In the immediate aftermath of the tsunami in late 2004 there were many people who reached out to help, including researchers led by Colombo University. Six months later, after 800 focus group discussions in 1100 villages, their disturbing findings were captured in a UNDP report.
Fears were expressed about a second tsunami, children complained of sleeplessness, tremendous anxiety was detected, there was social stigma attached to being “tsunami-fellows” and people perceived a loss of kinship networks and neighbourliness. There was a marked increase in alcohol consumption. Those who had lost spouses often felt lonely and depressed.
Mental health is key to rebuilding communities after a disaster. Sri Lanka’s government understood this and estimated that as many as 30,000 people could require treatment. Where were the resources to address the enormity of the counselling needs? One expert estimated that there were more trained Sri Lankan psychiatrists in Toronto than in all of Sri Lanka.
In this stressful context, the Toronto-based Centre for Addiction and Mental Health (CAMH) which is one of the world’s major mental health institutions, decided to act.
CAMH received $1.75 million over three years from the Canadian International Development Agency (CIDA) and matched it with a $340,000 contribution of its own. It worked nationally and with groups of Sri Lankan partners in Batticaloa and Jaffna, in the east and north of Sri Lanka. Later, Mannar, in the conflict zone in the north, was added because of high mental health need even though it was barely affected by the tsunami.
CAMH and partners were determined to address the mental health demands. It meant working with the community and focusing on parents as well as schools, hospitals and Ministry of health officials at all levels. Addressing gender based violence became one of the most important and successful outcomes of their work.
The work involved a number of different groups. In Toronto the Canadian Medical, Dental Development Association brought many Sri Lankan Canadian professionals together with CAMH as well as Colombo’s National Institute of Mental Health (NIMH), Angoda, the Sri Lankan College of Psychiatrists and a local Sri Lankan NGO, Sahanaya, led by Professor Nalaka Mendis. There were regional teams such as Mannar’s Psychosocial Forum and Batticaloa’s gender based violence Task Force. Indian mental health experts from Bangalore and Chennai also played an active role.
Challenges faced by CAMH were common to other tsunami projects. There was the time pressure of wanting to respond quickly and flexibly with funding for maximum benefit. This had to be balanced with accountability and reporting challenges. Then there were differences of opinion on the manner and degree to which a participatory approach could be taken when faced with complicated cultural practices, such as deference from victims who might disagree with a particular action.
One of the Sri Lankan partners said later than CAMH’s strength included not having a fixed idea of what it wanted to do and also not insisting on visibility. CAMH was prepared to observe, learn and be flexible. Reinforcing the gender based violence desks in hospitals was effective because it was designed by Sri Lankans before the tsunami. This allowed for some important synergies, involving police with health workers and women and families. Training 700 hospital staff, from cleaners to top echelon officials, was also critical to success because a victim may speak to anyone she or he feels comfortable with.
While institutions and organizations are at the heart of many projects, success usually requires committed individuals. At the June 2010 opening of the Acute Mental Health Clinic and inpatient facility in Mannar, some individuals were clearly enthusiastically behind the event. Dr. Arun Ravindran from CAMH in Toronto, Dr. Ganesan from Colombo who practices at the NIMH, Angoda and the regional team members, were proud of the Clinic and facilities and the cost saving manner in which they had brought it together collectively.