Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study in Northern Sri Lanka

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.

Perceptions about implementation of a Narrative Community-based Group Therapy for Afro-Colombians victims of Violence

“…In Buenaventura, LPCWs had experience in religious and community processes, which could explain better results in quantitative analysis compared with Quibdó 9 . Although a religious approach was not part of the NCGT protocol, religiosity may promote greater motivation and listening skills by LPCWs, as it has been demonstrated by the literature 23,25 . As for the effects reported by respondents, and according to the results of the other quantitative study 9 , NCGT users showed improvement in functionality and performance of family and social roles.…”

Disaster and mental health: the role of Sri Lankan psychiatrists

“…Individual based treatment such as trauma focused cognitive behavioural therapy and community based interventions such as structuring of daily activities, engaging children in various education methods, fostering cultural and religious rituals, and group discussions with validation of survivor's experience have been found to be useful (5). In post-war Sri Lanka, community and school based programmes to increase knowledge and skills to deal with common mental health and psychosocial issues and use of collective cultural practices were beneficial in reducing collective trauma (11). Another important role is providing care to the disaster relief workers, such as defence personnel.…”

Failing Adolescents: Social Control, Political Economy & Human Development in post-war Sri Lanka

“…In a study from the North of Sri Lanka, Somasundaram and Sivayokan (2013) note the existence of complex mental health and psychosocial problems at the individual, family and community levels in the post-war context. These include domestic violence, self-harm and suicides, child abuse, and individual and collective trauma.…”