# Psychosocial wellbeing & intervention

"Psychosocial" is one word on purpose: the psychological (thoughts, emotions, behaviour) and the social (family, community, economy, culture) shape each other constantly. Intervention means acting on both sides at once, and mostly through communities, not clinics.

## The pyramid of need and intervention

The intervention pyramid (after Galappatti and the IASC guidelines). Most people are served by the bottom two layers alone; the psychosocial counselor's own tier is the third; only a few clients ever need the psychiatric top, and your referral is their bridge.

**A worked example:** A 40-year-old named Goma lost her home in a flood. The counselor uses the pyramid to explain: Goma needs basic services first (shelter, food), then community supports (a women's group), before any specialized counseling. The counselor's own role sits at the community tier, mobilizing what Goma already has rather than importing outside expertise.

**Core ideas the curriculum names:** psychosocial wellbeing has dimensions (biological, emotional, social, cultural, spiritual, material); intervention can be *individual* or *community-based (CBI)*: CBI mobilises the community's own resiliency rather than importing outside experts.

A *rights-based approach* treats women's, children's and elders' basic rights as the floor of wellbeing. A *multidisciplinary holistic approach* means the counselor, health worker, teacher, lawyer, and social worker act as one linked system, which is why referral, coordination and linkage get their own page.

## The layers around a person, and what wellbeing is made of

**Bronfenbrenner's social-ecological model** reads a life as rings around the person. A counselor who only works the innermost ring misses where most Nepali distress is made and where much of it can be eased.

| Ring | What sits there | A Nepali example |
| --- | --- | --- |
| Individual | Temperament, health, coping style, personal history | A quiet girl who somatises worry as stomach pain |
| Microsystem | Settings the person is directly in: family, school, workplace, peers | A joint household; a teacher who calls the child "lato" |
| Mesosystem | Links between those settings | Whether the school ever talks to the parents |
| Exosystem | Settings that shape life without the person being in them | The father's job in Qatar; the ward office; local media |
| Macrosystem | Culture, law, economy, shared beliefs | Caste, dowry expectations, karma explanations, the migration economy |

The rings around a person (Bronfenbrenner). Read a client outward: who is in the house, whether the school and the family talk, what the migration economy did to the household, what caste and karma explanations do to help-seeking.

**What wellbeing is made of** (the elements the curriculum lists): *psychological* includes self-acceptance, autonomy, environmental mastery, purpose, personal growth, and emotional self-regulation. *Social* includes warm relationships, belonging, contributing something, trust and safety in one's community, and cultural and spiritual connectedness. *Structural* includes physical safety, food, housing, livelihood, and access to health, education and legal protection.

The bottom row is the floor the other two stand on.

## Community-based support: principles and a roadmap

**Community-based MHPSS** treats the community as the agent of its own recovery, not the audience for outside experts. Its principles: *do no harm*, *meaningful participation*, *build local capacity*, *cultural fit*, and *inclusion* of the marginalised.

Modalities you will use include Psychological First Aid, psychoeducation, structured groups, task-shared protocols such as WHO's Problem Management Plus (PM+), and livelihood support joined to peer groups.

| Step | What you do | Looks like |
| --- | --- | --- |
| 1 · Assess with the community | Focus groups, key informants, a map of assets and existing coping | Who do people already go to? Mothers' groups, the health post, the jhankri |
| 2 · Co-design | Adapt materials with a local committee: language, metaphors, timing | "Man" not "mental health" on the poster; sessions after the harvest |
| 3 · Build capacity, share tasks | Train gatekeepers and volunteers in basics, PFA, groups, safe referral | Female community health volunteers who can spot risk and refer |
| 4 · Run core activities | Peer groups, child-friendly spaces, cultural and recreational events | A women's circle; a safe space in the school after the flood |
| 5 · Referral pathways | Link to the health system for those who need layer 3 or 4 care | A named person and number at the nearest hospital |
| 6 · Monitor together | Track outcomes with validated tools and community feedback | Nepali PHQ-9 or GAD-7 at start and end; a review meeting the group owns |

Key points

1. Psychosocial means mind and social world shaping each other; intervention works on both at once.
2. The IASC pyramid: most people need only basic services and community support; the counselor works in the third layer; few need specialists.
3. Community-based support builds on what the community already has: do no harm, involve everyone, train local people.
Learn more

Pick one, not all.

Guideline**IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007)**: the source of the pyramid; skim the action sheets.

Paper**Galappatti (2003), "What is a psychosocial intervention?", Intervention journal**: the typology your curriculum cites by name.

Website[TPO Nepal](https://www.tponepal.org): Nepali CBI in practice: manuals, community programmes.


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*Source: https://manoatlas.com/wellbeing · Licence: CC BY-NC-SA 4.0. Mano Atlas is an educational resource, not a diagnostic tool.*