Community Mental Health and Wellbeing: A Case Study

1. Community Mental Health and Wellbeing: A Case Study Janaka Jayawickrama, PhD September 2010 Community-University Collaborations: Exploring Models, Sharing Good Practice Durham University

2. Genesis • UNHCR partnership to evaluate mental health and wellbeing interventions for refugees in Malawi. • Additional accompanying field work was conducted with support from UNHCR.

3. Purpose • To analyse the nature of individually and communally focussed mental health and wellbeing interventions for developing country communities that are affected by conflicts.

4. 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.

5. Most Influential Literature

6. Most Influential Literature

7. Mainstream Literature Body Clinical Psychology and Trauma/ PTSD International Standards and Practice Wellbeing 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)

8. UNHCR Malawi Place Positivist Evaluation of Programme Purpose Re-examine 163 Responses Quantitative Assessment Critical Realism Judgement of Practice: difficult to analyse information Judgement and Analysis Subjectivism 16 Detailed Responses Qualitative Analysis ? • THE RESEARCH PROCESS • (Source: Author)

9. Burden of policy Different research steps 3. Literature review and secondary readings on policies Policy Programme 2. Qualitative: Key interviews Burden of delivery Practice 1. Quantitative: Evaluations Evaluation Criteria (Adapted from OECD) • Theoretical basis / Relevance • Coverage • Efficiency • Effectiveness • Impact • Community • Sustainability FROM PRACTICE TO POLICY (Source: Author)

10. 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.

11. Evaluative Judgement

12. Evaluative Judgement

13. Evaluative Judgement

14. Evaluative Judgement

15. Emerging Themes

16. 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

17. Interventions (insensitive to community systems) – maintaining a total greater wellbeing, but insensitivity leads to recurring uncertainties and dangers Wellbeing Community systems (Sensitive to outside pressure) – maintain a low level from an outside view, but sustainable wellbeing Uncertainties and Dangers Time Source: Author

18. Knowledge retrieval through collaboration between insiders and outsiders Preconditions • Trust • Conformity • Genuine engagement • Transparency • Accountability • Equal participation • Ownership and responsibility Retrieved knowledge systematised and validated within its own cultural setting Source: Author Setting up of ecologically sound knowledge systems to deal with suffering and improve wellbeing Creative and flexible processes of implementing knowledge systems

19. Bibliography Collins, A.E. (2009) Disaster and Development, Routledge Perspectives in Development Series, London Craig, 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

20. Biblography Jayawickrama, 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

21. 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

22. Janaka Jayawickrama, PhDCommunity Wellbeing ProgrammeDisaster and Development CentreSchool of the Built and Natural EnvironmentNorthumbria Universityj.jayawickrama@northumbria.ac.uk