Partnerships to develop new solutions to mental health challenges in Jordan
Bringing together client perspectives and a community of practitioners
“But would that help Rana?” I asked the discussion group in response to an idea for an awareness campaign on mental health issues. I saw them all look down at the illustrated journey in front of them and once more read about Rana’s experience fleeing Syria, the bullying and discrimination she encountered after arriving in Jordan, and her inability to access services from community based organizations due to a controlling family environment.
“Well, no, I think her mother-in-law still wouldn’t allow her to go. We need to find a way to reach her first,” a colleague replied, and a lively discussion ensued about how to deliver messaging and programming in a targeted way to address Rana’s problems. Using Rana, who is not a real person, but rather a persona that represents a combination of stories we heard firsthand in our discussions with community members, ensured that the issues and barriers that they described were brought to the forefront and heard by the broader mental health community in Jordan.
Partnering for design and implementation
Every project we launch at the Airbel Impact Lab begins by listening to and understanding the firsthand perspectives and challenges faced by members of the community who we are trying to serve, followed by co-designing solutions with them. But to tackle some of the thorniest problems, we also need to build strong coalitions of partners to test and scale the ideas that show potential for impact. This is especially true in our work to better understand and meet the mental health and psychosocial support (MHPSS) needs faced by vulnerable communities, particularly refugees, living in Jordan.
Working hand-in-hand with local mental health professionals from the beginning has been vital to our approach to ensure that the work is grounded in a technical understanding of the mental health field in the specific cultural context of Jordan. Furthermore, the highly cross-cutting nature of the work and the daunting scale of the problem is not an issue that can be addressed by a single actor or sector, rather it requires building a broad coalition of partners across disciplines and approaches. Therefore, we have been collaborating closely with the Jordan Mental Health and Psychosocial Support Working Group, which is co-chaired by the International Medical Corps and the World Health Organization and comprised of a diverse set of organizations and government ministries involved in mental health and psychosocial support service provision in Jordan. Our role has been using our design methodology to better understand what barriers affected community members are facing in accessing quality mental health and psychosocial services, working with them to develop solutions, and bringing these perspectives and ideas to the broader group of MHPSS actors in the region.
Familiar content, but a new perspective
In late 2019, thirty organizations came together to share feedback on the findings from our design research, prioritize challenges to accessing quality MHPSS services, brainstorm potential solutions, and gather feedback on prototyped solutions developed with our community design group and a local patients’ advocacy group (Our Step). This collaboration allowed us to surface unique insights between practitioners and communities impacted by the challenges in a way that is difficult to have when these two groups meet face-to-face due to power differentials. It also allowed us to fill the gaps in our understanding of the practitioner’s perspective, which is critical to being able to design effective solutions.
As a strategist without a formal design background, I find presentations on human-centered design fascinating because it’s a methodology that is simultaneously quite simple and intuitive, but also revolutionary and radical. It brings community perspectives to the front and center of discussion and analysis. This means that, instead of focusing on disease prevalence or incidence rates, participants in the working group could contemplate stories (synthesized into representative user journeys and personas) from actual community members experiencing psychological distress as well as the beliefs, attitudes, and practices that help them cope or inhibit their ability to access services. In the case of Rana, this was a reminder that family and friends are often the first line of support for those experiencing psychological distress, but they can also serve as barriers when they are unsupportive of seeking care.
During the workshop, we asked practitioners to vote on the top barriers to high-quality mental health and psychosocial support service provision from their own perspective. Then we asked them to take on a user persona－such as Rana－and to vote again. When thinking about the issues from a client perspective, many of the barriers or challenges that practitioners face on a day-to-day basis, such as coordination or funding, were not as high priority. Clients were more concerned with issues around awareness, trust in services, and perceived quality.
This was a powerful reminder that impactful solutions must not just be efficacious, but also desirable. This means that practitioners must respond to the needs of the clients as they see them, not as organizations see them. Based on both of these votes, we selected four priority challenge areas to address:
- Stigma (including trust in services)
- Lack of trained professionals
- Lack of awareness of mental health conditions
- Need for sustainable funding models
“This was a powerful reminder that impactful solutions must not just be efficacious, but also desirable. This means that practitioners must respond to the needs of the clients as they see them, not as organizations see them.”
“Is it new and does it scale?”
We soon experienced in our afternoon sessions that it is always easier to identify challenges than to come up with solutions, however.
Having the liberty to think freely and come up with new ideas is exciting and energizing, but also inherently difficult. People often default to doing more of what is already being done. If an idea was suggested that already existed or couldn’t be scaled up, we instructed them to rip up the paper and try to think of another. We ended up with a lot of ripped paper, yet through several rounds of iteration, a few promising ideas emerged.
The low-fidelity prototypes shown below were some of what emerged from the brainstorming during the workshop. In some cases, these were ideas that community members had previously brainstormed and that practitioners then built on and refined; in others, these were new ideas that emerged from the discussions. Yet in every case, we left this workshop with stronger ideas than we entered with, thanks to a potent combination of our clients’ honest reflections on the challenges that they face and the deep technical expertise from our partners.
The first prototype considers the opportunity to integrate basic mental health training or psychoeducation into existing livelihoods programs conducted by partner organizations to embed trauma-informed practices into businesses that interact with a large number of potentially affected clients. Put differently, if Rana cannot access services at a local community-based organization, what if, as a first step, she could be better supported by the community businesses that she is interacting with daily?
The second prototype responds to the challenge of awareness and psychoeducation, not just for those affected by mental health challenges, but also for their family and friends as a first line of support as well as pharmacists as the first line of medical care. Hopefully, we can reach Rana’s mother-in-law with messages tailored to changing her perception of mental health care, but if not, we can ensure that the pharmacist Rana goes to for medical advice is equipped to provide basic information and refer her to more specialized care as needed.
Finally, the group identified an opportunity to scale up current programming by creating a mobile training and supervision program to increase local capacity for MHPSS services in more remote areas of Jordan. While Rana lives in Amman and had previously accessed services at a local community-based organization, for many in more remote and rural areas, these services are out of reach, and high quality training and capacity building for local organizations is needed.
What comes next?
While this workshop marked the end of our first phase of work, it’s just the beginning of a larger push to identify solutions to better meet the needs of Jordanians experiencing psychological distress. The feedback and input from all of the participants in the MHPSS Working Group was instrumental in revising our design research outputs, including the user personas and journeys and low-fidelity prototypes. We were also able to identify further information gaps that we need to fill through follow-up design work in the next phase. In particular, we’re interested in gathering more insights around the informal stakeholders to whom people are turning for support, including family and friends, religious leaders, and even service providers such as pharmacists and café owners.
However, the main focus of the next phase is to begin testing at a small scale the three prototypes that we’ve developed in collaboration with our partners in the MHPSS Working Group. By combining our partners’ deep knowledge of the field with the insights derived from our design methodologies, the workshop created a lot of momentum and excitement that we want to seize upon as we explore further building these partnerships in the coming year. While we expect the work to evolve as we learn more and iterate, we will remain laser-focused on finding solutions that meet the needs of Rana and all other affected community members.
This work would not have been possible without the enthusiastic engagement of many of the actors and organizations who comprise the MHPSS working group in Jordan. Special thanks to Dr. Ahmad Bawaneh of the IMC, and Dr. Khaldoun Al Amire of the IRC for their critical support and advice.
