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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 20 | Issue 1
Page Nos. 1-135

Online since Tuesday, May 31, 2022

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EDITORIAL  

Exploring current responses to the climate crisis in MHPSS interventions in humanitarian settings p. 1
Wendy Ager, Lennart Reifels, Jura Augustinavicius, Lena Pschiuk
DOI:10.4103/intv.intv_3_22  
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ARTICLES Top

Trafficking and exploitation of children in fragile environments: Is prevention possible? p. 5
Ajwang' Warria
DOI:10.4103/INTV.INTV_1_21  
Children's vulnerability increases and child protection systems are weakened in fragile states due to fragmentation of services and severe resource gaps. In the pursuit to identify and recommend preventative interventions, this study presents the multifaceted and transnational connections between, and mechanisms behind, child exploitation and trafficking and fragile states. The causes of exploitation in fragile contexts are best understood using the socioecological approach. Within this approach, protective factors such as school and parents can be risks in certain circumstances. Thus, in developing prevention interventions, both protective and risk factors should be assessed and analysed together. In addition, findings of this study show that effective responses to child exploitation and trafficking in fragile environments can be ideally found within these environments. In conclusion, acts ofchild exploitation and trafficking in fragile states are not always random, but they can be predicted. If they can be predicted, then they can be prevented.
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Violence and traumatic exposures among islamic high school students in thailand's subnational conflict p. 14
Mahsoom Sateemae, Tarik Abdel-Monem, Suhaimee Sateemae, Abdullah Uma, Denise Bulling
DOI:10.4103/INTV.INTV_2_21  
Since 2004, nearly 7,000 people have been killed in Thailand's subnational conflict in its southernmost provinces – one of the longest running domestic insurgencies in Southeast Asia. This study assesses exposure to conflict-related trauma among a sample of high school students (n = 419) in Islamic private schools within the conflict-affected area. Responses to the Posttraumatic Stress Disorder Check List 6-item version indicated that 18.6% of the students had symptomology consistent with probable posttraumatic stress disorder (PTSD). A survey of traumatic events specific to the conflict area was constructed, identifying the types and frequency of exposure to conflict-related traumatic events among our sample. Correlation analysis showed significant associations between exposure to trauma, with PTSD symptomology, life satisfaction, happiness and perceptions of neighbourhood security. Results of this study suggest that many youth in the region experience continuous and multiple forms of trauma that are detrimental to emotional wellbeing, heightening the need to provide protective interventions.
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The impact of persons with mental health problems on family members and their coping strategies in Afghanistan p. 28
Spozhmay Oriya, Tayeba Alekozai
DOI:10.4103/intv.intv_13_21  
Afghans are suffering from mental health problems because of 40 years of war and its consequences, and their distress is exacerbated by the lack of professional mental health services. This study is one of few to shed light on this challenging situation. It explores the experiences of families who have a family member with mental health problems and its effects on their wellbeing and coping strategies. Using qualitative methods, the research questions guided the sampling of the informants (purposive sampling), the data collection method (semi-structured interviewing) and data analysis (comparative analysis). After 60 interviews, the study achieved saturation. Findings show that living with a person with mental health problems impacted caregivers' wellbeing. In particular, living with a family member with a mental illness impacted caregivers' behaviour and practical life and caused severe stigma for the family. Caregivers tried in a variety of ways to cope with the situation. Due to the high level of distress experienced by caregivers, they need equal, though different, caring attention to their ill family members. Because of a lack of awareness related to mental illness, families feel helpless when it comes to effective coping. There is therefore a great need to pay attention to people with mental health problems and their caregivers.
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Mental health and psychosocial wellbeing in education: The case to integrate core actions and interventions into learning environments p. 36
Ashley Nemiro, Zeinab Hijazi, Ruth O'Connell, April Coetzee, Leslie Snider
DOI:10.4103/intv.intv_20_21  
Exposure to adversity, particularly in early childhood, can lead to lifelong struggles with learning and adverse physical and mental health. Mental health promotion and prevention, care services and psychosocial approaches can play an important role in mitigating these adversities and improving a range of developmental outcomes for children – including learning, relational and social skills, and health and nutrition. This study explores effective mental health and psychosocial support (MHPSS) programming integrated within education in emergencies (EiE). Core actions developed through a participatory consultation with multisectoral actors are outlined to address the common challenges and barriers associated with MHPSS programming in emergency education. Targeted approaches, resources and case studies from humanitarian settings are highlighted and provide detail on how to address planning, coordination and implementation barriers to effective MHPSS integration. This study explores the social and psychological foundations of MHPSS programming in EiE and how caregivers, teachers and communities can meaningfully participate in creating safe and healing learning environments, forming the critical safety net for children's wellbeing in situations of adversity.
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”Peace starts with peace of mind”: Study of the intersection between postconflict trauma, peacebuilding and economic development in Northern Uganda p. 46
Marian Tankink, Ben Otto, Patrick Onyango Mangen
DOI:10.4103/intv.intv_15_21  
The 21-year conflict with the Lord's Resistance Army caused terrible experiences for people in northern Uganda. After the war, people returned home but with continuing mental and interpersonal problems they have found it difficult to engage in activities that would improve their wellbeing, relationships and their community's social fabric. Disharmony on all levels appears to obstruct recovery and peaceful coexistence. This study examines an intervention implemented by TPO Uganda in northern Uganda addressing mental health challenges, conflict mediation and economic empowerment. The research consisted of 23 individual in-depth interviews and 16 focus group discussions, supported by a quantitative questionnaire completed by people who had participated in the intervention. There were strong indications that psychosocial support interventions for traumatic experiences and postconflict difficulties are essential for peacebuilding and economic development. Participants of the study were found to have considerably fewer mental complaints, better coping mechanisms to manage stress and the ability to relate in a satisfactory way with their intimate partners and family members than before the intervention. In addition, they had supportive relationships with their group members and other community members.
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FIELD REPORT Top

