USAID’s

Mental Health
FRAMEWORK
Introduction
Mental health encompasses emotional, cognitive, psychological, and social well-being, and people may conceptualize
it diferently based on their culture and other factors. As with physical health, mental health is complex. Even at the
same time, people can experience the various parts of mental health diferently. Multiple determinants, including culture,
biological factors, and social and environmental conditions, infuence mental health. A person’s mental health can change,
sometimes suddenly, because of confict, violence, loss, and other stressful life events. Mental health impacts all aspects
of life, including engagement with family, friends, education, and employment. It also infuences physical health, including
morbidity and mortality.
USAID’s 2024 Mental Health Position Paper emphasizes that mental health is integral to well-being, including physical
health, child development, educational outcomes, and workforce participation.1 Evidence shows that mental health
conditions are prevalent across the globe, including in high-income countries. Populations exposed to extreme poverty,
confict, food insecurity, community violence, stigma, and other potentially traumatic events often experience even higher
rates of mental health issues. These factors, compounded by factors related to the COVID-19 pandemic and other global
challenges, have intensifed mental health challenges and conditions and made it clear that mental health is crucial for
achieving development objectives across sectors.
The determinants of mental health are multifaceted and operate at various social levels: population, community, relational,
and individual. Creating a strong enabling environment for mental health involves integrating policies, resources, and
societal attitudes that support individual well-being. This environment integrates human rights considerations, ensures
services are culturally sensitive and contextually relevant, and upholds individual dignity. Creating an enabling environment
necessitates dismantling stigma, promoting mental health literacy, and integrating mental health into broader health and
development agendas. Collaboration among governments, NGOs, healthcare providers, and communities is essential to
foster collective commitment and action.
 Overview: Mental Health Framework

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USAID’s Mental Health Framework illustrates how context, determinants, and supports infuence the mental health and
well-being of populations. USAID’s main goal is to support populations, communities, families, and individuals by
promoting strong enabling environments. Promoting these enabling environments is depicted at the center of the
sunburst graphic, a data visualization tool used to represent how diferent aspects of mental health are related and
contribute to the whole.
The framework represents approaches to address the determinants of mental health at various levels of society. The
middle circles of the sunburst chart provide examples of the various levels, determinants, approaches, and contexts
involved in mental health prevention, support, and response but do not encompass all possible issues, approaches, or
strategies. The critical importance of contextualizing prevention, support, and response approaches in full partnership
with local communities is represented by its placement on the outermost circle, encompassing all other aspects.

Center: Enabling Environment2

Defnition: An enabling environment is a setting or context that promotes and supports mental health by addressing
determinants and providing necessary resources, support, protection, and infrastructure. To address the complex nature
of mental health across the human lifespan, an efective enabling environment should include a variety of individual,
relational, community, and population-level factors.
Aspects of enabling environments that impact mental health include supportive policies, community programs that
promote mental well-being, prevention programs that address determinants, integration of mental health services into
primary healthcare or other service settings (e.g., employment, education), and direct services, such as psychotherapy.

Ring 1: Level Within Society3

Defnition: The levels of approaches refer to the diferent societal levels at which interventions, programs, policies,
and services are designed and implemented to prevent, support, and respond to mental health challenges and conditions.
Each level targets specifc groups and contexts, from broad societal impacts to individual support mechanisms. These
levels are:
• Population: This level focuses on approaches, including programs, interventions, services, systems, and
policies that impact entire populations. It aims to improve overall mental health outcomes by addressing
societal factors and implementing large-scale initiatives.
• Community: This level addresses mental health systems, policies, and interventions in communities,
including, but not limited to, the availability, type, quality, and equity of programs, services and resources
support.
• Relational: This level targets the dynamics within relationships, such as those between family members,
friends, and colleagues, which can signifcantly infuence mental health. This includes direct support of
programs, interventions, services policies, and other approaches designed to impact people at the relationship
level.
• Individual: This level focuses on approaches directly impacting individuals, aiming to address personal mental
health needs and challenges.

Ring 2: Determinants4
Defnition: Determinants of mental health are the conditions in which people are born, grow, live, work, and age that
can have an impact–positive or negative–on various aspects of mental health and can increase or decrease the chances
of experiencing mental health challenges. Examples include socioeconomic factors, genetic infuences, physical health,
life experiences, educational opportunities, physical environments, social support networks, and access to mental health
services.
Impact on Mental Health: Determinants infuence mental health in complex ways. For instance, poverty, lack of
education, and exposure to violence can increase the chances of experiencing mental health challenges. Conversely,
strong social support networks and access to quality education can decrease the chances of experiencing mental health
challenges.

USAID’S MENTAL HEALTH FRAMEWORK 3

 Ring 3: Approach5

The intentional integration of mental health considerations

into programming increases positive impacts on sector-specifc
development outcomes of interest.

Prevention: Preventative approaches aim to decrease the chances of future mental health conditions and challenges
within the general population or among individuals exposed to determinants known to increase the chances of
developing related conditions or challenges.6,7 These include but are not limited to emergency preparedness, stigma
reduction campaigns, workplace regulations, violence prevention programs and outreach, peer-led school initiatives, and
culturally relevant coping strategies.
Supporting Elements:8 Supporting Elements aim to strengthen systems and increase social determinants that foster
mental, cognitive, and psychosocial well-being and set up the conditions that allow individuals to lead healthy, dignifed
lives free of discrimination, stigma, and abuse. These elements include but are not limited to early intervention social and
public service programs, housing and food security services, equitable compensation for all people in the society, safety
planning (i.e., population, community, individual), increased access to green spaces, community support groups, medical
care, and social assistance programs.
Response: Response refers to approaches aimed at improving mental health outcomes, addressing mental health
challenges and conditions, and providing ongoing support. These responses include, but are not limited to, improving
access to legal support and justice services, promoting legislation that requires care coordination, expanding access to
care, and case management.9

Ring 4: Contextualization10
Contextualizing global mental health programs, interventions, services, policies, and other approaches involves ensuring
that approaches ft diferent regions and communities’ unique cultural, social, economic, and environmental contexts.
This process aligns with the principles of locally-led development.11 Contextualization acknowledges the diverse
conceptualizations of mental health across cultures. It involves building and diversifying the evidence base to include
locally supported approaches, fostering collaboration among diverse stakeholders, including people with mental health
issues and community mental health experts, and adhering to best practices for ensuring cultural ft.12

Evidence briefs that informed the development of the USAID Mental Health
Framework can be found here: https://www.usaid.gov/inclusivedevelopment/mental-
health/mental-health-position-paper

4
Population Level
Population-level approaches focus on aspects of the enabling environment that impact entire populations by addressing
societal factors. This level includes improving legislation, policies, and economic conditions and strengthening social and
public services across healthcare, education, housing, transportation, and social welfare sectors. These eforts aim to
increase the availability, quality, and equity of essential services, ensuring they are well-funded, stafed, and maintained to
meet the needs of all individuals within the population.

USAID’S MENTAL HEALTH FRAMEWORK 5

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6
 1 Population Level

Determinant: Environment and context13

Aspects of the context and environment infuence the mental health status of the population. These factors relate
directly to the situations people are exposed to, such as, but not limited to, the level of violence and confict, social
cohesion, frequency of extreme weather events, health of the physical environment, inequality, cultural attitudes toward
people with mental health challenges (e.g., stigma, discrimination, cultural norms regarding types of support, etc.), and
access to education and healthcare.

