Gaps and priority areas in psychosocial support for emergencies and disasters: a qualitative study in Iran

Inefficiencies within the structures, processes, and resources associated with mental health and psychosocial support (MHPSS) can lead to adverse individual and collective health outcomes among disaster survivors. Therefore, accurately identifying the barriers to implementing these interventions is essential for strengthening the disaster response system. This study aimed to explore and extract the key challenges and recommendations related to MHPSS in disasters within the national health system in Iran.

This study was conducted in December 2024 using a qualitative research design and a directed content analysis approach. Participants consisted of 20 experts in mental health, disaster management, and health policy, selected through purposive sampling. Data were collected via semi-structured, in-depth interviews, and the trustworthiness of the findings was ensured using Lincoln and Guba's criteria.

Nine major challenge domains were identified. At the macro governance level, a limited recognition of the importance of MHPSS and insufficient attention to the long-term psychosocial consequences of disasters were reported. Within the domains of organization and coordination, the absence of a unified command and the presence of parallel activities across agencies were identified. Structural constraints included the lack of formally approved organizational structures, inadequate infrastructure, and the absence of a clear framework for the management and integration of volunteers. In the area of human resources, key challenges comprised a shortage of psychiatrists, misalignment between workforce capacity and assigned responsibilities, and insufficient attention to the motivation and welfare of responders. Training and research gaps were noted, including insufficient pre-disasters training and limited context-specific applied research. In addition, ineffective risk communication and limited consideration of cultural and social dimensions were identified as prominent obstacles to delivering effective MHPSS interventions.

MHPSS in disasters is confronted with complex and intersectoral challenges, the resolution of which requires a coordinated and evidence-informed approach. Enhancing policymakers' awareness, ensuring sustainable financial resources, developing needs based training programs, leveraging local human resources, and incorporating cultural considerations can substantially improve the effectiveness of MHPSS services during crises and provide a foundation for future policymaking and planning in the health system.