Timely publication for MHPSS sector
View(s):Transitions in Mental Health and Psychosocial Support Services (MHPSS) in Sri Lanka: A Decade in Review (2004-2015)
Published by The Asia Foundation under its Victims of Trauma Treatment Programme with support from USAID (United States Agency for International Development.)
Excerpts from the presentation by Dr. Harini Amarasuriya at the launch of the publication on September 8 at the BMICH
At the podium is Dinesha de Silva Wikramanayake, Country Representative of The Asia Foundation, seated from left to right -Dr. Harini Amarasuriya, Senior Lecturer at the Department of Social Studies, Open University of Sri Lanka and Elizabeth Davnie-Easton, Supervisory Program Officer USAID
This important publication: “Transitions in Mental Health and Psychosocial Support services in Sri Lanka : A Decade in Review”, is a huge undertaking and it aims to, “look at the growth and transitions of the mental health and psychosocial support sector ( MHPSS) in Sri Lanka over the period of a decade to better understand what aspects have acted as enablers and what factors have been challenges to the development and growth of the sector”.
The publication is divided into three sections. Section 1 deals with the literature on PS services in Sri Lanka and literature on the sustainability of MHPSS services in Sri Lanka. Section 2 deals with Services Providers – specifically community level government service providers. Section 3 deals with the issue of sustainability – and especially sustainability in the context of certain transitions. There are six chapters in all.
The chapters in the publication each deal with the issue of sustainability and coping with transitions in the context of certain specific events and or situations: the tsunami and the conflict. Each of these events or series of events or situations generated specific challenges for the MHPSS Sector – and the chapters attempt to map how these shaped the ways in which the sector responded as well as how they affected the sustainability, growth and development of organisations and initiatives in the sector.
The influx of agencies, organisations, funds and the huge attention on MHPSS issues post-tsunami generated issues regarding coordination, efficacy and quality of interventions, capacity, human resources, competition for resources and clients etc. In many ways it also led to initiatives that led to redefining the sector – just as much as the trauma vs. resilience debates that surfaced during the early period of the war – questions about defining the field; exploration of various models of intervention and approaches were triggered by the response of the MHPSS sector to the tsunami. Coordination became a key concern – and many of the initiatives for coordinating the sector and the resultant difficulties of coordination are well documented in this publication.
With regard to the enablers and challenges for the development and growth of the MHPSS sector in the last decade, I found that there are broadly four factors that seem to be key: 1) the relationship between the state and NGOs; 2) Changes to the political context 3) relationship with donors 4) the capacity of individuals to manage those other 3 factors. With regard to the latter, it is interesting how individuals – and the specific skills, capacities and networks of individuals were key enabling factors in managing challenges in the sector. Thus, the capacity of individuals to mobilise networks, manage relationships and the quality and type of contacts they maintained were key factors that enabled them to manage challenges and the transitions that were often a result of events in the broader political context.
One of the very interesting things in the publication was the extent to which the relationships between NGOs and the state defined what is possible or not in the MPHSS sector. As the war escalated, and the relationship between the state and NGOs deteriorated, the ability of NGOs to provide MHPS support services became affected badly. In the post-war context with the threat of human rights and war crimes investigations the state’s suspicion of MH and PS work became even significant. This led to the situation where MHPS work was banned or could only take place under the surveillance and supervision of the state. This affected coordination mechanisms as well as the type of interventions that were possible.
The extent to which the MHPSS sector – especially NGOs, are affected by the political context is something that comes through very clearly in this publication, this is also common to other parts of the world. However, it is not necessarily taken into account when designing interventions and in considering their effectiveness and sustainability. As the case study in this publication on the Task Force for preventing GBV in Batticaloa shows the hostile relationship with the state post 2005 meant that the Task Force became a means by which the state attempted to control the work of NGOs; heightened militarisation meant that incidents of GBV involving the state military for example could not be addressed directly; state policy and ideology on women resulted in particular approaches to GBV having to be discarded or reconceptualised.
Should NGOs be in the business of service delivery or should they be focusing on advocacy? Has the shouldering of the burden of service delivery by NGOs facilitated the withdrawal of the state from its welfare responsibilities towards its citizens? Can working too closely with the state stifle the space for innovativeness and creativity of non-state actors, and what does it mean in terms of their independence? And most importantly, in situations of state repression, who is there on the side of affected individuals and communities? I think recent experiences in Syria for example have thoroughly exposed the limitations of the humanitarian and development sector response in such situations.
And perhaps we also need to think about what this may mean not only when states are repressive but also when states are more open to working with different actors. We are probably in a situation now where there is going to be a surge of activity in the MHPSS sector in relation to transitional justice and reconciliation work. Are we ready? Have we learned our lessons from the post-tsunami response adequately? This publication dwells at length about how the post-tsunami response generated the urgent need for effective coordination mechanisms to ensure that interventions were not duplicated, that there was sharing of resources and experiences, that human resource capacity was considered and that human resources were built and nurtured. As documented in this publication, that period gave rise to a multitude of research and publications on the MHPSS sector – including research in which The Asia Foundation (TAF) itself invested quite substantially.
This publication draws our attention to the vulnerability of the MHPSS sector and its responses to external factors – politics and ideology of the state certainly – but also to that of donors and the international community. So the effectiveness of coordination mechanisms and the sustainability of interventions fluctuate based on these external factors. Now, in the MHPSS sector – the consequences of this vulnerability can be quite serious.
This publication raises the question whether the focus on service delivery and negotiating relationships with the state (and donors), has resulted in the MHPSS sector missing out on a really important aspect of work: and that is generating knowledge and advocacy. However, in order for knowledge generation and advocacy to be useful, it also means that those involved in those areas need some degree of autonomy and independence. How much have we compromised on both of these for our survival? This question is especially pertinent for non-state actors in the MHPSS field. Who really determines the agenda for MHPSS especially for the NGO sector? If tomorrow, we abandon our work on GBV, child protection, suicide prevention and torture and start focusing on transitional justice and reconciliation, who will benefit and who will lose?
In this regard, I wish the publication had provided us also with a review of the growth and development of the state in the MHPSS sector. What are the significant policy level, structural, institutional and human resource changes in how the state engaged during the last decadein the MHPSS sector? A good case study of a state programme (like the one of the GBV Task Force in Batticaloa) might have proved invaluable insights in this review of the sector. Given the extent to which state/NGO relations seem to affect how the MHPSS sector operates, I think this would have been useful so that we can think about how different actors in the sector should work together, independently, collaboratively and also to think about how the state and non-state agencies are perhaps positioned differently to address issues in the MHPSS sector.
In conclusion, I think this publication is timely and provides us with an opportunity to reflect and learn as we embark on yet another phase in the MHPSS sector in Sri Lanka. There is no doubt in my mind that in the coming months, the demands that are made of the sector will multiply –and I think it is incumbent on us all to ensure that the people at the receiving end of MHPSS services remain at the centre of our planning and strategizing efforts. This publication provides insights as to the difficulties we may face in doing so and hence serves as a timely reminder that in our enthusiasm to respond, how we respond is ultimately the most important consideration of our intervention.