Approach:
• Prevention: Population-level preventative approaches include addressing structural and systems factors
P contributing to determinant exposure; launching violence and confict prevention initiatives; creating mental
health stigma reduction or healthy behavior campaigns; designing social safety net and healthcare access
programs; developing emergency preparedness, climate change, and safety initiatives; bolstering eforts to
increase social cohesion; strengthening economic systems; and implementing urban and infrastructure planning
that encourages social support or addresses mental health needs; and integrating prevention programs into
education, workplace, and other systems.
• Supporting elements: Population-level supporting elements include implementing mental health literacy
S campaigns (e.g., addressing situational needs, anti-stigma messaging, culturally aligned education about
mental health symptoms, applying culturally relevant coping skills); strengthening and professionalizing the
mental health workforce; increasing access to green spaces; establishing regulatory and ethical standards and
accountability systems; creating mental health human rights legislation and policies; funding that equalizes levels
for mental and physical health; advocating for legislation that decriminalizes mental health (including suicide);
reducing access to harmful and dangerous chemicals; and developing of standards of care with accountability.
• Response: Population-level response approaches include working with national and local governments
R and other stakeholders at the population or systems level to integrate mental health support across various
systems and sectors, approaches that increase the capacity to provide proactive support during and following
emergencies and other potentially traumatizing events (e.g., confict and crisis, climate, and other emergencies)
to include support for mental health providers and staf and national and local-level initiatives that increase
access to legal support and justice services.
See additional examples in the annex tables on page 30.

Contextualization:
• Collaborate with national-level stakeholders to understand the most relevant population-level factors.
• Partner with members of marginalized groups to address their specifc mental health needs.
• Collaborate with national and international crisis response teams to ensure that mental health integration is
driven by and responsive to local needs, cultural and contextual factors, and local defnitions and concepts
related to mental health.
• Form collaborative, systems-level partnerships and linkages to ensure that local needs, expertise, and
contextual factors (including social norms and culture) are integrated into and drive all stages of policy and
service development.

USAID’S MENTAL HEALTH FRAMEWORK 7

 2 Population Level

Determinant: Legislation and policies

Government policies, regulations, and laws related to the rights of persons with mental health issues, mental health
services, social welfare, employment, housing, and education can impact the mental health of a population. Efective
policies that prioritize mental health and provide adequate support can lead to better outcomes, while neglectful or
discriminatory policies can exacerbate mental health challenges.

Approach:
• Prevention: Population-level legislative and policy approaches to prevention include revising policies
P and regulations to reduce discrimination and exclusion, in general and towards people with mental
health challenges; educating policymakers on mental health issues; improving digital safety (e.g., reducing
cyberbullying, address technology-facilitated gender-based violence, harms related to social media use
by teens); promoting supportive workplace regulations (e.g., workplace mental health and well-being
programs); and addressing social determinants through policies and regulations that promote safe and secure
environments.
• Supporting elements: Population-level supporting elements include increasing basic and applied mental
S health research funding; establishing regulatory and ethical standards, such as those related to reducing
coercive mental health treatment; decriminalizing mental health and reducing stigma, including for suicide;
supporting the deinstitutionalization of those with mental health challenges; professionalizing mental health
providers; encouraging strong privacy and confdentiality practices, review boards, and accountability systems
for service providers; integrating mental health considerations into other types of policies (e.g., education,
healthcare, justice systems); strengthening the integration of human rights considerations related to mental
health; and providing multisectoral training on mental health (e.g., law enforcement to recognize and respond
appropriately to mental health crises).
Response: Population-level response approaches include establishing and strengthening standards of care,
R• practice, and service user rights codes, and reporting mechanisms; promoting legislation that requires or
establishes care coordination, referral mechanisms, and emergency response standards of practice related
to mental health; and promoting legislation that increases access to justice for people with mental health
challenges.
See additional examples in the annex tables on page 30.

Contextualization:
• Collaborate with national-level stakeholders working on legislation, policy, and regulations related to mental
health.
• Collaborate with national-level stakeholders to improve the responsiveness of policies and legislation to
community mental health needs; reinforce individual decision-making autonomy; and increase interjurisdictional
relationships and collaboration on mental health.
• Advocate for policies that promote social inclusion, especially for the most marginalized populations, and
encourage continued inclusion and collaboration during implementation.
• Work with pre-existing systems at the local level with respect for cultural, religious, and linguistic needs and
perspectives.
• Collaborate with local experts, persons who have or have had mental health challenges, and other
stakeholders to deliver and adapt programming.
8
 3 Population Level

Determinant: Economic factors15

Factors, such as living wage requirements, types of safety net programs available, level of income equality, access to
healthcare and housing, and availability of high-quality education, can profoundly impact the mental health of populations.
Addressing systemic issues like poverty can decrease the prevalence of mental health challenges, improve economic
conditions more broadly, and decrease the cost of mental health services.16

Approach:
• Prevention: Population-level approaches to address economic factors related to mental health include
P reducing poverty; improving social protection; increasing access to physical and mental health services,
especially preventative care to support engagement in the workplace; and encouraging the integration of
mental health into livelihood initiatives.
• Supporting elements: Population-level supporting elements related to economic factors include
S addressing housing and food insecurity; building on existing community assets and strengths; and ensuring
equitable compensation for marginalized groups.
• Response: Population-level approaches to address economic factors include supporting career and education
R programs; increasing compensation for the mental health workforce; reducing fnancial barriers to mental
health services; preserving decision-making autonomy and choices for individuals with mental health challenges
that have lower incomes; and increasing the fexibility of services by addressing barriers such as childcare,
perceived stigma, long waiting times, and provider availability.
See additional examples in the annex tables on page 31.

Contextualization
• Collaborate with national-level stakeholders to ensure equitable resource allocation and reach underserved
populations.
• Collaborate with national-level stakeholders working on economic growth and related eforts.

USAID’S MENTAL HEALTH FRAMEWORK 9

 4 Population Level

Determinant: Social and public services

The availability of high-quality social and public services signifcantly impacts populations’ mental and physical health. Most
often, the availability and quality of services are determined at the population or systems level through government funding,
regulations, policies, and programs. Even when communities serve as the primary access point for administering, funding,
and designing local systems, population-level factors have a signifcant impact. For instance, communities often depend on
national funds for basic fnancial support and may be constrained or discouraged from expanding local services based on
national policies and other infuencing factors.

Approach
• Prevention: Population-level prevention approaches can include strengthening fnancial systems for social
P and public services, strengthening mental health systems, integrating prevention initiatives into existing social
and public services, and establishing comprehensive funding structures to make social and public services more
sustainable.
• Supporting Elements: Population-level supporting elements include ensuring equitable application
S of mental health standards of care; supporting early intervention programs, including strengthening the
integration of mental health into existing early intervention programs and/or services for caregivers; developing
capacity strengthening interventions that focus on the professionalization of the mental health workforce;
integrating cultural and contextual factors into systems; creating regulatory frameworks to incorporate ethical
practices into social and public services better.
• Response: Population-level initatives that strengthen social and public services include supporting stepped
R care options; expanding access by reducing barriers, such as those related to gender, fnancial status,
transportation, mental health literacy, safety, and confdentiality; encourageing more person-centered and
equitable mental health services; establishing or strengthening integrated crisis and mobile support teams
(e.g., mandating the inclusion of mental health providers in law enforcement response teams); developing
laws, policies, and regulations that increase access to community-based mental health services and decrease
long-term institutional care; integrating trauma-informed approaches; creating regulatory frameworks that
encourage recovery-based approaches with adequate follow-up care, multidisciplinary coordination, and
efective case management services; and establishing mental health helplines (e.g., national suicide helplines).
See additional examples in the annex tables on page 31.

