Contenido de Proteína y Lignina

Only one participant directly linked changing policy to a downgrading of the Centre’s mental health communication programmes. This highly experienced staff member preferred the second targeted group phase because “work focused on community”. In the third phase, these focussed mental health communication programmes were discontinued and new general ones were hard to evaluate:

I thought it [the general programme] was useless. This year we worked on this issue and then next year the policy was changed to the new issue, unless the local community thought it was useful and they have continued by themselves. For us as the staff, we had to work following the policy because we needed to report the output to the Department of Mental Health. (Staff no. 7)

She also insisted phase 2 for the Rehabilitation Sub-Committee was successful because it was on-going and she could see positive changes over this time:

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We worked on children’s programmes for 5 to 6 years. We could see the

changes from those children who have always cried or women who did not talk to became helpers and set up their self-help club. Those widows who had only ever stayed home and did nothing because their husbands looked after them could turn out to be the family leaders. (Staff no. 7)

Another participant did not criticise the policy but tried to explain why Centre 12 changed its focus:

Later, many organisations went in for home visiting, such as the Provincial Public Health Office, the Social Development and Human Security, NGOs. People became tired of answering the same questions so many times. So, the Department of Mental Health said we did not have to go anymore. (Staff no. 3)

4.6 Conclusion

The 12th Mental Health Centre was set up specifically as an academic support organisation. The Centre’s major role is using communication strategies and techniques to promote mental health and provide mental health knowledge through home visiting, group meetings, training the deliverers, and producing and disseminating mental health media and collateral. This case study of Centre 12’s mental health communication programmes in response to a decade of the mass violence situation in southern Thailand reveals government policy is a key factor in influencing practice. Interviews, participant observation, and document analysis illustrated four interrelated phases of programme development, reflecting policy shifts. They are a reactive programme (2004–2005); policy of targeted groups (2005–2010); policy of general age-group targets (2011– 2014); and the emerging phase of “severe and complicated cases” (2014 on).

In the first phase, one year after the violence broke out, the programme mainly responded to the urgent violence situation because the rehabilitation system was just being set up. In the second phase, during 6 years of on-going crisis, the Centre’s practices were judged by participants as effective in terms of setting up the delivery system by hiring and training 73 psychologists and merging them into the public health service system. Those psychologists had been sent to work in every hospital in the three southern border provinces. Furthermore, in this second phase, Centre 12 worked on

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behalf of the government-appointed Rehabilitation Sub-Committee, which focused on seven target groups. Mental health communication programmes were perceived as effective for several reasons. For instance, working with networks both inside and outside public health sectors, delivering programmes to people who were directed affected by the violence, focusing on mental health healing and rehabilitation rather than psychiatric treatment, a community-based focus (and bottom-up approach), and training mental health deliverers or intervening publics (psychologists, public health practitioners, mass media, teachers, religious leaders, and opinion leaders) to deliver mental health messages.

In the third phase, Centre 12’s practice was affected by the new Thai government’s policy, especially by the dissolution of the Rehabilitation Sub-Committee. The Centre’s communication programmes in general changed to focus on the four age groups (children, teenagers, adult, and the elderly) whom Centre 12 provided with mental health promotion and mental health education. Last, in the fourth phase, Centre 12’s activities, while continuing the four age group programmes, were supplemented by a specific focus on ‘severe and complicated cases’, which were explained as traumatised people in the dangerous area or people who were suspected of being terrorists.

The mass violence context impacted on Centre 12’s staff members’ work in various ways such as an increasing numbers of mental health communication programmes and workloads, programme contents that emphasised healing aspects and resilience (new knowledge in which they needed to be trained), and the expectations of roles and staff members’ courage. Additionally, while the staff mentioned mutual caring and support, it is worth noting here that there was no evidence in the interviews about systematic support for staff and mental health practitioners working in the crisis area who may themselves suffer secondary traumatic stress.

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CHAPTER FIVE: MENTAL HEALTH COMMUNICATION

PROGRAMME DELIVERY, AND THE SUCCESSES AND

CHALLENGES OF CENTRE 12’S PROGRAMME

DELIVERY

5.1 Introduction

Chapter Four identified the impact of policies on the establishment, funding, and delivery of Centre 12’s mental health communication programme, and reported in detail on the four overlapping phases of programme delivery across the decade. This chapter is related with programme delivery, answering research questions two to five that is, how Centre 12’s mental health communication programmes were planned, implemented, evaluated, and relating successes and challenges of Centre 12’s programme delivery in the mass violence area.

This chapter draws on interviews with the Director of the 12th Mental Health Centre, eleven of the Centre’s staff, and five participant representatives of partner groups. Additional material comes from field notes made by the researcher during participant observation in 2014, seven annual reports from the Mental Health Centre (2005–2006, 2008, 2009, 2012, 2013, 2014, and 2015), and a journal article by Centre 12’s Director on mental health therapy for people affected by the unrest in the study area (Tohmeena, 2013).

The chapter begins by identifying the participants’ perceptions of the overall communication programme framework, then provides details about programme planning, media/message development, implementation, and evaluation. Next, the major roles and relationships of partner groups involved in communication programme delivery are identified. Last, the chapter illustrates the perceptions of successes and challenges of staff members and the Director in delivering mental health communication programmes, particularly in a context of mass violence.

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