Humanitarian funding is contracting while needs continue to rise, and Mental health and psychosocial support (MHPSS) enters this period after years of chronic underinvestment. Donors therefore face two linked tasks: protect MHPSS services that are already limited and change the funding practices that keep local actors under-resourced, fragment the continuum of care and make integrated work difficult to sustain.
What funders need to know:
- Protect MHPSS during the funding contraction. Mental health and psychosocial support is lifesaving and rights-based. It also strengthens outcomes in health, education, protection, livelihoods and recovery.
- Make localisation a transfer of power. Moving implementation without moving resources, decision-making and institutional support merely transfers cost and risk to local organisations and communities.
- Use integration to expand access, not replace care. Integrated approaches need dedicated resources, supported workers, functioning referrals and continued focused and specialised services.
Six funding commitments
- Fund continuity. Provide multi-year, flexible grants that include core and overhead costs, bridge funding and protection against inflation.
- Share authority. Give local actors and affected communities real influence over priorities, design, adaptation, budgets and definitions of success.
- Support the people who deliver care. Pay workers and volunteers fairly and resource supervision, safeguarding, manageable workloads and wellbeing.
- Keep the continuum of care intact. Fund community support, embedded approaches, referrals, medication continuity, focused care and specialised services together.
- Invest in local knowledge and capacity. Resource organisational systems, locally led research and learning, and South-South exchange.
- Measure local, cross-sectoral and longer-term change. Use shared, locally meaningful indicators that capture relationships, social value, implementation and systems change.
Why acting now matters
Humanitarian funding is undergoing a deep contraction while armed conflict, displacement and climate-related shocks continue to increase need. Official development assistance from the wealthiest donors fell by 23.1 percent in 2025, and humanitarian assistance fell by 35.8 percent. MHPSS enters this period from chronic underinvestment, with governments allocating an average of only 2.1 percent of health budgets to mental health and far less through other sectors.
The effects are already visible in interrupted treatment, medication shortages, closed programmes and a shrinking workforce. A 2025 survey of 131 programmes across 32 countries found that the number of people supported fell from 981,850 to 207,030 within a year, while staffing fell from 9,343 posts to 2,508. Cuts to training have also reduced the number of people available to provide safe support in future emergencies.
Around one in five people in settings affected by armed conflict lives with a mental health condition. Unaddressed needs can contribute to suicide, one of the leading causes of death among adolescents and young adults. The MHPSS continuum ranges from everyday measures that help people remain safe and connected, through structured psychological support, to clinical treatment for people living with the most serious conditions. It concerns survival, dignity and rights, and it also shapes whether investments in other sectors succeed.
Psychosocial wellbeing affects children’s learning, adherence to medical treatment, recovery after violence and people’s ability to benefit from cash, livelihoods and protection assistance. Because MHPSS runs through health, education, protection, nutrition and livelihoods, cuts in those sectors can also remove psychosocial support.
MHPSS belongs within core humanitarian assistance
Sustaining investment in MHPSS localisation
As resources shrink and humanitarian needs continue to grow, investing in localisation is more important than ever. Affected communities should meaningfully influence how increasingly scarce resources are prioritised and used, and localisation should not be framed simply as a means of “doing more with less.”
Localisation is particularly important in MHPSS because locally led approaches can strengthen relevance, trust, agency and social cohesion by building on communities’ own priorities, knowledge, resources, and support systems. In contrast, externally designed and standardised approaches can overlook local realities and marginalise existing capacities, with potential unintended harms. Investment in localisation can shift power, uphold communities’ right to self-determination, and help ensure that MHPSS is relevant, equitable and effective.
Yet funding, decision-making and knowledge production in MHPSS remain disproportionately shaped by international actors and Global North institutions, while locally grounded approaches receive less funding and research attention. Direct funding to local and national actors remained below one percent of humanitarian funding in 2023. As budgets contract, localisation must not become an austerity strategy that moves delivery costs and operational risk downwards while priorities, contracts and budgets remain controlled elsewhere.