Drama therapy as a mental health intervention for women in the shatila refugee camp, Lebanon p. 58
Sara Sakhi, Lina Haddad Kreidie, Farah Wardani, Karima Anbar
DOI:10.4103/INTV.INTV_12_20  
Shatila camp is the largest refugee camp in Lebanon and home to many refugees needing psychological support as a result of war and postmigration stress. However, there is a severe lack of mental healthcare resources and strong social stigma towards psychological and psychiatric interventions. This field report describes four drama therapy programmes implemented by Intisar Foundation between 2018 and 2019 in Shatila camp. The first is an intensive five-phase programme that tackled trauma and improved wellbeing. The second, a follow-up, is a long-term programme aimed at providing continued community support. Approaches and techniques used in drama therapy are presented. The impact of the programmes is shown through compiled qualitative findings from over 50 interviews, focus group discussions and subsequent programme reports. The findings include emotional regulation, benefits of movement and exercise, a sense of belonging and changes within the family after the intervention. Drama therapy can be an effective psychological intervention for refugee women as it provides inclusive care and avoids stigma.
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PERSONAL REFLECTION Top

Azhee: Turning personal grief into collective action against suicide p. 65
Sabah Abdulrahman
DOI:10.4103/INTV.INTV_7_21  
Suicide is still a taboo issue in Iraqi society. Many in Iraq still feel shame in admitting that they have lost a loved one to suicide for fear of societal stigmatisation. With a lack of understanding about mental illness, it can be even more difficult for professionals to treat mental health issues properly. The cultural norms that stigmatise suicide create obstacles that discourage, or even prevent, many vulnerable people from reaching out for help. While life is full of challenges, suicide prevention is riddled with even more. Suicide prevention requires collective multisectoral intervention, but in the absence of endorsed national strategy, the interventions have been so far short-term and sporadic. Nongovernmental organisations like Azhee are not funded adequately to implement long-term, multisectoral interventions for effective suicide prevention. Different official entities collect and disseminate statistics on suicide, contradicting one another more than often. Absence of credible statistics at regional and national levels adversely affects the quality of interventions. The media in Iraq and its Kurdistan Region report irresponsibly on suicide which serves as a risk factor in relation to suicide. Another challenge is the weakness of coordination among national and international actors working in suicide prevention interventions.
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ARTICLES Top