Contextualization
• Collaborate with local disaster/crisis response teams to strengthen their ability to provide adequate support
(including basic mental health support) and reduce harm to those experiencing mental health challenges as
they interact with these teams.
• Collaborate with local stakeholders to ensure that services are context-specifc.
• Ensure that service users, caregivers, and others most impacted by services are integral to all phases of
planning, implementation, and evaluation of these services.

10
Community Level
The community-level approach refers to aspects of the enabling environment for mental health that are applied at the
community level. These include factors that address the availability, type, quality, and equity of essential services provided
by the public sector or to meet the basic needs and rights of all individuals within a community. It also encompasses the
safety and security of the community, access to resources and opportunities, and the social norms and culture that
impact individuals and their mental health status, how people with mental health conditions and challenges are treated,
and their tendency to seek and utilize services and other supports.
Many determinants and approaches are similar to and infuenced by those at the population level. However, because
individuals directly engage with programs, services, and other initiatives at the community level, the impact and
opportunities to contextualize are signifcant. As with population-level approaches, mental health factors must be
explicitly considered to achieve the desired efects.

USAID’S MENTAL HEALTH FRAMEWORK 11

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12
 1 Community Level

Determinant: Access to mental health services and resources18

The availability of high-quality social and public services signifcantly impacts communities’ mental and physical health. Most
often, the availability and quality of these services are partially determined at the population or systems level, often through
government funding, regulations, policies, and programs, but are operationalized and contextualized at the community level.

Approach:
Prevention: Community-level prevention approaches include providing general or issue-specifc,
P• preventative supports (e.g., parenting programs or programs related to general determinants, such as violence
prevention, physical health issues, early intervention, or peer support programs), promoting mental health
literacy, and reducing stigma.
• Supporting elements: Community-level supporting elements include establishing regulatory and legal
S frameworks; creating vetted referral networks and care coordination structures, programs and regulations that
ensure equitable distribution and quality of resources and services; and building and maintaining strong support
networks and connections among community members.
• Response: Community-level response approaches include proactively integrating mental health into crisis
R response structures; increasing mental health funding parity; reallocating funds to community-level mental
health services and supports, such as by routing new funds or shifting existing funds away from institutional
care; supporting communities as they tailor initiatives to their needs and priorities; strengthening regulatory
systems to ensure integration and coordination among care providers; ensuring that services and support
is culturally appropriate, safe and ethical; ofering increased choice, facilitating supported decision-making
and mental health directives, post-treatment care, and transitional services; strengthening the integration
of mental health support into existing community infrastructure (e.g., education, safety net programs, law
enforcement, justice systems, primary care, workplaces, emergency services); and integrating task-shifting and
professionalization approaches into leveled systems of care to increase the availability of care.
See additional examples in the annex tables on page 32.

Contextualization:
• Collaborate with local stakeholders to understand specifc needs and services and tailor mental health
programs accordingly, including conducting community mapping of available services or support.
• Partner with community members to ensure cultural relevance and appropriateness of mental health services.
• Integrate local knowledge and practices into program design and implementation whilst upholding human
rights standards, including, for example, co-creation and consultation with service users and caregivers.
• Ensure that services are adaptable to changing local conditions and needs.

USAID’S MENTAL HEALTH FRAMEWORK 13

 2 Community Level

Determinant: Safety and security19

Living in a safe and secure environment promotes mental well-being; conversely, an unsafe environment increases exposure
to potentially adverse and distressing events, increasing the likelihood that community members will experience mental
health conditions. Population-level factors undoubtedly impact community safety and security; however, those impacts are
often directly operationalized and experienced at the community level.

Approach
Prevention: Community-level prevention approaches related to safety and security include securing
P• neighborhood-gathering spaces (e.g., community centers); establishing safety infrastructure (e.g., well-lit paths);
creating community-level violence prevention programs and outreach; ensuring safe public transportation;
implementing programs and regulatory approaches that address the specifc safety and security of marginalized
groups; developing confict resolution and peacebuilding initiatives; and designing programs that increase social
cohesion.
• Supporting elements: Community-level supporting elements include increasing safety planning (e.g., urban
S and infrastructure plans) and implementation; developing legal frameworks that promote community safety
and security; creating local regulations and systems strengthening activities that integrate improved safety and
security into various sectors and organizations (e.g., schools, workplaces); establishing strong confdentiality
and privacy regulations and accountability structures; initiating neighborhood watch programs, especially those
that promote safety and inclusion of specifc groups of people such as those with mental health issues or
members of other marginalized groups; supporting civic education campaigns to promote good governance for
community safety factors, and designing mental health community programs and services that address safety
and security barriers.
• Response: Community-level response approaches to safety and security include, but are not limited to,
R integrating mental health considerations, including trained professionals, into cross-sectoral safety and
security services (e.g., policing, justice systems); establishing confict resolution services; implementing case
management services for those who have experienced safety and security violations; integrating regulations
and local policy that supports the safety and security of service users and caregivers and provides access to
justice and other recourse when violated; creating anonymous helplines and referral pathways to multisectoral
service providers, including access to justice, social services, and security services; and supporting groups and
peer support programs for those who have experienced violations to their safety and security.
See additional examples in the annex tables on page 32.

Contextualization
• Conduct community mapping to identify gaps and opportunities to improve mental health-integrated safety
and security within communities, including those related to accessing mental health support.
• Establish cross-sectoral and other community partnerships to address safety and security issues.
• Collaborate with various local actors, including marginalized groups and various segments of communities, to
identify safety and security needs and possible solutions and implement strategies to address them.
• Work with local actors to understand local conficts and community tensions and support their eforts to
ensure interventions do not exacerbate these issues.
• Identify, support, and build on efective existing programs and initiatives that integrate mental health, safety,
and security.
14
 3 Community Level

Determinant: Economic resources and opportunities20

A community’s economic resources and opportunities signifcantly afect mental health. This relationship can be
bidirectional, where mental health and economic challenges exacerbate each other. Key factors include access to jobs
that pay a living wage, other income-generating opportunities (e.g., job creation, entrepreneurship), national and local
fnancial stability, and the community’s overall economic health.

Approach
• Prevention: Community-level prevention eforts include ensuring mental health considerations are taken
P into account in community-level food, housing, education, and employment programs; integrating regulations
and other approaches that address barriers to economic equality; establishing fnancial literacy programs that
reduce fnancial stress; and supporting local eforts that promote economic growth.
• Supporting Elements: Community-level supporting elements that address this determinant include
S designing multi-stakeholder approaches to decreasing economic disparities, including promoting equitable
compensation; creating employment and education programs for people with mental health challenges; and
establishing equitable and participatory decision-making in public service regarding mental health resource
allocation and planning.
• Response: Community-level response approaches that address this determinant include equitable access to
R employment, workplace mental health and well-being programs, access to mental health leave for employees,
free or low-cost accessible mental health treatment and care, establishing options for teletherapy to increase
access to those living in remote/rural areas, and fnancial counseling.
See additional examples in the annex tables on page 33.