Locally led MHPSS and meaningful localisation
Locally led MHPSS means local actors lead priority-setting, design, implementation, evaluation and governance. Meaningful localisation concerns the funding, partnerships, governance and knowledge-production arrangements that redistribute power and make that leadership possible. Local implementation can expand while control over funding, priorities, and evidence remains elsewhere, so the distinction matters.
| Current practice | Shift required for sustainable integration |
|---|---|
| MHPSS added after the host-sector programme is designed | Joint planning with the host sector from preparedness and programme design through implementation, learning and recovery |
| Short-term training or task-sharing without continued support | Ongoing supervision, mentoring, translation, fair compensation, safeguarding, manageable workloads and worker wellbeing |
| The host system is assumed to absorb additional work | Assessment of workforce, infrastructure, leadership, mandates, medication and referral capacity, with support for community-based organisations where formal systems are weak |
| An integrated activity is funded in isolation | Protected MHPSS funding alongside community support, referrals, medication continuity, focused care and specialised services |
| Separate sector budgets and one-directional partnerships | Flexible cross-sector budgets, local leadership, power-sharing and clear responsibilities across sectors |
| Psychosocial contributions disappear into host-sector reporting | Shared, locally meaningful indicators and learning systems that capture psychosocial, host-sector and longer-term systems outcomes |
Move from short project cycles to multi-year, flexibly reported grants
Short, project-based grants are one of the clearest barriers to local sustainability. They keep local organisations dependent on the next cycle, make it harder to retain staff, and leave them exposed when funding shocks arrive. Funders able to commit multi-year, flexibly reported grants give organisations the stability to plan, adapt, and continue essential work through disruption. Where multi-year commitments are genuinely out of reach, the same intent can be signalled in other ways: predictable renewal, lighter reporting, and core costs covered within shorter grants.
Pay core and overhead costs alongside project activities
Core costs are the things that keep an organisation running: staff, office space, finance and safeguarding systems, supervision, management, and, where programmes demand it, vehicles, fuel, power, and connectivity. Funding activities while refusing these costs leaves an organisation without the basic capacity to function, and the strain falls directly on staff. Paying core and overhead costs is not an add-on to localisation; it is one of the conditions that make it possible. Treating them as excessive overhead while asking local actors to carry more responsibility leaves localisation underfunded at the point where it needs to become operational.
Fund staff and volunteer wellbeing as a protected line, and consider a duty of care standard
Frontline workers in conflict and emergency settings often carry the same displacement, grief, and exposure to violence as the people they support. Yet the systems meant to protect them are often cut first when budgets shrink. Funding staff and volunteer wellbeing helps prevent burnout and protects the quality of care. Funders could also include a duty of care standard in partnership agreements, covering psychological safety, supervision, and manageable caseloads for those handling the most demanding work.
Design exits as phased transitions paired with capacity support
When international actors are stepping back, transitions need to be carefully planned, so that abrupt withdrawal does not harm the people the programme was built to serve. Transitions work when they are phased and matched with capacity support, with the more everyday forms of support moving to local hands earlier and specialised care handed over more gradually.
Resist forcing the pilot-to-scale pathway onto every organisation
The expectation that every intervention should move from concept to pilot to scale does not fit all local organisations. Some are valuable precisely because they are rooted in one population, community, or area. Work that was never designed to scale can still be essential where it operates and funding should make room for it. Seed funding and small grants help here, giving a local actor room to build ownership and strengthen what works on its own terms, rather than treating growth as the only sign that funding was worthwhile.
Establish pooled funds for localised programming
Pooled funds bring contributions from several donors into one funding pot, with a shared allocation process, common due diligence, and proportionate reporting. For localised programming, this could take the form of a dedicated local funding window within an existing country-based pooled fund, a pooled philanthropic fund managed by a trusted local, national, or regional intermediary, or a re-granting facility governed with local and national actors. The purpose is not simply to pool money, but to make smaller, direct grants to local actors easier to manage, while reducing the monitoring burden that often leads funders to route money through large intermediaries by default. o.
Make capacity building demand-driven and invest in organisational systems
Capacity support works best when local actors shape it around what they need. This includes the organisational systems that determine whether an organisation can absorb and account for funds, such as finance, accounting, management, and reporting. Investing in these systems is what makes direct funding possible.
Require and fund meaningful participation by the most marginalised children and young people
Mechanisms that meaningfully and safely include children, including adolescent girls, children with disabilities, and those outside formal schooling, are still rare, and local leadership processes can also privilege adult gatekeepers in ways that reinforce the exclusion of children who are already least heard. The same gap applies to people with lived experience of mental health conditions, whose involvement in shaping support is named far more often than it is funded. Funders should pay for structured advisory mechanisms for both groups and treat their input as part of programme governance, not as consultation after decisions have been made.
Fund context-appropriate models and local knowledge generation
The evidence points away from importing diagnostic models and assessment scales that were developed and validated in Europe or the United States without careful adaptation. Funding should back models that fit the context and support local knowledge, while holding one nuance in view: localised provision does not mean non-clinical provision. Local organisations also provide psychiatric and specialised care, and that care should be funded when it is needed, adapted to local context and language.
