575381 research-article2015
ANP0010.1177/0004867415575381Australian & New Zealand Journal of PsychiatryTierney et al.
Commentaries Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(5) 481–483
Commentaries
© The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
The aftermath of the Bougainville Crisis: Mental health and psychosocial impacts and the need for services David Tierney1, Paul Bolton2, Barnabas Matanu3, Lorraine Garasu4, Essah Barnabas5 and Derrick Silove6 1St.
John of God Frankston Rehabilitation Hospital, Frankston, VIC, Australia 2Center for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 3Director Medical Services, Buka Hospital, Autonomous Region of Bougainville, Papua New Guinea 4Nazareth Treatment Centre, Chabi, Autonomous Region of Bougainville, Papua New Guinea 5Mental Health Nurse, Buka Hospital, Autonomous Region of Bougainville, Papua New Guinea 6Psychiatry Research and Teaching Unit, Ingham Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Corresponding author: David Tierney, Clinical Psychologist, St. John of God Frankston Rehabilitation Hospital, 255-265 Cranbourne Rd, Frankston, VIC 3199, Australia. Email: [email protected] DOI: 10.1177/0004867415575381
Although the armed conflict in Bougainville (1988–1997) (referred to locally as ‘the Crisis’) was the most extensive in the Pacific since World War II, there is little awareness of its mental health and psychosocial (MH&PSS) impacts. We provide a brief overview of the history of the conflict and consider the long-term
effects on MH&PSS needs of the indigenous population. The Bougainville archipelago of islands was incorporated into Papua New Guinea (PNG) during the colonisation period. In December 1988, PNG Police came into conflict with landowners mounting protests concerning a range of grievances related to the Panguna mine. Rebels formed the Bougainville Revolutionary Army (BRA) whose support widened in response to harsh tactics by police to quell the protests. The PNG Defence Force was then deployed to Bougainville and conflict with the BRA continued until a ceasefire in March 1990, resulting in the withdrawal of the PNG military and services. Subsequently, a blockade was imposed by the PNG government which prevented all goods, including medical supplies, entering Bougainville, resulting in severe hardship and adverse health consequences. During the ceasefire, undisciplined actions of the BRA led to the formation of the Bougainville Resistance Forces (BRF) and conflict between the two factions ensued. The PNG Defence Force returned to Bougainville and joined the BRF in conflict with the BRA. In 1997, the peace process commenced resulting in the Bougainville Peace Agreement (2001) which established the Autonomous Region of Bougainville and a commitment to a future referendum on independence (Braithwaite et al., 2010). During the war, approximately 20,000 indigenous persons died (Boege, 2009) and 80,000 were displaced from a total population of 160,000 (Braithwaite et al, 2010). Widespread human rights abuses
occurred, including extra-judicial killings, murders, arbitrary arrests, assaults, sexual assaults, harassment, torture, and property theft and damage (Boege, 2009, Regan, 1988). The war had profound social, educational and economic impacts (Braithwaite et al, 2010, Regan, 1988). Following requests from local agencies and government, the first author (DT) undertook field visits to Bougainville in 2009, 2011 and 2013, where he met politicians, senior public servants, service providers, women’s groups, church groups and villagers (Tierney, 2013). A consensus emerged concerning key MH&PSS issues: (1) a substantial number of persons continued to manifest various mental health and behavioural problems arising from the Crisis; (2) high-risk groups included ex-combatants and a generation of young persons denied education during the Crisis; (3) there appear to be high rates of substance abuse and gender based violence, including sexual assault; (4) traumatic stress reactions in adults affected their parenting capacity, resulting in adverse transgenerational effects, including behavioural disturbances in children and adolescents; and (5) ongoing social, educational and economic problems arising from the Crisis were adding to MH&PSS problems. It was evident that MH&PSS skills and human resources were severely limited. Bougainville has one dedicated mental health nurse for 254,000 persons, making it difficult to address all core mental health problems such as psychosis, mood disorders, and drug and alcohol abuse. In addition, there is a small number of faith-based, voluntary and non-government agencies
Australian & New Zealand Journal of Psychiatry, 49(5)
Downloaded from anp.sagepub.com at FUDAN UNIV LIB on May 10, 2015
482
ANZJP Correspondence