Contextualization
• Work with local stakeholders to complete economic and market analyses integrating mental health
considerations.
• Collaborate with local actors to address community-specifc barriers to employment and other livelihood
activities.
• Work with local actors to complete gender analyses to understand cultural and gender norms related to work,
entrepreneurship, and access to capital and fnancial systems; research contextual information about gender
roles and economic responsibilities and integrate fndings to provide gender transformative, contextualized
mental health-integrated programming to address this determinant.
• Work with members of marginalized groups to complete inclusive development analyses to identify barriers
to economic stability and access to mental health services and collaborate with local actors to address these
barriers.

USAID’S MENTAL HEALTH FRAMEWORK 15

 4 Community Level

Determinant: Culture and social norms:21

A community’s prevailing cultural and social norms signifcantly impact mental health in complex and interrelated ways.
Communities that stigmatize mental health or discourage help-seeking behaviors often exacerbate the difculties faced
by individuals with mental health challenges and conditions. Norms that support inequity, discrimination, violence,
stigmatization, and other human rights violations can increase the likelihood that mental health challenges will develop and/
or be exacerbated and reduce access to needed support. Conversely, norms that foster mutual support, prioritize mental
health support systems, including individuals with lived experience, view mental health as a human rights concern, and
normalize attention to mental health can decrease the likelihood and severity of mental health challenges.

Approach:
Prevention: Prevention approaches that address this determinant include destigmatizing mental health
P• challenges; utilizing locally led social and behavior change strategies to shift harmful norms and cultural
practices; addressing harmful gender norms, such as those related to participation in political systems, access
to education, and gender-based violence; increasing availability of safe and efective medical care and fair
compensation in the workplace; and supporting mental health literacy programs that normalize accessing
mental health support, teaching coping skills and practices, and encouraging help/support-seeking behavior
supported by cultural, religious or other leaders.
Supporting elements: Supporting elements that can address this determinant include shifting norms that
S• contribute to the maintenance of barriers to care for particular groups; supporting regulatory frameworks
and policies that decrease human rights violations toward people with mental health challenges; increasing the
use of locally developed ethical practices and establishing accountability mechanisms; providing social support
services in culturally signifcant places and/or by peers or respected community members; and establishing
regulations or local policies that shift attitudes and practices toward people with mental health challenges.
Response: Response elements that can adress this determinant include ofering culturally and contextually
R• appropriate mental health services in the communities where people work, live, and play; integrating
traditional practices that promote care into mental health services and support with full respect for human
rights; engaging local religious and other community leaders; increasing the number of providers who speak
local languages or, when not possible, ofering translation/interpretation services; developing helplines that
provide support aligned with cultural concepts of mental health; establishing confdential and private referral
and services; and ensuring that service providers reduce cultural concerns about help-seeking behaviors (e.g.,
where possible and helpful, match provider and service users on key factors such as gender, religion, etc.).
See additional examples in the annex tables on page 33.

Contextualization:
• Collaborate with local actors to conduct gender and inclusive development analyses that consider factors
related to mental health and integrate fndings into programming.
• Work with local actors to understand local conceptualizations and norms related to mental health and help-
seeking behaviors.
• Work with local stakeholders to understand community norms and narratives about mental health and the
potential impacts of trauma.
• Implement community-led needs assessments to identify gaps, barriers to care, and preferred solutions.

16
Relational Level
Relational-level approaches ensure that individuals receive support through interactions with family members, friends,
colleagues, and other close connections. This level emphasizes the importance of approaches that enhance interpersonal
dynamics. Unlike the population and community levels, which focus on policies and systems needed to create an enabling
environment, the relational level is where people directly interact with these services and programs, ensuring that they
can manage their relationships in ways that support mental health.

USAID’S MENTAL HEALTH FRAMEWORK 17

 Honor
culture KEY
and co Level: Relational
ntext
Determinants
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18
 1 Relational Level

Determinant: Social support22

Social support and a strong sense of belonging and connectedness within a community can protect against mental health
challenges and promote resilience and recovery. Conversely, social isolation, exclusion, rejection, and loneliness signifcantly
contribute to the development of mental health challenges.

Approach:
Prevention: Prevention-level approaches to address this determinant include establishing and/or reinforcing
P• supportive networks that respect community dynamics and peer-led school initiatives.
• Supporting elements: Supporting elements that address this determinant include promoting a sense of
S belonging and collective care, providing widespread education about and use of foundational helping skills, and
increasing access to community programs to promote social cohesion.
• Response: Response-level approaches to addressing this determinant include establishing anger and confict
R management services programs and other skills to strengthen relationships; implementing safe reconciliation
programs; increasing accessible services for couples and families, including therapy; providing access to justice
services; rethinking the relevance and acceptability of sources of evidence (e.g., diversifying the evidence
base by supporting research on local approaches and/or co-creation); designing helplines designed to support
families and/or couples; and integrating local language, practices, ceremonies, values, heritage, and worldview
into mental health programs and supports.
See additional examples in the annex tables on page 35.

Contextualization:
• Ensure knowledge of culture and context to promote a sense of belonging and foster community support
systems.
• Design engagement strategies that honor cultural identity and collective values.
• Collaborate with local groups and community structures to foster a sense of belonging.
• Address potential stigma associated with mental health support.
• Foster inclusion of people with lived experience, caregivers, service users, and other local/community
stakeholders to inform all contextualization eforts and all phases of programs, services, and supports.

USAID’S MENTAL HEALTH FRAMEWORK 19

 2 Relational Level

Determinant: Family structures and dynamics23

The dynamics within a family, including parent-child relationships, sibling relationships, and the overall family environment,
play a crucial role in one’s general well-being and mental health status across the life course. A variety of individual,
relationship, community, and population-related factors infuence these dynamics and provide opportunities to improve
the enabling environment for better mental health, decrease reactions to adverse events and potentially distressing
circumstances, and support those with mental health challenges.

Approach:
• Prevention: Prevention approaches to address this determinant include strengthening programs for social
P supports for families; contextualizing education and other eforts to encourage psychological safety within
families; providing family-centered mental health education and support; and parenting and family support.
• Supporting elements: Supporting elements that address this determinant include strengthening family
S communication and support systems; establishing crisis management services; supporting respite care for
caregivers; and providing problem management services that support coping and resilience.
• Response: Response approaches to address this determinant include engaging families in mental health
R services; increasing access to culturally relevant family and systems-based therapies; increasing afordable case
management services; ofering safety net programs that address basic needs and decrease family stress; and
increasing access to mental health services for individuals and families.
See additional examples in the annex tables on page 35.

Contextualization:
• Recognize diversity in family structures to support inclusion.
• Understand cultural and socioeconomic pressures and barriers that might infuence family dynamics.
• Be aware of cultural and gender norms related to family roles, hierarchies, and expectations.
• Foster inclusion of people with lived experience, caregivers, service users, local mental health providers, and
other local/community stakeholders to inform all contextualization eforts and all phases of programs, services,
and supports.

20
 3 Relational Level

Determinant: Interpersonal communication

Interpersonal communication involves individuals exchanging information, feelings, and thoughts through verbal and
nonverbal messages. The quality of this communication can signifcantly infuence an individual’s emotional well-being.24

Approach:
• Prevention: Approaches to prevention that address this determinant include encouraging locally led,
P contextually relevant programs that promote healthy relationships, strong social bonds, and positive
emotional connections; fostering supportive human resource and workplace policies; creating programs that
improve relationship skills, such as culturally relevant communication, healthy emotional expression, stress
management, and listening skills; teaching skills that contribute to healthy relationships; and creating programs
that create safe and inclusive spaces to build positive relationships.
• Supporting elements: Supporting elements that address this determinant include fostering facilitated
S dialogue; working with communities to increase family programs and activities; designing media and other
campaigns to encourage help-seeking behavior; providing capacity strengthening for parents that is contextually
relevant; developing initiatives that strengthen relationships; and creating opportunities for members to
support each other (e.g., encouraging supportive kinship and cultural traditions).
• Response: Relationship response approaches to improving interpersonal interactions include ofering confict
R resolution services; building trust and encouraging strong relationships; integrating culturally based practices
into family and relationship-related therapy; and providing other mental health support.
See additional examples in the annex tables on page 36.

