Understanding Mental Health Understanding Mental Health and Wellbeing in and Wellbeing in

Displaced and Resettled Displaced and Resettled CommunitiesCommunities

Chamindra WeerackodyChamindra Weerackody

Project Lead, Trauma & Global Health Programmein Sri LankaProject Lead, Trauma & Global Health Programmein Sri Lanka

(McGill University, Canada & People’s Rural Development Association) (McGill University, Canada & People’s Rural Development Association)

Child Protection and Juvenile JusticeChild Protection and Juvenile Justice

Training of Trainers Programme for Police TrainersTraining of Trainers Programme for Police Trainers2323rdrd June 2010 June 2010

Mental Health and WellbeingMental Health and Wellbeing

‘‘Health is a state of complete physical, mental and social Health is a state of complete physical, mental and social well-well-beingbeing and not merely the and not merely the absence of diseaseabsence of disease’ (WHO, 2008 – ’ (WHO, 2008 – Mental Health) Mental Health)

WellbeingWellbeing: Reflects values, norms human needs etc. as : Reflects values, norms human needs etc. as perceived by people themselves (Diener and Suh, 2000; perceived by people themselves (Diener and Suh, 2000; Prlleltensky Prlleltensky et alet al. 2000; Myers et al. 2005). 2000; Myers et al. 2005)

Understanding of ‘wellbeing’ (in development studies) Understanding of ‘wellbeing’ (in development studies) reflects range of human experience - social, mental, reflects range of human experience - social, mental, spiritual, material. (Chambers 1997).spiritual, material. (Chambers 1997).

Effects of conflict and natural disasters Effects of conflict and natural disasters on communities on communities

Death Death Destruction Destruction Displacement Displacement Disappearances Disappearances Detention Detention Disorders (PTSD, anxiety, depression)Disorders (PTSD, anxiety, depression) Poverty and deprivation Poverty and deprivation

Factors influencing reduction of wellbeing in affected communities Factors influencing reduction of wellbeing in affected communities

Refugee communities Refugee communities Tsunami affected communitiesTsunami affected communities

Economic Economic inadequate incomes from casual labour workinadequate incomes from casual labour work

Economic Economic decrease of incomes from fishingdecrease of incomes from fishing

limited employment opportunities for menlimited employment opportunities for men weakening of supplementary livelihood sources weakening of supplementary livelihood sources (e.g. coir) (e.g. coir)

lack of land/resources for livelihoods lack of land/resources for livelihoods loss of local markets with out-migration loss of local markets with out-migration

restrictions on fishing and animal husbandryrestrictions on fishing and animal husbandry Housing Housing incomplete rehabilitation of damaged housesincomplete rehabilitation of damaged houses

inability to find/engage in employment due to inability to find/engage in employment due to restricted physical mobility restricted physical mobility

poor conditions and quality of the new housespoor conditions and quality of the new houses

HousingHousingpoor housing conditions poor housing conditions

close proximity of houses and loss of privacy close proximity of houses and loss of privacy and and security security

close proximity of houses and loss of privacy close proximity of houses and loss of privacy Social and natural environments Social and natural environments intra-family conflicts intra-family conflicts

Social and natural environSocial and natural environments ments intra-family conflicts intra-family conflicts

limited space limited space

unclean environments and limited space unclean environments and limited space lack of a waste disposal system lack of a waste disposal system

lack of a waste disposal systemlack of a waste disposal system

rapid spread of communicable diseases rapid spread of communicable diseases

Factors influencing reduction of wellbeing in affected communities Factors influencing reduction of wellbeing in affected communities (contd.) (contd.)

Refugee communities Refugee communities Tsunami affected communitiesTsunami affected communities

Access to services Access to services lack of drinking water and sanitary facilities lack of drinking water and sanitary facilities

Access to servicesAccess to serviceslack of transport facilities for children lack of transport facilities for children

poor road conditions and lack of public transport poor road conditions and lack of public transport absence of a temple and absence of a temple and dahamdaham school school

inadequate medical/health services inadequate medical/health services Social and psychologicalSocial and psychologicalhigh prevalence of alcohol and drug abuse high prevalence of alcohol and drug abuse

lack of educational facilities for childrenlack of educational facilities for children domestic violence domestic violence

Social and psychological Social and psychological high prevalence of alcohol and drug abuse high prevalence of alcohol and drug abuse

inequities/injustices in aid distribution inequities/injustices in aid distribution

domestic violence domestic violence dependent mentality dependent mentality

children getting labeled children getting labeled social exclusion on grounds of caste and social exclusion on grounds of caste and occupationsoccupations

inability to support children’s inability to support children’s education/negligence of children education/negligence of children

feelings of loss, grief, separation feelings of loss, grief, separation

breakdown of social bondages, community breakdown of social bondages, community harmony and mutual support harmony and mutual support

change of gender roles change of gender roles

feelings of loss, insecurity, deprivation and feelings of loss, insecurity, deprivation and isolation isolation

Community perceptions of mental health Community perceptions of mental health and wellbeingand wellbeing

Material wellbeing Material wellbeing Social wellbeing Social wellbeing Security Security Physical, mental and moral/spiritual wellbeing Physical, mental and moral/spiritual wellbeing

Material wellbeingMaterial wellbeing

having stable employment/livelihoodshaving stable employment/livelihoods having stable cash incomes having stable cash incomes access to adequate landaccess to adequate land having permanent, secure and spacious house having permanent, secure and spacious house

Social wellbeingSocial wellbeing

providing good education and socialization for childrenproviding good education and socialization for children caring for childrencaring for children unity and harmony within family unity and harmony within family unity and harmony within community unity and harmony within community unity and harmony with neighbouring communities/host unity and harmony with neighbouring communities/host

communities communities access to services access to services self-respect and dignityself-respect and dignity clean and free environment clean and free environment free of alcohol and drug abuse free of alcohol and drug abuse

