Perceptions of mental health and psychosocial problems among conflict-affected adults in North Bougainville: Results of a rapid qualitative assessment

The Bougainville Crisis (1988–1997) was characterized by widespread human rights violations, civilian deaths, and displacement. In March 2017, a rapid qualitative assessment was conducted to better understand the major mental health and psychosocial (MHPS) problems of conflict-affected adults living in North Bougainville in order to contribute to the design of feasible interventions to address these problems and inform the development of culturally appropriate assessment instruments. We conducted 54 free-list interviews to gather information on the problems of people in local communities, and further explored five priority MHPS problems through 38 key-informant interviews. The major MHPS problems that emerged and were subsequently explored included alcohol use, drug use, arguments and fights, physical violence against women, and rape. Frequently reported indicators of these problems included anger, aggression, sadness, shame, worry, trauma, neglect, and fear. Findings highlight the highly interconnected relationship between substance use and violence in North Bougainville, as well as the set of emotional and behavioral problems that both contribute to and result from this relationship. The primacy of both drug and alcohol use in this setting is particularly notable, as is the role of these substances as individual coping mechanisms and instigators of violence. Overall, findings suggest the need for integrated strategies toward addressing MHPS issues in North Bougainville, with violence and substance use incorporated as both causes and consequences of psychological distress.