Does one size fit all?A retrospective analysis of 18 individual-focused non-specialised
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Does one size fit all? A retrospective analysis of 18 individual-focused non-specialised counselling programmes in humanitarian contexts Leslie Shanks 1 , Cono Ariti 2 , Ruby Siddiqui 3 , Giovanni Pintaldi 1 , Sarah Venis 3 , Kaz de Jong 1 , Marise Denault 1 1 Médecins Sans Frontières (MSF), Amsterdam, Netherlands; 2 London School of Hygiene and Tropical Medicine, London, UK; 3 MSF, London, UK Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differ across contexts. MSF-Operational Centre Amsterdam provides individual counselling interventions as part of its medical programmes in contexts affected by conflict and violence. Individual and group counselling and community activities are integrated into basic health care. We aimed to determine: •Who accessed MSF counselling services and why •Individual and programmatic risk factors for poor outcomes MSF-OCA Mental Health Programmes 2009 (Red Areas : Administrative level containing MSF project. Green Areas : Wider administrative level) •Within the limits of the outcome measures used, the analysis confirms that for patients treated by individual counselling in 2009, the intervention was effective •Regardless of whether the outcome measure was self scored or counsellor scored, over 90% of individuals who returned for follow-up showed improvement or resolution of their complaints •Positive outcomes were more likely 1) the more sessions received, 2) in conflict and unstable settings and 3) when the presenting problem was not a major psychiatric disorder BACKGROUND METHODS RESULTS CONCLUSIONS •We did a retrospective analysis of data from 18 mental health projects run by MSF in 2009 in 8 countries •Outcome measures were client rating scores for complaint severity and functioning and counsellor assessment •Data were analyzed using Stata/IC 11.1 for Windows, using multiple regression analysis with change in complaint rating as the dependent variable LIMITATIONS •Data quality varied between projects •Intervention approaches were standardized but counsellors or Mental Health Officers could have modified them •High number of single sessions (45%) resulted in exclusion of a substantial subset of records from the outcome analysis •The rating score itself is not a standardized tool •No control group—so patients may have improved naturally over time RECOMMENDATIONS • Pay attention to access for male clients • Focus on appropriate psychiatric care • Adapt approach in settings of social violence or in post-conflict settings • Increase the number of patients receiving multiple sessions • Use of scales as a tool needs to be validated as well as the intervention model • Excluding women-focused projects, 66.8% of patients were women. • Complaint rating scores improved by a mean of 4.7 points (SD 2.36, p<0.001). • Functional rating scores improved by a mean of 4.2 points (SD 2.33, p<0.001). • In multiple regression analysis factors associated with poor outcomes were: Having a serious mental health condition (p=0.003) Attending few sessions (p<0.001) Living in a stable setting or one with high level of societal violence (p<0.001) A busy (p<0.001) or recently opened project (p=0.003) Main presenting complaint Precipitating event Average number of sessions per project Focus of intervention 0% 5% 10% 15% 20% 25% 30% 35% 40% Other serious mental health conditions Other Mood-related Loss/mourning Physical complaints Family-related Behaviour-related Anxiety-related 0 2 4 6 8 10 12 Boguila, CAR Sucre Bolivar, Colombia Uraba, Colombia Kupwara, India Norte de Santander, Colombia Lae, PNG Tari, PNG Srinagar, India Manipur, India Chaman, Pakistan Baghdad, Iraq Mweso, DRC Dubie, DRC Quetta, Pakistan Inguchetia, Russia Chechnya, Russia Shamwana, DRC Kitchanga, DRC 0% 5% 10% 15% 20% 25% 30% 35% 40% Physical violence (intentional) Intentional abuse in detention Displacement, migration and related problems Deprivation or discrimination Witnessing, hearing about abuse, injury or death Sexual abuse or trauma Psychological violence Domestic discord or violence Conflict and violence Other precipitating events (including non- violence related) 0% 5% 10% 15% 20% 25% 30% 35% 40% Overwhelming feelings Trauma-related symptoms Lack of skills Practical problems Inner problems Psychiatric support treatment
description
