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July 2022

Prepared independently by EnCompass LLC: jjones@encompassworld.com

Background and Evaluation Methodology

Of the estimated 84 million people forcibly displaced worldwide,  some faced traumatic experiences, and most experienced grief, sadness, and loss.  For a significant minority, these experiences triggered or exacerbated mental health conditions.  Since 2018, the U.S. Department of State Bureau of Population, Refugees, and Migration (PRM) has funded MHPSS programs through major international organizations, as well as non-governmental and community-based organizations.

In October 2021, PRM commissioned EnCompass LLC to evaluate the Bureau’s 2018-2021 MHPSS programming.  The evaluation focused on: 1) the extent to which PRM supported programs contributed to meeting needs; 2) how PRM implementing partners (IPs) integrated the needs and perceptions of beneficiaries; 3) how the COVID-19 pandemic affected the efficacy of the IP’s MHPSS programming; and 4) adjustments to PRM’s MHPSS strategy to strengthen the Bureau’s ability to address MHPSS needs among all other persons of concern (POCs).  Between October 2021 and July 2022, the EnCompass Evaluation Team carried out portfolio and literature reviews, online consultations, an online survey, and interviews in Belgium, Switzerland, Turkey, and Bangladesh.  The key conclusions and recommendations are summarized below.

Conclusions

PRM’s IPs primarily integrated MHPSS across humanitarian sectors (e.g., health, protection, education), however, they also supported standalone programs and some POCs requiring advanced clinical care were referred to primary health care (PHC), regional, and/or national facilities.  IPs employed diverse feedback mechanisms to identify POCs’ needs and adapt program content and logistics accordingly.  MHPSS service gaps remained for persons with disabilities (PwDs), rural and/or older people, those on the move, LGBTQI+ people, and men.

COVID-19 increased service users’ and providers’ mental health concerns.  During COVID19 lockdowns, women faced increased sexual and gender-based violence and children lacked access to education. Increased isolation contributed to increased mental health concerns globally.  Providers suffered burnout and higher staff turnover. However, PRM’s flexible funding helped IPs adapt to the new demands, shifted resources to address new or expanded needs, trained POC volunteers to support MHPSS service provision, and pivoted to virtual or hybrid service provision.

Given a rapidly evolving field with high health care provider turnover and migration, secondary stress, and language and cultural differences, the existing MHPSS human resources were insufficient to address the needs and expectations at every level of service provision across diverse populations or to go to scale through national integration.

Recommendations

  • PRM’s MHPSS strategy should be updated to reflect the Bureau’s MHPSS community-based and cross-sectoral programming, COVID-19 adaptations, and expected funding modalities, outcomes, and impact.
  • PRM should encourage the IPs through its reporting requirements to develop metrics to track MHPSS programming outcomes and impact, benefit cost analyses of interventions, and specific, local strategies for accessing the hardest to reach.
  • PRM should ensure that future funding allows for ongoing self-care interventions for MHPSS professionals and volunteers to prevent provider burnout and turnover.
  • To lessen the mental health impact of future crises, health service providers and sector specialists should receive ongoing training on MHPSS interventions. Depending on context, the training should include how to provide interventions through in-person, hybrid, and virtual means.
  • Most critically, PRM should prioritize supporting IPs to address human resource requirements across all levels of MHPSS care. Such support could include the training and/or re-credentialing of: community-based volunteers, refugee psychiatrists, a new generation of MHPSS clinicians from POC communities, and PHC clinicians, including psychiatrists, clinical psychologists, and psychiatric nurses, to address humanitarian mental health needs.
  • Strengthen the human resource base to effectively respond to increased MHPSS needs and integrate refugee, internally displaced and all POC populations into host government health care and social welfare systems.

U.S. Department of State

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