Abstract
BackgroundIndividuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. The objective of the study was understanding common psychosocial problems faced by families and communities, and the associated risk and protective factors, so that practical and effective community based interventions can be recommended to rebuild strengths, adaptation, coping strategies and resilience.MethodsThis qualitative, ecological study is a psychosocial ethnography in post-war Northern Sri Lanka obtained through participant observation; case studies; key- informant interviews; and focus groups discussions with mental health and psychosocial community workers as well as literature survey of media and organizational reports. Qualitative analysis of the data used ethnography, case studies, phenomenology, grounded theory, hermeneutics and symbolic interactionism techniques. Quantitative data on suicide was collected for Jaffna and Killinochchi districts.ResultsComplex mental health and psychosocial problems at the individual, family and community levels in a post-war context were found to impair recovery. These included unresolved grief; individual and collective trauma; insecurity, self-harm and suicides; poverty and unemployment; teenage and unwanted pregnancies; alcoholism; child abuse and neglect; gender based violence and vulnerability including domestic violence, widows and female headed-household, family conflict and separation; physical injuries and handicap; problems specific for children and elderly; abuse and/or neglect of elderly and disabled; anti-social and socially irresponsible behaviour; distrust, hopelessness, and powerlessness. Protective factors included families; female leadership and engagement; cultural and traditional beliefs, practices and rituals; and creative potential in narratives, drama and other arts. Risk factors that were impeding community rehabilitation and recovery included continuing military governance, depletion of social capital particularly lack of trust, hope and socio-economic opportunity structures for development that would engender a sense of collective efficacy.ConclusionsIn view of the widespread trauma at the individual, family and collective levels, community based programmes to increase local awareness, knowledge and skills to deal with common mental health and psychosocial issues; and training of community level workers and others in basic mental health and psychosocial problem solving are recommended to rebuild family and community agency and resilience. The use of cultural practices and school based programmes would rekindle community processes.
Highlights
Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources
The study attempts to understand the mental health and psychosocial problems faced by families and communities in the current realities of a post war context in northern Sri Lanka, analyze the risk and protective factors to recommend ways of addressing these needs based on expert consensus on best practice, our previous experiences gained during the war [86,87] and after the tsunami [85,88], as well as findings from the study
Results & discussion The common psychosocial problems and adaptive changes that were observed and brought out by the Key Informant (KI) and Focus Groups (FG) discussions were inserted into a Trauma Grid [49] adapted for the Northern Sri Lanka context
Summary
Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. Whether natural, for example after a tsunami, or manmade as in war, are recognized to cause a variety of psychological and psychiatric sequelae [1]. These could range from adaptive and resilient coping responses in the face of catastrophic events to understandable non-pathological distress as well as a number of maladaptive behavioural patterns to diagnosable psychiatric disorders. There is less recognition or understanding of the effects disasters have at the supra-individual family and community levels [6,7,8]. The diagnosis of PTSD was accepted only in 1980 with the American DSM III [10] following extensive experiences with Vietnam war veterans
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