Heartland Alliance International (HAI) is dedicated to providing mental health and psychosocial support (MHPSS) to individuals, families, and communities that have been exposed to conflict and displacement, political oppression, torture, and gender-based violence.
HAI provides direct MHPSS services, builds local capacity through education and training, engages in advocacy and policy work, and conducts monitoring, evaluation, and research in the Middle East and North Africa, Sub-Saharan Africa, and Latin America and the Caribbean.
Exposure to chronic stress and terrifying life events can negatively affect wellbeing and increase risk of mental health challenges. In particular, conflict and related displacement occurring in many contexts throughout the world have exacerbated mental health concerns and limited access to quality care. Research shows that rates of mental disorders often double after emergencies and crisis-affected populations report significantly higher rates of depression, anxiety, and post-traumatic stress disorder (PTSD) than the global population., In low- and middle-income countries, shortages of psychiatrists, psychologists, counselors, and social workers mean that many affected communities are unable to access appropriate treatment.,
HAI strives to address these needs, both by providing MHPSS services to communities that have been exposed to conflict or complex humanitarian emergencies, as well as building the capacity of local mental health systems through training, education, and advocacy.
Mental Health and Psychosocial Support (MHPSS): What does it mean?
The World Health Organization defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Mental health is not simply the absence of mental disorders, but an individual’s ability to flourish in his or her environment. The term psychosocial refers to the dynamic relationship between psychological aspects of our experience (that is our thoughts, emotions, and behaviors) and our wider social experience (this is, our relationships, family and community networks, social values, and cultural practices).
Mental health and psychosocial support (MHPSS): The term ‘mental health and psychosocial support’ (MHPSS) describes any type of local or outside support that aims to protect and promote psychosocial wellbeing and/or prevent or treat mental disorders for people in crisis situations.
- The “MH” in MHPSS: Mental health interventions are specialized services designed to address symptoms associated with mental health disorders. They are interventions that are implemented by specialists (i.e., psychiatrists, counselors, clinical psychologists, psychiatric nurses). Examples of mental health interventions include psychotherapy (e.g., cognitive behavioral therapy) and pharmacological management of mental health disorders.
- The “PSS” in MHPSS: Goals of psychosocial support (PSS) include identifying common reactions to stress, teaching positive coping skills, promoting a sense of competence and control over one’s life, and building social connections and community cohesion. PSS interventions include peer support and self-help groups, structured recreational and skill-building activities, and referral/linkage to services such as medical and livelihoods support. These interventions can be implemented by trained members of affected communities, primary healthcare workers, or by professional mental health workers.
HAI’s approach to MHPSS:
HAI currently has MHPSS programming in Colombia, Dominican Republic, the Democratic Republic of Congo (DRC), Nigeria, Iraq, and Lebanon. Its programs have assisted refugee and displaced populations, stateless individuals, religious and ethnic minorities, survivors of torture and other human rights violations, survivors of gender-based violence, victims of human trafficking, people with HIV/AIDs, and sexual minorities.
What makes HAI unique?
Building upon a rich history in Chicago and significant international expertise, HAI strives to:
- Prioritize the most vulnerable populations, including those that may be neglected by other actors due to their complex needs and hard to reach status – including survivors of torture, former child combatants, key populations, and LGBT individuals.
- Employ a participatory approach to elicit input from affected communities and staff at all phases of program development, implementation, and evaluation.
- Empower participants to create sustainable change in their own communities through peer-support interventions and promoting community-led advocacy.
- Utilize a multidisciplinary and multisectoral approach in which mental health and psychosocial support services are integrated with other sectors – gender, access to justice (legal), HIV/AIDs (medical) – and a trauma-informed approach is incorporated into all sectors of care.
- Prioritize development and implementation of tailored staff support programming (developed with staff input) to ensure that team members working in challenging contexts are fully supported.
Guided by these principles, HAI affects change through a multi-level approach consisting of the following components:
Direct Service Provision: HAI’s direct MHPSS services use a human rights framework, characterized by culturally-tailored and holistic services for individuals, families, and communities.
