War Child Holland, Amsterdam, The Netherlands.
Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
Epidemiol Psychiatr Sci. 2021 Jan 8;30:e5. doi: 10.1017/S2045796020001110.
When the Interagency Standing Committee (IASC) adopted the composite term mental health and psychosocial support (MHPSS) and published its guidelines for MHPSS in emergency settings in 2007, it aimed to build consensus and strengthen coordination among relevant humanitarian actors. The term MHPSS offered an inclusive tent by welcoming the different terminologies, explanatory models and intervention methods of diverse actors across several humanitarian sectors (e.g., health, protection, education, nutrition). Since its introduction, the term has become well-established within the global humanitarian system. However, it has also been critiqued for papering over substantive differences in the intervention priorities and conceptual frameworks that inform the wide range of interventions described as MHPSS. Our aims are to clarify those conceptual frameworks, to argue for their essential complementarity and to illustrate the perils of failing to adequately consider the causal models and theories of change that underlie our interventions.
We describe the historical backdrop against which the term MHPSS and the IASC guidelines were developed, as well as their impact on improving relations and coordination among different aid sectors. We consider the conceptual fuzziness in the field of MHPSS and the lack of clear articulation of the different conceptual frameworks that guide interventions. We describe the explanatory models and intervention approaches of two primary frameworks within MHPSS, which we label clinical and social-environmental. Using the examples of intimate partner violence and compromised parenting in humanitarian settings, we illustrate the complementarity of these two frameworks, as well as the challenges that can arise when either framework is inappropriately applied.
Clinical interventions prioritise the role of intrapersonal variables, biological and/or psychological, as mediators of change in the treatment of distress. Social-environmental interventions emphasise the role of social determinants of distress and target factors in the social and material environments in order to lower distress and increase resilience in the face of adversity. Both approaches play a critical role in humanitarian settings; however, the rationale for adopting one or the other approach is commonly insufficiently articulated and should be based on a thorough assessment of causal processes at multiple levels of the social ecology.
Greater attention to the 'why' of our intervention choices and more explicit articulation of the causal models and theories of change that underlie those decisions (i.e., the 'how'), may strengthen intervention effects and minimise the risk of applying the inappropriate framework and actions to a particular problem.
当机构间常设委员会（IASC）采用“心理健康和社会心理支持（MHPSS）”这一综合术语，并于 2007 年发布其在紧急情况下 MHPSS 的指导方针时，旨在建立共识并加强相关人道主义行为者之间的协调。该术语通过欢迎不同人道主义部门（例如卫生、保护、教育、营养）的不同行为者的不同术语、解释模型和干预方法，提供了一个包容性的框架。自推出以来，该术语已在全球人道主义系统中得到广泛认可。然而，它也因掩盖了告知广泛的 MHPSS 干预措施的干预优先事项和概念框架之间的实质性差异而受到批评。我们的目的是澄清这些概念框架，论证它们的基本互补性，并说明未能充分考虑我们干预措施所依据的因果模型和变革理论的危险。
我们描述了 MHPSS 术语和 IASC 指南制定的历史背景，以及它们对改善不同援助部门之间的关系和协调的影响。我们考虑了 MHPSS 领域的概念模糊性以及指导干预措施的不同概念框架缺乏明确表述的问题。我们描述了 MHPSS 内两个主要框架的解释模型和干预方法，我们将其标记为临床和社会环境。使用人道主义环境中亲密伴侣暴力和育儿能力受损的例子，我们说明了这两个框架的互补性，以及当任何一个框架不恰当地应用时可能出现的挑战。
临床干预侧重于个体变量、生物和/或心理因素在治疗痛苦中的中介作用，以改变治疗效果。社会环境干预强调痛苦的社会决定因素和目标因素在社会和物质环境中的作用，以降低痛苦并在逆境中提高韧性。这两种方法在人道主义环境中都发挥着至关重要的作用；然而，采用一种或另一种方法的理由通常没有得到充分阐述，应该基于对社会生态系统多个层面因果过程的全面评估。
更多地关注我们干预选择的“为什么”，并更明确地阐明这些决策所依据的因果模型和变革理论（即“如何”），可能会增强干预效果，并最大程度地降低将不适当的框架和行动应用于特定问题的风险。
