Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences

Abstract

Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low-and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility. Impact statementAs the global population continues to experience displacement due to conflict, disasters and other crises, addressing the mental health and psychosocial well-being of displaced communities in low-and middle-income countries (LMICs) remains a critical and ongoing concern. This review has identified 15 high-quality studies on the key factors impacting the acceptability and accessibility of mental health and psychosocial programmes targeting displaced populations in LMICs, such as stigma, gender, language, literacy and the locational reach of services. The stigma surrounding mental health remains pervasive in many societies, impeding help-seeking behaviours and reinforcing a culture of shame around psychological health. Addressing stigma requires psychoeducative approaches that respect cultural beliefs and promote mental health awareness and acceptance. Similarly, acceptability of programme components can differ by gender; thus, an assessment of gender and other sociocultural factors could be assessed during feasibility phases of programme trials to inform whether any adjustments need to be made to ensure greater equity in participation. Consideration of language and literacy barriers is also crucial for ensuring access to all programme components and optimising engagement in MHPSS services. Furthermore, the physical location of the displaced populations can hinder programme accessibility. In remote or conflict-affected regions, access to mental health and psychosocial support services may be limited, and timing and competing demands may necessitate taking a pragmatic approach to programming. Overall, understanding w...