Sustainable peace is unlikely to be achieved in African countries until mental health and psychosocial support (MHPSS) is mainstreamed in peacebuilding and transitional justice processes, writes Celeste Matross.
In Africa, colonialism, genocide, conflict, unrest and natural disasters have disrupted the status quo of societies for centuries, with lasting effects on individuals, families and communities across generations. Despite ongoing efforts and large amounts of material investment, violence and human rights abuses continue throughout the continent. This situation will not change until mental health and psychosocial support (MHPSS) is mainstreamed in peacebuilding and transitional justice processes.
The drivers of cycles of violence are many, with poverty, unemployment, struggles over power and material resources, and corruption being a few examples. But one of the main causes of continued violence in Africa is lack of attention to the unresolved psychic wounds and trauma – both collective and individual – experienced by its people and communities. Even the leaders we rely on to help the continent were themselves often at the coalface of the violence and are thus highly traumatised.
The focus of peacebuilding and transitional justice processes is largely political in nature. If decision makers and authorities leading these processes even think of including MHPSS, they stop at ensuring that mental health professionals are at hand to offer services to affected people.
I have heard legal and other professionals refer to MHPSS as a ‘soft’ issue, which gives the idea that it is a ‘nice to have’ rather than a key element of ensuring a successful transition. In many country contexts, MHPSS is considered a ‘heart’ issue and thus less important than ‘head/mind’ and ‘body’ issues. In fact, in many cultures in Africa, most people still describe mental health symptoms as physical symptoms, saying “I have a sore head” instead of “I keep having repetitive thoughts” (rumination).
Mental health still carries stigma in Africa. Given that the number of mental health professionals is too few compared to the number of people needing assistance, it is often not possible to leave MHPSS solely in the responsibility of these professionals. In addition, on a continent characterised by collectivist cultures, where trauma is experienced at a collective as well as an individual level, approaches that focus on the individual – as many psychological and psychiatric treatments do – are insufficient to deal with the complexities that result from human rights violations enacted on people and communities.
This is especially true when dealing with the impact of violations on vulnerable groups such as women, children, refugees, particular ethic groups and others, who experience a myriad negative experiences, including re-traumatisation, because of the many intersecting vulnerabilities they have, which put them at higher risk of harm.
Unaddressed mental health challenges and trauma exhibited by individuals as well as collectives like families, communities, institutions and societies as a result of violence and human rights abuses are critical factors hindering the success of transitional justice and peacebuilding processes in many countries across Africa and the world.
After conflict, the root causes of the conflict are likely to still be present and unresolved. Often the divisions between individuals and groups have widened as a result of the violence and resulting trauma, which causes fragmentation of social bonds and heightened levels of mistrust. These act as barriers to sustainable peace and often result in recurring outbreaks of violence. Recurring violence then pushes the cycle of trauma and unhealed societies, as people become re-traumatised and the gaps between them widen further, making healing and thus peace even more difficult to achieve.
Mainstreaming MPHSS
Mainstreaming MHPSS within peacebuilding and transitional justice efforts ensures that social bonds are healed and strengthened in order for sustainable peace to be achieved. Assisting affected people and communities to enjoy robust mental health and wellbeing in all its forms is itself a form of justice and thus key to achieving peace.
Mainstreaming entails including MHPSS across all aspects and mechanisms. Instead, it is often treated as an add-on, for example as an element of reparations or as something that can only be provided by mental health professionals. The stream of MHPSS needs to flow strongly and continuously around every affected person and community. This includes key actors, including government officials, truth commissioners, civil society leaders, traditional authorities and community leaders, among others.
Mainstreaming involves incorporating MHPSS into policies and procedures, plans and budgets, programme design and activities, and capacity building and human resource development. It entails self-care and mitigation of vicarious trauma, and measures to address compassion fatigue and burnout of those involved in transitional justice and peacebuilding processes, especially those directly engaging with affected and traumatised people and communities.
Interventions and initiatives that promote mental wellbeing should be carefully identified, taking into consideration the contextual, cultural and gender realities of those affected. They also need to be holistic in nature, providing for the biological, social and psychological needs of those affected. If these three elements are not addressed together, the cycle of violence is less likely to be broken, resulting in continued outbreaks of various forms of violence and unrest.
A holistic approach requires linkages across multiple sectors, in order to ensure all the needs of those affected are met. Examples include healthcare for dealing with the physiological needs of survivors of torture and sexual violence; legal support for restitution and protection of rights; and engagement with community development for livelihoods and socioeconomic recovery.
Other examples include providing trauma debriefing to truth commissioners and staff as part of a truth-seeking process; training community members to conduct social cohesion dialogues between community members and former child soldiers as part of reintegration processes to promote rehabilitation; and taking government, traditional and community leaders through a dedicated healing process to address their woundedness as a form of institutional reform.
Interventions conducted at the community level by trained community members may include support groups for survivors of sexual violence, body map exhibitions curated by survivors affected by conflict, and radio programmes that advocate for justice for survivors. They also include various memorialisation activities, such as community members recording the stories of loved ones who are victims of enforced disappearance and displaying them in a museum, with the aim of educating people on who their loved ones are and what it is like living without them.
Efforts to recognise the importance of MHPSS in transitional justice, as seen in the African Union Transitional Justice Policy and the Gambian transitional justice process, are encouraging. These are the exceptions rather than the norm, however. Mainstreaming MHPSS in transitional justice and peacebuilding processes may seem complicated, time-intensive and expensive, but as seen countless times in countless countries, cycles of violence continue when we do not utilise this approach. In terms of achieving sustainable peace, MHPSS is truly the ‘stitch in time which saves nine.’
Celeste Matross
Celeste Matross is the Country Director for South Africa at the Regional Psychosocial Support Initiative (REPSSI).