A Public Health Approach to Address the Mental Health Burden of Youth

In Situations of Political Violence and Humanitarian Emergencies

De Jong, JTVM., Berckmoes LH., Kohrt, BA et al (2015). A Public Health Approach to Address the Mental Health Burden of Youth in situations of Political Violence and Humanitarian Emergencies. Curr Psychiatry Rep 17:60.

Kohrt, BA., Jordans, MJD., Koirala, S. et al (2014). Designing Mental Health Interventions Informed by Child Development and Human Biology Theory: A Social Ecology Intervention for Child Soldiers in Nepal. American Journal of Human Biology 27, 27-40.

Political violence, including war and armed conflict, impacts adversely upon the mental health of a substantial proportion of children and youth who experience it. A number of papers on our psychosocial page have addressed the issue of what type of psychosocial interventions are most useful in such situations, particularly in Lower and Middle Income Countries (LMIC). (See http://www.child-soldiers.org/psychosocial.php).

In this edition we present two recent papers that, while focussing on this issue, take a systemic perspective. Each presents a broadly based ecological model of intervention incorporating contributions from a range of disciplines, including human biology, developmental psychology and social ecology. Each model rests upon a fundamental assumption – that individual well-being is heavily influenced, for better or for worse, by the social, political and economic context in which individuals affected by violence live.

The population-wide mental health model espoused by Kohrt, Jordans and colleagues derives from, and is illustrated by, their psychosocial intervention with Nepalese former child soldiers. The on-the-ground evolution of this programme was guided by the authors’ accompanying research into the psychosocial outcomes of programme recipients. This indicated that differences between local communities in their social, religious, economic and political make-up had the potential to exert substantial positive or negative influences upon recipients’ mental health outcomes. Reviewing the resulting variability in individual outcomes leads the authors to suggest that, if they are to be successful, interventions for former child-soldiers need to be embedded within their local communities. In their own programme, this had been achieved by training and supporting locally identified key stakeholders to deliver aspects of the intervention. The result was a flexible programme able to take account of both local community characteristics and former child soldiers’ particular circumstances and experiences. The authors identify and discuss four key systemic principles that drove the successful delivery of their intervention - and that are generalisable to the development of other mental health programmes in similar situations. Namely: life history theory and tradeoffs; redundancy and plurality of pathways; cascades and multiplier effects; feedback processes and proximate effects.

De Jong and colleagues focus on the unmet mental health needs of youth in situations of political violence, especially in LMIC. In such contexts there is a lack of access to mental health services, an unequal geographic distribution of services, an absence of trained mental health workers and a limited evidence-base as to which type of interventions are effective locally. To address these problems, the authors propose a public health service model based on the principles of equity, feasibility and a balance between prevention and treatment. There would be a number of benefits of the suggested service. These include: a comprehensive community based and prevention-oriented intervention service; systematic collaboration between a variety of sectors such as health and education and the local assessment of actual, rather than presumed, health needs. The authors discuss the importance of systemic support for long term financial sustainability and also the need to assess which interventions are effective in situations of ongoing adversity. Together, these two papers provide much food for thought for practitioners in the field.

Dr Linda Dowdney
Editor, Psychosocial content for Child Soldiers International

June 2016

Download this report here.