Suchergebnisse

BACKGROUND: There are ongoing methodological advances in measuring mental health in humanitarian crises. This Special Section describes numerous innovations. Here we take a practitioners view in understanding the key issues related to assessment of mental health in humanitarian contexts and how the innovations contribute to the field. MAIN BODY: In this guide for practitioners, we address the following issues: (1) clarifying the intended purpose of conducting mental health assessment in humanitarian crises: why is this information collected and for what intended purposes?; (2) determining what type of tool should be selected and the types of psychometric properties that are important for tools serving this particular purpose; (3) when a validated tool is not available, considering how qualitative and quantitative methods should be used to generate information on validity; and finally, (4) how to report on validity and its implications for interpreting information for humanitarian practitioners, governments, care providers, and other stakeholders supporting people affected by humanitarian emergencies. CONCLUSION: Ultimately, mental health assessment tools are not independent of the group with which they were designed, nor are the psychometric properties of the tools or their utility universal across purposes. Therefore, organizations and stakeholders will optimize their positive impact when choosing tools wisely, appropriately adapting and validating tools, and providing guidance on how to interpret those findings to best serve populations in need.

This paper discusses the current U.S. practices in providing refuge and complying with human rights law. In order better to understand why applications for asylum from Mexico, Central America, and the Caribbean have a far poorer success rate than those from any other region of the world, the authors explore the history of U.S. asylum legislation with a specific focus on international human rights documents. They suggest that a U.S. asylum system more concordant with human rights law could contribute to a more equitable granting of asylum status and refugee resettlement. En este ensayo se discuta las prácticas legales con respecto de los procuradores de asilo en los Estados Unidos de hoy. Al preguntar porque las aplicaciones de los procuradores de asilo del México, de la América Central, y del Caribe típicamente no tengan mucho éxito en los EEUU, los dos autores exploran la historia del sistema de inmigración de los Estados Unidos con foco especial en documentos internacionales sobre los derechos humanos. Proponen reformar ese sistema, levando las prácticas legales de los EEUU más en acuerdo con las leyes internacionales de derechos humanos para crear situaciones más iguales para todos los procuradores de asilo. Este artigo examina a política atual dos Estados Unidos em asilar refugiados e cumprir com leis internacionais de direitos humanos. Para entender melhor por que os pedidos para asilo de México, América Central, e o Caribe têm um êxito muito menor dos pedidos de qualquer outra região do mundo, os autores examinam a história da legislação estadunidense concernente asilo com um enfoque especial em documentos internacionais de direitos humanos. Os autores sugerem que um sistema de asilo nos Estados Unidos mais concordante com os leis de direitos humanos pode ajudar estabelecer a prática de albergar asilo e tratar com os refugiados de uma maneira mais eqüitativo para todas as regiões do mundo. Dans cet article il s'agit des procédés actuels aux Etats-Unis pour fournir asile aux réfugiés et pour se conformer à la loi des droits humains. Pour mieux comprendre pourquoi les demandes d'asile du Mexique, de l'Amérique Centrale et des îles Caraïbes témoignent d'un taux de succès bien inférieur à celles des autres régions du monde, les auteurs analysent l'histoire de la législation de l'asile aux Etats-Unis avec une concentration spécifique sur des documents internationaux de droits humains. Ils proposent qu'un système d'asile aux Etats-Unis plus concordant avec la loi des droits humains pourrait contribuer à une accordance plus équitable de statut d'asile et de rétablissement des réfugiés.

Abstract
Background
There are ongoing methodological advances in measuring mental health in humanitarian crises. This Special Section describes numerous innovations. Here we take a practitioner's view in understanding the key issues related to assessment of mental health in humanitarian contexts and how the innovations contribute to the field.

Main body
In this guide for practitioners, we address the following issues: (1) clarifying the intended purpose of conducting mental health assessment in humanitarian crises: why is this information collected and for what intended purposes?; (2) determining what type of tool should be selected and the types of psychometric properties that are important for tools serving this particular purpose; (3) when a validated tool is not available, considering how qualitative and quantitative methods should be used to generate information on validity; and finally, (4) how to report on validity and its implications for interpreting information for humanitarian practitioners, governments, care providers, and other stakeholders supporting people affected by humanitarian emergencies.

Conclusion
Ultimately, mental health assessment tools are not independent of the group with which they were designed, nor are the psychometric properties of the tools or their utility universal across purposes. Therefore, organizations and stakeholders will optimize their positive impact when choosing tools wisely, appropriately adapting and validating tools, and providing guidance on how to interpret those findings to best serve populations in need.

