The qualitative assessment of trauma-affected populations in Cap Haitian, Haiti, was conducted by Boston University’s Applied Mental Health Research Group in March 2006 for USAID/Haiti. The study aimed to identify the needs of victims of torture and other forms of violence and recommend possible interventions. The assessment focused on understanding how local people affected by violence perceive the problems resulting from these experiences, including the variety of problems, their perceived importance and severity, their nature, local terminology used to describe these problems, the cause of these problems, and what people do when they have them.
The assessment used qualitative methods, including free listing, key informant interviewing, and focus groups, to collect data from victims of violence, their families, and other community members knowledgeable about the effects of violence. The results showed that the problems resulting from violence can be divided into four related themes: severe psychosocial distress, ongoing fear and lack of security, economic losses, and continuing inability to function.
Nine major psychosocial problems were identified as the result of violence, including fear, startle/loss of self-control, sadness/grief, continuing to suffer from reliving/re-experiencing past events, loss of dignity, helplessness/discouragement, problems in the head, deep suffering in the heart, and thinking too much. These problems tend to result in reduced function, both as a result of direct effects on the brain and other parts of the body, such as producing hypertension, diabetes, and heart problems.
Common ways of dealing with mental problems mentioned by respondents include seeking medical help and medicines, using traditional medicines, consulting with friends, prayer and church, and distraction with other activities. The data suggest that local people recognize the need for psychological and clinical services but that many people cannot afford them.
The study recommends designing and implementing a program of interventions to address the six psychosocial issues identified in the study. The program should include interventions that directly address the psychosocial effects of violence, such as trauma-based counseling, and should be implemented through existing local organizations and NGOs. Interventions should also address issues exacerbating the psychosocial effects of violence, such as ongoing insecurity and mistrust, stigmatization of victims of violence, medical problems, economic deprivation, and lack of distractions.
The study suggests that combining psychosocial interventions with measures to address these other issues is likely to have a much greater impact on psychosocial problems. Delivering many of the counseling interventions requires trained mental health workers, and Haiti has a small number of well-trained medical, auxiliary, and lay professionals who can competently deal with these issues.
The assessment also identified the normal tasks and activities that constitute the roles of men and women in the Cap Haitian area. This information can be used to design measures to assess functioning, as part of future efforts to assess the impact of interventions. The study’s findings highlight the need for community-based interventions that address the psychosocial effects of violence and other issues exacerbating these effects.