GOAL: Supporting government and partners in strengthening health systems for better mental health of Syrian refugees and host communities in Lebanon
Lead Research Organisation:
London School of Hygiene and Tropical Medicine
Department Name: Public Health and Policy
Abstract
GOAL focuses on the challenge of supporting health systems providing for the mental health needs of people affected by protracted displacement, focusing on Lebanon. Poor mental health causes long-term suffering and disability, is a barrier to realising full potential of individuals and society, and impedes progress in achieving the SDGs. Poor mental health is often more common among protracted refugee populations than non-crisis affected populations. Effective mental health services exist, but there are major gaps in access to them, especially among refugee populations. The challenge is how to best deliver such services, including the design of health systems required to support this delivery. This is particularly challenging in protracted displacement settings which can place substantial additional pressure on already strained health systems and where an influx of international aid and actors can risk weakening national government-led responses.
GOAL is a partnership between universities, the National Mental Health Programme at the Ministry of Public Health and civil society organisations in Lebanon. It addresses the following questions in the UKRI-GCRF Protracted Displacement call: (i) what should governments at every level do in order to anticipate and efficiently manage protracted stays, reduce refugees' dependence on humanitarian aid and implement systems that facilitate refugee /IDP integration, inclusion and social wellbeing? (ii) How can health care systems for the displaced be expanded to cover areas that are usually neglected in refugee/IDP settings such as (though not limited to) treatment of chronic illnesses, disability and mental health? (iii) How does gendered access to services, economic and cultural opportunities and levels of power influence differently the experiences, opportunities and limitations of men and women?
The overall aim of GOAL to support government and partners in strengthening the ability of health systems to meet the mental health needs of refugee and host communities affected by protracted displacement, focusing on Lebanon as it is home to over one million Syrian refugees. It addresses two health system topics, governance and financing, identified as priority areas by key stakeholders in Lebanon and by external independent experts. GOAL's research is framed by the use of Transition Theory and gender is addressed as a cross-cutting issue informing all aspects of the project research. It follow a co-production approach, working closely with key stakeholders - particularly mental health service users. Quantitative and qualitative methods will be used and interdisciplinarity fostered. We also work with mental health service users to produce innovative materials (e.g. animations and augmented reality digital images) communicating the benefits of participation from people with lived experience of mental disorders in research and policy-making processes, and for advocacy and teaching. GOAL has capacity strengthening activities to provide technical training to project partners and key stakeholders, and to support institutional capacity and individual career progression.
The main immediate beneficiary will be the National Mental Health Programme at the Ministry of Public Health in Lebanon. Other beneficiaries will include key stakeholders including mental health service users, NGOs, and UN agencies, both in Lebanon and other countries responding to protracted displacement situations. The proposal responds to SDG 3 (good health and well-being) and DFID's strategic objectives of strengthening resilience and response to crises, and tackling extreme poverty and helping the world's most vulnerable.
GOAL is a partnership between universities, the National Mental Health Programme at the Ministry of Public Health and civil society organisations in Lebanon. It addresses the following questions in the UKRI-GCRF Protracted Displacement call: (i) what should governments at every level do in order to anticipate and efficiently manage protracted stays, reduce refugees' dependence on humanitarian aid and implement systems that facilitate refugee /IDP integration, inclusion and social wellbeing? (ii) How can health care systems for the displaced be expanded to cover areas that are usually neglected in refugee/IDP settings such as (though not limited to) treatment of chronic illnesses, disability and mental health? (iii) How does gendered access to services, economic and cultural opportunities and levels of power influence differently the experiences, opportunities and limitations of men and women?
The overall aim of GOAL to support government and partners in strengthening the ability of health systems to meet the mental health needs of refugee and host communities affected by protracted displacement, focusing on Lebanon as it is home to over one million Syrian refugees. It addresses two health system topics, governance and financing, identified as priority areas by key stakeholders in Lebanon and by external independent experts. GOAL's research is framed by the use of Transition Theory and gender is addressed as a cross-cutting issue informing all aspects of the project research. It follow a co-production approach, working closely with key stakeholders - particularly mental health service users. Quantitative and qualitative methods will be used and interdisciplinarity fostered. We also work with mental health service users to produce innovative materials (e.g. animations and augmented reality digital images) communicating the benefits of participation from people with lived experience of mental disorders in research and policy-making processes, and for advocacy and teaching. GOAL has capacity strengthening activities to provide technical training to project partners and key stakeholders, and to support institutional capacity and individual career progression.