Priorities for Mental Health and Psychosocial Support Intervention Research in the Context of the Climate Crisis: A Modified Delphi Study p. 68
Jura Augustinavicius, Viola Graef, Alessandro Massazza, Michelle Engels, Julian Eaton, Kyle Hill, Michael Ungar, Leslie Snider
DOI:10.4103/intv.intv_39_21  
The climate crisis is adversely impacting mental health and wellbeing. Research on interventions to address these impacts remains scarce, particularly in humanitarian settings. This study used a modified Delphi process to identify research priorities for mental health and psychosocial support (MHPSS) and climate crisis research, drawing on the perspectives of those with demonstrated interest, engagement, and/or expertise in MHPSS and the climate crisis. The study consisted of two online surveys. In the first survey, demographic and qualitative data were collected and analysed to generate a list of research priorities and a concept map to describe the area of climate crisis and MHPSS research. In the second survey, participants ranked and rated their agreement with priorities and provided recommendations for modification of individual priorities and the concept map. In total, 91 experts working primarily but not exclusively in MHPSS programming or practice participated in the study. Consensus was reached on 20 research priorities, and 8 top-ranked priorities were identified. Given the urgency of the climate crisis, MHPSS and climate crisis research must contribute to mitigating and adapting to the climate crisis while promoting both mental health and psychosocial wellbeing and just international development.
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Supporting adolescent mental health in humanitarian settings: To what extent do interventions consider climate change and its intersectional impacts? p. 81
Megan Devonald, Joost Vintges, Nicola Jones
DOI:10.4103/intv.intv_31_21  
Research suggests that adolescents in humanitarian settings are particularly vulnerable to mental health challenges, but there is less attention to how mental health and psychosocial support (MHPSS) in these settings considers climate-related factors. This article aims to bridge this gap by reviewing studies on the impact of MHPSS interventions in humanitarian settings for adolescents in low- and middle-income countries. Our findings indicate there is a lack of attention to climate change; none of the 25 studies identified mentioned climate change or considered it in the intervention design. Given the urgency of the climate crisis, it is vital that MHPSS interventions for adolescents in humanitarian settings are adapted to respond to climate change-related factors. We also found that the data from such studies are rarely disaggregated by sex or disability. This is vital in order to deepen our understanding of the intersectional impacts of MHPSS on adolescents.
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Assessment of perceptions of climate change and its causes and impacts on mental health and psychosocial wellbeing among a group of internally displaced persons in Iraq p. 98
Hatem Alaa Marzouk, Yasin Duman, Julie Meier, Qanea Lashkri Khudhur, Omar Alani
DOI:10.4103/intv.intv_40_21  
Extreme weather conditions across Iraq influence people's psychosocial wellbeing, particularly the wellbeing of internally displaced persons (IDPs). This research examines the perceptions of climate change, as well as its causes and impacts on the everyday lives of IDPs in Iraq, and what needs to be done to mitigate these impacts. Following a literature review, this study presents a survey developed and carried out by the International Organisation for Migration (IOM) with IDPs in Ninewa and Duhok camp settings to assess interest in climate change, the impacts of climate change on the IDP population, the observed importance of addressing climate change and what actions can be taken to mitigate such impacts. Key research findings illustrate that most IDPs (80%) have observed climate change in their lives and have been affected directly by climate change (74%). Apart from detailing these findings, the study presents the solutions suggested by the IDPs to address climate change impacts. Based on these suggestions, this study then introduces policy-relevant recommendations to enhance the psychosocial wellbeing of the IDPs across Iraq and support government authorities, national policymakers and humanitarian actors in responding to the needs of the affected population associated with the consequences of climate change.
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FIELD REPORTS Top

Addressing mental health and wellbeing in the context of climate change: Examples of interventions to inform future practice p. 107
Julian Eaton, Emeka Nwefoh, Joshua Duncan, Oumar Sangare, Yukarah Weekes, Ben Adams
DOI:10.4103/intv.intv_35_21  
Climate change is now recognised as contributing to an increasing number of emergencies globally, which are having substantial effects on mental health and wellbeing of affected populations. In this report, we give case studies of mental health and psychosocial support (MHPSS) activities linked to climate change-related emergencies in Bangladesh, Burkina Faso, Madagascar, Nigeria, Sierra Leone and Zimbabwe. The emergencies range from floods and cyclones to drought and food scarcity, often in complex humanitarian settings including conflict affected regions. A range of activities, based on the Inter-Agency Standing Committee Guidelines for MHPSS in emergency settings, are discussed, many of which also focus on inclusion of people with disabilities. These include preparedness and resilience building as well as responses such as provision of basic needs, strengthening community capacity to provide psychosocial support and mental health system strengthening. We conclude that meeting basic needs is an essential prerequisite to address mental distress, that MHPSS is an essential component of any climate change-related response, that advance preparedness and adaptation is a good investment, and that meaningful participation of people in the global South, particularly marginalised communities such as people with disabilities and the very poor, is essential for the transformative change needed in addressing climate change.
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Integration of Mental Health into Emergency Preparedness and Response Planning for the Monsoon Season in Bangladesh p. 114
Mohamed Elshazly, Olga Rebolledo, Simon Rosenbaum
DOI:10.4103/intv.intv_38_21  
The monsoon season in Bangladesh is an example of how climate-related events can have a significant impact on mental wellbeing of affected individuals and communities. In this field report, we reflect on the integration of mental health and psychosocial support (MHPSS) services into emergency preparedness efforts. The report aims to offer an understanding of the risk associated with the monsoon season on both refugees and host communities and how likely this risk could affect mental health and mental health services. The MHPSS working group in Cox's Bazar identified four major areas resulting from the impact of the monsoon season: increased incidence of mental health and psychosocial problems, relocation of individuals and families from high-risk areas to safer locations, disrupted provision of mental health and psychosocial services, and lack of self-care knowledge and practice for the humanitarian staff. To mitigate these impacts, an emergency preparedness and response plan was developed and included a wide range of activities aiming to better coordinate and scale up mental health services during the monsoon season.
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PERSONAL REFLECTIONS Top