Security Security

a a secure environment for their living without fear and outside secure environment for their living without fear and outside threats threats

a secure physical environment and protection from natural a secure physical environment and protection from natural disasters and conflictsdisasters and conflicts

free movement and living without being subject to suspicionfree movement and living without being subject to suspicion a a peaceful peaceful atmosphere free of regular checks and intimidation atmosphere free of regular checks and intimidation

from security forces.from security forces. secure and strong houses to prevent intruderssecure and strong houses to prevent intruders houses that ensure privacy and personal safety houses that ensure privacy and personal safety community members coming together to intervene and resolve community members coming together to intervene and resolve

problems and issuesproblems and issues

Physical, mental and moral and spiritual Physical, mental and moral and spiritual wellbeingwellbeing

living without illness and sufferingliving without illness and suffering having mental happiness having mental happiness having good thoughts/feelings towards others having good thoughts/feelings towards others living with courage/endeavour, self-initiative and living with courage/endeavour, self-initiative and

drive drive living with wisdom (not acting on emotions/rational living with wisdom (not acting on emotions/rational

behaviour)behaviour) moral behaviour of community members moral behaviour of community members careful spending careful spending living religiouslyliving religiously

Mental health and wellbeing Mental health and wellbeing in displaced communitiesin displaced communities

1.1. Communities perceive a severe reduction in their wellbeing after Communities perceive a severe reduction in their wellbeing after displacementdisplacement

a.a. economic poverty, economic poverty, b.b. lowered sense of insecuritylowered sense of insecurityc.c. loss of privacy loss of privacy d.d. intra-family conflicts intra-family conflicts e.e. alcoholism/drug abuse alcoholism/drug abuse f.f. children vulnerable to deprivation and neglectchildren vulnerable to deprivation and neglect

2.2. Perceptions of wellbeing are ‘holistic’Perceptions of wellbeing are ‘holistic’

a.a. social, psychological and material domains seen as unified ‘whole’. social, psychological and material domains seen as unified ‘whole’. b.b. psychological wellbeing not considered in isolation from material and social psychological wellbeing not considered in isolation from material and social

wellbeingwellbeingc.c. psychological feelings and ‘psychological trauma’ experienced as inseparable psychological feelings and ‘psychological trauma’ experienced as inseparable

from material and social issues. from material and social issues.

Recommendations (on interventions)Recommendations (on interventions)

Interventions should: Interventions should:

reflect how people themselves perceive wellbeing and ways in reflect how people themselves perceive wellbeing and ways in which wellbeing has been affected by displacementwhich wellbeing has been affected by displacement

be planned and implemented in close consultation with be planned and implemented in close consultation with communities (for example) using participatory approaches for communities (for example) using participatory approaches for community consultations community consultations

adopt a differential approach to understand wellbeing as factors adopt a differential approach to understand wellbeing as factors vary with gender, age and social groups. vary with gender, age and social groups.

promote community participation and avoid dependencypromote community participation and avoid dependency

Recommendations (on interventions)Recommendations (on interventions)

- address material and social issues as a part of - address material and social issues as a part of addressing ‘psychological trauma’ addressing ‘psychological trauma’

re-union of families re-union of families re-settlement in original landre-settlement in original land rehabilitation and reconstruction of damaged rehabilitation and reconstruction of damaged

propertyproperty support livelihood restorationsupport livelihood restoration rehabilitation and support for widows, children, rehabilitation and support for widows, children,

ex-combatants, displaced people ex-combatants, displaced people

Recommendations (on policy)Recommendations (on policy)

Policies (of State and NGOs) should:Policies (of State and NGOs) should: be devised in consultation with communities concerned be devised in consultation with communities concerned

especially to fill gaps resulting from withdrawal of some aid agencies   especially to fill gaps resulting from withdrawal of some aid agencies      

involve communities in designing and planning secure and comfortable housing. involve communities in designing and planning secure and comfortable housing.

strengthen the human and social assets of communities (‘social capital’) e.g.strengthen the human and social assets of communities (‘social capital’) e.g.• promote community organizationspromote community organizations• involve communities in decision-makinginvolve communities in decision-making

constitute a differential approach to respond to the diverse needs of the different constitute a differential approach to respond to the diverse needs of the different socio-economic groups socio-economic groups

address alcohol and drug abuse among men e.g. address alcohol and drug abuse among men e.g. • reduce availabilityreduce availability• provide meaningful occupations for menprovide meaningful occupations for men

Policies (of State and NGOs) should:Policies (of State and NGOs) should: address special vulnerability of women and childrenaddress special vulnerability of women and children

reduce tension and violence within neighbourhoodsreduce tension and violence within neighbourhoods Promote better understanding among ‘host’ communitiesPromote better understanding among ‘host’ communities

address issues of insecurity felt by refugee groups e.g address issues of insecurity felt by refugee groups e.g based on understanding what security means based on understanding what security means for themfor them..

support religion or spiritual development from the start e.g.support religion or spiritual development from the start e.g. Aid agencies work with religious institutions rather than independentlyAid agencies work with religious institutions rather than independently

promote organizations of the people to implement changes e.g.promote organizations of the people to implement changes e.g. Build community centers quickly and establish community organizationsBuild community centers quickly and establish community organizations Establish a governance structure that involves whole community Establish a governance structure that involves whole community Ensure communities are consulted on State and NGO activityEnsure communities are consulted on State and NGO activity Establish community meeting and mediation systemsEstablish community meeting and mediation systems

Recommendations (on policy)Recommendations (on policy)