Fragile and Conflict-affected settings (FCS) are often sites of intense adversity and stress. Wars, natural disasters, forced displacement, as well as the chronic stress of trying to make ends meet in FCS, all take their toll on the mind, body and spirit. As the impacts of such stressful experiences accumulate, they hinder an individual’s ability to engage in economic and social life. On the collective level, chronic stress makes it hard for people, families, and communities to trust one another and come together to realize common goals.
In FCS, where 1.2 billion of the world population lives, mental health issues are compounded by exposure to conflict and violence and embedded in a larger context of adversity. With the presence of conflict situations, psychiatric literature estimates an increase in disorder prevalence explained by high levels of stress that can prompt psychosocial or psychiatric disorders that were previously nonexistent or dormant. Within armed conflict situations globally, WHO estimated that approximately 10 percent of people who experience traumatic events will have serious mental health problems and another 10 percent will develop behavior that hinders daily functioning. In addition, 30-70% of people who have lived in war zones suffer from symptoms of post-traumatic stress disorder (PTSD) and depression. Violence such as targeted killings, physical maiming, and gender-based violence, often have long-term psychological effects on those who have experienced or witnessed them. These experiences, coupled with widespread insecurity, increased poverty, and a lack of basic services such as healthcare, education, water and sanitation, and housing, not only aggravate mental distress and strain psychosocial well-being, but further constrain individuals from being economically and socially productive.
The adverse impacts of stress on economic productivity and social cohesion are well-documented across diverse contexts from Uganda, Liberia, Sierra Leone to Bosnia and Herzegovina and Tajikistan. At the same time, many individuals and communities demonstrate incredible resilience, and offer strong coping mechanisms that development projects can build upon.
Given that the world’s poor are increasingly concentrated in high-violence and disaster-prone settings, addressing psychosocial needs will be critical to achieving the World Bank’s twin goals of eradicating extreme poverty and enhancing shared prosperity by 2030.
A growing body of evidence shows that including measures to improve psychosocial well-being in development projects can enhance overall project outcomes. These impacts have been demonstrated across different sectors, including microfinance, youth development, education, and post-disaster interventions. With this in mind, the World Bank Group now includes psychosocial support in over a dozen operations spanning sectors from Social Protection to Health and reintegration of ex-combatants.
INITIATIVES
Restoring Livelihoods with Psychosocial Support Initiative
Funded by the Korea Trust Fund for Economic and Peacebuilding Transitions (KTF), this initiative aims to improve effectiveness of World Bank efforts in fragile and conflict-prone situations by (i) building the capacity of development practitioners to understand trauma and psychosocial well-being and how they manifest in the projects, and (ii) piloting small-scale activities in two to three projects to further build the evidence base for trauma-sensitive operations. Activities include:
- Invisible Wounds – a conversation among development practitioners, mental health and psychosocial experts, and researchers about how we can improve effectiveness of our projects by integrating sensitivity to trauma and psychosocial well-being.
- A workshop held in 2015 in partnership with the United States Institute of Peace, which hosted a small group of researchers, clinical practitioners, program designers, and Bank experts to discuss pedagogy, create a framework of key themes, and identify critical components of the training course. This workshop had two products:
- A Bite-Size Learning Video Series on the World Bank Group’s Open Learning Campus, which introduces why and how livelihood initiatives can be designed to appropriately and ethically respond to psychosocial and mental health needs of the populations affected by trauma and economic hardship.
- A comprehensive course on trauma-sensitive design that is expected to roll out in the spring of 2016. This e-learning course aims to build the capacity of development and humanitarian practitioners to design development projects that are appropriately responsive to psychosocial and mental health needs, and in turn, contribute to improved outcomes for projects.
Youth Livelihood Program
As part of the main objectives of the Trauma-Sensitive Livelihoods initiative, a process evaluation of an integrated trauma and youth livelihood program in Freetown, Sierra Leone, is being conducted, in collaboration with Harvard University and CARITAS Freetown.
Youth in Sierra Leone have been adversely affected not only by the decade-long civil war but also the recent Ebola epidemic. Now, as Sierra Leone enters the post-Ebola period, it is even more critical to ensure that youth receive the support they need to take full advantage of livelihood opportunities. As such, this project aims to evaluate the cognitive behavioral therapy-based intervention, Youth Readiness Intervention (YRI), as a promising approach for improving employment and mental health outcomes among war-affected youth. In particular, it aims to determine if YRI enhances the efficacy of providing unconditional cash grants to at-risk youth. The potential of this intervention goes beyond improving mental distress, behavior and functioning among troubled youth, by aiming to also enhance engagement and productive use of unconditional cash grants and foster longer term employment and economic self-sufficiency.
High Level Meeting on Global Mental Health with World Bank and World Health Organization
A two-day series of events, co-hosted by the World Bank and the World Health Organization during the World Bank-International Monetary Fund Spring Meetings, aims to move mental health from the margins to the mainstream of the global development agenda. The events engaged finance ministers, multilateral and bilateral organizations, the business community, technology innovators, and civil society and emphasized the urgent investments needed in mental health services, and the expected returns in terms of health, social and economic benefits. In addition, the focus on mental health include the disaster risk management agenda to build social resilience, particularly in post-conflict and post-epidemic countries (such as Ebola-affected countries in West Africa) and the disability-inclusive development agenda. Efforts highlight opportunities for addressing priority groups such as displaced populations, refugees, women, and children.
Resources for Psychosocial Support in Fragile and Conflict-Affected Settings
Last Updated: May 09, 2016