The main immediate beneficiary will be the National Mental Health Programme at the Ministry of Public Health in Lebanon. Other beneficiaries will include key stakeholders including mental health service users, NGOs, and UN agencies, both in Lebanon and other countries responding to protracted displacement situations. The proposal responds to SDG 3 (good health and well-being) and DFID's strategic objectives of strengthening resilience and response to crises, and tackling extreme poverty and helping the world's most vulnerable.
Planned Impact
Poor mental health causes long-term suffering and disability and it is often more common among protracted refugee populations than non-crisis affected populations. Effective, feasible and scalable mental health services exist, but there are major gaps in access to appropriate mental health care globally, especially among forcibly displaced populations. The challenge is how to best deliver such services equitably and effectively, including the design of systems required to support this delivery. This is particularly challenging in protracted displacement settings which can place substantial additional pressure on already strained health systems as they face increasing demand for services without an increase in resources. The GOAL project seeks strengthen health system responses for the mental health needs of Syrian refugees and host population in Lebanon, focusing particularly on governance and financing as these are two key areas requiring support in Lebanon. Importantly, GOAL works closely with the government of Lebanon and key partners including mental health service users, civil society organisations, and UN agencies. The research findings and capacity strengthening activities will help strengthen mental health care provision in Lebanon to refugee and host populations, thereby improving their health, functioning and well-being. The findings and approaches used in the study will also be shared with other key stakeholders involved in mental health care in other protracted displacement settings which will support their work in improving mental health outcomes globally. The following stakeholders would be expected to be positively impacted by GOAL:
1. Individuals and communities affected by protracted displacement would benefit through improved mental health services and care which would lead to improved health and related development outcomes (e.g. economic benefits among crisis-affected individuals through improved productivity and earnings and reduced health care expenditure).
2. Government partners in Lebanon would benefit through the findings being used to support improved governance and financing arrangements for mental health in Lebanon; and the capacity strengthening activities in GOAL.
3. Universities would be positively impacted through the development of new networks and the sharing of new ideas, approaches, methods and skills; and the capacity strengthening activities included in GOAL.
4. Civil society organisations and individuals would benefit from the new networks, knowledge, and strengthened capacity.
5. Humanitarian and development funding and policy-making agencies (e.g. donor agencies and UN agencies) would benefit from the findings and guidance generated by the study.
Poor mental health is a barrier to realising full potential of individuals and society, and impedes progress in achieving the SDGs. We believe the proposal responds to SDG 3 (good health and well-being) and DFID's strategic objectives of strengthening resilience and response to crises, and tackling extreme poverty and helping the world's most vulnerable. It support's DFID's approaches of: developing and using partnerships to promote greater accountability; supporting partnerships to encourage advocacy for change; strengthening the ability of existing and new advocacy actors to enable decision makers to be held to account; improving access, supply and quality of basic services; and strengthening the response to conflict and local-level crisis to improve resilience in fragile and conflict-affected states.
The separate 'Pathways to Impact' document describes the plan to achieving this impact. This will be supported by the Theory of Change process that will guide the project in achieving impact.
1. Individuals and communities affected by protracted displacement would benefit through improved mental health services and care which would lead to improved health and related development outcomes (e.g. economic benefits among crisis-affected individuals through improved productivity and earnings and reduced health care expenditure).
2. Government partners in Lebanon would benefit through the findings being used to support improved governance and financing arrangements for mental health in Lebanon; and the capacity strengthening activities in GOAL.
3. Universities would be positively impacted through the development of new networks and the sharing of new ideas, approaches, methods and skills; and the capacity strengthening activities included in GOAL.
4. Civil society organisations and individuals would benefit from the new networks, knowledge, and strengthened capacity.
5. Humanitarian and development funding and policy-making agencies (e.g. donor agencies and UN agencies) would benefit from the findings and guidance generated by the study.