operating with fragile and inconsistent funding in attempting to provide psychosocial support and counselling. In 2013, the Bougainville Mental Health Steering Group (BMHSG) was established. An expatriate team (DT, DS and PB) was invited to undertake a consultancy to Bougainville in 2014. Meetings of the team with the BMHSG (including BM, LG and EB) and other stakeholders confirmed many of the previous observations (Tierney, 2013), including the paucity of resources to meet core mental health needs, widespread, untreated traumatic stress reactions, and broader psychosocial issues impacting on the community, including family conflict, increased gender-based violence (including sexual assault), social and cultural disruptions resulting in antisocial behaviour, and adverse trans-generational impacts on children and youth. A strategic framework was submitted to the Bougainville Government in 2014. Recommendations include: (1) undertaking research on MH&PSS needs and current services (formal and traditional); (2) establishing a comprehensive community-based model of mental healthcare and
treatment, piloting the model in one region, then rolling it out across Bougainville; (3) initiating steps to develop a comprehensive mental health policy and legislation; and (4) raising awareness and promoting advocacy aimed at highlighting MH&PSS issues. Although systematic data are limited, observations from Bougainville coincide with those derived from the post-conflict field internationally in identifying the need for core community mental health services, skills to address traumatic stress reactions, and community strategies to address family and broader psychosocial issues arising from the Crisis (Silove and Steel, 2006). Australia has a long history of providing expert support, training and resources to our island neighbours in developing mental health systems and capacity, for example, in TimorLeste. A program of support for Bougainville would be timely given the level of unmet needs in the territory and the strong commitment among indigenous leaders and stakeholders to address MH&PSS issues.
Declaration of interest
Building capacity in academic psychiatry: The Queensland Mental Health Research Alliance Shuichi Suetani1, Bjorn Burgher2, Duncan McLean1, Michael Breakspear2,3 and John McGrath1,4
We note with interest a recent cluster of articles in the Australia and New Zealand Journal of Psychiatry (Henderson et al., 2015; Lewis and Jorm, 2015) and Australasian Psychiatry (Kisely, 2015) on the topic of academic psychiatry. These articles highlight problems in recruitment and capacity building in academic psychiatry. Why aren’t more psychiatric registrars and junior psychiatrists engaged in research and attracted to research careers? The re-introduction of a Scholarly Project is a positive step by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to foster that crucial clinical curiosity in trainees. In this commentary, we would like to discuss new developments designed specifically to encourage capacity building in academic psychiatry in Queensland. In 2013, three leading academic centres in Brisbane formed the
Queensland Mental Health Research Alliance. The three founding partners in the Alliance are the Queensland Centre for Mental Health Research, the QIMR Berghofer Medical Research Institute and the Queensland Brain Institute (University of Queensland). In addition to consolidating and growing collaborative research between these three peak mental health research bodies, the Alliance aims to ‘synergize efforts to build capacity within mental health research – in particular to recruit and train clinicians in mental health research and to attract emerging mental research leaders to Queensland’. The Alliance quickly identified a need to invest in research training for psychiatric registrars. Research seminars have been held with a specific focus on opportunities for clinicians interested in commencing a PhD. Based on the goodwill generated
1Queensland
Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia 2Royal Brisbane and Women’s Hospital, Herston, QLD, Australia 3QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia 4The University of Queensland, Queensland Brain Institute, Brisbane, QLD, Australia Corresponding author: John McGrath, The University of Queensland, Brisbane, St Lucia, QLD 4072, Australia. Email: [email protected] DOI: 10.1177/0004867415577980
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding Funding for the 2014 Consultancy was provided by Counterpart International as part of a two-year Women Peace Building Initiatives project in Bougainville supported by USAID. The program aims to address the issues of gender empowerment, civil society capacity building, postconflict recovery, policy development and advocacy.
References Boege V (2009) Peacebuilding and state formation in post-conflict Bougainville. Peace Review: A Journal of Social Justice 21: 29–37. Braithwaite J, Charlesworth H, Reddy P, et al. (2010) Reconciliation and architectures of commitment: Sequencing of peace in Bougainville. Canberra: ANU E Press. Silove D and Steel Z (2006) Understanding community psychosocial needs after disasters: Implications for mental health services. Journal of Postgraduate Medicine 52: 121–125. Regan AJ (1998) Current developments in the Pacific: causes and course of the Bougainville conflict. Journal of Pacific History 33: 269–285. Tierney D (2013) Assessing the interest in building the mental health capacity in Bougainville. June.
Australian & New Zealand Journal of Psychiatry, 49(5) Downloaded from anp.sagepub.com at FUDAN UNIV LIB on May 10, 2015
ANP0010.1177/0004867415575381Australian & New Zealand Journal of PsychiatryTierney et al.
