Upload
laura-vincent
View
38
Download
3
Tags:
Embed Size (px)
DESCRIPTION
Community Mental Health and Wellbeing: A Case Study. Janaka Jayawickrama , PhD September 2010. Community-University Collaborations: Exploring Models, Sharing Good Practice Durham University. Genesis. - PowerPoint PPT Presentation
Citation preview
COMMUNITY MENTAL HEALTH AND WELLBEING: A CASE STUDY
JANAKA JAYAWICKRAMA, PhD
SEPTEMBER 2010
Community-University Collaborations: Exploring
Models, Sharing Good Practice
Durham University
GENESIS
• UNHCR partnership to evaluate mental health and wellbeing interventions for refugees in Malawi.
• Additional accompanying field work was conducted with support from UNHCR.
PURPOSE
• To analyse the nature of individually and communally focussed mental health and wellbeing interventions for developing country communities that are affected by conflicts.
RATIONALE TO THE STUDY
• International Agencies including the UN have identified how wellbeing challenges lack appropriate policies and interventions implying that evaluations are required that include further investigations of the traditional knowledge systems of communities.
MOST INFLUENTIAL LITERATUREName SubjectDerek Summerfield – 1995, 1999, 2005
Critique of Mental Health in Humanitarian Assistance
Arthur Kleinman – 1988, 2005, 2006
Risk Reduction Vs Uncertainty/ Medical Anthropology/ Traditional Knowledge Systems
John Van Eenwyk – 2002
Traditional Knowledge Systems and Mental Healing of Torture
Amartya Sen – 1993, 1999
Development as Freedom
MOST INFLUENTIAL LITERATUREName SubjectLao Tzu – circa 100 BC
Tao Te Ching – Ancient Knowledge
Walpola Rahula – 2003
Compassion, Uncertainty and Danger
Religious Texts Different Perspectives on Life, Mental Health and Wellbeing
Folk Stories Different Traditional Knowledge Perspectives on Wellbeing
MAINSTREAM LITERATURE BODYClinical Psychology and
Trauma/ PTSDInternational Standards
and PracticeWellbeing and
Capability
• Uncertainty and dangers are abnormal in life situations.• Suffering is avoidable. • Human conditions can be controlled.• Interventions to address suffering should be objective.• The individual is the most important entity in social settings.• Life is predictable / manageable.
What are the strengths and weaknesses of individual mental health and wellbeing interventions and their appropriateness in
developing country, conflict affected communities?
(Source: Author)
Place
Purpose
Quantitative Assessment
Judgement and Analysis
Qualitative Analysis
UNHCR Malawi
Evaluation of Programme
Re-examine 163 Responses
Judgement of Practice: difficult to analyse information
16 Detailed Responses
Posi
tivis
tC
ritic
al
Rea
lism
Subj
ectiv
ism
? THE RESEARCH PROCESS
(Source: Author)
FROM PRACTICE TO POLICY
(Source: Author)
2. Qualitative: Key interviews
1. Quantitative: Evaluations
Policy
Programme
Practice
Evaluation Criteria (Adapted from OECD)1 Theoretical basis / Relevance2 Coverage3 Efficiency4 Effectiveness5 Impact6 Community7 Sustainability
Burden of delivery
Burden of policy
Different research steps
3. Literature review and secondary
readings on policies
MALAWI
• One of the poorest countries in Sub-Saharan Africa.
• Evaluation of mental health and wellbeing interventions of UNHCR partners.
• Mainly refugee communities from other African countries.
EVALUATIVE JUDGEMENTCriterion Aspect
Measured /Assessed
Source of Viewpoint
Methodology
Theoretical basis Developed by foreign consultants and staff in Geneva.
UNHCR Staff members and policy documents
Interviews and review of documents
Coverage Quantitative coverage of refugees. However, there are many gaps in qualitative coverage.
Refugee communities and field staff of UNHCR partners
Interviews and observations
EVALUATIVE JUDGEMENTCriterion Aspect
Measured /Assessed
Source of Viewpoint
Methodology
Efficiency Social, political, cultural and economic problems in project delivery.
Refugee communities and field staff of UNHCR partners
Interviews and observations
Effectiveness Objectives set by UNHCR are not agreed by partners or refugee communities.