Poor mental health is a barrier to realising full potential of individuals and society, and impedes progress in achieving the SDGs. We believe the proposal responds to SDG 3 (good health and well-being) and DFID's strategic objectives of strengthening resilience and response to crises, and tackling extreme poverty and helping the world's most vulnerable. It support's DFID's approaches of: developing and using partnerships to promote greater accountability; supporting partnerships to encourage advocacy for change; strengthening the ability of existing and new advocacy actors to enable decision makers to be held to account; improving access, supply and quality of basic services; and strengthening the response to conflict and local-level crisis to improve resilience in fragile and conflict-affected states.
The separate 'Pathways to Impact' document describes the plan to achieving this impact. This will be supported by the Theory of Change process that will guide the project in achieving impact.
Publications
Chaar S
(2025)
Developing guidelines for culturally relevant informed consent: an example from Lebanon
in PLOS Mental Health
El Chammay R
(2020)
Using COVID-19 responses to help strengthen the mental health system in Lebanon.
in Psychological trauma : theory, research, practice and policy
El Masri R
(2024)
Barriers and enablers to a coordinated MHPSS response in Lebanon: A case study of the MHPSS Taskforce
in SSM - Mental Health
| Title | Animation on mental health service user participation |
| Description | This animation seeks to provide an accessible source of information to help guide mental health service users in their decision-making and rights. It will also be a useful tool to help inform mental health care providers and practitioners. It is in Arabic and English and will be of relevance in Lebanon, the region and more globally. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2025 |
| Impact | None as yet as it is has only just been released. However, we have produced a number of social media briefs and tools to support dissemination. We are also working closely with key partners (most notably the National Mental Health Programme in Lebanon) to support dissemination. |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications |
| Title | Perspectives on Mental Health: Voices from Lebanon (graphic novel) |
| Description | This was a graphic novel based on findings from our qualitative interviews. It details the experiences and challenges faced by Syrian refugees and Lebanese living with mental health conditions in Lebanon. |
| Type Of Art | Artwork |
| Year Produced | 2024 |
| Impact | The graphic novel was only released in late 2025 and so it is too early to tell any impact. However, we have produced a number of social media briefs and tools to support dissemination. We are also working closely with key partners (most notably the National Mental Health Programme in Lebanon) to support dissemination. |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications |
| Description | We present the key findings from our research, drawing on papers that have been published, are under journal review, about to be submitted to a journal. We also highlight our other outputs. These findings are organised for key work packages on health system governance, health system financing, and capacity strengthening. We have also produced findings on the use of co-production in humanitarian health research and in GOAL specifically and these are also detailed below. 1. Health System Governance Work Package: Our case-study exploring decision-making in health systems governance focused on a case study of the Mental Health and Psychosocial Support (MHPSS) Task Force in Lebanon. This has resulted in two published publications. The findings in the first case study (published in PLOS Global Public Health) highlighted the challenges of perceptions that UN agencies and international NGOs hold more decision-making power due to their access to funding and credibility and how this was shaped by structural problems within the humanitarian system. Our findings also suggest that power dynamics arising mainly from differences in seniority, relations between 'local' and 'expat' staff, and language used in meetings may affect, to varying degrees, decision-making power and members' voices. We also show how the agenda/focus of meetings, meeting format, language, and existing relationships with Taskforce leaders can influence levels of participation and decision-making in Taskforce meetings, ranging from lack of participation through being informed or consulted about decisions to decisions made in partnership. Our findings have broader implications for coordinating service delivery within the humanitarian sector, emphasising the need to reflect upon power imbalances critically and continually and to ensure a shared understanding of decision-making processes. The findings in the second case study (published in SSM Mental Health) show that the positioning of MHPSS within the humanitarian cluster system acts as a barrier to mounting an effective response, with the MHPSS Taskforce sometimes siloed rather than integrated across clusters. Coordination within the Taskforce was reported to be effective in some respects, but limited by a lack of clarity about its decision-making processes, affiliation, mandate, and inclusion of regional perspectives and key groups such as mental health services users in Lebanon. While the technical capacity of the Taskforce is strong, limited funding and staffing were seen to impact its capacity to effectively oversee the MHPSS response in Lebanon. Key recommendations from this second case study include: the need for stronger mechanisms and operating procedures for interagency and inter-sectoral collaboration on MHPSS within the humanitarian cluster system; greater clarity on the role of the Taskforce and key Taskforce actors, streamlined reporting channels and greater inclusion of diverse perspectives, particularly mental health service users; and greater financial and human resources within coordination mechanisms