Leslie Shanks, Cono Ariti, Ruby Siddiqui, Giovanni Pintaldi, Sarah Venis, Kaz de Jong and Marise Denault
Transcript of Does one size fit all?A retrospective analysis of 18 individual-focused non-specialised
Does one size fit all? A retrospective analysis of 18 individual-focused non-specialised counselling programmes in humanitarian contexts
Leslie Shanks1, Cono Ariti2, Ruby Siddiqui3, Giovanni Pintaldi1, Sarah Venis3, Kaz de Jong1, Marise Denault1
1Médecins Sans Frontières (MSF), Amsterdam, Netherlands; 2London School of Hygiene and Tropical Medicine, London, UK; 3 MSF, London, UK
Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differ across contexts. MSF-Operational Centre Amsterdam provides individual counselling interventions as part of its medical programmes in contexts affected by conflict and violence. Individual and group counselling and community activities are integrated into basic health care. We aimed to determine: •Who accessed MSF counselling services and why •Individual and programmatic risk factors for poor outcomes MSF-OCA Mental Health Programmes 2009 (Red Areas: Administrative level containing MSF project. Green Areas: Wider administrative level)
•Within the limits of the outcome measures used, the analysis confirms that for patients treated by individual counselling in 2009, the intervention was effective •Regardless of whether the outcome measure was self scored or counsellor scored, over 90% of individuals who returned for follow-up showed improvement or resolution of their complaints •Positive outcomes were more likely 1) the more sessions received, 2) in conflict and unstable settings and 3) when the presenting problem was not a major psychiatric disorder
BACKGROUND METHODS
RESULTS
CONCLUSIONS
•We did a retrospective analysis of data from 18 mental health projects run by MSF in 2009 in 8 countries •Outcome measures were client rating scores for complaint severity and functioning and counsellor assessment •Data were analyzed using Stata/IC 11.1 for Windows, using multiple regression analysis with change in complaint rating as the dependent variable
LIMITATIONS
•Data quality varied between projects •Intervention approaches were standardized but counsellors or Mental Health Officers could have modified them •High number of single sessions (45%) resulted in exclusion of a substantial subset of records from the outcome analysis •The rating score itself is not a standardized tool •No control group—so patients may have improved naturally over time
RECOMMENDATIONS
• Pay attention to access for male clients • Focus on appropriate psychiatric care • Adapt approach in settings of social violence or in post-conflict settings • Increase the number of patients receiving multiple sessions • Use of scales as a tool needs to be validated as well as the intervention model
• Excluding women-focused projects, 66.8% of patients were women. • Complaint rating scores improved by a mean of 4.7 points (SD 2.36, p<0.001). • Functional rating scores improved by a mean of 4.2 points (SD 2.33, p<0.001). • In multiple regression analysis factors associated with poor outcomes were: Having a serious mental health condition (p=0.003) Attending few sessions (p<0.001) Living in a stable setting or one with high level of societal violence (p<0.001) A busy (p<0.001) or recently opened project (p=0.003) Main presenting complaint
Precipitating event
Average number of sessions per project
Focus of intervention
0% 5% 10% 15% 20% 25% 30% 35% 40%
Other serious mental health conditions
Other
Mood-related
Loss/mourning
Physical complaints
Family-related
Behaviour-related
Anxiety-related
0 2 4 6 8 10 12
Boguila, CAR
Sucre Bolivar, Colombia
Uraba, Colombia
Kupwara, India
Norte de Santander, Colombia
Lae, PNG
Tari, PNG
Srinagar, India
Manipur, India
Chaman, Pakistan
Baghdad, Iraq
Mweso, DRC
Dubie, DRC
Quetta, Pakistan
Inguchetia, Russia
Chechnya, Russia
Shamwana, DRC
Kitchanga, DRC
0% 5% 10% 15% 20% 25% 30% 35% 40%
Physical violence (intentional)
Intentional abuse in detention
Displacement, migration and related problems
Deprivation or discrimination
Witnessing, hearing about abuse, injury or death
Sexual abuse or trauma
Psychological violence
Domestic discord or violence
Conflict and violence
Other precipitating events (including non-violence related)
0% 5% 10% 15% 20% 25% 30% 35% 40%
Overwhelming feelings
Trauma-related symptoms
Lack of skills
Practical problems
Inner problems
Psychiatric support treatment