Commentaries Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(5) 481–483
Commentaries
© The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
The aftermath of the Bougainville Crisis: Mental health and psychosocial impacts and the need for services David Tierney1, Paul Bolton2, Barnabas Matanu3, Lorraine Garasu4, Essah Barnabas5 and Derrick Silove6 1St.
John of God Frankston Rehabilitation Hospital, Frankston, VIC, Australia 2Center for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 3Director Medical Services, Buka Hospital, Autonomous Region of Bougainville, Papua New Guinea 4Nazareth Treatment Centre, Chabi, Autonomous Region of Bougainville, Papua New Guinea 5Mental Health Nurse, Buka Hospital, Autonomous Region of Bougainville, Papua New Guinea 6Psychiatry Research and Teaching Unit, Ingham Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Corresponding author: David Tierney, Clinical Psychologist, St. John of God Frankston Rehabilitation Hospital, 255-265 Cranbourne Rd, Frankston, VIC 3199, Australia. Email: [email protected] DOI: 10.1177/0004867415575381
Although the armed conflict in Bougainville (1988–1997) (referred to locally as ‘the Crisis’) was the most extensive in the Pacific since World War II, there is little awareness of its mental health and psychosocial (MH&PSS) impacts. We provide a brief overview of the history of the conflict and consider the long-term
effects on MH&PSS needs of the indigenous population. The Bougainville archipelago of islands was incorporated into Papua New Guinea (PNG) during the colonisation period. In December 1988, PNG Police came into conflict with landowners mounting protests concerning a range of grievances related to the Panguna mine. Rebels formed the Bougainville Revolutionary Army (BRA) whose support widened in response to harsh tactics by police to quell the protests. The PNG Defence Force was then deployed to Bougainville and conflict with the BRA continued until a ceasefire in March 1990, resulting in the withdrawal of the PNG military and services. Subsequently, a blockade was imposed by the PNG government which prevented all goods, including medical supplies, entering Bougainville, resulting in severe hardship and adverse health consequences. During the ceasefire, undisciplined actions of the BRA led to the formation of the Bougainville Resistance Forces (BRF) and conflict between the two factions ensued. The PNG Defence Force returned to Bougainville and joined the BRF in conflict with the BRA. In 1997, the peace process commenced resulting in the Bougainville Peace Agreement (2001) which established the Autonomous Region of Bougainville and a commitment to a future referendum on independence (Braithwaite et al., 2010). During the war, approximately 20,000 indigenous persons died (Boege, 2009) and 80,000 were displaced from a total population of 160,000 (Braithwaite et al, 2010). Widespread human rights abuses
occurred, including extra-judicial killings, murders, arbitrary arrests, assaults, sexual assaults, harassment, torture, and property theft and damage (Boege, 2009, Regan, 1988). The war had profound social, educational and economic impacts (Braithwaite et al, 2010, Regan, 1988). Following requests from local agencies and government, the first author (DT) undertook field visits to Bougainville in 2009, 2011 and 2013, where he met politicians, senior public servants, service providers, women’s groups, church groups and villagers (Tierney, 2013). A consensus emerged concerning key MH&PSS issues: (1) a substantial number of persons continued to manifest various mental health and behavioural problems arising from the Crisis; (2) high-risk groups included ex-combatants and a generation of young persons denied education during the Crisis; (3) there appear to be high rates of substance abuse and gender based violence, including sexual assault; (4) traumatic stress reactions in adults affected their parenting capacity, resulting in adverse transgenerational effects, including behavioural disturbances in children and adolescents; and (5) ongoing social, educational and economic problems arising from the Crisis were adding to MH&PSS problems. It was evident that MH&PSS skills and human resources were severely limited. Bougainville has one dedicated mental health nurse for 254,000 persons, making it difficult to address all core mental health problems such as psychosis, mood disorders, and drug and alcohol abuse. In addition, there is a small number of faith-based, voluntary and non-government agencies
Australian & New Zealand Journal of Psychiatry, 49(5)
Downloaded from anp.sagepub.com at FUDAN UNIV LIB on May 10, 2015
482
ANZJP Correspondence