Contextualization:
• Build knowledge of and work with local social, relationship, and group dynamics.
• Conduct mental health integrated gender and inclusive development analyses and integrate fndings into
program design and implementation.
• Collaborate with local actors to integrate an understanding of norms related to mental health and
interpersonal relationships.
• Support locally led interventions prioritizing community needs and preferences related to literacy levels,
language, and communication norms.

USAID’S MENTAL HEALTH FRAMEWORK 21

 4 Relational Level

Determinant: Social norms, including those related to gender and mental health25
Refer to the societal and cultural expectations and rules that dictate appropriate behaviors, roles, responsibilities,
and attributes within relationships. Social norms have a complex and multidirectional relationship with mental health
at all levels, including the relational level. They can infuence various mental health and well-being factors, such as the
likelihood that specifc relationships will provide support or cause harm. Social norms also afect whether people are
willing or able to ofer and/or utilize support (e.g., relationship therapy), how children are treated, the level of violence
considered acceptable within a relationship, and the level of accountability a community provides for those who cause
harm.

Approach:
• Prevention: Prevention-based approaches addressing this determinant at the relational level include
P fostering equitable mental health norms in relationships; implementing mental health stigma reduction
campaigns; working with local leaders to address harmful norms related to interpersonal relationships and
mental health; developing communication programs that promote healthy relationships; and establishing
programs or interventions that teach skills for navigating conversations about roles and responsibilities in
relationships, such as those related to gender.
• Supporting elements: Relationship-level approaches to strengthening supporting elements include
S facilitating dialogues and community discussions related to mental health (e.g., stigma); designing programs
that integrate mental health considerations into cultural practices and traditions and vice versa; implementing
initiatives that integrate the perspectives of diverse groups of people (e.g., women, girls, Indigenous peoples,
etc.); supporting laws, policies, and regulations that address social norms; and integrating mental health
considerations into gender-transformative programs.

R• Response: Relational approaches to address this determinant include creating support groups, mental health
programs, and interventions that integrate norms-based considerations and access to justice services.
See additional examples in the annex tables on page 36.

Contextualization:
• Understand and foster cultural respect, humility, and safety.
• Integrate cultural norms related to mental health into programs and other initiatives (e.g., level of collectivism
vs. individualism) and conduct gender, inclusive development analyses that integrate concerns from many
diferent groups.
• Engage men and boys in programs that not only refer to their role concerning women but also address their
problems.
• Identify and collaborate with local champions or role models.

22
Individual Level
Individual-level approaches focus on providing direct support through accessible services and programs that cater to
each person’s unique circumstances and mental health needs. This level emphasizes using client-centered approaches to
building mental health literacy, learning coping skills, and building resilience to outside stressors.

USAID’S MENTAL HEALTH FRAMEWORK 23

 KEY
Level: Individual alysis to
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Determinants Conduc
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24
 1 Individual Level

Determinant: Psychological resilience, resources, and skills26

The ability to recover psychologically from challenges can vary among individuals. If well-developed, it can help someone
adapt to and recover from difcult life situations. If less developed or lacking, mental health distress may increase when
someone faces challenges, such as a loss or other potentially traumatizing events.

Approach:
Prevention: Prevention-level approaches related to this determinant include strengthening resilience,
P• resources, and skills (e.g., coping and problem-solving skills, emotional regulation, stress management,
relaxation and self-soothing techniques, mental health literacy, social skills training) that foster well-being and
decrease the likelihood of experiencing mental health challenges; implementing initiatives that reduce exposure
to adverse life events and other determinants or provide mentoring, coaching or coping skills training to those
who have experienced these types of events; and providing workplace programs that provide support, share
culturally relevant coping strategies and foster a psychologically safe environment.
Supporting elements: Supporting elements related to this determinant at the individual level include
S• providing mental health literacy, skills training, and community programs that foster supportive relationships;
and strengthening skills training for teachers, primary care providers, and traditional and spiritual leaders to
provide supportive interactions.
• Response: Response-level approaches related to this determinant include providing individual and group-
R based therapy and other focused support; establishing client-centered approaches; implementing strength-
and recovery-based inteventions and supports; and sharing vetted referral pathways to facilitate help-seeking
behaviors.
See additional examples in the annex tables on page 37.

Contextualization:
• Use contextually and culturally rooted approaches.
• Ensure interventions address culturally specifc stressors and coping mechanisms.
• Use culturally sensitive practices and local terminology related to mental health conditions.
• Conduct feasibility analyses and factor in local economic challenges when planning for interventions.

USAID’S MENTAL HEALTH FRAMEWORK 25

 2 Individual Level

Determinant: People’s life experiences27

Context, environment, and circumstances contribute signifcantly to an individual’s well-being. Exposure to potentially
traumatizing events, such as natural disasters, adverse childhood experiences, war, gender-based violence, physical or
emotional abuse, accidents, or the loss of a loved one, can have profound and long-term impacts on individuals’ mental
health. Although many people recover on their own, some people experience long-term mental health challenges, which
are exacerbated in the absence of appropriate and accessible support.

Approach:
• Prevention: Prevention approaches at the individual level include increasing access to integrated
P preventative services (e.g., community systems, such as early intervention, healthcare, justice systems,
education, and primary healthcare); bolstering community supports; fostering supportive interpersonal
connections; developing school-based anti-bullying campaigns; using comprehensive safeguarding practices; and
promoting supports for parents and caregivers.
• Supporting elements: Supporting elements related to this determinant include increasing access to and
S exposure to community outreach programs, case management, equitable access to services, safety and security
infrastructure, and social assistance programs.
• Response: Response approaches related to this determinant at the individual level include implementing
R direct services for individuals such as clinical/psychological interventions (e.g., psychotherapy, peer support
programs, family education, crisis response services, access to safe and secure environments and services, and
substance use programs).
See additional examples in the annex tables on page 37.

Contextualization:
• Understand regulatory, legal, economic, and policy context.
• Collaborate with local actors throughout all phases of the Program Cycle and conduct needs assessments.
• Embed contextually relevant psychological, environmental, and age/stage considerations into programs.
• Understand relevant psychological, biographical, interpersonal, and developmental factors and dynamics.
• Integrate collective experiences as relevant (i.e., natural disaster, war, communal violence, intergenerational
trauma).
• Integrate cultural narratives.
• Leverage family- and community-support structures.
• Integrate local healing practices.
• Foster a culturally relevant understanding of human rights protections.

26
 3 Individual Level

Determinant: Psychological health

Psychological health refers to an individual’s emotional, social, and psychological state and encompasses how individuals
feel about themselves and their lives, their sense of purpose, their relationships, and their ability to manage their
emotions and behavior.

