Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

Background: Médecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian
programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions
are a common part of the humanitarian response, little is known about how the profile and outcomes for
individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to
determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for
poor outcomes.

Methods: We analysed data from 18 mental health projects run by MSF in 2009 in eight countries. Outcome
measures were client-rating scores (1–10 scale; 1 worst) for complaint severity and functioning and counsellor
assessment. 

Conclusions: The majority of clients accessing counselling services present with anxiety related complaints. Attrition
rates were high. Good outcomes were recorded among those who attended for more than one visit. Lessons learned
included the importance of adaptation of approach in non-conflict contexts such as societal violence or post-conflict
contexts. There is a need for further research to evaluate the intervention against a control group.