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Sherly Saragih Turnip

The Role of Counseling to Promote Positive Mental Health in Violent Conflict Affected Community in Indonesia. Sherly Saragih Turnip. Introduction. In Indonesia there were more than 1,4 million internally displaced persons ( IDP s) at its peak ; 70% of them wer e women and children

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Sherly Saragih Turnip

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  1. The Role of Counseling to Promote Positive Mental Health in Violent Conflict Affected Community in Indonesia Sherly Saragih Turnip

  2. Introduction • In Indonesia there were more than 1,4 million internally displaced persons (IDPs) at its peak; 70% of them were women and children • 55-60% of IDPs in Indonesia have psychological problems and Mental Health services have been identified to be one of the urgent need by the government

  3. Introduction • Violent conflict in Maluku, Indonesia, started in 1999 • Believed as religious conflict, produced more than 500.000 internally displaced persons (IDPs) and 25000 fatalities • Relatively stable but high alertness • SegregateMoslem-Christian areas

  4. IDPs in Indonesia • By nature,forced migrants were vulnerable to mental health problems and poverty • There has been no comprehensive assessment on psychological problems of IDPsin Indonesia • Lack of cultural validation in low income countries of established instruments measuring mental healthneed to be addressed

  5. Setting • Maluku province islocated in eastern part of Indonesia, it is an archipelago province where Ambon city is the capital • Major violence was last seen in April 2004, smaller incidents have been going on sporadically in the island ever since (until now) • Most affected area is Ambon city

  6. it

  7. Ambon Island

  8. Aim Study the vulnerability and resilience of communities in relation to violent conflict and forced migration

  9. Methods • Quantitative longitudinal community based study • Data collected through home visits with self report instruments • 10 camps and relocation areas in Ambon island were chosen to represent the real IDP settlement condition in Ambon • Cultural validation of international intruments and on site development of instruments

  10. Methods • Training for 9 research assistants to collect the data • All questionnaire were self report, possible to request help from research assistants • Data collected by home visits • List of household were obtained from camp leader/ community leader, picked household with lottery system

  11. Methods • Assistants can help respondent to read and/or write answer into the forms if respondent is not able to do so • Later switch to Community Based Participatory Research (CBPR), where the researcher shares power with and engages community partners in the research process and that benefits the communities involvedestablished equal partnership with local community and organization

  12. Methods • Written informed consent to be collected at the beginning of the data collection process • Research must comply with the ethical guide and provide help to anticipate possible negative side effects of the research for the participants

  13. Subjects in T1 • 460 consented IDP adults living in scattered 10 relocations and camps in Ambon island. • Multi stage sampling (convenience and simplerandom sampling),approached 480 persons from 200 families. 6 refused to participate for various reasons, 14 dropped from analyses stage due to incomplete response.

  14. Subjects in T2 • IDPs: managed to get 399 participants (85%) of those who participated in T1 • We added non IDPs subjects, from 2 villages in 2 neighboring islands, 111 adults participants from 47 households

  15. Subjects • Range of age of participants is from 18-80 years old with mean age 37 • More than 56% of participants have less than 9 years of formal education • 74% of participants are married, 5% are widow and no widower

  16. Results • Total prevalence of mental distress was 48% • Prevalence of mental distress across gender indicatedthat significantly more women (55%)were experiencing mental distress compared to men (37%)

  17. Results • Different risk factors were identified for women, men and adolescents • Women: • Head of family • Poorer • Short term illness • Old age

  18. Results • Men: • Involved in life threathening situation • Had long term illness  physical disability • Old age

  19. Counseling service • Started as individual counseling only • Common problems: • Symptomps of PTSD • Inability to function in daily life activities/ at work • Somatic complaints • Family relational problems • Domestic violence

  20. Problems related toadolescents • Higher aggressiveness, hatred against the other religious group • Lack of motivation to go to school or work • Disobey to adults/parents/other authority figures • Abuse of drugs and alcohol • Increasedcriminality rate, prostitutions • Traumatic stress related symptoms

  21. Challenges • Difficult terrain • Large number of clients • Only 1 psychologist • Only 1 psychiatrist for Eastern Indonesia • No Pscyhiatric nurse, no social worker • No social work or counseling education at local university in Maluku

  22. Community Based Counseling • Community meetings with participants to discuss the results of the study • Open discussions with and between every member of the community • Discuss the possible solutions to the problem of unavailability of mental health personels

  23. Community Based Counseling • Involved local primary health care providers to participate in the solution • Community education of the importance of positive mental health • Talking group (group counseling) for women, men and adolescents • Training of counseling basic skills for health providers and community group

  24. Community Based Counseling • Weekly meetings for women groups • Development of “talking room” in every primary health care • Counseling post in every village • Regular meetings to strengthen the commitment and counseling skills of the community volunteers • Customized training for health personnels for referral puspose

  25. Community Based Counseling • Established “long distance consultation” program....thanks to the cellular service! • Regular sport activity for men, as a starting point for group counseling • Sport and artistic activities for adolescents

  26. Impact Evaluation Study (2011) • Preliminary epidemiology findings indicated that the IDPs’ mental health had significantly improved • Indicators: • psychological distress • sense of coherence • subjective well being

  27. Other contributing factors to positive mental health • Better income and purchasing power significantly improved positive mental health • Better satisfaction of one’s economic condition improved positive mental health although the result was not significant

  28. Results from qualitative study • Able to function in a better way • Increased respect for others • Increased self esteem • Promote inter religious interaction and understanding • Higher motivation to pursue education • Improved communication skills

  29. Next steps • Conduct evaluation study in a more comprehensive manner • Maintain the relationships with community • Maintain and develop relationships with local organization

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