A System Innovation Perspective on the Potential for Scaling Up New Psychological Interventions for Refugees

In recent years, a range of brief protocolised psychological interventions like Problem Management Plus have been developed. Such “scalable psychological interventions” are meant to be delivered by nonspecialists which can greatly increase access to psychological therapies for people affected by adversity, including forced displacement.

However, embedding new interventions into mainstream practices is challenging. Novel interventions can remain in the research phase for a long time or stop altogether, which minimises their intended impact and reach. In this conceptual paper we propose a “system innovation perspective” on scaling up new psychological interventions for refugees and argue that existing mental health systems often need to change to integrate new interventions in a sustainable way. We present a conceptual framework, which includes ideas on cycles of deepening (learning by doing), broadening (repeating and linking), and scaling up (embedding) and the multilevel and constellation perspective.

This framework has been operationalised in our scalability research as part of the STRENGTHS study in which we increase our understanding of the opportunities for scaling up four new psychological interventions in eight countries hosting Syrian refugees, including in Europe (Germany, Netherlands, Sweden and Switzerland) and the Middle East (Egypt, Jordan, Turkey and Lebanon).