Rethinking mental health and wellbeing interventions in disaster and conflict affected communities: case studies from Sri Lanka, Sudan and Malawi

Jayawickrama, Janaka (2010) Rethinking mental health and wellbeing interventions in disaster and conflict affected communities: case studies from Sri Lanka, Sudan and Malawi. Doctoral thesis, Northumbria University.

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Abstract

This thesis examines the traditional knowledge and capabilities that disaster, conflict and unplanned development affected communities utilise to deal with uncertainties and dangers inherent in their lives. The key question is whether a model of individual care, core to the tradition of western disciplines, is appropriate for humanitarian assistance largely delivered to ‘non-western’ countries. The methodology uses both quantitative and qualitative techniques, and moves beyond a conventional science approach. Guided by a broader ontology and epistemology, it engages an evaluative judgement of three project based case studies in Sri Lanka, Sudan and Malawi. These evaluative judgements build on the adapted OECD/DAC criteria of relevance, efficiency, effectiveness and impact. The “lived experiences” of mental health and wellbeing for individuals amongst these communities are then further examined through their personal stories. The outcomes of this process are used to inform a discussion on mainstream interventions and to provide a basis for exploring improved practice in this field. The scope of the study presented here was limited to Sri Lanka, Sudan and Malawi. These countries were selected based on their geographical locations, nature of the disaster, conflict or development problem and most importantly access to communities through Disaster and Development Centre’s (DDC) research work with United Nations Refugee Agency (UNHCR) and Green Movement of Sri Lanka (GMSL). The researcher trained one colleague each from Sudan, Malawi and Sri Lanka to assist in the translation of Arabic, Swahili, Tamil and tribal dialects. This process was conducted by explaining the objectives of the research, refreshing basic interviewing skills, concepts of translation and addressing the research ethical framework. The findings of the study indicate that most disaster, development and conflict-affected communities are positively dealing with uncertainties and dangers in life without outside‘expert’ help. Although there are evident levels of mental health and wellbeing related issues that are visible to the outside view of a community, the inside view is that there are traditional knowledge systems, religions, cultures, attitudes and values that address uncertainty and dangers in a sophisticated though pragmatic manner. The conclusion of this research process is that suffering through danger and uncertainty is part of human experience; it is an attribute of the human condition. However, disaster and development experts, psychologists, psychiatrists and sociologists are occupied in documenting, describing, analysing and diagnosing risks, vulnerabilities, coping strategies, and post-traumatic stress. Along with the costs of murder, rape, torture, and other forms of human malice, a deeper understanding of mental health and wellbeing in adversity is little understood. This is complicated by the varying nature of events that take place and the variable ways they are experienced by individuals and communities. The onset of uncertainty and danger are sometimes sudden, like the brutal attacks in Western Darfur. At other times they take the form of a continuous reign of suffering like the failed development, disaster reduction and conflict mitigation strategies witnessed in Sri Lanka. Even when suffering is not present in such striking forms, there can be slow deterioration of communities through policies that severely disrupt the lives of people, such as experienced by refugees in Malawi. However, in the middle of the worst circumstances, communities continue to carry on with their livelihood regimes, to celebrate, and to enjoy. This is an achievement beyond everyday life. The thesis findings and conclusions point to the need for collaboration with disaster, conflict and unplanned development affected communities to retrieve their knowledge systems to improve their mental health and wellbeing. This can create new processes to deal with suffering...

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