“Like a parent leaving a child” is how one senior mental health professional expressed his sadness of the end of Voluntary Service Overseas’s (VSO) Mental Health Programme in Sri Lanka. Today is 28 February 2013, and the room I am sitting in is full with mental health policymakers, professionals, service users, and us, a group of volunteers. We are at the impressive Bandaranaike Memorial International Conference Hall in Colombo to celebrate the work of VSO and their partners, but the air is tinged with sadness. It is the end of an era. In fact, it is the end of VSO’s fifteen years of focus on the Sri Lankan mental health sector to ensure people with mental health problems are able to realize their right to access community-based, quality mental health services that are available, accessible and inclusive.
The day is a mixture of emotions for me, alongside a battleground of thoughts. Middle income country versus obvious poverty. Achievements versus sustainability. Capacity building versus dependency culture. Here are some of my reflections on why the contradictions exist for me as I complete my volunteer placement here.
In late 2010 the World Bank reclassified Sri Lanka as a middle-income country, and as a result a number of large development and aid organisations have been withdrawing from the country, including VSO. However, for the past 18 months I have been living and working in the North where a majority of the inhabitants live on less than a dollar a day. Over sixty percent of households in the Northern districts are food-insecure, and therefore fail to meet their own basic needs. The reality is that there is food, but it is very expensive, and people don’t have the income to buy it. The fact that there are insufficient job opportunities is all too apparent. Without the means of feeding yourself and your family, how can we begin to address mental health issues and needs of this country, post-Tsunami and post-war?
Working with over 65 international volunteers, contributing tens of thousands of volunteer hours, VSO’s mental health programme focused on sharing skills with 10 local partners across the country (both government and non-profit/charitable organizations) in a wide range of disciplines including psychiatric nursing, occupational therapy, social work, training and education, advocacy, organizational development and media relations. Here is a quick look at some achievements through numbers:
- 40 – Number of rehabilitation centres, resource centres, horticulture projects, day centres, out-patient clinics, community housing projects, community occupational therapy services and adolescent/child mental health clinics created with VSO volunteer support across the country over the past 15 years.
- 46,762 – Number of people who attended workshops/trainings/awareness raising activities carried out by VSO volunteers targeted at professionals directly involved with service users to improve the quality of care on various fronts.
- 395,801 – Number of people who attended workshops/trainings/awareness raising activities carried out by VSO volunteers targeted at professionals working in non-mental health government organizations, service users, carers and family members of service users, and members of the general public, on various mental health issues.
- Over 2.5 million – Estimated number of Sri Lankans reached through VSO-supported media promotion and awareness activities.
But to me the far greatest achievement, and one that can bring true sustainability, is assisting our partner organisations to implement a ‘rights-based approach’ to developing and delivering their mental health services. It is an innovative approach linking development directly to a framework that both strengthens the focus on the most vulnerable giving them a voice. And it emphasizes the relationship between ‘rights-holders’ and ‘duty-bearers’.
A rights-based approach requires us to examine and transform the language, terminology, and models of mental health that have previously prevailed. Such an approach also requires us to examine the multiple ways in which inequality and discrimination characterise the lives of people with mental health problems and to formulate a response based on a human rights framework (something which can provoke governments and decision-makers into non-cooperation). So this requires capacity building – the building of organisational and institutional capacity which in turn can strengthen civil society and empower individuals.
We all know the classic capacity building cliche: “Give a man a fish, feed him for a day; teach him how to fish, feed him for a lifetime”. But have we successfully taught anybody to fish, or are we still just handing fishes out? Do our partner organisations feel like dependent children abandoned by their parent, as expressed by one senior mental health professional? Or are we leaving independent young people who have the capacity to grow, learn and flourish as adults?Perhaps it is too early to tell. Conceivably we have all contributed to work that is established enough that it will evolve and grow in its local context. Certainly though I have seen good practice develop, gaps in knowledge decrease, and shared skills and experiences adapted – by myself and by my local colleagues. I am therefore hopeful for the future, and leave feeling that capacity building in the mental health sector of Sri Lanka has been a reality.
Dr Marcia Brophy is a Child Psychologist, and Wellbeing and Mental Health Specialist, and a fellow of The Young Foundation. Over the past 18 months she has been working on a voluntary basis as a Mental Health and Wellbeing Development Worker and Training Advisor in Jaffna, north Sri Lanka, as part of VSO’s mental health and wellbeing programme. Marcia has been working with Shanthiham, a non-for-profit charity and the Sri Lankan Government’s Department of Health.