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 Sch of Hygiene and Trop 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.

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.

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