to support the national MHPSS response in Lebanon. Our focus on participation in health system governance was conducted through two case studies. The first case study (under journal review) explored the barriers, facilitators, and power dynamics influencing service user participation at the micro-, meso- (service), and macro- (policy) levels. Our findings reveal that participation is limited and predominantly consultative, with power imbalances including gender, socioeconomic status, stigma, and displacement status creating significant barriers. Users reported more participation in decision-making at the individual level, particularly in seeking services and treatment planning, but meaningful participation at service or governance levels was rare. Providers highlighted efforts to gather user input but often framed participation as part of routine monitoring and evaluation. Reluctance to engage formal governance structures, due to mistrust and structural and attitudinal barriers, further inhibited participation. Strategies to enhance meaningful participation include increasing awareness, capacity-building, promoting flexibility in service design, and strengthening user-led advocacy. Addressing power imbalances and promoting inclusive, user-centered approaches are essential to advancing meaningful participation in mental health systems, with valuable implications for humanitarian and crisis-affected settings globally. The second case study (under journal review) explored the establishment and experience of the first mental health service user association in Lebanon. The findings The findings highlight several critical issues: positional challenges and tokenistic behaviors that undermine meaningful SUA participation, financial and structural obstacles that threaten SUA sustainability, and the essential need for group support and collaboration between the SUA and other organizations. Additionally, the study emphasizes the importance of robust monitoring and evaluation mechanisms. These insights have implications for similar associations and policymakers in complex settings, offering guidance on fostering genuine engagement and support for SUAs. In addition, we used our research to produce a graphic novel titled 'Perspectives on Mental Health: Voices from Lebanon' which used illustrations to highlight the challenges and experienced faced by mental health service users in Lebanon. This was developed to help our research findings reach a wider audience and in a more accessible way. This is available in Arabic and English at https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications. As formative work for the empirical research on health system governance, we had also conducted a systematic review on health system governance in conflict-affected (published in the journal Health Policy and Planning in 2022). The key findings were as follows. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. Few studies provided a theoretical framework or definition for governance. In summary, the review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance. In preparation for our primary research case-studies on participation, we had also conducted a systematic review on participation by conflict-affected communities in humanitarian healthcare responses (published in the journal Migration and Health in 2020) The key findings as follows. Participation mostly involved in implementing interventions rather than framing problems or designing solutions. Most studies on community participation focused on changes in health services (access, utilisation, quality), community acceptability and awareness, and ownership and sustainability. Key barriers and facilitators to community participation included political will at national and local level, ongoing armed conflict, financial and economic factors, socio-cultural dynamics of communities, design of humanitarian responses, health system factors, and health knowledge and beliefs. The eligible studies were of mixed quality and the overall strength of evidence was weak. More generally there was limited critical engagement with concepts of participation. 2. Health System Finance Work Package: We conducted qualitative and quantitative research on mental health care financing in Lebanon. This has resulted in three papers (one published, one under second stage review, and one being drafted). The published paper explored the barriers, facilitators, and proposed solutions to MH financing and access for Lebanese populations and Syrian refugees in Lebanon. It highlights challenges in the face of ongoing multiple crises, including inequitable coverage, dependence on external humanitarian funds, and risks associated with short-term funding and their impact on sustainability of services. The built environment presents additional challenges to individuals trying to navigate, access and use existing MH services, and the social environment and service provider factors enable or hinder individuals accessing MH care. Registered Syrian refugees appear to have better financial coverage to secondary MH care than Lebanese populations. However, given the economic crisis, both populations are facing similar challenges in paying for and accessing MH care at primary health care (PHC) level. Multiple crises in Lebanon have exacerbated challenges in financing MH care, dependence on external humanitarian funds, and risks and sustainability issues associated with short-term funding. The paper highlights how urgent reforms are needed to Lebanon's health financing system, working with government and external donors to equitably and efficiently finance and scale up MH care with a focus on PHC, and to reduce inequities in MH service coverage between Lebanese and Syrian refugee populations. The second paper (under second-stage review) was in recognition that globally over 250 million children and young people require mental health support. There are also well over 40 million forcibly displaced children globally and they are at especially high risk of developing mental health problems. In refugee and complex emergency