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 LITERATURE
Name
Subject
Derek
Summerfield –
Critique of Mental Health in
Humanitarian Assistance
1995, 1999, 2005
Arthur Kleinman Risk Reduction Vs Uncertainty/ Medical
– 1988, 2005, 2006 Anthropology/ Traditional Knowledge
Systems
John Van
Eenwyk – 2002
Traditional Knowledge Systems and
Mental Healing of Torture
Amartya Sen –
Development as Freedom
1993, 1999
MOST INFLUENTIAL LITERATURE
Name
Subject
Lao Tzu – circa
Tao Te Ching – Ancient Knowledge
100 BC
Walpola
Compassion, Uncertainty and
Rahula – 2003 Danger
Religious Texts Different Perspectives on Life,
Mental Health and Wellbeing
Folk Stories
Different Traditional Knowledge
Perspectives on Wellbeing
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)
Subjectivism
Realism
Critical
Positivist
UNHCR Malawi
Place
Evaluation of Programme
Purpose
Re-examine 163 Responses
Quantitative
Assessment
Judgement of Practice: difficult
to analyse information
Judgement
and Analysis
16 Detailed Responses
Qualitative
Analysis
?
THE RESEARCH PROCESS
(Source: Author)
Burden of
policy
Different research
steps
Policy
Programme
Burden of
delivery
Practice
Evaluation Criteria (Adapted from OECD)
1 Theoretical basis / Relevance
2 Coverage
3 Efficiency
4 Effectiveness
5 Impact
6 Community
7 Sustainability
3. Literature review
and secondary
readings on policies
2. Qualitative: Key
interviews
1. Quantitative:
Evaluations
FROM PRACTICE TO
POLICY
(Source: Author)
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 JUDGEMENT
Criterion
Aspect Measured
/Assessed
Theoretical basis Developed by
foreign consultants
and staff in
Geneva.
Quantitative
Coverage
coverage of
refugees. However,
there are many
gaps in qualitative
coverage.
Source of
Viewpoint
UNHCR Staff
members and
policy
documents
Refugee
communities
and field staff
of UNHCR
partners
Methodology
Interviews and
review of
documents
Interviews and
observations
EVALUATIVE JUDGEMENT
Criterion
Aspect Measured
/Assessed
Social, political,
Efficiency
cultural and
economic problems
in project delivery.
Effectiveness Objectives set by
UNHCR are not
agreed by partners
or refugee
communities.
Source of
Viewpoint
Refugee
communities
and field staff of
UNHCR partners
UNHCR Staff,
Refugee
communities
and field staff of
UNHCR partners
Methodology
Interviews and
observations
Interviews and
observations
EVALUATIVE JUDGEMENT
Criterion
Impact
Aspect Measured
Source of
Methodology
/Assessed
No changes to
refugee conditions
in terms of policy
or practice.
Viewpoint
Government Interviews and
of Malawi,
observations
UNHCR Staff,
Refugee
communities
and field staff
of UNHCR
partners
EVALUATIVE JUDGEMENT
Criterion
Community
Sustainability
Aspect Measured
Source of
Methodology
/Assessed
No ownership or
responsibility over
activities.
Short term
planning. No
concepts of
sustainability.
Viewpoint
Refugee
communities
Interviews and
observations
Government
of Malawi,
UNHCR Staff
and field staff
of UNHCR
partners
Interviews ,
observations
and review of
documents
EMERGING THEMES
Population
Emerging Themes
Malawi:
 Uncertainty and dangers  Going back to old life styles
Conflict
are unavoidable
 Moving on and planning for
affected
 Suffering is part of being
a future
refugee
human
 Worry about the future
communities  Not taking action to deal  Importance of community
with suffering
and family
 Taking action to deal
 Value of religious support
with suffering
(i.e. God)
 Helplessness and
 Experience of torture and
powerlessness
violence
 Sadness and
 Community support
unhappiness
 Security and protection
 Needing help
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
Interventions (insensitive to community
systems) – maintaining a total greater
wellbeing, but insensitivity leads to recurring
uncertainties and dangers
Community systems
(Sensitive to outside
pressure) – maintain a
low level from an
outside view, but
sustainable wellbeing
Uncertainties and Dangers
TIME
Source: Author
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
Preconditions
 Trust
 Conformity
 Genuine
engagement
 Transparency
 Accountability
 Equal participation
 Ownership and
responsibility
Source: Author
Knowledge retrieval through
collaboration between
insiders and outsiders
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
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
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 PROGRAMME
DISASTER AND DEVELOPMENT CENTRE
SCHOOL OF THE BUILT AND NATURAL ENVIRONMENT
NORTHUMBRIA UNIVERSITY
j.jayawickrama@northumbria.ac.uk