The long-running civil war in Sri Lanka is causing more mental health problems and social breakdown than the catastrophic 2004 tsunami, according to research published in the online open access publication International Journal of Mental Health Systems.
The study, conducted by Professor Daya Somasundaram, currently at the University of Adelaide, is based on published data and qualitative research methods including participatory observation, key informant and focus group interviews, highlights the importance of the family and community in maintaining good mental health. For example, the terrorisation of many Tamil communities and the destruction caused by the tsunami meant many villages were abandoned and the villagers separated. Even when people returned, the village was not the same. The old structures and institutions were no longer functioning and the protective environment, the social fabric, provided by the village was no longer there.
"The natural disaster was a one off catastrophic event that left a trail of destruction and loss," says Somasundaram, "but it did not continue to exert a prolonged effect. As a result the severity of the collective trauma was much less. In fact, having lived through a prolonged war situation has meant that Tamil communities have learned skills and strategies that make them better able to cope with disasters."
The ecological research study suggests that grass roots work within communities may work best. Somasundaram found that the protocol developed by the Transcultural Psychosocial Organization (a WHO collaborating centre, working around the world to relieve the psychosocial problems of people affected by internal conflict and war) was very effectively adapted to the situation in northern Sri Lanka. "Community-level approaches empower the community to look after their own problems," he says, "through psychoeducation to transfer basic psychosocial knowledge and skills, and through encouragement, support, affirmation and re-establishment of traditional practices, rituals, resources and community relationships."
To combat post-disaster mental health problems Somasundaram argues that it is helpful to consider the extent of collective traumatisation. "In the aftermath of war communities suffer from mistrust, suspicion, silence, brutalization, deterioration in morals and values, poor leadership, dependency, passivity and despair. Apart from attending to the immediate basic needs and other acute problems in the rescue and relief phases after a major disaster, rehabilitation, reconstruction and development strategies need to include collective-level interventions. In fact, our experiences show that many individually oriented mental health interventions appear to fair much better when undertaken within an overall framework of a community strategy."