Strategies to improve access to mental health and psychosocial support among displaced populations in Ethiopia

Abstract

Background: In 2021, more than 23 million people were in need of humanitarian assistance in Ethiopia, including four million internally displaced persons and returnees. Displaced populations face an elevated risk of mental health and psychosocial problems, yet they often have limited access to mental health and psychosocial support. Objective: This study aimed to assess: 1) the mental health and psychosocial needs and resources among displaced persons in Ethiopia; and 2) examine barriers, and facilitators, and identify strategies to improve access to culturally appropriate mental health and psychosocial support in this population and context. Methods: We conducted a sequential mixed-methods assessment of mental health and psychosocial needs and resources. First, we conducted 16 key informant interviews with those who had experience and knowledge regarding the mental health situation of displaced persons in Ethiopia, including mental health providers and humanitarian practitioners. Second, we conducted an assessment of available mental health services in 15 internally displaced persons (IDP) sites in Ethiopia along with 28 key informant interviews in this context to explore some of the challenges and strategies to improving access to mental health and psychosocial support. Results: Access to mental health services was limited in IDP sites. Participants identified numerous barriers to accessing services that ranged from limited supply and fragmentation of existing mental health services to an incongruence between formal mental health services and explanatory models of mental illness. Strategies to address these barriers included engagement of community members and key stakeholders (e.g., traditional and religious healers), improving mental health literacy, strengthening referral systems and mental health capacity, and improving coordination and integration of mental health within the national health system. Conclusion: This study highlights several challenges and opportunities for improving access to mental health and psychosocial support among displaced persons in Ethiopia. Efforts to bridge gaps in access to mental health and psychosocial support must consider both systems-level factors that influence availability as well as community factors influencing perceptions and acceptability of services within this context.