Trauma, Mental Health & Psycho-social Well-being: Actors

A wide array of actors

There is a wide array of actors working on trauma and mental health issues such as governments, intergovernmental organizations, international and local non-governmental organizations (NGOs), foreign and local experts including medical staff and social workers, and community leaders. Individuals range from workers in the field to specialists in psychiatry, psychology or social work who train others to assist communities and individuals dealing with trauma in post conflict areas.

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A wide array of skills

In addition to the variety of actors, the skill levels of field workers also vary considerably as they may or may not be trained to deal with trauma and mental health issues. Among ongoing debates on the subject is whether emotional support should be provided by specialists.1 While specialists may have extensive expertise in dealing with trauma, the paucity of those with such professional backgrounds and experience coupled with the sheer numbers of individuals and communities in post-conflict plight make it difficult to implement expert-driven assistance efforts solely.

A number of organizations are specialized in training and providing guidelines to those working to heal trauma in post-conflict settings. For example, the International Society for Traumatic Stress Studies established a Task Force on International Trauma Training in 1999 and "refers to the training initiatives by professionals with expertise in trauma mental health who travel from one country to another in the effort to teach and train local persons to respond better to trauma-related problems."2 Other organizations have also been supporting many local health professionals in psychotherapy and counseling, such as the International Rehabilitation Council for Torture Victims whose network today embraces 136 rehabilitation centers and programs from all over the world. Some concentrate their efforts mainly on medical staff whereas others embrace a large spectrum of actors who can support individual and community healing processes.

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Insiders/outsiders dynamics

The question of the status and role of the provider of psychosocial support is particularly critical.3 There has been growing concern about shipping trauma experts to war-torn societies around the world.4 Outsiders often bring a wide array of expertise and agendas that do not always meet local expectations and needs. Outside interventions can also inhibit social rebuilding and psychological healing, if not handled properly or sensitively.5 However, "outsiders can play essential roles by introducing new or independent perspectives about the conflict, by providing needed expertise, and/or by mediating among parties to the conflict."6

On their part, locals may have a disadvantage as compared to foreign experts, depending on their role in the conflict and the consequences on the way they have perceived by traumatized populations. However, they also have advantages of understanding nuances in local languages, a deeper understanding of the conflict, history, cultural norms and traditions, and often an easier connection with the populations they aim to serve. They may also be more easily identifiable to those recipients of psychosocial support. At a minimum, many recommend including local experts in the design and delivery of mental health services. "Research has demonstrated the capacity of local primary health care systems, traditional healers, and national and international NGOs to play a major role in reducing the suffering and disability associated with mass violence."7 "In order to work in communities at a level that is appropriate, the matter of insider and outsider knowledge must become a dialogical exchange in the hands of the local community, as outsiders' and insiders' conceptual categories are put in service to the imagination that seeks to re-imagine peace. Outsiders can serve in the role of idea givers, researchers and facilitators, as well as advocates. Insiders can examine traditional resources and perhaps rehabilitate those that have been sullied by appropriation or misuse. They can conduct deep and historical analyses of what happened and even of widely accepted 'truths.' They may develop new, locally valid approaches to post-massacre issues and carry them out with outsider resources."8

1. Kaz De Jong and Rolf J. Kleber, "Emergency Conflict-related Psychosocial Interventions in Sierra Leone and Uganda: Lessons from Mdecins Sans Frontires," Journal of Health Psychology 12, no. 3 (2007): 485-497.
2. "Draft Guidelines for International Trauma Training," International Society for Traumatic Stress Studies.
3. M. Brinton Lykes and Marcie Mersky, Reparations and Mental Health, in The Handbook of Reparations, ed. Pablo De Grieff (New York: Oxford University Press, 2006): 589-622.
4. Patrick Bracken and Celia Petty, eds., Rethinking the Trauma of War (London: Free Association Books, 1998).
5. Judy Barsalou,"Trauma and Transitional Justice in Divided Societies," Special Report 135 (Washington DC: US Institute of Peace, April 2005).
6. Ibid.
7. Richard Mollica and Laura McDonald, "Project 1 Billion: Health Ministers of Post-Conflict Nations Act on Mental Health Recovery," UN Chronicle 4 (2003).
8. Beatrice Pouligny, Simon Chesterman, and Albrecht Schnabel, After Mass Crimes: Rebuilding States and Communities (New York: United Nations University Press, 2007), 283; see also Roberta Culbertson and Batrice Pouligny, "Re-imagining peace after mass crime: A dialogical exchange between insider and outsider knowledge," in After Mass Crimes: Rebuilding States and Communities: 271-287.

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