UNHCR Staff, Refugee communities and field staff of UNHCR partners
Interviews and observations
EVALUATIVE JUDGEMENTCriterion Aspect
Measured /Assessed
Source of Viewpoint
Methodology
Impact No changes to refugee conditions in terms of policy or practice.
Government of Malawi, UNHCR Staff, Refugee communities and field staff of UNHCR partners
Interviews and observations
EVALUATIVE JUDGEMENTCriterion Aspect
Measured /Assessed
Source of Viewpoint
Methodology
Community No ownership or responsibility over activities.
Refugee communities
Interviews and observations
Sustainability Short term planning. No concepts of sustainability.
Government of Malawi, UNHCR Staff and field staff of UNHCR partners
Interviews , observations and review of documents
EMERGING THEMESPopulation Emerging Themes Malawi: Conflict affected refugee communities
Uncertainty and dangers are unavoidable
Suffering is part of being human
Not taking action to deal with suffering
Taking action to deal with suffering
Helplessness and powerlessness
Sadness and unhappiness
Needing help
Going back to old life styles Moving on and planning for
a future Worry about the future Importance of community
and family Value of religious support
(i.e. God) Experience of torture and
violence Community support Security and protection
DISCUSSION: COMMUNITY PERSPECTIVE
Community Different understanding of uncertainty and dangers to that of the academic and policy worlds
Tendency for activities of agencies to be largely irrelevant
Use of traditional knowledge systems: religions, folk stories and traditional healing/medicine
WELLBEING TIM
E
Uncertainties and Dangers
Community systems (Sensitive to outside
pressure) – maintain a low level from an outside view, but
sustainable wellbeing
Interventions (insensitive to community systems) – maintaining a total greater
wellbeing, but insensitivity leads to recurring uncertainties and dangers
Source: Author
Preconditions
Trust Conformity Genuine
engagement Transparency Accountability Equal participation Ownership and
responsibility
Knowledge retrieval through collaboration between insiders and outsiders
Retrieved knowledge systematised and validated
within its own cultural setting
Setting up of ecologically sound knowledge systems to
deal with suffering and improve wellbeing
Creative and flexible processes of implementing
knowledge systems
Sour
ce: A
utho
r
BIBLIOGRAPHYCollins, A.E. (2009) Disaster and Development, Routledge
Perspectives in Development Series, LondonCraig, D., Porter, D. (2003), “Poverty Reduction Strategy
Papers: A New Convergence” World Development, 31(1), 53–69
Das, V., Kleinman, A., Ramphele, M., Lock, M. and Reynolds, P. (eds) (2001), Remaking a World: Violence, Social Suffering and Recovery, Berkeley: University of California Press
Hancock, G., (1989), Lords of Poverty: the power, prestige, and corruption of the international aid business, The Atlantic Monthly Press, New York
BIBLOGRAPHYJayawickrama, J, (2007), Concepts of Care: A Workbook
for Community Practitioners, DDC and UNHCR, Geneva
Kleinman, A. Das, V. and Lock, M. (eds) (1997), Social Suffering, Berkeley: University of California Press
Kleinman, A, (2006), What really matters: Living a Moral Life Amidst Uncertainty and Danger, Oxford University Press
Sen A. (1993). Capability and Well-being, In Nussbaum and Sen (Eds.) The Quality of Life. Oxford: Clarendon Press
BIBLIOGRAPHY
Sen. A. (1999), Development as Freedom, New York: Random House
Smillie, I and Minear, L (2003), The quality of money: Donor behaviour in humanitarian financing, An independent study, Humanitarianism and War Project, The Feinstein International Famine Center, MA
Summerfield, D., (2005a), What exactly is emergency or disaster ‘mental health’?, Bulletin of the World Health Organization; 83(1), (pp.76-77)
UNHCR (2007) A Community –Based Approach to UNHCR Operations
JANAKA JAYAWICKRAMA, PhD
COMMUNITY WELLBEING PROGRAMMEDISASTER AND DEVELOPMENT CENTRESCHOOL OF THE BUILT AND NATURAL
ENVIRONMENTNORTHUMBRIA UNIVERSITY