any intervention. The second part of the blog will highlight best practices according to the available literature.
Important considerations for planning and implementing Mental Health interventions in conflict-affected communities
In conflict-affected countries, the delivery of mental health services faces a multitude of challenges, exacerbating an already dire situation (Shoib et al., 2022). Firstly, these fragile and conflicted nations typically allocate lower than average government spending on mental health (Pedersen et al., 2015). This lack of financial investment translates into underdeveloped mental health infrastructure and a scarcity of resources. In Low- and Middle-Income Countries (LMICs) – which most conflict-affected countries are (Vestby et al., 2021) – mental health services often suffer from inequity and inefficiency even in times of peace. Thus, when conflict strikes, the situation worsens dramatically. The already limited human resources and infrastructure become further strained, unable to meet the heightened demand resulting from the psychological toll of war. Typically, in their nascent stage even before conflict erupts, many mental health facilities struggle to cope, and the availability of mental health professionals and psychiatric medications becomes severely restricted, with focus shifting to more severe mental health disorders such as Bipolar Disorders, Major Depressive Disorder and Schizophrenia Pedersen et al., 2015; Shoib et al., 2022). This leaves those affected specifically by the trauma and anxiety caused by conflict without the care that they so desperately need.
Compounding this, as conflict escalates, violence against healthcare and humanitarian workers becomes a grim reality in these zones, making it increasingly perilous to provide mental health support to those in need (Shoib et al., 2022). Furthermore, beyond the physical dangers, stigma and low mental health literacy persist as significant barriers to accessing care. Societal attitudes towards mental illness often lead to social marginalization, discouraging individuals from seeking medical assistance (Bruhn et al., 2022; Shoib et al., 2022). This reluctance is further fuelled by a pervasive mistrust of health services in conflict-affected societies, where accessing care may be perceived as an act of vulnerability or betrayal.
Best practices for conducting a Mental Health Intervention in conflict-affected communities
Thus, in such environments, the combination of limited resources, security threats, and deeply entrenched stigma creates formidable obstacles to delivering effective mental health services to those who need it most. Therefore, addressing these challenges requires not only increased financial investment but also concerted efforts to combat stigma, improve mental health literacy, and ensure the safety of healthcare providers in conflict zones. Only through holistic and sustained interventions can we hope to bridge the gap in mental health services and provide support to those struggling amidst the ravages of conflict.
In response to these challenges, mental health interventions in conflict-affected countries must encompass a multifaceted approach (Bruhn et al., 2022). Psychosocial support, training interventions, counselling, creative art therapy, and psychoeducation have emerged as crucial tools for addressing the mental health needs of women and children in such environments (Shoib et al., 2022). Advocacy for changes in psychiatry curricula, expanding public awareness initiatives, and leveraging less expensive options like remote counselling via mobile phones are essential steps towards bridging the gap in mental health services (Goodman et al., 2020; Shoib et al., 2022). Furthermore, it is imperative to prioritize person-centred care, building emotional resilience, coping skills, and fostering community-based support networks (Knaevelsrud et al., 2017). Collaboration with primary care providers, utilizing telepsychiatry, and establishing organized referral systems are also vital components of a comprehensive mental health strategy in conflict zones (Bruhn et al., 2022; Shoib et al., 2022).
References
Bruhn, M., Laugesen, H., Kromann-Larsen, M., Trevino, C. S., Eplov, L., Hjorthøj, C., & Carlsson, J. (2022). The Effect of an Integrated Care Intervention of Multidisciplinary Mental Health Treatment and Employment Services for Trauma-Affected Refugees; Study Protocol for a Randomised Controlled Trial. https://doi.org/10.21203/rs.3.rs-2035017/v1
Drange, B., & Binningsbø, H. M. (2019). Catering to Conflict-Affected Communities? The Trajectory and Relevance of Judicial and Non-Judicial Measures in Colombia. All Is Fair in Law and War: Judicial Behavior in Conflict-Affected Societie. https://www.prio.org/projects/1940
Goodman, R., Tip, L., & Cavanagh, K. (2020). There’s an app for that: Context, assumptions, possibilities and potential pitfalls in the use of digital technologies to address Refugee Mental Health. Journal of Refugee Studies, 34(2), 2252–2274. https://doi.org/10.1093/jrs/feaa082
Knaevelsrud, C., Stammel, N., & Olff, M. (2017). Traumatized refugees: Identifying needs and facing challenges for mental health care. European Journal of Psychotraumatology, 8(sup2). https://doi.org/10.1080/20008198.2017.1388103
Pedersen, D., Kienzler, H., & Guzder, J. (2015). Searching for Best Practices: A Systematic Inquiry Into the Nature of Psychosocial Interventions Aimed at Reducing the Mental Health Burden in Conflict and Postconflict SettingsSearching for best practices. SAGE Open, 5(4), 1–25. https://doi.org/10.1177/2158244015615164
Shoib, S., Javed, S., Alamrawy, R. G., Nigar, A., Das, S., Saeed, F., Handuleh, J. I. M., Shellah, D., Dazhamyar, A. R., & Chandradasa, M. (2022). Challenges in mental health and psychosocial care in conflict-affected low- and middle-income countries. Asian Journal of Psychiatry, 67, 102894. https://doi.org/10.1016/j.ajp.2021.102894
Vestby, J., Buhaug, H., & von Uexkull, N. (2021). Why do some poor countries see armed conflict while others do not? A dual sector approach. World Development, 138, 1–9. https://doi.org/10.1016/j.worlddev.2020.105273