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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)636-662
Number of pages27
JournalCulture Medicine and Psychiatry
Volume43
Issue number4
Early online date15 Nov 2019
DOIs
Accepted/In press16 Jun 2019
E-pub ahead of print15 Nov 2019
Published31 Dec 2019

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King's Authors

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.

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