How do we back local leadership while keeping affected people’s agency and choice central?
The idea that local provision is always preferable does not hold in every setting. One participant described contexts where some people ask specifically for a therapist from outside their own community or conflict environment. This is less about geography than about trust: people may be seeking someone outside the conflict and its factions, or someone they feel they can speak to freely. In some settings, that preference may also have been shaped by 03 Recommendations and questions for funders: Localisation colonial histories that taught people to value outside expertise over their own. The deeper issue is that the opposite assumption often goes unnamed. The field may ask whether local is better, but funding systems still often behave as though global is better: approaches developed in context rarely make it onto evidence-based lists unless they have access to trial funding that few local organisations can secure. A related assumption is that a local organisation speaks for the people it serves, which is not always the case. Backing local leadership therefore also means asking whether the organisations a funder supports meaningfully involve people with lived experience of mental health conditions in their leadership and design, or whether they represent them from a distance. The question for funders is how to support local leadership while keeping affected people’s agency at the centre, including their right to choose specialist or outside support, and while examining which assumptions their own systems reinforce.
What is our responsibility for building grant-management capacity, and what role do intermediaries play?
A local actor may understand local mental health needs well but struggle to manage a grant. Treating that capacity gap as a reason to keep routing money through international intermediaries by default reproduces the problem localisation is meant to solve. At the same time, moving large sums too quickly to organisations that cannot yet absorb them carries real risk, and intermediary organisations may fear being designed out of the agenda altogether. Funders therefore need to decide where their own responsibility for building operational capacity begins, and what role intermediaries can usefully play. These intermediaries can bridge vertically between government and local civil society, and horizontally among local actors who do not otherwise work together. The more useful question is not whether intermediaries should exist, but which of those functions a funder is paying them to perform.
How do we avoid adopting imported approaches that may pathologise people’s experiences, while keeping specialised care accessible?
The move away from imported diagnostic models is important, but it can create another mistake: assuming that anything clinical or specialised belongs to international actors. Both assumptions distort the funding decisions that follow from them. The issue is not that local actors reject outside knowledge; communities have the right to draw on knowledge from anywhere. The problem begins when outside knowledge arrives tied to funding, authority, and fixed requirements that leave little room for local judgement. The line to hold is between funding context-appropriate, non-pathologising models and continuing to resource the specialised and clinical care that local organisations provide and that some people actively want.
Sustaining investment in MHPSS integration
People affected by emergencies face interconnected social, economic and psychosocial challenges, with adversity such as poverty, violence and food insecurity both affecting and being affected by mental health and psychosocial wellbeing. Integrating MHPSS across health, education, protection and other systems is therefore essential to address these interconnected needs, improve access and equity, and provide sustainable, person-centred support.
Integration has long been a priority in humanitarian MHPSS, reflected in the 2007 IASC Guidelines and more recently reinforced through the MHPSS Minimum Service Package, which provides practical guidance for integrating MHPSS across sectors. It can involve adding specific MHPSS activities, such as structured psychological or psychosocial support, screening, referral or task-sharing, within another service. It can also involve applying a psychosocial lens across a programme so that dignity, safety, agency, participation and wellbeing shape its design and delivery.
Integration ranges from light-touch linkage to system-wide work, with the benefits dependent on funding and system conditions. At one end, an activity or referral is added with little shared planning, and at the other, MHPSS and the host sector share concepts, processes and outcomes, and adapt to each other. Without joint design, supported staff, functioning referrals and continued focused and specialised services, integration can become an unfunded addition to already stretched services.
From current practice to meaningful localisation
| Current practice | Funding shift |
|---|---|
| Short, restricted projects | Multi-year, flexible grants with core costs, bridge funding and inflation protection |
| Due diligence mainly as a gate | Due diligence linked to funded organisational strengthening and proportional controls |
| Donor-defined priorities and indicators | Shared decisions and locally meaningful definitions of quality and success |
| One-way capacity building | Mutual learning, organisational systems, locally led research and South-South exchange |
Account for political and social risk
In settings where mental health, gender-based violence, sexual and reproductive health and rights, girls’ education or support for specific groups are politically restricted, funders should support local partners to identify safe language, entry points, referral options and safeguarding measures without exposing communities or providers to avoidable risk.
6 recommendations for funding integration
- Co-develop from the outset.Design with health, education, protection, livelihoods or other host sectors, as well as local actors and affected communities, from preparedness and programme design through implementation, learning and recovery.
