Young, displaced, anxious, and online

Designing safe digital mental health and psychosocial support for displaced and stateless adolescents.

By Tala Budziszewski, Innovation Officer

Imagine you’re forced to flee your home with what little you can carry. Imagine, too, that you are suffering from anxiety and depression — made worse by your situation — and you have regular thoughts of self harm. Then, imagine that when you ask for help, you get the above response.

Humanitarian actors seeking to support the mental health of forcibly displaced people are always trying to keep pace with changes, developments, and new situations. In recent years, these actors have sought to make the most of the many opportunities offered by digital tools in the mental health space. However, these new opportunities come with new risks and challenges.

A report commissioned by the UNHCR Innovation Service explores these dynamics in relation, specifically, to the provision of digitally supported mental health and psychosocial support (MHPSS) services for forcibly displaced adolescents, and provides guidance for humanitarian actors wishing to design MHPSS services for this population using digital tools.

Enduring challenges, new tools

Forced displacement has been shown to have serious impacts on the mental health of children and adolescents, with this population experiencing high rates of post-traumatic stress disorder (PTSD), anxiety, and depression. However, many of these young people face multiple barriers to accessing relevant services and support.

Digital tools and interventions to provide mental health and psychosocial support have become increasingly popular in all kinds of contexts, receiving a huge boost after the arrival of COVID-19 and the shift to remote service delivery. People and organizations are making extensive use of the opportunities such solutions bring, including in displacement settings, with evidence emerging on positive impacts, key considerations, and how to take initiatives to scale.

There are clear advantages to online modalities — particularly the possibility of significantly expanding user-friendly access to this vital support. However, digital solutions need to be carefully designed to ensure their effectiveness and to mitigate their potential for causing further harm.

Building an evidence base

UNHCR’s Innovation Service, through its Digital Innovation Programme, commissioned a study on the use of digital technologies to support MHPSS services for young people in displacement settings.

The report, completed by Linda Raftree, outlines the basic challenge of safely, comfortably and privately accessing digital technologies and connectivity in order for forcibly displaced young people to make use of these services in the first place, as well as bringing to light many nuances that must be considered to ensure the efficacy of digitally supported MHPSS services.

Despite the diversity of these considerations, one key design principle was loud and clear: Such services should be designed with the young people they aim to support.

Co-designing support tools and approaches

Effective digitally supported MHPSS services for displaced and stateless young people must be created in collaboration with them. A good, non tokenistic co-design process can result in tools that are accessible, relevant, credible, inclusive, and safe for adolescents to use.

What exactly does this co-design process involve?

The report provides a detailed checklist, but here are key steps, in brief:

• Design content that displaced adolescents can navigate: Displaced young people experiencing mental health challenges may be overwhelmed by an overload of information and suggestions. Your digital tool should be designed to minimize difficulties to engage with the content, streamline user experience, and cater to the needs and preferences of the people it aims to support.
• Make your support discoverable: Working with young people can help you identify the best places and channels for this population to discover the support that is available to them. Understanding how displaced and stateless adolescents access information and use digital tools and platforms, where they feel comfortable, and whom they trust is essential.
• Privacy, confidentiality, and security by design: A “privacy by default” approach should be taken to ensure users can trust that their information, data, and identity will not be revealed in unexpected or harmful ways — without placing the burden of ensuring this on them.
• Generate trust and credibility: Achieving this crucial step can be supported by engaging meaningfully with communities, prioritizing privacy and informed consent, being transparent about data use, and choosing the right voices and messengers to spread the word.
• Build evidence to guide interventions: There are few studies on the development and implementation of digital MHPSS support specifically for displaced or stateless adolescents. Strengthened collaboration between practitioners and researchers could help to build on the existing evidence base to improve our understanding of best practices.

Defining the intended level of support

Another key design decision is around the level of support a given intervention aims to provide. Not every initiative or organization has the capacity to deliver clinical psychological services — they might instead work toward ensuring displaced and stateless young people have better access to such services.

The report identifies four possible levels of intervention:

• Level 1: Provision of safe, secure, dignified, inclusive, and participatory connectivity services that enable access to digital MHPSS services.
• Level 2: Digital interventions that support MHPSS through self-help and non-specialized support from friends, family, and community members.
• Level 3: Integration of digital social and psychological interventions into existing (digital and analogue) programmes in related areas, along with non-specialized MHPSS through digital channels.
• Level 4: Online provision of clinical mental health screening and specialized MHPSS services, with referral to in-person counseling and treatment.

Each level has its own potential benefits, risks, and challenges. Some may require much more specialized support and strong links to services, while others may be able to make use of existing resources and structures.

By understanding what different interventions may entail, their limitations and key considerations, digital MHPSS services can be designed in a more robust way, with a clear scope and informed methods to mitigate risks to potential users.

Looking ahead

There’s no doubt that digital MHPSS tools offer many advantages and opportunities for those engaged in the urgent work to provide displaced and stateless young people with the support they need. However, such tools must be carefully designed — and, crucially, young people must still be provided with a holistic support structure, including access to offline services.

A robust, population-specific evidence base must be assembled in order to ensure digital-supported MHPSS services are designed to maximize their benefit to young people affected by mental health disorders and issues.

This research has provided a baseline on which UNHCR will build, as it continues to deliver MHPSS support to forcibly displaced adolescents. The Innovation Service is now turning its attention to piloting the tools and approaches identified in this study, as part of its wider work to test how digital approaches can be most effectively integrated into UNHCR’s tools, policies, and frameworks.

If you’re exploring digital tools and approaches for MHPSS in displacement settings, we’d love to hear from you. Get in touch at hqconref@unhcr.org.