In Indonesia, 303 Afghan refugees living in prolonged limbo opened a simple illustrated workbook and picked up the phone for five brief calls—and in doing so, became part of the first large-scale test of whether a WHO-designed self-help program could genuinely improve mental health outcomes in one of the world's most resource-scarce settings. The results, published in JMIR Mental Health, offer quiet hope for millions displaced across the globe.
The context is urgent. In 2024, one in every 67 people worldwide was forcibly displaced. More than three-quarters of them landed in lower- and middle-income countries, where access to formal mental health care is severely limited. In Indonesia alone, approximately 12,000 refugees exist in a state of waiting—sometimes for over a decade—unable to work, separated from family, without clear pathways to resettlement. This prolonged limbo creates a devastating gap: refugees face an estimated 31.5% rate of both post-traumatic stress disorder and depression, yet resources to address these needs are almost nonexistent.
Professor Angela Nickerson, a clinical psychologist and lead researcher at UNSW Sydney's Refugee Trauma and Recovery Program, describes the toll plainly: "People are often living in prolonged limbo, without stable rights, work or support, sometimes for over a decade." Their lack of legal status compounds vulnerability to discrimination, violence, and exploitation—yet traditional mental health interventions require infrastructure these communities simply do not have.
The intervention tested here was born from pragmatism. The WHO's "Doing What Matters in Times of Stress" program was originally designed specifically for low-resource settings. Researchers from UNSW Sydney, the University of Newcastle, and the University of Melbourne partnered with refugee-led organizations, including the Refugee Learning Nest, SUAKA (an Indonesian legal aid organization), and Universitas Gadjah Mada to adapt and deliver it within Afghan refugee communities in Indonesia. This was the first fully powered trial to test the program as a standalone intervention—no clinical infrastructure required.
Participants received an illustrated workbook in Farsi, their own language, paired with five short phone calls from facilitators who were themselves trained members of the refugee community. This approach did two things at once: it delivered care where it was desperately needed, and it built capacity from within communities rather than relying on scarce external resources. "This not only overcomes some of the difficulties with resources, but it also builds capacity within refugee communities," explains Dr. Philippa Specker, a UNSW clinical psychologist who led the facilitator training.
The randomized controlled trial yielded the finding the team had cautiously hoped for: those who participated in the program showed significantly greater mental health improvements than the control group. The effect was both measurable and meaningful—proof that something brief, low-cost, and deeply respectful of community knowledge could work even under the hardest circumstances. "We were really excited to see that such a brief, light-touch kind of intervention could have a meaningful impact," Specker says.
For the 12,000 refugees in Indonesia and the millions more across lower-income countries living in similar conditions, this study opens a door. It suggests that solutions to the mental health crisis among displaced people do not require waiting for resources that may never arrive. They can begin now, with a workbook, a phone call, and the leadership of those who understand best what their communities need.