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By Ruwandi Gamage
Launched in 2006, two years after the tsunami hit Sri Lanka, Samutthana was one of the pioneers of setting up mental health support in the country. Samutthana Executive Director Dr. Isuri Roche Dharmaratne, together with Dr. Shamil Wanigarathne had geared the idea to launch Samutthana, mainly to help the victims of the tsunami. The focus had later shifted to other crises, such as war and other natural disasters.
“At that time, mental health was not even heard of in Sri Lanka, not even among the forces. They never understood the consequences of those circumstances,” Dr. Dharmaratne said.
Dr. Dharmaratne is proud to say that Samutthana helped build mental health awareness in Sri Lanka, in terms of training and capacity building, at a time when no one wanted to talk about mental health, and thought it didn’t exist. According to Dr. Dharmaratne, people are now more aware that there’s help and also there are more qualified people to work even in the mental health sector.
“In tsunami times, there were no qualified local people. People used to come from France and other countries to do therapy and counselling, which was not successful because they did not understand the culture,” she added.
Dr. Dharmaratne mentioned how Samutthana was a project initially and currently funded by King’s College, and that it is ending. She added that their organisation does receive funds for their projects, but anyone who is willing to donate is welcome.
Samutthana’s key objective is capacity building. They were also instrumental in initiating the master’s degree in the University of Colombo on capacity building. Dr. Dharmaratne says they are a proud organisation, having aided their services in building capacity with regards to mental health support in the country.
“When the Easter attack happened, everybody rushed in to give mental health support, but we backed off and took our time to understand the scope of support that is needed and required by the people affected,” Dr. Dharmaratne explained.
Dr. Dharmaratne claims that all of the people who rushed in to offer counselling and mental health support aren’t following up after two months have passed by, to evaluate if the people are coping, or if the people are given any assistance. She says that now is when psychological support is needed the most. It is her strong belief that organisations and companies should focus their CSR initiatives towards the support of building mental health. She says that way the impact will be much more.
Dr. Dharmaratne wanted to specially mention the invaluable support given by the churches in regard to mental health. She says that if it wasn’t for the churches, it would have been impossible to think anyone would have gotten together to offer mental health support.
“However, we felt that Batticaloa didn’t receive the same support as everywhere else. The support was concentrated in other areas that were affected and Batticaloa didn’t receive the same response of support,” she added.
Samutthana Resident Psychologist Sindujaa Nandhakumar Selliah explained further on their decision to wait, and explained that in such a crisis, there are needs that need to be addressed immediately. She says that if she was one of those who was affected, the first thing she would do, wouldn’t be to sit down and have a conversation about how she’s feeling, because at that moment there was a threat to people’s safety.
“If I was directly affected by the crisis, I would be looking for a lot of other things to be set in place before I can sit down and talk about what happened, because there’s a numbness that comes with it. There’s a shock and a dissociation from reality that comes with experiencing something like this. At that moment if we jump in and say we want to do therapy or counselling, it is firstly not ethical and secondly, it is not going to be effective,” Selliah added.
As an organisation, Samutthana’s mandate is not to work directly with clients, it is about capacity building. Therefore, as an organisation, they had decided that their part will come as time passes, when people are in a position to sit down and reflect and feel what they have gone through. Selliah says that it is only after a few months that reality will kick in and people will think that they need help because of all the feelings and emotions that are overwhelming them.
“In this instance, since the crisis occurred in churches, there was a lot of spiritual counselling and intervention done. That was another reason we wanted to step back and let that take place,” Samutthana Assistant Psychologist Anju Ambawatte added into the conversation.
Sri Lanka being a very spiritual population, regardless of which religion, Selliah says dominates who we are as a people. She says that should be given respect, because it is culturally appropriate. Not letting that religious/spiritual support take its course and jump in to put to use the Western concepts of counselling and therapy would be to not understand the context that people are in, and what really works for them, says Selliah.
“When the tsunami happened, there were no psychologists to support anybody. At that time, there was no psychological support available and it was a much larger crisis in scope. This is when Samutthana came into existence and we were one of the pioneering organisations that started uplifting the psychological and psychiatry knowledge in Sri Lanka. When the Easter bombings occurred, Sri Lanka already had an idea of what trauma was, and how to address it, and what sort of intervention was required,” said Samutthana Counsellor/Trainer Duminda Wanigasekera also sharing his thoughts.
Wanigasekera says that Samutthana was instrumental in building up the capacity from then to this day, and that they have demonstrated how to build up capacity in this country. Hence, this is why when bombs struck on Easter, there was no urgency for Samutthana to enter the scene as it happened.
The first project Samutthana had done was in Minuwangoda, after the communal violence that took place, post the Easter attacks, titled ‘Coping with crisis,’ for the Sinhala and Muslim communities, on how to live with reconciliation. It had been a one-day awareness workshop, for the workers at the factory and then for the management.
The staff had shown resistance even at that instance, in terms of understanding that everyone was scared. Samutthana had sat down with them and had come up with different safety policies that were general to that organisation.
“We went and spoke to them about understanding the crisis, because they haven’t had first-hand experience of what actually happened. They were dealing with the after-effects of what happened. They were living together in harmony, and all of a sudden there was a division.
The fear that the other party will attack them, and the built-up anger had led to them being suspicious of their new employee who happened to be a Muslim. The management had sensed the tension among the workers and requested Samutthana for a training or awareness session, to educate them about division, why it occurs, how crises happen and how they can better communicate and understand through non-violence.
