Psychology and Mental Health: A community perspective

1
Psychology and Mental HealthA community
perspective

• Umesh Bawa
• Department of Psychology
• University of the Western Cape
• South Africa
• ubawa_at_uwc.ac.za

2
Psychology and mental health

• The context of mental health
• Considerations for Mental Health Promotion
• Structural Violence
• Models of Intervention
• The case of South Africa, Sierra Leone and Rwanda
• Risk and Resilience
• Challenges and Triumphs
• Lessons Learnt
• Voices from the Community

3
The context of mental health in South Africa

• Adequate Natural and Human Resources
• Poverty and lack of infrastructure
• UN Development Index Africa has most
  representation in the lowest in the world
• Global Peace Index- SA is ranked 114 (2008)
• Lack of safety and security
• Tropical diseases, malaria, TB/HIV
• Lack of adequate health services and trained
  personnel
• International vested interests - conflict
  diamonds
• Issue of Incapacity vs Unwillingness
• Culture of Impunity

4
Key Considerations for Mental Health Promotion

• Cannot separate mental health from physical
  safety
• Intervention at both macro-social and
  micro-social level
• A Human Rights Rights Focus
• Political, social, psychological and economic
  development
• Justice and impunity counter-balancing
  retributive and restorative justice
• Crucial as unhealed wounds of society and of
  individual victims may continue to fester long
  after cessation of fighting or end of a
  repressive regime (Hayner,2001)
• Need to address structural violence that
  exacerbates the crises of health and
  psychological well-being

5
Crucial questions for Psychology in the African
community?

• What are Appropriate Interventions
• What Transgenerational modalities work?
• Prevention of intergenerational transmission of
  violent behaviour
• Transgenerational transmission of trauma
• Break cycle of violence
• What is the impact of living under conditions of
  prolonged community violence, deprivation or war?
• What works in other societies that may benefit
  African practice?
• Develop Best practice models

6
Models of Intervention

• Is Psychotherapy appropriate when there is no
  food?
• Western psychology and traditional African models
• Curative, Promotive and Preventive interventions
• Mental health before physical health?
• The relevance of psychoanalytic thinking and
  western psychology models
• Polyrhythmic transitions mobilising for action
• Rethinking the frame-analytic, political and
  cultural interventions
• Accommodation vs. Empowerment
• Issues of gender and patriarchy
• Policy development and Accountability
• Individual and Collective resiliency
• Prevention and Advocacy

7
The Case of South Africa

• Curative ,promotive and preventive models
• Structural violence the main cause of mental
  health problems
• Impact of Apartheid and Neglect
• Children for Tomorrow Clinic
• Transgenerational transmission of trauma
• Personal and social disintegration
• Complex PTSD
• Child Rape and sexual exploitation
• In South Africa, 40 of 50000 raped in 2007 were
  children under 18
• Gender and patriarchy
• Culture of Silence
• Cultural practices- virginity testing, female
  genital mutilation
• Violence, Alcohol and Homicide
• What have we learnt?
• Contextual, culturally appropriate models
• Language, Culture and the Ancestral World
• Advocacy, flexibility and agility

8
The case of Sierra Leone

• Post conflict society in transition
• Abundance of natural resources
• Ravaged by ten year civil war
• International vested interests
• Institutional collapse
• Health crises Malaria, Lassa fever
• Child soldiers
• The short sleeve campaign
• TRC and the UN Special Court
• Liberia- The Charles Taylor issue
• Impunity and the quest for justice (ICC)
• What learnt?
• - the Mending Hearts Programme
• - indigenous models
• - role of spirituality

9
The case of Rwanda

• Genocide
• 1 million people killed in 100 days
• Lack of responsiveness of the international
  community
• Safety and Security not guaranteed
• History of ethnic hatred
• Gacasa and the TRC
• Challenge is the restoration of humanity and
  dignity
• What have we learnt?
• Capacity to heal
• Capacity to forgive
• Need for psychic renewal
• Safety and fear of reprisal
• Self-reliance

10
Resilience

• Ways in which trauma survivors cope to survive
  thrive in context of adversity.
• Individual, family community
• Pattern of positive adaptive responses.
• Ability to draw lessons from traumatic event,
  make meaning, humour, compassion, creativity,
  initiative.
• Social networks.
• Belief system spirituality.
• Important to identify nurture individual, and
  community strengths.

11
Triumphs and Challenges of Psychology in South
Africa and the African continent

• Triumphs
• The end of apartheid
• The absence of war
• Post-war trauma rehabilitation
• Economic development
• Governance and accountability
• Structural intervention-legislation and policy

• Challenges
• Micro-and macrosocial interventions
• Poverty and health
• The struggle for health
• The fragility of peace
• Reduce structural inequity
• Economic development
• Transmutation of trauma and oppression
• Structural violence
• Capacity building

12
Further Challenges

• Need to address poverty and health
• Foregrounding of spirituality
• Knowledge of integrative approaches and
  interventions
• Need for effective, time limited contextual
  approaches
• Struggle to manage their feelings and to resolve
  their own trauma
• Loss of agency and dependency
• Agentic Autonomy
• Shift from issues of the self to the pro-social
  behaviour of serving others
• Maintain boundaries but be agile
• Culture of Peace and Solidarity
• Advocate for discontent

13
Lessons Learned

• Humility
• Set realistic goals and be aware of contextual
  constraints
• Contextualised models of psychological
  interventions
• Consult and utilise indigenous knowledge /
  indigenous healing systems
• Importance of psycho-spiritual dimension
• Some models do work
• Counter-transference and self-care
• Dance to the polyrhythm

14
Psychology and HealthVoices from the Community

• The fragility of peace
• Capacity building
• Individual and collective resiliency
• Advocacy and empowerment
• Solidarity, exchange and collaboration
• Contextualised models of psychological and
  political interventions
• Self care and burnout
• Hope and renewal

15
In the Best Interest of Mental Health in Africa

• The 4 Rs
• Re-establish Safety
• Remembrance
• Reconnection
• Revitalisation
• And
• RECONSTRUCTION and RENEWAL

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)