settings, host community and refugee parents must often navigate complex pathways to attain the care their children need. In this case study, we qualitatively explored Lebanese and Syrian refugee parents' experiences of seeking MH care for their children in Lebanon. In the study, parents reported that the decision to seek mental health services for their children commonly followed an acute event, encouragement by family members, or advice from health and child protection organisations. Many described how, even though stigma associated with MH is decreasing in Lebanon, it persists among some communities and creates significant barriers to accessing care, with parents often concealing their care seeking activities. Parents followed a range of pathways to access care, often encountering financial and accessibility barriers. The economic and COVID-19 crises in Lebanon have exacerbated their problems, affecting Lebanese and Syrian families alike. However, Syrian parents needed more support for their children's basic and educational needs, vital aspects of maintaining their MH and wellbeing. All parents stressed how important it was for mental health services to provide comprehensive family support, preserving parents' dignity, and building trust with both parents and children. They also recommended integrating life skills, recreational activities, and assistance with basic needs into MH services and preferred counselling and psychotherapy over medication. It was observed that Lebanon's health financing system needs urgent reform to improve MH services to host-community and refugee populations, while governmental and humanitarian stakeholders must seek to deliver cross-sectoral holistic services to children and their families, avoiding the siloed approach that focuses only on children's MH in isolation from family and social environments. The third paper in the health financing work package involved a survey of mental health service users. The survey revealed that the average annual direct medical costs per mental health service user totalled US$1,681, with significant contributions from medication and diagnostic tests. Transportation costs added $475 annually for outpatient care. Productivity losses due to absenteeism (71$)and presenteeism (62$) were substantial, with unskilled workers incurring higher indirect costs. The policy implications are: (i) resource Allocation - the findings underscore the need for increased funding for the NMHP to subsidize mental health services, particularly for uninsured populations; (ii) insurance coverage - expanding affordable insurance options could alleviate the financial burden on patients and improve access to care; (iii) infrastructure Development - strengthening primary care facilities and community mental health centers will enhance service delivery and reduce transportation costs; (iv) targeted Interventions - tailored programs for Syrian refugees and vulnerable Lebanese citizens are essential to address disparities in access and affordability. Recommendations include that: (i) the Ministry of Public Health should prioritise mental health within its health budget, leveraging these findings to advocate for international donor support; (ii) policymakers should implement strategies to reduce out-of-pocket expenses and provide sustainable funding for subsidised care; and (iii) future research should explore longitudinal impacts of mental health costs and the efficacy of policy interventions. 3. Capacity Strengthening Work Package: Our collaboration the Liverpool School of Tropical Medicine (Centre for Capacity Research) produced a successful joint assessment of the research capacity needs in the Institute of Public Health at the University of St. Josephs Beirut. Many of the recommendations have subsequently been implemented by the university. 4. Equitable Research and Co-Production: GOAL had a strong commitment to equitable research and the use of co-production in research. This involved producing a best practice guide and journal paper (published in the journal Disasters in 2023). The key findings from this work highlighted the problems with "research as usual" partnerships in humanitarian settings, specifically: the burden on communities as merely sources of data, certain forms of knowledge being valued over others, lack of reflection on the power hierarchies structuring research partnerships, top-down decision-making and lack of transparency, one-way "capacity-building", lack of mutual benefit, and rigid research processes and timeframes. The paper also identifies seven key principles of co-production that can be helpful in attempting to equalise power dynamics within research partnerships, specifically in conflict-affected and humanitarian settings and these are: tackling unequal power dynamics, challenging knowledge production hierarchies, ensuring more equitable partnerships and shared decision-making, emphasising reciprocity, promoting mutual capacity strengthening, ensuring greater reflexivity, and enabling flexible ways of interacting and working. We also conducted an additional piece of research reflecting on the experience of using co-production in GOAL. This was published as a paper and research brief. This work documented how co-production principles were embedded into GOAL, explored contextual factors influencing the collaboration, identified successes and challenges to co-production and future opportunities for research co-production. The findings highlighted a mixed understandings of co-production between team members and siloed efforts to co-produce within our partnership. Key challenges included contextual factors related to Lebanon and COVID-19, institutional power dynamics, budgets, difficulties in engaging service users and availability of stakeholders to co-produce. A number of examples of successful co-production in our project were also mapped. The study highlights the importance of ensuring shared understandings of the scope of co-production at the outset of projects and suggests the collaborative analysis processes provide a key opportunity for researchers