Global mental health in the anthropocene: Opening to a planetary health paradigm shift p. 119
Davide Ziveri
DOI:10.4103/intv.intv_32_21  
Facing the urgent, unchartered and tremendous challenge of the ongoing climate crisis, social and health sciences have a pivotal role to play. Starting from an analysis of the consequences of the climate crisis narrative for mental health and psychosocial support (MHPSS), we explore different roles that the MHPSS actors could play. We show how business-as-usual does not work in the Anthropocene epoch. We argue that an inclusive critical debate on the theoretical framework, the role and the practices of MHPSS is highly needed, integrating the emerging planetary health approach. An overview on the history of the client–helper relationship and ongoing changes in a warmer planet makes the case for a paradigm shift. We conclude by calling for a reframing of MHPSS using a planetary health perspective.
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The nature photography project: A creative approach to the climate and ecological emergencies p. 123
Lynne Jones
DOI:10.4103/intv.intv_28_21  
This is a personal account of conducting a nature-based photography project with British primary school children aged 8–10 years. The purpose of the project was to give children the opportunity to engage in a positive and creative activity that would allow them to share what they cared about in the natural world around them, and discuss what they wanted to protect from the climate and ecological crises. It involved giving children cameras for a half day in an area of natural beauty and encouraging them to photograph whatever they liked. They were then asked to select one picture for exhibition and explain in their own words what the picture meant for them. They also had the opportunity to send messages to global political leaders who were attending the G7 meeting that was held in the neighbourhood, if they wished. In keeping with other research, the majority of children enjoyed the project, noticed things in nature they had never noticed before, felt that it connected them to nature and that it would be good for other children. Their stories showed how much they valued nature and recognised the need to protect it. Many also saw the connections between biodiversity, habitat loss and the climate crisis, and demanded action from politicians on all three. The project is simple to implement and is recommended for other children as a means to enhance nature connectedness, increase children's wellbeing and their wish to protect the environment.
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COMMENTARY Top

Opportunities for the Use of Brief Scalable Psychological Interventions to Support Mental Health and Wellbeing in the Context of the Climate Crisis p. 128
Alessandro Massazza, Julian Eaton, Mohamed Elshazly, Fiona Charlson, Jura L Augustinavicius
DOI:10.4103/intv.intv_30_21  
Climate change is negatively impacting mental health through multiple pathways. Research to date has largely focused on characterising the link between climate change and mental health and no mental health and psychosocial support intervention has been explicitly designed to address the mental health consequences of climate change. In this commentary, we argue that brief, scalable psychological interventions represent an opportunity to fill this gap. Brief psychological interventions have been shown to be effective in the context of disasters, armed conflict and displacement, which have all been predicted to increase because of climate change. Brief psychological interventions are also likely to be relevant in the context of chronic climate stressors including temperature and sea-level rise or droughts. Additionally, they hold the potential to be used within a prevention and promotion framework, which is likely to be relevant in the context of increasing cumulative and overlapping climate-related adversities. Finally, brief psychological interventions could address several implementation challenges resulting from global climate change and could also be integrated with other programmes, including those that support climate change adaptation and mitigation. Research is urgently needed to provide evidence for the implementation and effectiveness of brief psychological interventions in the context of climate change.
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