operating with fragile and inconsistent funding in attempting to provide psychosocial support and counselling. In 2013, the Bougainville Mental Health Steering Group (BMHSG) was established. An expatriate team (DT, DS and PB) was invited to undertake a consultancy to Bougainville in 2014. Meetings of the team with the BMHSG (including BM, LG and EB) and other stakeholders confirmed many of the previous observations (Tierney, 2013), including the paucity of resources to meet core mental health needs, widespread, untreated traumatic stress reactions, and broader psychosocial issues impacting on the community, including family conflict, increased gender-based violence (including sexual assault), social and cultural disruptions resulting in antisocial behaviour, and adverse trans-generational impacts on children and youth. A strategic framework was submitted to the Bougainville Government in 2014. Recommendations include: (1) undertaking research on MH&PSS needs and current services (formal and traditional); (2) establishing a comprehensive community-based model of mental healthcare and
treatment, piloting the model in one region, then rolling it out across Bougainville; (3) initiating steps to develop a comprehensive mental health policy and legislation; and (4) raising awareness and promoting advocacy aimed at highlighting MH&PSS issues. Although systematic data are limited, observations from Bougainville coincide with those derived from the post-conflict field internationally in identifying the need for core community mental health services, skills to address traumatic stress reactions, and community strategies to address family and broader psychosocial issues arising from the Crisis (Silove and Steel, 2006). Australia has a long history of providing expert support, training and resources to our island neighbours in developing mental health systems and capacity, for example, in TimorLeste. A program of support for Bougainville would be timely given the level of unmet needs in the territory and the strong commitment among indigenous leaders and stakeholders to address MH&PSS issues.
Declaration of interest
Building capacity in academic psychiatry: The Queensland Mental Health Research Alliance Shuichi Suetani1, Bjorn Burgher2, Duncan McLean1, Michael Breakspear2,3 and John McGrath1,4
We note with interest a recent cluster of articles in the Australia and New Zealand Journal of Psychiatry (Henderson et al., 2015; Lewis and Jorm, 2015) and Australasian Psychiatry (Kisely, 2015) on the topic of academic psychiatry. These articles highlight problems in recruitment and capacity building in academic psychiatry. Why aren’t more psychiatric registrars and junior psychiatrists engaged in research and attracted to research careers? The re-introduction of a Scholarly Project is a positive step by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to foster that crucial clinical curiosity in trainees. In this commentary, we would like to discuss new developments designed specifically to encourage capacity building in academic psychiatry in Queensland. In 2013, three leading academic centres in Brisbane formed the
Queensland Mental Health Research Alliance. The three founding partners in the Alliance are the Queensland Centre for Mental Health Research, the QIMR Berghofer Medical Research Institute and the Queensland Brain Institute (University of Queensland). In addition to consolidating and growing collaborative research between these three peak mental health research bodies, the Alliance aims to ‘synergize efforts to build capacity within mental health research – in particular to recruit and train clinicians in mental health research and to attract emerging mental research leaders to Queensland’. The Alliance quickly identified a need to invest in research training for psychiatric registrars. Research seminars have been held with a specific focus on opportunities for clinicians interested in commencing a PhD. Based on the goodwill generated
1Queensland
Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia 2Royal Brisbane and Women’s Hospital, Herston, QLD, Australia 3QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia 4The University of Queensland, Queensland Brain Institute, Brisbane, QLD, Australia Corresponding author: John McGrath, The University of Queensland, Brisbane, St Lucia, QLD 4072, Australia. Email: [email protected] DOI: 10.1177/0004867415577980
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding Funding for the 2014 Consultancy was provided by Counterpart International as part of a two-year Women Peace Building Initiatives project in Bougainville supported by USAID. The program aims to address the issues of gender empowerment, civil society capacity building, postconflict recovery, policy development and advocacy.
References Boege V (2009) Peacebuilding and state formation in post-conflict Bougainville. Peace Review: A Journal of Social Justice 21: 29–37. Braithwaite J, Charlesworth H, Reddy P, et al. (2010) Reconciliation and architectures of commitment: Sequencing of peace in Bougainville. Canberra: ANU E Press. Silove D and Steel Z (2006) Understanding community psychosocial needs after disasters: Implications for mental health services. Journal of Postgraduate Medicine 52: 121–125. Regan AJ (1998) Current developments in the Pacific: causes and course of the Bougainville conflict. Journal of Pacific History 33: 269–285. Tierney D (2013) Assessing the interest in building the mental health capacity in Bougainville. June.
Australian & New Zealand Journal of Psychiatry, 49(5) Downloaded from anp.sagepub.com at FUDAN UNIV LIB on May 10, 2015