to embed co-production principles. We also had a related paper published on the use of 'collaborative data coding' . This paper explored the value and benefit of collaborative data coding used in the GOAL project, reflecting on how coding together enabled greater inclusion, teamwork, improved analysis as well as improved future data collection. It also discussed the technical and logistical challenges faced in coding within a team and using internet-based software, including the complications involved in navigating power dynamics between researchers and coming to final decisions about codes. The paper contributes a reflexive analysis on the power dynamics and decision-making complexities involved in collaborative coding. It emphasizes the importance of investing in interpersonal relationships over time and prioritizing less-centralized decision-making within research collaborations. We have also produced an animation in Arabic and English intended to support mental health service users better understand the rights in accessing and decision-making for their mental health care. This was based on our research findings. The animation is available here: https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications. A number of social media posts and tools were used to raise awareness of the animation. We also conducted an additional piece of work on how to strengthen informed consent as this issue was raised by a number of stakeholders in Beirut. This has led a journal paper accepted for publication by PLOS Mental Health (In Press). This paper explored: what constitutes culturally relevant informed consent in the study context; and ii) use these insights to create a guideline aimed at enhancing informed consent processes for vulnerable populations involved in mental health research. The findings revealed that motivations for participation, trust-building, and timing are critical yet often overlooked aspects in informed consent processes. Language and literacy barriers, along with power imbalances, present significant challenges that can be mitigated by involving community members and trained interpreters. Trust-building, especially in long-term studies, requires sustained relationships and recognizing participants' intrinsic value. Timing and clarity in consent forms, along with concise and straightforward communication, are essential for genuine informed consent. The study also highlighted the impact of gender, nationality, and community support in research participation, underscoring the need for culturally sensitive research practices. Recommendations include using audio-visual methods and the "Teach Back Method" to enhance understanding and engagement. This research emphasizes the importance of inclusive and participant-centric approaches in informed consent processes. The collaborative development of the guideline ensured diverse perspectives, leading to a comprehensive and relevant outcome. Future research should focus on testing the guideline. As noted above, the work on culturally relevant informed consent has resulted in a best practice guide for culturally informed consent which is available here: https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications.A number of social media posts and tools were used to raise awareness of the best practice guide for culturally informed consent. |
| Exploitation Route | The published findings from our work on participation and financing have been shared with key stakeholders in Lebanon, including through the Ministry of Public Health. We are also discussing with the Ministry of Public Health the findings from the financing survey work and their policy implications. The findings from the co-production work have been disseminated through public seminars, conferences and training activities and have been used by researchers in their projects to strengthen co-production and more equitable ways of conducting research projects. The findings from the systematic reviews provide the first systematic investigation into the current evidence and so provide a strong empirical basis from improving both practice of community participation and health system governance with conflict-affected populations as well as supporting improved research on these topics. We have also produced a series of 'research briefs' summarising the key findings in accessible form and these are produced in Arabic and English (please see https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications) The outputs on informed consent (a journal paper and best-practice guide) could be extremely valuable in supporting more equitable and ethical research. We have also produced a number of 'non-academic' outputs to support patient and public awareness of the issues covered in the GOAL project. These include our graphic novel on mental health service user experience in Lebanon, and our animation to support mental health service user decision-making and rights. These are based on our interview findings and intended to support mental health service users and broader public understanding on rights and decision-making for mental health service users. These have been produced in Arabic and English and are of relevance in Lebanon, the region and more globally. Finally, we are also producing a series of social media releases to support dissemination of our outputs, particularly the graphic novel and animation. |
| Sectors | Healthcare |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal |
