Integration of psychological interventions in multi-sectoral humanitarian programmes : a systematic review

Background
Every year, millions of people are affected by humanitarian crises. With a growing population of people affected, the need for coordination and integration of services aiming to improve the effectiveness of mental health and psychosocial support also grows. In this study, we examine how psychological interventions in humanitarian settings globally have been implemented through integration into programming outside of formal healthcare delivery through multisectoral integration.

Methods
A comprehensive search of six databases and reference checking was undertaken in 2022. We included studies focusing on implementation strategies and implementation outcomes of multi-sectoral, integrated psychological interventions, with no year limits. We extracted data using the software Covidence, and used the software to manage screening and reviewing processes. All studies were critically appraised for quality and rigor using the mixed-methods appraisal tool.

Results
Eight studies were included in total. We found that interventions targeted conflict affected, displaced and disaster recovering populations. The interventions demonstrated moderate success in reducing psychological distress and enhancing disaster preparedness. We found that key implementation outcomes investigated and prioritised include acceptability, feasibility, and relevance. The studies reported on integration processes that involved task shifting primarily, with an emphasis on different formats of adaptation, partnership creation and capacity development to maximise effectiveness of integrated interventions.

Conclusion
Overall, there is little research being done to rigorously document the processes and experiences of integrating psychological interventions with non-health interventions. This could be an indication that, while multisectoral integration may be more common in practice, little research is being done or reported in this area formally. There is an urgent need for further research into integrated multi-sectoral interventions. This research should aim to understand how social, cultural, and environmental contexts in different ways, and to different degrees, affect what is acceptable and feasible to deliver and how these ultimately influence the impact of integrated interventions.