Mental Health System Reform in Contexts of Humanitarian Emergencies: Toward a Theory of "Practice-Based Evidence".

Hanna Kienzler
Author Information
  1. Hanna Kienzler: Department of Global Health & Social Medicine, School of Global Affairs, Faculty of Social Science and Public Policy, King's College London, Room 2, 10 East Wing, Strand, London, WC2R 2LS, UK. hanna.kienzler@kcl.ac.uk. ORCID

Abstract

Humanitarian emergencies such as armed conflicts are increasingly perceived as opportunities to improve mental health systems in fragile states. Research has been conducted into what building blocks are required to reform mental health systems in states emerging from wars and into the barriers to reform. What is less well known is what work and activities are actually performed when mental health systems in war-affected resource-poor countries are reformed. Questions that remain unanswered are: What is it that international humanitarian aid workers and local experts do on the ground? What are the actual activities they perform in order to enable and sustain system reform? This article begins to answer these questions through ethnographic case studies of mental health system reform in Kosovo and Palestine. Based on the findings, a theory of "practice-based evidence" is developed. Practice-based evidence assumes that knowledge is derived from practice, rather than the other way around where practice is believed to be informed by systematic evidence. It is argued that a focus on practice rather than evidence can improving system reform processes as well as the provision of mental health care in a way that is sensitive to local contexts, structural realities, culture, and history.

Keywords

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MeSH Term

Armed Conflicts
Community Mental Health Services
Evidence-Based Practice
Humans
Kosovo
Mental Health
Mental Health Services
Middle East
World Health Organization

Word Cloud

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