We are Elrha, a force for change in the humanitarian community. The research and innovation we support equips the humanitarian community with the knowledge of what works, so people affected by crises get the right help when they need it most.
Our purpose is clear: to empower the humanitarian community to improve humanitarian response. We make this happen by supporting and championing the outcomes of robust research and proven innovations.
We empower the humanitarian community. Find out how we can support you...

Principal Investigator: Mark van Ommeren, World Health Organisation


The long-term objective of this proposal is to reduce mental suffering and improve the mental health and functioning of people affected by humanitarian crises. Adequate ability to function is important for survival and for re-building communities. WHO’s aim is to contribute to this objective by developing a suite of evidence based interventions that are scalable in humanitarian settings.

We will evaluate the effectiveness and cost-effectiveness of Step-by-Step (SbS) with Syrian refugees in Lebanon. SbS is an innovative 5-session guided WHO intervention designed to improve mental health care coverage, with scalability as central design feature. It is delivered through (a) users’ own smartphones or desktop computers or (b) tablets placed in health/community facilities to enable access to those without devices or internet access. The intervention content involves a narrative with simple language, illustrations and interactive exercises. Step-by-Step centers on behavioural activation, an empirically-supported therapeutic strategy, with additional elements of cognitive coping, stress management and social support. Users receive weekly phone guidance from a helper to maintain motivation, ensure understanding of the intervention content and to prevent drop out.

Expected Outcomes

This research would provide a proof of concept for the use of SbS and other e-mental health intervention in humanitarian settings where (a) a meaningful proportion of the population has access to smartphones or other internet devices or (b) health and other facilities can provide access to devices and the internet. It will provide insight into the feasibility, effectiveness and cost-effectiveness of a locally adapted e-mental health intervention in a humanitarian setting. Evaluating SbS will (a) generate adequate evidence for the decision whether or not to release this guided e-mental health intervention as a public good and (b) improve the scant evidence-base for such interventions in humanitarian settings. The results of this research have the potential to inform scale up of Step-by-Step or similar interventions in humanitarian settings.

Related Resources

Article Mental Health and Psychosocial Support

Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon

Article Mental Health and Psychosocial Support

Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials

Subscribe to our newsletters....

Elrha © 2018 - 2022 Elrha is a registered charity in England and Wales (1177110). KEEP IN TOUCH Want to stay up to date with our latest updates? Sign up to our newsletters
Elrha Please upgrade your browser

You are seeing this because you are using a browser that is not supported. The Elrha website is built using modern technology and standards. We recommend upgrading your browser with one of the following to properly view our website:

Windows Mac

Please note that this is not an exhaustive list of browsers. We also do not intend to recommend a particular manufacturer's browser over another's; only to suggest upgrading to a browser version that is compliant with current standards to give you the best and most secure browsing experience.