From Healing to Leading: A Case Study of a Community-led Mental Health Program for Forcibly Displaced People (Preprint)

<sec> <title>BACKGROUND</title> There are over 120 million forcibly displaced people in the world, with numbers steadily increasing. The majority of refugees and asylum seekers are displaced in urban settings, with fragmented access to services. For refugees living in countries with minimal refugee protections, the situation is more dire. There are high rates of trauma exposure, and related mental disorders among these stateless and disenfranchised populations. Meanwhile, refugee-led organizations have stepped in to meet critical needs in refugee and asylum seeking communities. Empowering refugee community members to deliver mental health interventions requires steady commitment, but can have high impact and sustainable outcomes. </sec> <sec> <title>OBJECTIVE</title> We delve into one example of a critical intervention for refugees and asylum seekers who have been displaced for an extended period of time in Indonesia. </sec> <sec> <title>METHODS</title> We conducted a pre–post evaluation with data collected at three time points: baseline (t1), after Phase A (t2, participation in professionally facilitated psychoeducation groups), and after Phase B (t3, supervised co-facilitation by participants). Cope comprised ten weekly group sessions (≈2 hours; ~5 participants) supported by a translated workbook/manual in Farsi, Arabic, and Somali. Participants progressed through a generational model—first as group members, then as supervised co-facilitators, and finally as facilitators with ongoing mentorship. Outcomes included depressive symptoms (PHQ-9), PTSD symptoms (abbreviated PCL-5), psychological distress (HSCL-10), and perceived social support (3-item MSPSS). Paired t-tests assessed within-person changes, with sensitivity analyses using Wilcoxon tests when normality was violated. Bonferroni corrections addressed multiple comparisons, and Cohen’s d effect sizes quantified magnitude of change. </sec> <sec> <title>RESULTS</title> Thirty participants were enrolled at baseline, primarily young women from Afghanistan, Somalia, and Iran. Attrition due to relocation and scheduling yielded 16 participants with complete data at endline. From baseline to midline, participants demonstrated significant decreases in depressive (−40%), PTSD (−45%), and anxiety/distress symptoms (−40%), all with large effect sizes. From baseline to endline, reductions were even greater: depression (−52%), PTSD (−46%), and anxiety/distress (−50%). Improvements in perceived social support were observed but not statistically significant, possibly due to limitations of the abbreviated measure (α=0.50). Results were consistent across sensitivity analyses. </sec> <sec> <title>CONCLUSIONS</title> The Cope program demonstrates that refugee-led, apprenticeship-based MHPSS interventions can be feasible and effective in urban transit settings where formal services are scarce. Significant improvements in depression, PTSD, and anxiety underscore the potential of participatory approaches that leverage community expertise while maintaining professional supervision. Although findings are limited by small sample size, attrition, and lack of a control group, the model offers a promising pathway for scalable, culturally adapted, and sustainable psychosocial support. Future research should strengthen measurement of social support, examine long-term outcomes, and explore mechanisms for scale-up and institutional support for refugee-led initiatives. </sec>