"In tsunami times, there were no qualified local people. People used to come from France and other countries to do therapy and counselling, which was not successful because they did not understand the culture – Samutthana Executive Director Dr. Isuri Roche Dharmaratne
If I was directly affected by the crisis, I would be looking for a lot of other things to be set in place before I can sit down and talk about what happened, because there’s a numbness that comes with it. There’s a shock and a dissociation from reality that comes with experiencing something like this. At that moment if we jump in and say we want to do therapy or counselling, it is firstly not ethical and secondly, it is not going to be effective – Samutthana Resident Psychologist Sindujaa Nandhakumar Selliah
When tsunami happened, there were no psychologists to support anybody. At that time, there was no psychological support available and it was a much larger crisis in scope. This is when Samutthana came into existence and we were one of the pioneering organisations that started uplifting the psychological and psychiatry knowledge in Sri Lanka. When the Easter bombings occurred, Sri Lanka already had an idea of what trauma was, and how to address it, and what sort of intervention was required – Samutthana Counsellor/Trainer Duminda Wanigasekera"
“Though we went there to educate them, we also learnt something – that people were feeling very unsafe. That even though people accepted and understood how these incidents occur, there was always a question of how they could protect themselves,” Selliah explained.
Assistant Psychologist Ambawatte stated that the workers displayed trust issues. That they couldn’t come to terms with keeping trust with the people they knew so well, because of all that was taking place. Wanigasekera also added that they had difficulty approaching their neighbours and talking to them. “We helped them in building that dialogue. If they could’ve known how to have that conversation, the separation wouldn’t have occurred that fast.”
Selliah explained how people were developing their own set of coping mechanisms; that though we had experienced 30 years of war, this incident seemed and felt new. “This was not facing weapons, but facing an ideology, something that you couldn’t see, but you were scared of it.”
One focus of theirs was to make the workers understand that situations like the communal riots trigger negative coping mechanisms such as substance abuse, sexual violence, violence and aggression. That when something like that happens and we feel threatened and unsafe, that’s just how we know to respond.
“We wanted to explain to the factory workers that, negative coping mechanisms only lead to negative feelings and emotions, which again would add to the cycle of violence. We spoke with them on how to break that cycle and look more towards positive coping mechanisms that can lead to positive outcomes,” Selliah added.
The difficulty for people to take responsibility for what they feel, and the attempt of reflecting it onto somebody else, was what caused the outcome of riots, according to Wanigasekera. He said that, recognition of what you feel, leads to being able to talk about them, which in turn makes it easy to explain that they don’t have to feel that way.
Samutthana had offered their services and training to all three hotels that were affected, and only one of them had come forward seeking support. However, after one program, they hadn’t felt the need to continue, believing that they were okay, and they weren’t affected that much.
The program had been an awareness session with some of the staff at the hotel, about a month after the attacks. They had educated the employees about psycho-education, making them aware of what such an incident is, what could be the consequences, what could they be facing, what are the immediate reactions to an incident like this, and how it may develop into Post Traumatic Stress Disorder (PTSD).
“We have to understand as a community, whether the organisations want to provide that type of support to their employees. They approached us, but they weren’t sure whether it was support that was really needed. They weren’t even certain if the employees would respond to receive such support. Regardless of how much we are talking about mental health, when it comes to isolated cases there’s always resistance to accepting and acknowledging psychological help, the emotions and feelings you go through,” Selliah detailed.
Selliah says that their goal is to do sustainable work that is impactful and effective when they provide their expertise.
Samutthana is preparing to start on their next project to help the survivors of the Zion church bomb. This is the project they are looking forward to as they feel that Batticaloa had received less attention with regards to any help given when compared with Colombo and Negombo.
“There was a lot of prominence that was given to Colombo and Katuwapitiya, and there’s a lot of funding that was given, and Batticaloa was left out. We received a request to work with children and adults, but we sat back. We learnt from one of the pastors in Batticaloa that so many had come there to do counselling and also to do assessments and collect data, and all that the people have requested for was to have a good sleep. People didn’t necessarily want counsellors at their house all day, they just wanted to be left alone and to sleep,” Selliah detailed in.
According to Selliah, our natural response to want to help people is beautiful, but it shouldn’t be mechanical. We must remind ourselves that we’re dealing with humans.
The project runs close to Samutthana’s key objective of capacity building. They will be working with nursing officers, teachers and counsellors in Batticaloa who will provide direct support to the survivors of this particular incident. They believe that after the immense trauma that people have gone through, if the appropriate and relevant skills in primary healthcare officials aren’t built, their lack of capacity to support the survivors could be quite detrimental.
“As an organisation, one of the reasons why we focus on capacity building is mainly because for trauma or any type of mental illness, you have to provide the correct type of intervention and train people to provide the correct type of intervention or support. Otherwise that could be detrimental as well,” Selliah stated.
According to Ambawatte, some organisations that went out there had actually gone to promote their visibility, not mainly to support the survivors. She added that they wanted to do what was appropriate and required for the people, and not jump to capture the market of what’s going on. “We are already known for our work with trauma. And we do set the trend for others to build on their work.”
“There’s a component of people who are willing to go directly from home to home and work on it, but we believed that if we help to increase the capacity and the skills of people who are directly supporting the locals, that would be more sustainable,” Selliah added.
Pix by Chamila Karunarathne
