Conflicts and disasters are widespread, with internal conflicts and massive natural disasters such as the 2004 Boxing Day Tsunami devastating many countries. Psychosocial and mental health needs in the aftermath of such events are significant, and have in recent years attracted substantial attention from the donor community.
Despite this attention, much policy and system reform is promoted in the absence of a clear evidence base.
The School of Public Health & Community Medicine and the School of Psychiatry are investigating psychosocial and mental health service delivery and policy formulation and implementation in conflict- and disaster-affected countries of the Solomon Islands, Sri Lanka, and East Timor.
Undertaking the research in these three countries, using a systematic replication of a case-study approach, will allow generation of theoretical insights based on emerging themes, as well as consideration of the transferability of lessons across different settings.
The research will identify how international guidelines, standards and recommendations, national policies and plans of action are implemented at service and community levels, and the extent to which they respond to local need. In addition, it will identify which models and approaches are responsive to culture, gender, conflict and human rights.
The project is supported by the Australian Research Council.
Recent publications arising from this project:
Insider-outsider positions in health-development research: Reflections for practice
Authors: Ritchie, Jan; Zwi, Anthony B; Blignault, Ilse; Bunde-Birouste, Anne; Silove, Derrick.
Development in Practice, Volume 19, Issue 1, Feb 2009.
http://www.developmentinpractice.org/apc_ae-v19n1x544050.html
Recognising that the stance of investigators could make a major impact on the quality and/or interpretation of development-study findings, a small investigation to explore researcher positions and roles was implemented. This was a subsidiary component of a larger health-development study which aimed to explore the evidence base for psychosocial and mental-health policy formulation and implementation in two conflict-affected, low-resourced countries. Five of the research team were interviewed by a sixth member in an open, semi-structured interview format, and the data were analysed thematically. The primary learning for the team, with wider implications for others in development research and practice, is that if the aim is to produce credible findings from investigations of this nature, it is important to exhibit a high degree of transparency regarding the role and position of each researcher, and an explicit attempt to be reflexive in relation to the associated challenges.
Community perceptions of mental health needs: A qualitative study in the Solomon Islands
Authors: Blignault, Ilse; Bunde-Birouste, Anne; Ritchie, Jan; Silove, Derrick; Zwi, Anthony B.
International Journal of Mental Health Systems, Volume 3, Issue 6, Mar 2009.
http://www.ijmhs.com/content/3/1/6/
Background: Psychosocial and mental health needs in the aftermath of conflict and disaster have attracted substantial attention. In the Solomon Islands, the conceptualisation of mental health, for several decades regarded by policy makers as primarily a health issue, has broadened and been incorporated into the national development and social policy agendas, reflecting recognition of the impact of conflict and rapid social change on the psychosocial wellbeing of the community as a whole. We sought to understand how mental health and psychosocial wellbeing were seen at the community level, the extent to which these issues were identified as being associated with periods of 'tension', violence and instability, and the availability of traditional approaches and Ministry of Health services to address these problems.
Methods: This article reports the findings of qualitative research conducted in a rural district on the island of Guadalcanal in the Solomon Islands. Key informant interviews were conducted with community leaders, and focus groups were held with women, men and young people. Wellbeing was defined broadly.
Results: Problems of common concern included excessive alcohol and marijuana use, interpersonal violence and abuse, teenage pregnancy, and lack of respect and cooperation. Troubled individuals and their families sought help for mental problems from various sources including chiefs, church leaders and traditional healers and, less often, trauma support workers, health clinic staff and police. Substance-related problems presented special challenges, as there were no traditional solutions at the individual or community level. Severe mental illness was also a challenge, with few aware that a community mental health service existed. Contrary to our expectations, conflict-related trauma was not identified as a major problem by the community who were more concerned about the economic and social sequelae of the conflict.
Conclusion: Communities identify and are responding to a wide range of mental health challenges; the health system generally can do more to learn about how this is being done, and build more comprehensive services and policy on this foundation. The findings underscore the need to promote awareness of those services which are available, to extend mental health care beyond urban centres to rural villages where the majority of the population live, and to promote community input to policy so as to ensure that it 'fits' the context.
Additional publications will be added to this list as produced. For PDF copies of the articles listed above, please email
s.north@unsw.edu.au.
A 2-page summary of the project up to February 2007 is available for download: “
Investigating psychosocial and mental health policy and services in countries emerging from conflict and natural disaster 2 page summary”.