Approach:
• Prevention: Prevention approaches at the individual level include creating mental health literacy and
P psychoeducation initiatives; strengthening advocacy and awareness raising; establishing emotional wellness and
self-care programs, including integration into community settings such as schools and workplaces; ofering
mental health checkups in primary care; fostering interconnected emotional belonging through targeted
interventions; addressing determinants of mental well-being; and promoting physical health, including exercise
and nutrition programs that integrate knowledge about their impacts on mental health.
• Supporting elements: Supporting elements at the individual level for this determinant include ensuring
S access to quality services and supports, including helplines and support groups; designing access to services
tailored to the needs of various groups; supporting initiatives that encourage help-seeking behaviors and
reduce barriers to access; providing job counseling; and integrating trauma-informed approaches into public
safety services.
• Response: Individual-level approaches to psychological health include providing individual clinical
R interventions; increasing access to case management services; promoting person-centered, strength-based, and
recovery-focused substance use programs; and strengthening social support.
See additional examples in the annex tables on page 38.

Contextualization:
• Co-design with people who have mental health challenges, caregivers, and other stakeholders.
• Understand and address the needs of diverse groups of people.
• Understand community-specifc accessibility constraints.
• Understand and respect local conceptualizations and indicators of psychological well-being.
• Use local concepts of holistic, person- and community-centered approaches to understand and address this
determinant.
• Collaborate with local stakeholders to understand how stigma related to mental health operates across
relevant levels and integrate it into programming.
• Consider the availability and accessibility of service providers for diferent groups and settings.
• Recognize and work within community dynamics.

USAID’S MENTAL HEALTH FRAMEWORK 27

 4 Individual Level

Determinant: Physiological health28

Genetic and other biological and health factors play a role in predisposing individuals to specifc mental health conditions.
Addressing these physiological determinants through mental health services and support is crucial for improving mental
health outcomes.

Approach:
Prevention: Prevention-level approaches to this determinant include providing early screening and
P• intervention for mental health conditions and determinants; conducting developmental assessments, including
at birth, during adolescence, and throughout the life cycle; providing treatment for medical issues; increasing
access to primary physical and mental health services; and implementing supports and skill building related to
physiological health concerns.
• Supporting elements: Supporting elements-level approaches to this determinant include fostering
S equitable access to mental and physical health support and services; integrating mental health considerations
into treatments for physical health concerns; providing physical, occupational, and speech therapy; and
developing individual education plans that address physiological concerns.
• Response: Response approaches for this determinant at the individual level include ensuring access to
R integrated and stand alone mental health interventions, specialist care, and treatment for physical health
concerns.
See additional examples in the annex tables on page 38.

Contextualization:
• Conduct contextual analysis of an individual’s environment.
• Understand local beliefs about heredity as they relate to mental health.
• Consider how interventions can integrate traditional practices.
• Work with local actors to develop and work with a locally informed understanding of how stigma and
discrimination impact mental health and approaches to addressing mental health at various levels.
• Integrate a locally informed understanding of the interaction between physical and mental health.

28
 Annex Tables
These tables expand upon the information included within USAID’s
Mental Health Framework graphics. While the graphic prioritizes key
actions from the report, the table includes more suggested actions.

USAID’S MENTAL HEALTH FRAMEWORK 29

 Population Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Environment and • Increase emergency • Implement MH • Integrate MH • Partner at the
context preparedness and literacy campaigns support across national-level to
safety • Reduce access to various systems/ understand the most
• Violence and harmful and sectors relevant factors to
confict dangerous • Support MH during address MH
prevention chemicals crises and confict • Partner with
• Increase social • Increase access to • Integrate support members of
cohesion green spaces for MH and crisis marginalized groups
staf/providers to address specifc
• Address climate • Establish MH needs
change regulatory, ethical • Provide emergency
standards, and and climate disaster • Collaborate and
• Reduce mental coordinate with local
health (MH) stigma accountability MH response
services and international
campaigns • Strengthen systems crisis response teams
• Address factors that • Provide access
professionalize to legal support • Create MH system-
determinants level
the mental health services
• Implement urban workforce partnerships and
and infrastructure linkages
planning that • Partner with local
encourages actors to understand
social support or context, including
addresses other social norms and
MH needs culture

Legislation and • Promote anti- • Establish • Establish and • Conduct economic

policies discrimination MH interventions that strengthen and market analyses
legislation and combat MH stigma standards of MH • Reduce
policies • Fund basic and care, practice, community-specifc
• Educate applied research service user rights barriers to
policymakers about related to MH frameworks, and employment
MH reporting
• Establish mechanisms • Conduct gender
• Improve digital regulatory and analyses that
safety ethical standards, • Promote integrate MH
review boards legislation that
• Promote policies requires or • Conduct inclusive
and legislation that and accountability development
systems establishes care
support community coordination, analyses that
safety and security • Integrate MH and referral integrate MH
human rights into mechanisms, and
all policies and emergency
legislation response
• Professionalize MH mechanisms
providers • Promote legislation
• Train on multi- that increases
sectoral approaches access to justice for
to MH people with MH
challenges

30
 Population Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Legislation and • Promote policies • Decriminalize
policies and legislation that MH and support
address social deinstitutionaliza-
determinants tion of those with
MH challenges

Economic factors • Create poverty • Address housing • Support career and • Collaborate with
alleviation initiatives and food insecurity education programs national actors
• Improve social • Ensure equitable • Reduce fnancial working on economic
protection compensation barriers to MH care growth and related
programs eforts
• Increase workforce
• Increase access to compensation • Capitalize on
health and MH care community assets
• Support individuals and strengths
• Integrate MH with MH challenges
services into that have lower
livelihood initiatives incomes
• Increase fexibility
of MH services by
address barriers to
care

Social and public • Strengthen fnance • Ensure equitable • Tiered care options • Collaborate with
services systems standards of care • Expand access and national social
• Strengthen MH • Integrate MH into remove barriers to and public service
care systems early intervention access systems

• Integrate programs • Establish equitable • Create context-

prevention • Support MH and person- specifc services
programs into provider centered MH care • Collaborate with
systems professionalization • Establish integrated service users and
• Establish • Strengthen the crisis response caregivers
comprehensive integration of teams that include • Integrate cultural and
funding structures ethical practices MH professionals contextual factors
into systems • Increase access to into systems
community-based
MH care
• Support long-term
MH recovery
• Implement case
management
• Integrate
trauma-informed
approaches
• Establish MH-
related helplines

USAID’S MENTAL HEALTH FRAMEWORK 31

 Community Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
MH services and • Build community • Ensure equitable • Increase or • Implement
resources support for MH distribution of MH reallocate MH community mapping
interventions resources and funding of MH services
• Develop MH stigma services • Ensure MH crisis • Increase community
reduction initiatives • Establish response readiness collaboration around
• Conduct MH community MH • Develop MH MH services
literacy campaigns regulatory systems services that • Conduct service
• Create vetted MH respond to the user and caregiver
referral networks needs and priorities consultations
• Strengthen of communities • Establish fexible
community • Establish MH services meeting
networks and integrated services local conditions and
connections • Implement needs
culturally
appropriate ethical
and safe practices
• Ensure multiple
options for MH
service selection
• Use task sharing
and peer support
as components
of systems
strengthening
• Establish aftercare
and transitional MH
services

Safety and security • Secure • Safety planning • Integrate MH into • Increase community
neighborhood • Support local policing and justice collaboration around
gathering spaces community systems MH and security
• Establish safety safety regulations • Establish confict • Increase
infrastructure and frameworks resolution services collaboration with
(e.g. lit paths) • Support good • Address service marginalized groups
• Create governance user and caregiver • Develop cross
community-level campaigns safety and security sectoral
violence prevention • Promote local concerns partnerships
programs and security systems • Establish MH- • Expand existing
outreach strengthening related helplines violence prevention
• Develop confict • Establish strong • Implement case programs and
resolution privacy and management initiatives
initiatives confdentiality • Create improved
frameworks with referral pathways
accountability • Establish access to
justice and social
services
• Develop peer
support programs