| Description | The GOAL project has now finished. We had received kindly a no-cost extension for GOAL to June 2024. Despite all the ongoing challenges in Lebanon due to the political and financial crises there, we achieved almost all of the intended research and capacity strengthening deliverables by the end of the project (albeit with some delays). However, dissemination plans in Lebanon were curtailed because of the Gaza war and invasion of Lebanon. We list below the key contributions in the research and capacity strengthening activities from GOAL in this last reporting year. For the Governance Work Package, the data collection been completed for all the case studies. We have had 3 additional publications from the governance work package in 2024, and three other papers are under journal review. The data analysis and write-up of further publications is ongoing (most notably related to work on collaborative governance for which three papers are planned). The GOAL project also placed a strong emphasis on co-production and we published a paper in 2024 reflecting on the use of co-production in GOAL. This follows on from a paper we published in GOAL in 2022 on the use of collaborative data coding in GOAL. We have also conducted work on trying to strengthen culturally relevant informed consent in research and this has resulted in a journal paper (currently under second stage review) and a best practice guide (available at https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications). To further support the application of our research, we are also producing a toolkit to support the establishment and implementation of mental health service user associations in other countries. For the finance work package, the qualitative study has resulted in two papers. The first was published in 2024 and the second paper is under second-stage review and so should be published shortly. The finance work package's quantitative survey on costs incurred in receiving mental health services was finally completed (after context-related delays) and the data analysed and the findings are currently being written-up (publication submission expected in May 2025). The survey findings provide important new evidence on extremely high out-of-pocket costs being incurred by mental health service users in Lebanon. The capacity strengthening activities were completed, and included the completion of research capacity strengthening needs assessment with University of St. Josephs Beirut. We have also continued to run individual training courses - focusing particularly on qualitative data analysis and write-up. We have also produced a series of dissemination products activities and activities. The products include series of research briefs in Arabic and English based upon our study findings. We have also produced a graphic novel on the experiences of mental health service users in Lebanon (available at https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications). The best practice guide for culturally informed consent and the toolkit for service user associations will also support uptake of our findings. A number of conference and workshop presentations were made by project staff. Unfortunately, we were unable to conduct our planned end-of-project dissemination workshop in Lebanon because of the war in Gaza and invasion of Lebanon. |
| First Year Of Impact | 2024 |
| Sector | Education,Healthcare |
| Impact Types | Societal Economic Policy & public services |
| Description | Co-production Workshop |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Co-production Workshop led by GOAL staff, 14th January 2021. 25+ participants Participants mainly from Lebanon, with some from UK. |
| Description | Focused training on data coding of qualitative data analysis |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Improved skills in qualitative data coding |
| Description | Focused training on qualitative research interviewing skills |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Improved capacity to collect qualitative research data |
| Description | Gender Workshop |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Gender Workshop for GOAL staff on 22nd January 2021. 25+ participants (majority from Lebanon, others from UK) |
| Description | Guidelines for culturally relevant informed consent |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Contribution to new or improved professional practice |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications |
| Description | Lecture on mental health, armed conflict and health systems |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Lecture by Professor Bayard Roberts (PI of GOAL) to students in the MSc for Public Health at the University of St. Joseph's Beirut. The topic was mental health, armed conflict and health systems. There were approximately 25 students attending and all are public heath or medical practitioners. |
| Description | Mental Health Service User Participation Toolkit |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Contribution to new or improved professional practice |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal#publications |
| Description | Mental health policies and laws in Lebanon, 11th March 2021 |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Mental health policies and laws in Lebanon, 11th March 2021, 1.5 hours, 12 participants from Lebanon and the United Kingdom |
| Description | Qualitative research methods training programme |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Qualitative research methods training programme. This was a series of qualitative research workshops with GOAL research staff from Lebanon that were facilitated by LSHTM staff. The workshops were as follows: Introduction to Qualitative Methods, 23rd February 2021, 2 hours, 9 participants. Research ethics, confidentiality, consent and data management, 23rd February 2021, 3 hours, 9 participants. Safety, safeguarding, child protection and referrals, 24th February 2021, 3 hours, 9 participants. Participant observation (part 1 - basics), 2nd March 2021, 3 hours, 6 participants Translation and transcription, 3rd March 2021, 7 participants. Participant observation (part 2 - fieldnotes and coding after homework), 5th March 2021, 3 hours, 6 participants |
| Description | Training on introduction to health financing for GOAL staff from NMHP, ABAAD, War Child and LSHTM |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Improved knowledge and capacity on health financing. |
| Description | Training on writing up qualitative data for GOAL's War Child staff |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | ABAAD |
| Organisation | ABAAD Resource Center for Gender Equality |
