Written by Bayard Roberts, Professor of Health Systems and Policy at LSHTM
There are over one million forcibly displaced Syrians living in Lebanon, most of whom have been there for more than five years. Lebanon faces many of the same challenges seen in other protracted displacement settings: high levels of unmet mental health needs among both displaced and host communities, fragmented health policy responses, and significant gaps in access to existing services.
While effective mental health care options do exist, the key question is how to deliver them equitably and sustainably. This requires not only improved health system design, but also the meaningful involvement of Syrians and Lebanese people with lived experience of mental disorders in shaping services and systems.
The GOAL project is working to address these challenges. It is a four-year initiative funded by the UK’s Economic and Social Research Council. The project is a collaboration between the °®ÍþÄÌapp of Hygiene & Tropical Medicine (LSHTM), the National Mental Health Programme of Lebanon, St. Joseph’s University of Beirut, Abaad, War Child Holland (Lebanon office), and BeyondText.
Supporting stronger systems through collaborative research
The overall aim of GOAL is to support governments and partners in strengthening the ability of health systems to meet the mental health needs of displaced Syrians and host communities affected by protracted displacement, with a focus on Lebanon. The project applies a co-production approach, with mental health service users centrally involved in the design, implementation, and research. Gender is a core consideration across all activities.
The specific objectives of the project cover four key areas of work:
- Governance and transparency, accountability and integrity: to explore barriers and facilitators to strengthening health system governance for supporting access to culturally appropriate mental health care
- Governance and participation: to strengthen service user participation in health system governance in Lebanon
- Financing: to identify sustainable financing mechanisms to support mental health service delivery
- Capacity strengthening: to build capacity in governance and health financing to enable resilient, inclusive systems
A closer look at governance and access
One of the first activities of the GOAL team was a systematic review of health system governance literature in conflict-affected and displaced settings. The revealed a significant gap in the evidence base and the need for more research on health system governance in crisis-affected settings. Understanding how decisions are made, who participates, and how accountability works is essential for building better mental health systems.
GOAL has conducted primary research studies covering these issues in more depth. These have explored: and in mental health system governance; mental health service user involvement in service decision-making (in press); of displaced Syrians in accessing mental health care; mental health in Lebanon; and the use of participatory research methods and .
Creating tools to support participation
In addition to research, GOAL has developed a range of creative outputs to make mental health knowledge and tools more accessible to communities and practitioners:
- A bilingual graphic novel (Arabic and English) sharing stories about mental health and community solutions in Lebanon
- An on the challenges faced by mental health service users in Lebanon and their rights to participate in decision-making on their mental health services.
- A participation toolkit for involving mental health service users in decision-making
- A guide to contextualising informed consent in research settings
These tools reflect GOAL’s commitment to participatory, inclusive approaches that centre the experiences and insights of mental health service users.
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