32
 Community Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Economic resources • Improve • Address economic • Ensure people • Conduct economic
and opportunities community-level disparities have MH leave as a and market analyses
food security and beneft
• Increase equitable • Reduce
housing support compensation • Create equitable community-specifc
access to
• Establish education • Create employment barriers to
and employment employment and programs employment
programs education programs • Conduct gender
• Establish workplace
• Reduce barriers to for people with MH MH and well-being analyses that
income equality challenges programs integrate MH
• Establish fnancial • Establish equitable • Create access to • Conduct inclusive
free or low-cost
literacy programs and participatory MH treatment and development
decision-making care analyses that
regarding MH integrate MH
• Develop options
resource allocation for teletherapy
and planning
• Provide access to
fnancial counseling

Social norms and • Destigmatize MH • Provide social • Create localized • Conduct gender
culture challenges support in support for MH analyses that
• Implement social culturally signifcant • Utilize integrate MH
behavior change places and/or by contextualized MH • Conduct inclusive
programs peers or respected approaches development analyses
community that integrate MH
• Addressing norms members • Develop culturally
about MH aligned MH • Understand
• Support regulatory helplines community norms
• Increase MH frameworks that
literacy • Establish and narratives about
decrease human MH and trauma
• Address gender rights violations and confdential and
disparities and shift attitudes and private MH referral • Implement
harmful practices practices and services community-led needs
assessments

USAID’S MENTAL HEALTH FRAMEWORK 33

 Community Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Economic resources • Implement safe and • Increase locally • Engage local
and opportunities efective MH care developed ethical religious and other
• Develop MH MH practices leaders to shift
anti-stigma • Address barriers norms related to
campaigns led created by harmful MH help seeking
or supported by norms • Use local languages
cultural, religious or or ofer translation/
other leaders interpretation
services
• Train service
providers to ease
cultural concerns
about help-seeking
behavior

34
 Relational Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Social support • Create inclusive • Promote • Link interventions • Ensure knowledge of
support networks community with culture culture and context as
• Understand cohesion • Implement foundation for
community • Promote family or couples support and
dynamics widespread use of interventions belonging

• Establish peer-led foundational helping • Implement anger • Design strategies that

initiatives in schools skills within support and confict honor culture and
networks management collective values
• Promote belonging programs • Collaborate with local
and collective care • Implement safe groups
reconciliation • Address MH stigma
programs • Include persons with
• Establish access to lived experience in
justice services design and
• Establish MH- implementation
related helplines
• Use evidence-
informed
approaches and
resources

Family structures • Provide family- • Strengthen family • Involve family in • Understand family
and dynamics centered support support systems MH care structures and norms
services • Establish crisis • Provide family • Consider power
• Provide parenting management support programs dynamics in families
support services services and therapy • Include those with
• Strengthen social • Establish problem • Increase access to lived experience in
supports for management family and design and
families services system-based implementation
• Foster psychological • Support caregiver therapies
safety within respite services • Establish family
families case management
services
• Ofer safety net
programs that
address
• Basic needs and
decrease family
stress

USAID’S MENTAL HEALTH FRAMEWORK 35

 Relational Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Interpersonal • Encourage positive • Increase family • Implement family • Integrate knowledge
communication emotional programs and and relationship of knowledge of local
connections activities therapy social and group
• Foster healthy/ • Support kinship and • Ofer confict dynamics
supportive cultural traditions resolution services • Conduct gender and
relationships and • Create media • Implement inclusive
social bonds programs to programs that development analyses
• Encourage encourage help- promote trust that integrate MH
supportive human seeking building • Work with local
resource and • Teach positive actors to understand
workplace policies parenting and community norms
• Create caregiver helping and norms related
communication and skills to MH
listening skills • Promote facilitated • Ensure that all
programs community dialogue programs are
• Create programs locally-led and
• Develop contextualized
that teach educational
relationship skills programs that teach
relationship skills
Social norms, • Foster equitable • Implement • Support CSO’s • Understand and
including gender and MH and gender locally facilitated encouraging foster cultural
mental health norms roles/norms community dialogue positive norms respect and safety
• Implement MH • Foster supportive related to mental • Integrate cultural
stigma reduction cultural traditions/ health norms related to MH
campaigns practices/ • Establish access to • Conduct gender and/
• Establish programs ceremonies justice services or inclusive
or interventions • Integrate MH • Implement development
that teach skills for into gender programs that analyses that
navigating transformative support the use of integrate MH and
conversations programs (and therapy to address concerns from many
about roles and vice versa) MH issues related diferent groups
responsibilities in • Support laws, to stigma and
relationships, such policies, and discrimination
as those related to regulations that
gender address social
• Work with local norms
leaders to address
harmful norms
related to MH
• Develop
communication
campaigns to
promote healthy
relationships

36
 Individual Level
Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Psychological • Strengthen • Conduct • Provide individual • Use contextually
resilience resilience, community and group-based and culturally rooted
knowledge, and outreach on MH therapy approaches
skills • Implement MH • Establish client- • Ensure approaches
• Implement literacy programs centered address culturally
initiatives that • Skills training for approaches specifc stressors and
reduce exposure to multisectoral • Implement coping mechanisms
adverse events providers strengths-and • Use culturally
• Provide workplace • Skills training recovery-based sensitive local
programs that for community approaches terminology
foster support and members to • Share vetted • Conduct feasibility
psychological encourage referrals to analyses to support
safety supportive encourage help- sustainability
engagements seeking behaviors

People’s life • Increase access to • Increase access • Implement clinical • Leverage support
experiences integrated mental to community psychological structures
health (MH) outreach programs interventions • Understand
services • Implement case • Promote access to regulatory, legal,
• Bolster community management family education economic, and policy
support services services • Promote access to context
• Promote supportive • Promote equitable peer support • Collaborate with
interpersonal access to services • Establish crisis local actors
connections • Ensure safety response services throughout program
• Develop anti- and security • Provide access to • Conduct needs
bullying campaigns infrastructure safe and secure assessments
• Ensure safeguarding • Support social environments and • Embed contextually
practices in assistance programs services relevant
interventions considerations into
services
• Understand
interpersonal
dynamics

USAID’S MENTAL HEALTH FRAMEWORK 37

 Individual Level

Supporting
Prevention Response
Determinants Elements Contextualization
Approach Approach
Approach
Psychological health • Establish emotional • Ensure access to • Provide clinical/ • Co-design with those
wellness supports quality MH services specialized MH that have MH
• Promote MH and support interventions, challenges
literacy • Provide access including therapy • Improve accessibility
• Foster to helplines and • Implement to MH programs
interconnected support groups community-driven • Develop holistic
emotional belonging • Design services MH approaches approaches to MH
• Ofer MH checkups tailored to the • Implement rights- • Understand and
during healthcare needs of specifc based approaches address MH stigma
visits groups • Strengthen social • Understand and
• Integrate trauma- support integrate local
informed • Provide case concepts related to
approaches into management MH into initiatives
public safety services
services