- Assess readiness and fund missing capacity.Examine workforce, infrastructure, public-system capacity, leadership, mandates, medication and referral options. Where formal systems are weak or absent, resource community-based organisations rather than assuming the system can absorb more work.
- Protect the full continuum of care.Fund community-led support, embedded approaches, referrals, medication continuity, focused care and specialised services as complementary layers. Maintain a protected MHPSS funding line alongside cross-sector investment.
- Resource the workforce and partner organisations.Budget for training, ongoing supervision, mentoring, translation, fair compensation, safeguarding, manageable workloads, worker wellbeing and the organisational systems needed for safe delivery. Task-sharing should not become unpaid or unsupported labour.
- Measure shared outcomes and fund learning.Support shared and locally defined indicators that capture psychosocial and host-sector outcomes, implementation processes and longer-term systems change. Fund implementation research and collective reporting so that psychosocial contributions remain visible.
Fund integration as co-development with the host sector
Integration often runs in one direction: MHPSS activities are inserted into a host sector that otherwise stays the same. A stronger approach translates MHPSS into the language and logic of the sector it joins and develops the work with that sector from the outset. The benefit moves in both directions, because a livelihoods programme can produce wellbeing outcomes that counselling alone cannot, and integrated psychosocial expertise can protect the host sector from its own unintended harms, for example, when loan schemes raise household stress in the families they were designed to help. Funding that treats MHPSS as a component bolted onto an existing programme produces a weaker form of integration.
Assess host-system readiness, and resource communitybased organisations where systems are weak
Integration is difficult where the host system is weak or fractured, and many crisis-affected health and education systems are in exactly that position. Funders can assess host-system readiness before committing to integration into it, and where formal systems cannot carry the work, community-based organisations may be better placed to fill the gap. This is where the integration and localisation agendas converge, and where the conditions for safe, quality work (supervision, referral structures, medication continuity, and fair cost coverage) need funding alongside the delivery itself.
Fund embedded approaches that reduce stigma
Embedding support inside schools, savings groups, and cultural or religious spaces can allow people to access help without having to identify as mental health service users, which are less stigmatized and increase community acceptance. Accessing stand-alone psychiatric and psychological services can be highly stigmatized. Instead, funding programs embedded in community settings is one of the clearer opportunities in the integration evidence. In politically restricted settings, however, embedded approaches also need careful risk analysis. Funders should support local partners to identify language, entry points, referral options, and safeguarding measures that allow needs to be addressed without exposing communities or providers to avoidable political, social, or security risks.
Fund the layers of support together
Integration should add to the system of care, not replace other parts of it. Community-led MHPSS, specialist care for high-risk cases, and light-touch support embedded in systems such as health, education, and justice all do different work. If integration is treated as a substitute rather than an additional layer, some people will lose the level of support they need. Funding should keep these layers connected and prevent embedded approaches from crowding out specialised and community-led support.
Budget for the additional responsibilities that task-shifting places on workers
Integration and task-shifting add responsibilities for frontline and community workers, and those responsibilities need to be costed. Workers who take on new roles without supervision, training, or relief cannot sustain the work, and programme quality will suffer.
Treat translation and plain language as integration infrastructure
Clinical, academic, and English-first language is a concrete barrier to integrating across sectors. Integrating into water, sanitation, shelter, and other sectors, depends on language those sectors can use, while work in non-English-speaking communities, depends on translation and clear wording. Funding for translation and for stripping out jargon is integration infrastructure and should be budgeted from the start.
Fund longer-term workforce development alongside short courses
Investment in secondary and higher education as well as in clinical training is largely absent from humanitarian MHPSS funding. Short-term training cannot substitute for the long-term workforce pipeline of teachers, social workers, psychologists, psychiatrists, and nurses that sustained integration requires. Funders should support short-term training where useful, but also invest in the longer pathways that make integration last.
Fund and elevate contextually derived interventions alongside global frameworks
Contextually derived interventions should be funded and made visible alongside global frameworks. The IASC Minimum Service Package has helped make integration more accessible, but frameworks of this kind are designed to be adapted. Funders can pay for the work of challenging, translating, and adapting them to each setting.
Which integration are we funding, and have we defined it?
The field uses integration to mean at least two different things which it frequently conflates: integration into national systems, such as primary health care, and integration into humanitarian programmes, such as education, protection, livelihoods, or cash. These are different undertakings with different timelines, partners, risks, and funding implications. A useful starting point is to ask where MHPSS capability should sit in relation to the systems people already use, such as clinics, schools, markets, courts, and community spaces, and what it would take to hold it there.