| Country | Lebanon |
| Sector | Charity/Non Profit |
| PI Contribution | As a key project partner, ABAAD are supporting the implementation of the GOAL research and capacity strengthening activities |
| Collaborator Contribution | As a key project partner, ABAAD are supporting the implementation of the GOAL research and capacity strengthening activities |
| Impact | None yet |
| Start Year | 2020 |
| Description | National Mental Health Programme at Ministry of Public Health in Lebanon |
| Organisation | Ministry of Public Health |
| Country | Lebanon |
| Sector | Public |
| PI Contribution | We are collaborating with staff from the National Mental Health Programme as key partners in the project. This included in the project design, proposal, implementation, outputs, dissemination and pathways to impact. |
| Collaborator Contribution | Contributions by the National Mental Health Programme have included inputting on the overall project design, proposal, specific research protocols, their implementation, outputs (e.g. papers and blogs to date), and capacity strengthening activities. |
| Impact | Please see outputs listed as part of the GOAL project |
| Start Year | 2020 |
| Description | University of Saint Josephs, Beirut |
| Organisation | Saint Joseph University |
| Country | Lebanon |
| Sector | Academic/University |
| PI Contribution | One of the main partner in the project. USJ were involved in the study design, proposal development, protocol development, research outputs, and capacity strengthening plans. |
| Collaborator Contribution | One of the main partner in the project. USJ were involved in the study design, proposal development, protocol development, research outputs, and capacity strengthening plans. |
| Impact | None yet |
| Start Year | 2020 |
| Description | War Child |
| Organisation | War Child |
| Country | Netherlands |
| Sector | Charity/Non Profit |
| PI Contribution | Key partner involved in the project (including design, implementation, outputs and capacity strengthening activities) |
| Collaborator Contribution | Key partner involved in the project (including design, implementation, outputs and capacity strengthening activities) |
| Impact | Not yet |
| Start Year | 2020 |
| Description | BLOG: COVID-19 and mental health among displaced Syrians in Lebanon |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | A blog on COVID-19 and mental health among displaced Syrians in Lebanon. Further details can be found at https://www.lshtm.ac.uk/research/centres-projects-groups/goal#news-and-blogs |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.lshtm.ac.uk/research/centres-projects-groups/goal#news-and-blogs |
| Description | Co-producing culturally responsive consent in research (blog) |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a blog written by members of the GOAL project team in liaison with the Humanitarian Practice Network at the Overseas Development Institute in London. The blog discusses some key challenges and solutions related supporting informed consent in research and opportunities for co-developing informed consent materials with research participants and local researchers. It was written in the context of a larger piece of work we are doing on co-developing more appropriate and relevant informed consent materials and guidance. The blog can be found here: https://odihpn.org/publication/co-producing-culturally-responsive-consent-in-research/ |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://odihpn.org/publication/co-producing-culturally-responsive-consent-in-research/ |
| Description | Co-production Workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Study participants or study members |
| Results and Impact | Co-production Workshop led by GOAL staff, 14th January 2021. |
| Year(s) Of Engagement Activity | 2020 |
| Description | Conference Presentation by Thurayya Zreik: 'Co-production in Global Mental Health Research: Reflections from the GOAL project in Lebanon' at CARFMS22 Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Presentation at CARFMS22 Conference: Crisis and Forced Migration: Manifestations of power in a changing world (Canadian Association for Refugee and Forced Migration Studies), November 2022. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Conference Presentation: Barriers in participation in decision-making processes related to mental health services in Lebanon' at CARFMS22 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Conference Presentation at the CARFMS22 Conference: Crisis and Forced Migration: Manifestations of power in a changing world (Canadian Association for Refugee and Forced Migration Studies), November 2022. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Conference presentation by Rozane Al Masri: 'Responding to MHPSS needs - the case of the MHPSS Taskforce in Lebanon' at CARFMS22 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Presentation for the Canadian Association for Refugee and Forced Migration Studies, November 2022. |
| Year(s) Of Engagement Activity | 2022 |
| Description | IHSA conference presentation on co-production within GOAL |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | This was a conference presentation was selected through a competitive call. It was delivered online to the International Conference hosted by the International Humanitarian Studies Association (5-7 November 2023 in Dhaka/online). The presentation was based on a case-study on the use of co-production in the GOAL project. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://conference.ihsa.info |
| Description | Power dynamics and participation within humanitarian coordination groups: A case study of the MHPSS Taskforce in Lebanon |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Third sector organisations |
| Results and Impact | This was a presentation by Thurayya Zriek on GOAL's research with the mental health service participation. It was part of a conference organised by King's College London on health care responses to the Syria crisis. |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://r4hsss.org |