Physiological health • Conduct • Foster equitable • Ensure access to • Utilize integrated

developmental access to quality integrated and approaches to MH
assessments services and stand-alone MH and healthcare
• Provide early supports care • Conduct contextual
screening and • Provide physical, • Provide treatment analyses
intervention occupational, and for physical health • Address MH stigma
• Provide treatment speech therapy concerns and discrimination
for medical • Integrate MH into • Integrate a locally-
issues physical health care informed
• Develop education understanding of the
plans that address interaction between
physiological physical and MH
concerns

Endnotes
1 USAID. “Mental Health Position Paper.” May 2024. https://www.usaid.gov/inclusivedevelopment/mental-health/mental-health-position-paper
2 Powell, Tara, and Benjamin Lough. “Proposed Theory of Change for Global Mental Health.” USAID, September 2023.
3 Powell, Tara, Kate Andrus, and Benjamin Lough. “Terms and Approaches to Address Mental Health: What Diverse Terms Are Used to
Describe the Diferent Levels of Approaches to Addressing Mental Health in Global Settings?” September 2023
4 Ibid.
5 Powell, Tara, Kate Andrus, and Benjamin Lough. “Terms and Approaches to Address Mental Health: What Diverse Terms Are Used to
Describe the Diferent Levels of Approaches to Addressing Mental Health in Global Settings?” September 2023.
6 Eaton WW (2012) Public Mental Health. New York, NY: Oxford University Press. Tol WA, Purgato M, Bass JK, Galappatti A and Eaton W
(2015) Mental health and psychosocial support in humanitarian settings: a public mental health perspective. Epidemiology and Psychiatric
Sciences 24, 484–494.
7 Centers for Disease Control and Prevention (CDC). 2021. “Social Determinants of Health: Know What Afects Health.” https://www.cdc.gov/
scialdeterminants/index.htm
8 World Health Organization. 2021. Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches.
Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240025707.

38
Endnotes
9 Powell, Tara, Jenna Muller, and Benjamin Lough. “Contextualization of Mental Health Interventions in Global Mental Health.” September 2023.
10 Locally led development, as supported by USAID, empowers local actors—such as individuals, communities, organizations, private entities,
and governments—to set their own agendas and develop solutions using their leadership and resources, aiming for sustainable outcomes in
development and humanitarian assistance through various supportive roles in design, procurement, management, and measurement of
assistance, with a commitment to increasingly shift decision-making power to local entities. See: USAID. “What is Locally Led Development?”
11 Local, Faith, and Transformative Partnerships Hub. Accessed June 25, 2024. https://www.usaid.gov/local-faith-and-transformative-
partnershipslocal-works.
12 Miles, Ted, Tara M. Powell, and Benjamin J. Lough. Mental Health Research in Humanitarian and Development Settings. Washington, DC:
Research Technical Assistance Center, September 2023.
13 USAID (2021). Recommendations and Best Practices for Integrating Mental Health into USAID’s Global Health COVID-19 Response: A Call
to Action.
14 Kumar, et al. “System Level Interventions, Prevention Strategies, Mitigation Policies and Social Responses during Covid-19 that Improve Mental
Health Outcomes: Evidence from Lower-and Middle-Income Countries (LMICs).” 2022.
15 Powell, Tara, Kate Andrus, and Benjamin Lough. “Terms and Approaches to Address Mental Health: What Diverse Terms Are Used to
Describe the Diferent Levels of Approaches to Addressing Mental Health in Global Settings?” September 2023.
16 Ridley, Matthew, Gautam Rao, Frank Schilbach, and Vikram Patel. “Poverty, Depression, and Anxiety: Causal Evidence and Mechanisms.”
Science 370, no. 6522 (2020): eaay0214. https://doi.org/10.1126/science.aay0214. Erratum in Science 383, no. 6689 (2024): eadp1916. https://
doi.org/10.1126/science.adp1916. PMID: 33303583.
17 Freeman, M. “Investing for Population Mental Health in Low and Middle Income Countries—Where and Why?” International Journal of Mental
Health Systems 16, no. 38 (2022); USAID. “IDAMS Summary of Literature Review.” August 2023.
18 Braveman, Paula, and Laura Gottlieb. 2014. “The Social Determinants of Health: It’s Time to Consider the Causes of the Causes.” Public
Health Reports 129, no. Suppl 2 ( January-February): 19-31. https://doi.org/10.1177/00333549141291S206.
19 Powell, Tara, Jenna Muller, and Benjamin Lough. “Mental Health Treatment Approaches in the Global South: A Review of the Evidence.”
September 2023.
20 Powell, Tara, Jenna Muller, and Benjamin Lough. “Contextualization of Mental Health Interventions in Global Mental Health.” September 2023;
Patel, Vikram, Shekhar Saxena, Crick Lund, Graham Thornicroft, Florence Baingana, Paul Bolton, Dan Chisholm, Pamela Y. Collins, Janice
L.Cooper, Julian Eaton, Helen Herrman, Mohammad M. Herzallah, Yueqin Huang, Mark J. D. Jordans, Arthur Kleinman, Maria Elena Medina-
Mora, Emily Morgan, Unaiza Niaz, Olayinka Omigbodun, ... Jürgen Unützer. 2018. “The Lancet Commission on Global Mental Health and
Sustainable Development.” The Lancet 392, no. 10157: 1553-1598. https://doi.org/10.1016/S0140-6736(18)31612-X
21 USAID. Recommendations and Best Practices for Integrating Mental Health into USAID’s Global Health COVID-19 Response: A Call to
Action. 2021; Powell, Tara, Ted Miles, and Benjamin Lough. “Ethical Principles in Global Mental Health: What Core Ethical Principles Can
Organizations Apply to Ensure That Global Mental Health Policies and Practices Do No Harm?” September 2023.
22 Hall, C. E., H. Wehling, J. Stansfeld, et al. “Examining the Role of Community Resilience and Social Capital on Mental Health in Public Health
Emergency and Disaster Response: A Scoping Review.” BMC Public Health 23 (2023): 2482.
23 Li, F., S. Luo, W. Mu, et al. “Efects of Sources of Social Support and Resilience on the Mental Health of Diferent Age Groups during the
COVID-19 Pandemic.” BMC Psychiatry 21 (2021): 16. https://doi.org/10.1186/s12888-020-03012-1; Gariépy, G., H. Honkaniemi, and A.
Quesnel-Vallée. “Social Support and Protection from Depression: Systematic Review of Current Findings in Western Countries.” British
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People: A Theoretical Review.” Health Communication 38, no. 13 (2022): 2818–2832. https://doi.org/10.1080/10410236.2022.2121473; Zheng,
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USAID’S MENTAL HEALTH FRAMEWORK 39

 October 2024

Authors:
Breanne Kaiser, Consultant, Making Cents International
Dr. Christy Olenik, Senior Technical Advisor, Making Cents International
Nicola Chehade, Mental Health and Inclusion Senior Specialist, Making Cents International
Lindsay Bingaman, Consultant, Making Cents International

Special thanks to our USAID colleagues, who provided signifcant input and guidance to this document: Dr. Teresa
Parr, Senior Gender and Social Inclusion Advisor; Lyla Schwartz, Senior Mental Health Advisor; and Kathleen
O’Donnell Burrows, Mental Health and Psychosocial Support Program Advisor.

This framework is made possible by the support of the American People through the United States Agency for
International Development (USAID), under the terms of Inclusive Development Activity for Mission Support
AID Contract # 7200AA20D00018/7200AA22F00016. The contents are the sole responsibility of Making Cents
International and do not necessarily refect the views of USAID or the United States Government.
40