How do we pursue integration while protecting dedicated MHPSS funding?
If MHPSS is described as mainstreamed across sectors, donors may stop funding it as a dedicated line, and the support then becomes thinner under cover of being everywhere. A funder committed to integration needs to protect earmarked MHPSS resources at the same time, so that integration expands reach while dedicated funding sustains quality and specialist capacity.
How do we evidence integrated work without narrow mental-health metrics?
Evaluations of integrated programmes tend to measure MHPSS-specific outcomes, which can make the wider value of integration hard to show. The social component of the work is also less consistently measured than the clinical component. The visibility problem compounds it: when a livelihoods intervention improves a family’s wellbeing, the result may be recorded as a livelihoods outcome, and the contribution of psychosocial work disappears. Practitioners and researchers question exclusive reliance on randomised controlled trials, call for research into the active ingredients that produce change, and recognize that the field often knows that certain interventions work without fully understanding why. There is growing interest in co-creating indicators of success with communities so that integrated outcomes and hostsector outcomes are not pulled apart. Funders need to decide how far they will adapt their measurement requirements, whether they will fund co-created indicators, and whether they will pay for research that explains why effective approaches work.
Cross cutting tensions
The questions below cut across both localisation and integration, and they are included because funding decisions still have to be made where the evidence does not offer a settled answer. In those moments, funders are not only interpreting evidence; they are making choices about what they are willing to fund, who is trusted to decide, and what trade-offs they are prepared to carry.
Who holds decision-making authority, and what does shifting power require of us?
Power is poorly captured by the local and global labels, which flatten a set of questions that actually matter for funding: who makes the decisions, whose knowledge counts, and who answers for the results? These questions apply between people who own a problem and those who arrive to help, whether that help comes from the same community, a national institution, or an international one. These gaps run inside countries as much as between the Global North and South, which is why handing a grant to a national organisation can still leave the gaps in place. A funder serious about shifting power has to examine its own contracts, templates, reporting rules, timelines, and risk assumptions. It also has to ask who decides how needs are named when certain issues are politically restricted or treated as off-limits, such as gender-based violence, sexual and reproductive health and rights, girls’ education, or support for specific groups. In those settings, language, partnerships, and service entry points shape whether people’s needs can be addressed without increasing risk for communities, local actors, or implementing partners. The harder question is not only how money moves, but how accountability holds when decision-making moves with it.
Who defines wellbeing, and whose definition is the funding buying?
Before a funder decides what to pay for, someone has already decided what wellbeing means. Whether that someone is the community, the funder, or the implementer shapes everything the money buys. Communities may define wellbeing in their own terms, and those terms often rest on collective and relational ideas of a good life rather than through individual symptoms or outcomes. Funders need to ask whose definition their funding is built around, and whether they are willing to fund toward a community’s account of wellbeing when it differs from their own.
Do our measurement tools adequately capture the value created for local communities and society?
The monitoring and evaluation mismatch under localisation and the attribution problem under integration are two versions of the same issue: standard measurement often fails to capture local or social value, and that gap shapes what gets funded. The unresolved question is how much a funder is willing to change what and how it measures, given that their current systems already shape funding decisions.
How do our own language and model of care entrench or shift the problem?
Clinical, jargon-heavy, English-first language is a barrier to building trust with local partners and to integrating across sectors. The language a funder requires and the model of care it rewards, either reinforce the current problem or help shift it. Funders need to examine their own language and assumptions about good care as part of the funding decision.
About this brief
This brief summarises the paper Sustaining Investment in MHPSS Localisation and Integration: Recommendations for Donors. The full paper contains the evidence base, detailed case studies, featured funding approaches and questions for internal deliberation.
How the work was developed
The brief and full paper draw on a review of published and grey literature on humanitarian financing, localisation and integration; key informant interviews with funders, practitioners and researchers; case studies on localisation and integration across different contexts; featured approaches showing how funders and implementing organisations have built these principles into their work; and a co-creation workshop that tested and refined the emerging findings.
Produced by
The MHPSS Collaborative in partnership with Peace of Mind Foundation, Save the Children, MHPSS.net, Terres des hommes, Mental Health Innovation Network (MHIN), the Global Mental Health Action Network (GMHAN), George Washington University Center for Global Mental Health Equity, and UNICEF.
Funded by Peace of Mind Foundation, Save the Children Netherlands, and DANIDA
