1. Key Issues in Conducting Mental Health Research in Traditional Communities: Examples from Sri Lanka Gaithri A. Fernando, Ph.D. California State University, Los Angeles

2. Objectives Identify some issues relevant to conducting socially responsible mental health research with traditional communities Provide some recommendations for conducting long term programs of research that is sustaining for both researcher and communities where research is conducted

3. Global Mental Health: What is it? Definition Overall mental health of an individual Sum of all knowledge about mental health in all countries and cultures Conversations and discourses around mental health issues Typically by people in countries with resources About people in countries without resources [Measureable?]

4. Key Issue 1: Etic-Emic Tension Etic – culture-general Emic – culture-specific Pseudo-etic – assuming an etic position that is actually emic E.g. PTSD

5. Key Issue 1: Etic-Emic Tension Training Training is often conducted in developed countries, using etic or pseudoetic perspective Training often changes or solidifies the perspective of trainee

6. Examples Clinical work with bomb blast survivors “PTSD” work ended after 3 weeks Rest of the time – women supporting each other “Renuka” and her husband Clinical work with torture survivor How reincarnation impacted coping

7. Examples PTSD Intrapsychic vs. external and psychosocial SLIPSS-A

8. Predictors of Life Satisfaction SLIPSS-A Scores Life Concerns ( Finances, Education )    p =.000)  (p =.000) R 2 =.41, p <.000 Life Rating

9. Key Issue 1: Etic-Emic Tension Data gathering What data are gathered are now colored by trainee’s training Value of qualitative vs. quantitative data If data remains emic, researchers and editors of journals consider that ‘regional’ and reject papers If data become pseudoetic they are of no value to the local communities (can be harmful) Researcher has to navigate between two sometimes competing agendas

10. Example: Trauma and PTSD PTSD is the model that was being used by many researchers after tsunami Emic understanding: psychosocial vs. PTSD Emic understanding: daily stressors vs. trauma exposure

11. Traumatic Event Negative Outcomes ‘Black Box’ Model c Example: Trauma and PTSD

12. Traumatic Event Negative Outcomes Daily Stressors Mediation Model a c′c′ b c

13. Example: Resilience Research Resilience in Sri Lanka: “Aathmashakthiya” – strength of will; “hitha hadaagaththa” – mending one’s heart Psychosocial gratitude an important component of resilience

14. Key Issue 2: Classification “Western”/“Non-Western” Looking for a new language HIC-LIC – doesn’t capture cultural aspects “EA-17”, E. European, Asian, Hispanic, African (where does Russia fall)? “Euro-American/Developed” vs. “Asian/ Developed” vs.“Non-EA-Asian/Developing? Resistance to changing classification Why is it an issue? Precision of scientific language Identification of players/agendas

15. Key Issue 3: Identifying Stakeholders Funder Researcher’s institution Researcher Funder’s stakeholders – research organizations, national institutions, individual donors

16. Key Issue 3: Identifying Stakeholders Local organizations/liaisons Local community Gatekeepers and community leaders Members of community Research community The “premier” or pioneering researchers Editors of journals Peer reviewers Readers Researchers’ co-workers/students

17. Key Issue 4: Tying Goals and Outcomes of Research to Stakeholder Expectations Educating others (including other researchers) to the complexities of the lived experience of communities “What is needed, even in the poorest countries, are robust evaluations of innovative programs” – Kleinman, 2003

18. Key Issue 4: Tying Goals of Research to Stakeholder Expectations Educate the funder/funder’s stakeholders about the community being studied Policy implications of the research (e.g. daily stressor project) Establishing funding priorities Ensuring that the resources sent match the reality of the receiving community Persuade funders to invest in communities and facilitate that process Introduce local organizations to funders and making local communities ‘visible’ Persuade funders to include outcomes they may not have considered (those that communities consider important)

19. Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations Standing with local organizations to empower and educate communities Use the findings of the research to enhance quality of life of communities Encourage community members to step up as community leaders Build capacity for both research and intervention

20. Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations Educate the researcher Reflecting on whether/how the research changed the researcher in some way Inform future research of the researcher Reflect on context – historical, psychological, current realities Increase the credibility of the researcher Increase the fundability of the researcher

21. Key Issue 4: Tying Goals & Outcomes of Research to Stakeholder Expectations Enhance the profile of the researcher’s institution Provide data for the funder to keep funding mandate alive; generate reports that justify keeping funder in business

22. Key Issue 5: Evaluating the Effort Who benefits? Researcher – publications, presentations, credibility Institution – prestige, attracting important faculty Funder – further funding, credibility Community – greater understanding from others? Resources from researchers and funders?

23. Recommendations Be aware of your prejudices Ask others to hold up the mirror! Watch out for the power differential Be open to feedback (be humble) Learn from the communities in which you work Be creative in how you can bring resources to the communities you study