Education and Training: HAI aims to create sustainable change across the sector through collaboration with and education and training of partners, including local organizations, government actors, and academic institutions. HAI’s models embed trauma-informed care across all sectors that come into contact with vulnerable populations.
Awareness raising, advocacy, and policy work: HAI supports local communities to raise awareness about mental health needs and inequities. Through advocacy with government actors and other institutions, HAI strives to meet needs of vulnerable populations through services and policies that protect human rights and prioritize dignity of service participants.
Evidence-based practice, monitoring and evaluation, research, and knowledge dissemination: HAI’s MHPSS interventions are informed by review of existing evidence and by ongoing monitoring and evaluation to ensure continuous quality improvement. HAI strives to develop, pilot, and rigorously test interventions that are tailored to contexts and populations, and to disseminate results to strengthen MHPSS services both locally and globally.
HAI MHPSS Programming Across the Globe:
In Democratic Republic of Congo, through its Fikra Timamu project, HAI has contributed to health system strengthening by training healthcare providers within hospital settings in the identification and referral of priority mental health conditions and by engaging in advocacy related to mental health resource allocation with the Ministry of Health. Between January 2012 and June 2017, the program provided more than 9,000 participants with individual and group MHPSS services.
In Iraq, in collaboration with Iraqi stakeholders, HAI contributed to the 2013 drafting and passing of a Mental Health Act, which set forth guidelines regarding the rights of persons residing in psychiatric facilities. In 2008, HAI established the Trauma Rehabilitation and Treatment Center (TRTC), the first and largest independent torture treatment program in Iraq. TRTC evolved to become an independent mental health organization called Wchan, a name meaning “rest” in Kurdish which provides MHPSS services to hundreds of individuals in Sulaymaniah each year. As part of its Convention against Torture (CAT) project, HAI recently launched a TRTC in Mosul, known as the Smile of Hope Center, which provides MHPSS services to survivors of torture and war violence and persons afflicted by war-related disabilities.
In Colombia, HAI successfully partnered with Johns Hopkins University to create ACOPLE, an effective, evidence-based, and culturally adapted MHPSS intervention. Its hallmark is the provision of psychosocial support services by trained community psychosocial agents. Since 2011, the program has provided MHPSS services to over 3000 individuals. HAI conducts research to help measure the effectiveness of these interventions and to inform improvements to meet evolving needs of participants.
To promote success across the HIV prevention-treatment cascade for Key Populations in Nigeria, HAI introduced trauma-informed mental health and psychosocial services (TI-MHPSS) into its comprehensive programming. This includes training healthcare providers in task sharing in the implementation of screening participants for psychological distress, substance abuse, and gender-based violence.
 Miller, K., Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks, Social Science & Medicine, 70(1). doi.org/10.1016/j.socscimed.2009.09.029
 Marquez, P. Mental health among displaced people and refugees: Making the case for action at The World Bank Group (Washington D.C.: World Bank, 2017), 10.
 Depression and other common mental disorders: Global health estimates. World Health Organization. Retrieved from http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/.
 Mental health services in situations of conflict, fragility and violence: What to do? (n.d.). Retrieved August 1, 2019, from World Bank Blogs website: https://blogs.worldbank.org/health/mental-health-services-situations-conflict-fragility-and-violence-what-do
 Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., … Arbuckle, M. R. (2017). Challenges and opportunities in global mental health: a Research-to-practice perspective. Current Psychiatry Reports, 19(5), 28. doi:10.1007/s11920-017-0780-z
 Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., … UnÜtzer, Jü. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553–1598. doi.org/10.1016/S0140-6736(18)31612-X
 WHO | Mental health: A state of well-being. (n.d.). Retrieved August 1, 2019, from WHO website: https://www.who.int/features/factfiles/mental_health/en/
 Inter-Agency Standing Committee (IASC) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC.
 Key Populations include: Men who have sex with men (MSM), sex workers (SW), people in prisons or other closed settings, transgender people, and people who inject drugs (PWID).