Reducing psychological distress and depression in humanitarian emergencies: An essential role for nonspecialists

John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues’ accompanying research study on therapy for people with psychological distress in Nepal.

Humanitarian emergencies such as war, natural disasters, or pandemics profoundly disrupt the daily lives of those impacted and result in psychological distress and high risk of mental disorders. With increasing frequency of humanitarian emergencies over the past decade, including the most recent Coronavirus Disease 2019 (COVID-19) pandemic, there is immediate need for brief scalable interventions that can be readily delivered to at-risk population groups 1]. With the dearth of available mental health specialists, especially in low-resource settings susceptible to crises, natural disasters, or displacement, combined with fragmented or poor functioning health systems during emergencies, nonspecialists may be ideally positioned to deliver such programs 2]. Nonspecialists, such as community health workers or lay persons, do not have specialty training in mental healthcare; yet, these frontline providers often play an essential role in delivering primary care services in many low- and middle-income countries 3,4], and they are increasingly being recognized as critical for scaling up access to psychological treatments for mental disorders 5,6]. Further, in a humanitarian crisis, use of nonspecialists from the affected population offers key benefits, such as empowering community members and drawing upon the experience of facilitators 7].In an accompanying study in PLOS Medicine, Mark Jordans and colleagues demonstrate that community members with no prior mental health training could effectively deliver the WHO Group Problem Management Plus (Group PM+) program in a humanitarian setting in Nepal 8]. The research team conducted a cluster randomized controlled trial enrolling 72 wards and found that the 5-session Group PM+ delivered by nonspecialists contributed to reduction in psychological distress and depressive symptoms when compared to usual care. There may be opportunities to expand on these findings and further advance task sharing efforts in humanitarian settings.