Speaking as a psychosocial practitioner-researcher, the World Bank's recent “Invisible Wounds” conference, which enabled a rich dialogue between psychologists and the Bank's economically-oriented staff, was a breath of fresh air. In most war zones, humanitarian efforts to provide mental health and psychosocial support and economic aid to vulnerable people have frequently been conducted in separate silos. Unfortunately, this division does not fit with the interacting psychosocial and economic needs seen in war zones, and it misses important opportunities for strengthening supports for vulnerable people.
A case in point comes from my work (together with Susan McKay, Angela Veale, and Miranda Worthen) on the reintegration of formerly recruited girl mothers in Sierra Leone, Liberia, and northern Uganda. These girls had been powerfully impacted by their war experiences, which included displacement, capture, sexual violence, exposure to killing and deaths, and mothering, among others. After the ceasefire, they were badly stigmatized as “rebel girls” and were distressed over their inability to meet basic needs and to be good mothers. The provision of economic aid alone would likely have had limited effects since the girls believed that they were not fit for economic activity (many saw themselves as spiritually contaminated and as having “unsteady minds”), and they were so stigmatized that people would not do business with them. Similarly, the provision of psychosocial assistance alone likely would have had limited effects because the girls desperately needed livelihoods in order to reduce their economic distress and be good mothers.
Fortunately, an action research approach enabled the girls to synthesize psychosocial and economic support elements in a contextually appropriate manner. Group discussions over a period of months provided peer-based psychosocial support to each other (though they never used the term 'psychosocial') in the form of caring discussions, supportive interaction, and group problem-solving about how to move forward. Wanting to achieve a livelihood, the girls then developed group or individual farming, agricultural, or business activities with the aid of small grants or loans. The resulting improvements in the girl mothers' social acceptance, self-efficacy, self-esteem, and connectedness underscored how the combination of psychosocial and economic supports had an impact that would not likely have been achieved by non-integrated “siloed” interventions.
Breaking down the silos can be challenging, as most psychologists and economists have very different languages, training, approaches, professional cultures, and even world views. Although silos cannot be broken down by any single event, the “Invisible Wounds” meeting was an important step forward. The discussion wrestled with thorny issues where there is little consensus. I was impressed by the respectful tone of the dialogue, how welcoming Bank staff members were of outside views, and by the frequency with which issues of “Do No Harm” were discussed. The discussion allowed for divergent views and enabled rich reflection and problem-solving. It was clear that psychologists and economists really wanted to learn something from each other and to build a spirit of collaboration.
For me, the dialogue stimulated a plethora of ideas about how the World Bank is well positioned to help integrate mental health and psychosocial support with economic support.
Indeed, it was impressive to see how active the Bank is already in conflict torn and other highly vulnerable countries. The multi-year funding that the Bank frequently provides is of fundamental importance, as many mental health and psychosocial programs are limited by short funding cycles. The large scale on which the Bank works could significantly advance efforts to prevent mental health and psychosocial problems. Prevention is an area of immense significance since it makes little sense to wait for people to get overwhelmed by the nexus of mental health and economic problems and to try to “pick up the pieces” afterwards. In addition, the Bank seems well situated to support responsive interventions and approaches. Although mental health and psychosocial support is not the Bank's primary expertise, the Bank has the ability to partner with agencies that are present at the grassroots level and positioned to develop contextualized, holistic supports that integrate psychosocial and economic elements.
By stimulating much needed collaboration, the “Invisible Wounds” meeting helped to establish an essential foundation for moving forward together in a more holistic and integrated way that reaches and supports vulnerable people more effectively.
Photo by Arne Hoel via World Bank Photo Collection, available here
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