Introduction Key Definitions Terminology Literature Review Frameworks Ensuring Inclusion Tools, Resources, and Annexes Group Pull-outs
Key Definitions
USAID’s core mental health and psychosocial support (MHPSS) definitions can be found on pages 4 to 6 in Integrating Mental Health and Psychosocial Support into Youth Programming: A Toolkit.
Marginalized Groups: People who are typically denied access to legal protection or social and economic participation and programs, whether in practice or in principle, for historical, cultural, political, and/or other contextual reasons (USAID/DDI 2022). These may include, but are certainly not limited to, women; youth; children in adversity and their families; older persons; persons with disabilities; lesbian, gay, bisexual, transgender, queer, and intersex people, and those with other diverse sexual orientations and gender identities (LGBTQI+) people; displaced persons; migrants; Indigenous Peoples and communities; non-dominant religious, racial, and ethnic groups; people of castes traditionally considered lower; people of lower socioeconomic status; and people with unmet mental health needs (USAID 2023). This toolkit includes discussion of the following marginalized groups:
- LGBTQI+: This acronym stands for lesbian, gay, bisexual, transgender, queer, and intersex. The “+” represents other sexual orientations, gender identities, and gender expressions that do not fit within the “LGBTQI” identity labels. More information on USAID’s specific policies on promoting and supporting LGBTQI+ inclusion can be found in USAID’s LGBTQI+ Inclusive Development Policy (USAID 2023).
- Indigenous Peoples: Globally, there are more than 476 million Indigenous Peoples in 90 countries (Cultural Survival n.d.). Indigenous Peoples live in nearly every country USAID works in and our activities affect many of them. Indigenous Peoples are not a monolithic group, and it is critical to recognize that many distinct voices exist within each community. The USAID Policy on Promoting the Rights of Indigenous Peoples provides the following criteria for identifying Indigenous Peoples (USAID/DDI 2020):
- Self-identification as a distinct social and cultural group
- Recognition of this identity by others
- Historical continuity with pre-colonial and/or pre-settler societies
- Collective attachment to territories and their natural resources
- Customary social, economic, or governance institutions that are distinct
- Distinct language or dialect
- Resolve to maintain and reproduce their ancestral environments and systems as distinctive peoples and communities
- Victims of Torture: The Torture Victims Relief Act of 1998 authorized the United States Agency for International Development (USAID) to work through the Victims of Torture (VOT) program to provide assistance to individuals and families around the world who experienced physical and psychological effects of torture and trauma. Torture is the intentional infliction of physical, emotional, or psychological pain or suffering. The effects of torture are complex, resulting in psychological or physical trauma, and can last a lifetime, affecting survivors’ physical and mental health, including one’s ability to perform tasks that are important to caring for themselves, their families, and their communities. Recovery from the effects of torture and trauma often requires thoughtful psychological and medical attention (USAID n.d.).
- Underrepresented Groups: Underrepresented groups are communities or individuals who have limited presence and influence in various sectors of society, such as politics, policymaking, decision-making procedures, employment, economic opportunities, education, and media presence. Underrepresentation is typically rooted in historical discrimination and marginalization based on identity characteristics such as ethnicity, race, sexual orientation and gender identity, disability status, immigration status, and so on. Underrepresentation has harmful consequences for the lives of those affected. When groups continue to be underrepresented, they will continuously be excluded from discussions and decision-making processes that directly affect them, increasing their risk of experiencing oppression and having policies formulated without their input (Emory University n.d.).
- Persons with Disabilities: Disability is an evolving concept that results from the interaction between persons with impairments (including but not limited to persons who have long-term physical, mental, intellectual, or sensory impairments) and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others. Persons may be born with their disability or acquire it later in life. A person’s disability may not always be apparent and, due to stigma, not all may choose to self-identify. Persons with disabilities are part of every group and could experience increased discrimination due to intersections with disability and other facets of their identity. Note that some persons with disabilities prefer “functional conditions,” “conditions,” or similar terms instead of “impairments" (Emory University n.d.).
Inclusive Development: An equitable development approach built on the understanding that every individual and community, of all diverse identities and experiences, is instrumental in the transformation of their own societies. Their engagement throughout the development process leads to better outcomes. An inclusive development approach ensures that all people can participate fully in and benefit equally from all USAID development efforts (USAID 2023).
Intersectional: The complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, classism, ableism, ageism, heterosexism, etc.) combine, overlap, or intersect, especially in the experiences of marginalized or underrepresented individuals or groups. An intersectional approach recognizes that many elements of a person’s identity can affect how they experience the world. In combination with systems of inequality, these intersecting identities can lead to varying degrees of power and privilege that, in turn, create unique power dynamics, effects, and perspectives affecting individuals’ place in society, experience of, and potentially access to development interventions. Further, an intersectional approach advances efforts to address the specific inequalities women and girls face, because they make up approximately half of the population in any given country (USAID 2023).
Stigma: A negative or unfavorable perception, judgment, or stereotype that is attached to a particular individual, group, or characteristic. It is a social phenomenon characterized by the labeling, devaluation, or marginalization of individuals or groups based on attributes such as their race, ethnicity, gender, sexual orientation, disability, mental health condition, or any other characteristic that deviates from societal norms or expectations.
Determinants of mental health: These are factors that have a direct correlation with an individual’s mental health and psychosocial well-being. Determinants of mental health vary depending on a range of factors that differ based on the country and communities where a person lives, their race, ethnicity, gender, sexual orientation, and/or membership as part of a marginalized or underrepresented community. The United Nations Children’s Fund’s (UNICEF’s) MHPSS theory of change includes the following barriers and determinants of mental health and psychosocial well-being (UNICEF 2022a):
- Barriers: Stigma and structural discrimination; lack of political will; lack of (and access to) health care and services and skilled workforce; poor quality of limited services; lack of data, research and analysis; human rights violations; violence; abuse; coercion in formal and informal institutions; lack of sustainable resources and political will; lack of MHPSS financing within universal health coverage benefit packages/schemes with countries; scale of social determinants: poverty, inequalities, (gender-based) violence, childhood adversity, lack of coordinated emergency response, poor integration of physical and mental health care and comorbidities; and lack of shared community identity or dispersion in urban areas (UNICEF 2022a).
Determinants of mental health and psychosocial well-being: Lack of secure attachment or nurturing care; violence; exploitation; abuse in the home; caregiver mental health; poverty; disease outbreaks; race and gender; exposure to adverse experiences; prolonged conflict; terrorism; mass displacement; family separation; and intensifying natural disasters and climate change (UNICEF 2022a). Determinants of mental health are relative to each stage of development (the life course). For more information on the life course, please see the life course approach in UNICEF’s Global Multisectoral Operational Framework on page 10 and WHO’s discussion of the life course approach in Social Determinants of Mental Health.