The Middle East, North Africa and Europe currently host millions of Syrian refugees who have fled violence and destruction. Many have lost their loved ones, homes and belongings and their journeys to escape the Syrian conflict have often been dangerous and full of hardship. The life of a refugee or asylum seeker brings a whole new set of challenges and uncertainties. The erosion of social support systems (family, neighbours, friends) to whom individuals can turn to in the case of emotional distress only compound this.
Not all refugees will experience serious mental health problems, but many will face serious emotional distress.(1) Research shows that conflict-affected populations suffer higher levels of mental health problems, such as post-traumatic stress disorder (PTSD) and major depression, than non-affected populations.(2) Mental health issues are often so pervasive within these populations that conventional ways of assistance (for example regular psychotherapy that is often long-term and requires specialists) are not available. Even the most robust health systems will struggle to provide sufficient care to a high influx of patients with mental health concerns. This is currently the case in all refugee-hosting countries. Across the Middle East, there is a shortage of trained specialists who can provide high quality mental health care. In Europe, there are a limited number of Arabic speaking mental health care professionals, and the methods of psychotherapy employed are often not tailored to the needs of refugees. This limits access to appropriate mental health services for this vulnerable population.
The STRENGTHS project, funded by the European Commission’s Horizon2020 programme, aims to provide and scale-up evidence-based and cost-effective mental health interventions for Syrian refugees. Fifteen universities, non-governmental organisations and international organisations based in Syria’s surrounding countries Turkey, Lebanon and Jordan (which host the majority of refugees), Egypt and in Europe (Germany, Switzerland the Netherlands and Sweden) will jointly develop the project’s research activities. These consist of a series of formative research activities, material translation and adaptions, and randomized controlled trials, in different country contexts, of mental health interventions developed by the World Health Organization (WHO).
WHO has developed a range of scalable psychological interventions for use in low resource and humanitarian settings affected by adversity. One of these is Problem Management Plus (PM+) (3, 4) which provides elements of Cognitive Behavioural Therapy (CBT) and Problem Solving Therapy (PST) to individuals and groups dealing with depression, anxiety and stress and who have limited access to specialist care. In addition, two interventions are developed: a smartphone delivered psychological therapy for adults and a programme for young adolescent Syrian refugees (EASE). These programmes are short and can be provided or supported by trained non-professional helpers. They do not target a single disorder, but a set of symptoms of common mental disorders such as anxiety, depression, and PTSD, and are based on well-tested cognitive behavioural and problem solving techniques.
Local political, regulatory and governance processes for uptake and the scaling-up of interventions, and the key contextual and system-related factors for integration will be assessed to determine the impact of these interventions on the health system and the communities involved. The five-year STRENGTHS project will lead to a better understanding of the steps needed to integrate evidence-based scalable psychological interventions which specifically address the needs of refugees and those with common mental health disorders into diverse health systems.
1. Silove D et al. The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry 2017;16:130-9.
2. Charlson FJ, et al.. Post-traumatic stress disorder and major depression in conflict-affected populations: an epidemiological model and predictor analysis. Global Mental Health 2016;3:e4.
3. World Health Organization. Problem management plus (PM+): Psychological help by paraprofessionals for adults exposed to adversity. Geneva: WHO; 2016.
4. Dawson KB, et al. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry 2015;14:354-7.