Title

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

Authors

Jean-Francois Trani, Washington University in St. Louis, George Warren Brown SchoolFollow
Ellis Ballard, Washington University in St. Louis, George Warren Brown SchoolFollow
Parul Bakhshi, Washington University in St. Louis, Program in Occupational TherapyFollow
Peter Hovmand, Washington University in St. Louis, George Warren Brown SchoolFollow

Author's School

Brown School

Author's Department

Social Work

Document Type

Journal Article

Publication Date

2016

Originally Published In

Trani et al. Conflict and Health (2016) 10:25 DOI 10.1186/s13031-016-0089-2

Abstract

Background: Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. Methods: We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015. Results: We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently. Conclusions: Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played by

Comments

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. For more information on research please visit: https://sites.wustl.edu/globaldisability/

Recommended Citation

Trani, Jean-Francois; Ballard, Ellis; Bakhshi, Parul; and Hovmand, Peter, "Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan" (2016). Brown School Faculty Publications. 53.
https://openscholarship.wustl.edu/brown_facpubs/53