A simple self-help workbook, combined with simple telephone support, can make a measurable difference in the mental health of displaced people, a new study has found.
In Indonesia, where the UNSW researchers tested the intervention, around 12,000 refugees are unable to work, separated from their families and living in limbo, sometimes for years, with no clear path to resettlement.
“This is a very, very difficult situation,” says study lead author Professor Angela Nickerson, clinical psychologist and director of UNSW Sydney’s Refugee Trauma and Recovery Program.
“People often live in precarious conditions for long periods of time, sometimes for more than a decade, without stable rights, jobs or support,” Professor Nickerson said.
This creates a critical gap between the significant mental health burden on refugees and the resources available to facilitate their psychological recovery, she says.
To address this gap, a research team from UNSW Sydney, the University of Newcastle and the University of Melbourne partnered with Indonesian and regional organizations including the refugee-led Refugee Learning Nest, Indonesian legal aid organization SUAKA, Gadjah Mada University and HOST International.
Together, they adapted and delivered an intervention within Indonesian refugee communities.
“Working closely with refugee communities and local partner organizations was central to the project,” Professor Nickerson said.
“Their experience and understanding of the local context ensured that the program met the needs of the local community.”
Beyond the system
According to the study, one in 67 people worldwide will be forcibly displaced by 2024. More than three-quarters immigrated to low- and middle-income countries where access to formal mental health care is limited.
Exposure to persecution and war means refugees and asylum seekers face a significant burden of mental illness. The estimated prevalence of both post-traumatic stress disorder (PTSD) and depression is 31.5%.
“Resources are scarce and living conditions can be precarious for these refugees,” Professor Nickerson said.
“Because they do not have legal status, they have limited access to financial support, housing, and essential services,” she says.
“This increases their vulnerability to discrimination, violence and exploitation.”
She says the intervention is not only feasible, but can also be effective in low-resource settings.
measurable impact
The study evaluated an existing World Health Organization program among 303 Persian-speaking Afghan refugees living in Indonesia. The program is Do what matters in times of stressis a guided self-help intervention designed for low-resource settings.
Although the intervention itself is not new, this was the first fully functional trial to test it as a standalone program.
Researchers say Afghanistan’s humanitarian crisis is one of the “most complex crises of our time.” Many Afghan refugees are exposed to prolonged pre-migration trauma and dangerous migration journeys. Violence, loss, and prolonged insecurity experienced during migration and displacement can exacerbate psychological distress in new host countries.
Participants received an illustrated workbook written in their native language along with five short phone calls from a facilitator. The facilitators were members of the refugee community themselves and were trained and supported through collaboration with the Refugee Learning Nest, SUAKA, and local partner organizations to guide others through the materials.
“This not only overcomes some of the resource challenges, but also builds capacity within the refugee community,” says UNSW researcher and clinical psychologist Dr Philippa Specker, who led the training.
“It was exciting to work with Refugee Learning Nest and SUAKA, as well as an amazing team of evaluators and facilitators, to better understand what displaced communities are experiencing,” Dr. Specker says.
In randomized controlled trials, people who participated in the program showed significant improvements in their mental health compared to a control group who had not yet received the program.
“We were really excited to see that such a short, light-touch intervention could have a meaningful impact,” says Dr. Specker.
Compared to a control group, participants reported significantly reduced psychological distress and post-traumatic stress symptoms, and improved well-being, social functioning, and daily life.
“For refugees living in transit countries, it was effective in reducing psychological distress and symptoms of PTSD, and improving well-being and general daily functioning.”
At one-month follow-up, about half of the intervention group showed significant improvement or recovery, compared with about 30% of the control group.
keep it simple
This therapy approach is based on acceptance and commitment therapy and helps people manage their thoughts and emotions in stressful situations that cannot be changed.
Professor Nickerson said the therapy gives patients the skills and tools to manage cognitive and emotional avoidance that can worsen mental health problems.
“In situations like this, traditional problem-solving approaches may not be as effective because you don’t know if the problem can be solved right away,” Nickerson says.
The program teaches strategies such as mindfulness, acceptance, and values-based behavior – tools designed to be used in even the most constrained situations.
This point may be particularly important in transit countries like Indonesia, where refugees often lack basic rights such as access to work, health care, and education.
the power of connection
One surprising finding was that the control group, which had not yet received the intervention, also showed some improvement over the trial period.
The researchers suggest that regular contact with evaluators trained in empathic listening may have played a role.
“This highlights the potential importance of connectedness and psychological support in promoting refugee well-being,” the study said.
The research team is currently working with Indonesian and regional partners to share findings with community organizations, service providers, and policy makers, with the aim of supporting widespread implementation of low-cost mental health programs for displaced communities.
“At a time when the world is experiencing one of the largest evictions ever seen, the low-cost interventions that peers can provide are a critical step forward,” Professor Nickerson said.
sauce:
University of New South Wales
Reference magazines:
Nickerson, A. others. (2026). Effectiveness of a World Health Organization-led self-help intervention to reduce psychological distress in Afghan refugees: A randomized controlled trial. JMIR Mental Health. DOI: 10.2196/89928. https://mental.jmir.org/2026/1/e89928