BACKGROUND: There are ongoing methodological advances in measuring mental health in humanitarian crises. This Special Section describes numerous innovations. Here we take a practitioner's view in understanding the key issues related to assessment of mental health in humanitarian contexts and how the innovations contribute to the field. MAIN BODY: In this guide for practitioners, we address the following issues: (1) clarifying the intended purpose of conducting mental health assessment in humanitarian crises: why is this information collected and for what intended purposes?; (2) determining what type of tool should be selected and the types of psychometric properties that are important for tools serving this particular purpose; (3) when a validated tool is not available, considering how qualitative and quantitative methods should be used to generate information on validity; and finally, (4) how to report on validity and its implications for interpreting information for humanitarian practitioners, governments, care providers, and other stakeholders supporting people affected by humanitarian emergencies. CONCLUSION: Ultimately, mental health assessment tools are not independent of the group with which they were designed, nor are the psychometric properties of the tools or their utility universal across purposes. Therefore, organizations and stakeholders will optimize their positive impact when choosing tools wisely, appropriately adapting and validating tools, and providing guidance on how to interpret those findings to best serve populations in need.

Chronic pain is the leading cause of years lived with disability globally. Populations in low- and middle-income countries bear a disproportionate burden of chronic pain because of greater exposure to road injuries, interpersonal and political violence, unregulated manual labor and limited access to healthcare. Lessons from the field of global mental health can provide a foundation to begin tackling the global burden of pain. These lessons include the use of task-sharing of front-line psychosocial care to non-specialized health workers; a transdiagnostic approach; use of syndemic models incorporating social determinants and co-morbidities; incorporating cultural idioms of distress, the symbolic meaning of pain, and traditional healing practices; and a person-centered approach emphasizing the embedded nature of an individual in her/his family, context and culture. The implications of this evidence for chronic pain management are manifold, for example: using transdiagnostic psychosocial interventions delivered by non-specialist, non-physician health workers as the first step; personalized medicine approaches based on good practice principles of chronic disease management; and concurrently addressing the social determinants often associated with pain syndromes. Taken together, these principles should be used to design intervention platforms that can address the burden of chronic pain, while reducing risks of over-utilization of opioid medications, globally.

Child soldiers represent a challenging population for mental health and psychosocial support (MHPSS), as we have little evidence regarding their needs or the efficacy of interventions. Despite an increasing breadth of MHPSS interventions for children affected by war, very few are supported by evidence (Jordans et al, 2009). In a recent decade-long conflict, Maoists and the government of Nepal conscripted thousands of children to serve as soldiers, sentries, spies, cooks and porters. After the war ended in 2006, we began a project incorporating research into the development of interventions for former child soldiers. Through this work, conducted with Transcultural Psychosocial Organization (TPO) Nepal, we identified four key principles to guide research and intervention with child soldiers (Fig. 1). We present these principles as location-and context-specific examples of the growing effort to develop guidelines and recommendations for research and intervention in acute post-conflict settings (Inter-Agency Standing Committee, 2007; Allden et al, 2009).

In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003–2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.

Addressing mental health needs of 100,000 ethnic Nepali Bhutanese refugees relocated from Nepal is a new challenge for mental health clinicians in the receiving countries. A limitation of current services is the lack of knowledge about cultural understandings of mental health. Ethnopsychology is the study of emotions, suffering, the self, and social relationships from a cultural perspective. Nepali ethnopsychology can be used to develop and adapt mental health interventions for refugees. We discuss applying ethnopsychology to provide safe and effective mental healthcare for Bhutanese refugees, including cultural adaptation of cognitive behavior therapy, interpersonal therapy, and dialectical behavior therapy. Psychological interventions are proposed for the high rates of suicide among Bhutanese refugees. The contribution of ethnopsychology to applied anthropology and the growing field of neuroanthropology are discussed.

Abstract
Background
Humanitarian crises, such as armed conflict, forced displacement, natural disasters, and major disease outbreaks, take a staggering toll on human health, especially in low-resource settings. Yet there is a dearth of robust evidence to inform the governments, non-governmental organizations (NGOs), and other humanitarian organizations on how to best respond to them. The Fogarty International Center of the U.S. National Institutes of Health commissioned a collection of Research in Practice articles that highlights the experiences of scientists conducting research in the context of humanitarian crises. Unlike traditional research papers, the case analyses in this collection go beyond what research was completed and focus on why the research was important and how it was conducted in these extremely challenging settings.

Discussion
The papers selected for this collection span 27 countries, cover a broad range of humanitarian crises, and discuss a wide variety of disease and health risk factors. Of the 23 papers in the collection, 17 include an author from the affected country and five papers were authored by humanitarian NGOs. Throughout the collection, 43% of the authors were from low- and middle-income countries.
Across the collection, some general themes emerged that are broadly applicable. Importantly, there is a clear need for more, high-quality research to address evidence gaps. Community engagement, already a key element to global health research, was highlighted as especially important for research involving populations dealing with severe trauma and disruption. Partnership with humanitarian actors, including local governments, local and international NGOs, and UN agencies, was found to be a critical strategy as well.

Conclusion
A variety of audiences will find this collection useful. Global health educators can utilize papers to facilitate discussion around public health practice and equitable partnerships, among other topics. Humanitarian response organizations may use the collection to consider how research may inform and improve their work. Global health researchers, funders, and other stakeholders may use the collection to stimulate dialogue around key scientific research questions and better appreciate the importance of conducting research in humanitarian crises in the context of achieving broader global health goals.