# Barriers and facilitators to integrating mental health and psychosocial support into economic inclusion programming for displaced families in Ecuador

## TL;DR

This paper explores how to effectively combine mental health support with economic programs for displaced families in Ecuador, identifying what helps and hinders success.

## Contribution

The paper introduces and evaluates a new integrated mental health and economic inclusion toolkit for displaced families in Ecuador.

## Key findings

- The Toolkit was found acceptable, feasible, and adaptable by participants and staff.
- Key facilitators included social network building and alignment with organizational values.
- Barriers included economic demands, transportation costs, and limited youth and male participation.

## Abstract

Displaced populations have increased rates of mental health problems, which have been shown to have a bidirectional relationship with economic insecurity. Despite growing calls globally to integrate mental health and psychosocial support (MHPSS) with economic inclusion (EI) programming, few models exist for practical implementation. We co-developed and piloted the Building the Future Toolkit (i.e., the Toolkit), an integrated MHPSS-EI intervention for displaced families in Ecuador, a country that hosts a large number of displaced persons. Here, we present participant and implementer perspectives on the barriers and facilitators to implementation of the Toolkit.

Fifty displaced families in Quito participated in a pilot trial of the Toolkit between October 2023 and May 2024. Following completion of the trial, we conducted six focus group discussions (n=31; 22 intervention participants, 9 staff) to explore determinants of implementation outcomes, guided by Proctor’s Implementation Outcomes Framework and the Consolidated Framework for Implementation Research 2.0. Data were analyzed thematically using a hybrid inductive-deductive approach.

Both intervention participants and staff viewed the Toolkit as highly acceptable, appropriate, feasible, and usable, with strong potential for sustainability. Key facilitators included the holistic integration of mental health and livelihood skills, enhanced social network building among displaced families, the Toolkit’s standardized yet adaptable structure, and alignment with organizational values and existing activities. Barriers included competing economic demands, childcare responsibilities, transportation costs, limited participation of men and youth, and challenges related to donor reporting indicators. Contextual disruptions—such as Ecuador’s 2024 insecurity and energy crisis—posed additional challenges but also demonstrated the Toolkit’s adaptability in unstable environments.

The Building the Future Toolkitillustrates how integrated MHPSS-EI programming can be designed and implemented in humanitarian contexts through participatory methods. Our findings highlight the multilevel determinants supporting successful implementation and promoting sustainability. Future integrated program efforts should address structural participation barriers, develop strategies to target engagement of men and youth, and work with funding institutions to create indicators that recognize the interdependence of mental health and livelihoods.