From Uniformity to Need-Adaptive Capacity: A Scalable Model for Equitable Mental Health and Psychosocial Support After Disasters.

This Letter addresses a critical operational gap in disaster mental health and psychosocial support: how to deploy limited specialist capacity dynamically without fragmenting services. Evidence confirms substantial disparities in disaster-related mental health outcomes and identifies MHPSS, assessment, referral, and community engagement as core humanitarian response components. Yet a clear mechanism for allocating these components based on changing needs remains underdeveloped. We propose a need-adaptive model that standardizes the service backbone while adjusting specialist intensity according to operational signals. The model operates through four actions: assess for action--brief, decision-oriented assessment, as demonstrated by CASPER following the Eastern Kentucky floods; match tasks to complexity--frontline non-specialists provide basic care while specialists focus on complex cases, supported by meta-analytic evidence showing significant improvements in PTSD symptoms, deploy by threshold, not geography--a mobile multidisciplinary unit responding to predefined signals, and adapt delivery while preserving standards--local partners shaping culturally appropriate care. This approach reframes the equity question from "Which intervention should each subgroup receive?" to "What level of expertise is needed, where, and for how long?" The model reconciles equity with operational feasibility, is testable through implementation research, and offers a practical pathway from contextualized MHPSS principles to scalable field deployment.