Mental Health System Reform in Contexts of Humanitarian Emergencies: Toward a Theory of “Practice-Based Evidence”

Abstract

Humanitarian emergencies such as armed conflicts are increasingly perceived as opportunities to improve mental health systems in fragile states. Research has been conducted into what building blocks are required to reform mental health systems in states emerging from wars and into the barriers to reform. What is less well known is what work and activities are actually performed when mental health systems in war-affected resource-poor countries are reformed. Questions that remain unanswered are: What is it that international humanitarian aid workers and local experts do on the ground? What are the actual activities they perform in order to enable and sustain system reform? This article begins to answer these questions through ethnographic case studies of mental health system reform in Kosovo and Palestine. Based on the findings, a theory of ''practice-based evidence'' is developed. Practice-based evidence assumes that knowledge is derived from practice, rather than the other way around where practice is believed to be informed by systematic evidence. It is argued that a focus on practice rather than evidence can improving system reform processes as well as the provision of mental health care in a way that is sensitive to local contexts, structural realities, culture, and history.

Exploring the mental health and psychosocial problems of Congolese refugees living in refugee settings in Rwanda and Uganda: a rapid qualitative study

“…These indicate the sort of problems and proposed solutions participants may bring to a group psychosocial intervention, providing contextual information to situate the intervention in the lives of Congolese refugees. Some of this understanding could also have been obtained through "practice-based evidence" [54] that enters into a dynamic relationship with knowledge, practice and context. This could include for example gaining the knowledgeable insights of local researchers, the practicebased insights of stakeholders such as refugee organisations, and the contextual understanding of refugee community representatives and members.…”

Applying the national mental health policy in conflict-affected regions: towards better social inclusion (Ukrainian case)

“…All articles described emergencies, including those that result from conflict, as an opportunity to build sustainable mental health systems. The negative impact of conflict on a population's mental health and well-being draws attention and resources (De Vries and Klazinga, 2006; Epping-Jordan et al , 2015; Kienzler, 2019; Patel et al , 2011; World Health Organization, 2013). This, coupled with the degradation of existing mental health services, provides the opportunity to build mental health systems that are person-centred and in line with evidence-based global guidelines (Epping-Jordan et al , 2015; Patel et al , 2011; Ventevogel et al , 2022; World Health Organization, 2013).…”

“…In principle, the optimal mix of mental health services should ensure services in communities close to an individual's place of work and living (Thornicroft and Tansella, 2013;World Health Organization, 2007. Conflict and its consequences have led many settings and countries to move from institution-based mental health service delivery to enhanced community-based provision and a focus on prevention (Abuazza, 2013;Baignana et al, 2005;Epping-Jordan et al, 2015;Hasanovi c et al, 2006;Karam et al, 2016;Kienzler, 2019;Kucukalic et al, 2005;Maukera and Blignault, 2015;Patel et al, 2011;Sharma and Piachaud, 2011;Ventevogel et al, 2011Ventevogel et al, , 2012Ventevogel et al, , 2022World Health Organization, 2013). As the mental health infrastructure across Donetsk and Luhansk is not uniform, multiple constellations and levels of service provision should be considered (in line with the balanced care model as described by Thornicroft and Tansella, 2002).…”

Global Mental Health: Interdisciplinary challenges for a field in motion

“…The second special issue in 2016 offered further counterpoint to the public health oriented GMH approach through ethnographic accounts highlighting the cultural specificity of mental health in context (Ecks, 2016; Jain & Orr, 2016). Efforts to harness social science insights to critique and refine GMH practice have led to important edited volumes (Kohrt & Mendenhall, 2015; White, Jain, Orr, & Read, 2017) and a thematic issue of Culture, Medicine and Psychiatry (Lovell, Read & Lang, 2019) that takes the field itself as its empirical object, and analyses the history of its institutions (Henckes, 2019; Lovell, et al., 2019), its interventions as they unfold (Bemme, 2019; Kienzler, 2019; Read, 2019), and the sometimes paradoxical effects of public mental health surveillance (Béhague, 2019; Lang, 2019).…”