Addressing the Mental Health Issues of Post-War Sri Lanka

 

 

Dr. Sarath Panduwawala and Dr Ruwan M Jayatunge

The 'Post-War Period' can be defined as the years following a major war, characterized by significant changes in the individuals as well as in the society. The Eelam War in Sri Lanka erupted in 1983 and ended in 2009. Following these years, Sri Lankan society experienced a collective trauma. The Sri Lankan conflict caused widespread human suffering and population displacement. Many individuals were physically and mentally traumatized, and war trauma still echoes in society.

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community (WHO). Optimal mental health is important to personal, community, and socio-economic development. Prolonged armed conflict can extinguish the mental well-being of people.

There is a high prevalence of mental disorders in post-conflict situations. War has a catastrophic effect on the health and well -being of nations (Murthy & Lakshminarayana, 2006). War creates acute and long-lasting mental health problems (Kastrup,2006). Combat trauma has negative social and clinical outcomes. As a result of war-related collective trauma, people experience lower levels of mental well-being. The armed conflict in Sri Lanka has caused negative consequences in the general population (Somasundaram & Sivayokan,1994). Following war trauma, social equilibrium is shattered and it affected the mental health continuum.  

The Eelam War impacted both military and civilian lives and destroyed the social fabric. War-affected regions were left with weakened infrastructure, increased poverty, and dramatically under-functioning education and healthcare systems (Dissanayake et al., 2023). Armed conflicts produce a wide series of distressing consequences, including death, all of which impact negatively on the lives of survivors (Carpiniello ,2023). The Eelam War drastically and detrimentally affected the mental health of the people, and many victims still need treatment and psychosocial support. Although the war in Sri Lanka is over, the communities are still affected by the postwar consequences. 

There is poverty, wrecked social capital, and mental and psychosocial disorders in conflict settings. Carpiniello (2023) highlights a series of war-related, migratory and post-migratory stressors that contribute to short- and long-term mental health issues in the internally displaced, asylum seekers and refugees. Following war trauma, social violence, child abuse, high rates of substance misuse, breakdown in relationships, and mood disorders, grief symptoms follow, and the risk of suicide increases. Furthermore, unemployment, low productivity and poor coping strategies are evident. There is a significant association between psychiatric disorders (depression and PTSD) and disability among war victims. Some of the war victims have greater engagement in risk-taking behaviors and a tendency towards re traumatization. The collective trauma in Sri Lanka can lead to a generational trauma, and it can have a ripple effect beyond the immediate victims.

The burden of mental disorders is high in conflict-affected populations (Charlson   Et al., 2019). The war has disintegrated the existing protective networks in the communities. The community leaders have lost their designated positions in society. Due to poor social support, war-affected people are still struggling to build their lives. They experience high levels of psychosocial problems. The mental health consequences caused by armed conflicts are still underestimated in Sri Lanka. People are still experiencing the consequences of war, and it is essential to build resilience and establish supportive environments for mental health in war-affected areas with sustainable development goals.

Mental health can play an important role in effective post-conflict reconciliation and reconstruction (Baingana et al., 2005). Murthy and team (2006) indicate that populations in war and conflict situations should receive mental health care as part of the total relief, rehabilitation and reconstruction processes. Social support and resilience could be protective factors against mental health issues prevailing in victims (Dissanayake et al., 2023). Organizing mental health services in conflict and in post-conflict situations requires many skills and complex work across sectors (Piachaud, 2007) and it is a formidable challenge for mental health professionals. Culturally sensitive interventions have to be developed to meet the mental health needs of the population (Ghosh et al., 2004). Strengthening Coping strategies and promoting maternal psychosocial well-being in war-affected regions.  Provide fruitful ways of coping with the conflict situations.

In post-conflict situations there are six levels of interventions needed: first, increasing resilience; second, making the family the focus for effective support; third, encouraging community solidarity and traditional methods of support: fourth, using the media in mental health promotion; fifth, the integration of mental health skills of caring for the population with general services; and sixth, focusing on long-rather than short-term measures. (Ghoshet al.,2004).

Improving mental health facilities and providing psychosocial support for war affected communities are important. Mental health care must be prioritized, and effective community interventions should be implemented. Psychosocial rehabilitation is important, and these programs will encourage empowerment, self-management and autonomy in daily activities. These interventions would mitigate the harms caused by the armed conflict in Sri Lanka.

 (Dr Sarath Panduwawala is a retired Consultant Psychiatrist who served as a visiting psychiatrist of the Sri Lanka Army)

  

References

 

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Carpiniello B. (2023). The Mental Health Costs of Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones. Int J Environ Res Public Health. 6;20(4):2840. doi: 10.3390/ijerph20042840.

Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. (2019).New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet.  20;394(10194):240-248. doi: 10.1016/S0140-6736(19)30934-1.

 Dissanayake L, Jabir S, Shepherd T, Helliwell T, Selvaratnam L, Jayaweera K, Abeysinghe N, Mallen C, Sumathipala A. (2023).The aftermath of war; mental health, substance use and their correlates with social support and resilience among adolescents in a post-conflict region of Sri Lanka. Child Adolesc Psychiatry Ment Health. 2023 Aug 31;17(1):101. doi: 10.1186/s13034-023-00648-1. PMID: 37653394; PMCID: PMC10472617.

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