The aftermath of the Bougainville Crisis: Mental health and psychosocial impacts and the need for services

Although the armed conflict in Bougainville (1988–1997) (referred to locally as ‘the Crisis’) was the most extensive in the Pacific since World War II, there is little awareness of its mental health and psychosocial (MH&PSS) impacts. We provide a brief overview of the history of the conflict and consider the long-term effects on MH&PSS needs of the indigenous population.

The Bougainville archipelago of islands was incorporated into Papua New Guinea (PNG) during the colonisation period. In December 1988, PNG Police came into conflict with landowners mounting protests concerning a range of grievances related to the Panguna mine. Rebels formed the Bougainville Revolutionary Army (BRA) whose support widened in response to harsh tactics by police to quell the protests. The PNG Defence Force was then deployed to Bougainville and conflict with the BRA continued until a ceasefire in March 1990, resulting in the withdrawal of the PNG military and services. Subsequently, a blockade was imposed by the PNG government which prevented all goods, including medical supplies, entering Bougainville, resulting in severe hardship and adverse health consequences.

During the ceasefire, undisciplined actions of the BRA led to the formation of the Bougainville Resistance Forces (BRF) and conflict between the two factions ensued. The PNG Defence Force returned to Bougainville and joined the BRF in conflict with the BRA. In 1997, the peace process commenced resulting in the Bougainville Peace Agreement (2001) which established the Autonomous Region of Bougainville and a commitment to a future referendum on independence (Braithwaite et al., 2010).

During the war, approximately 20,000 indigenous persons died (Boege, 2009) and 80,000 were displaced from a total population of 160,000 (Braithwaite et al, 2010). Widespread human rights abuses occurred, including extra-judicial killings, murders, arbitrary arrests, assaults, sexual assaults, harassment, torture, and property theft and damage (Boege, 2009, Regan, 1988). The war had profound social, educational and economic impacts (Braithwaite et al, 2010, Regan, 1988).

Following requests from local agencies and government, the first author (DT) undertook field visits to Bougainville in 2009, 2011 and 2013, where he met politicians, senior public servants, service providers, women’s groups, church groups and villagers (Tierney, 2013). A consensus emerged concerning key MH&PSS issues: (1) a substantial number of persons continued to manifest various mental health and behavioural problems arising from the Crisis; (2) high-risk groups included ex-combatants and a generation of young persons denied education during the Crisis; (3) there appear to be high rates of substance abuse and gender based violence, including sexual assault; (4) traumatic stress reactions in adults affected their parenting capacity, resulting in adverse trans-generational effects, including behavioural disturbances in children and adolescents; and (5) ongoing social, educational and economic problems arising from the Crisis were adding to MH&PSS problems.

It was evident that MH&PSS skills and human resources were severely limited. Bougainville has one dedicated mental health nurse for 254,000 persons, making it difficult to address all core mental health problems such as psychosis, mood disorders, and drug and alcohol abuse. In addition, there is a small number of faith-based, voluntary and non-government agencies operating with fragile and inconsistent funding in attempting to provide psychosocial support and counselling.

In 2013, the Bougainville Mental Health Steering Group (BMHSG) was established. An expatriate team (DT, DS and PB) was invited to undertake a consultancy to Bougainville in 2014. Meetings of the team with the BMHSG (including BM, LG and EB) and other stakeholders confirmed many of the previous observations (Tierney, 2013), including the paucity of resources to meet core mental health needs, widespread, untreated traumatic stress reactions, and broader psychosocial issues impacting on the community, including family conflict, increased gender-based violence (including sexual assault), social and cultural disruptions resulting in antisocial behaviour, and adverse trans-generational impacts on children and youth.

A strategic framework was submitted to the Bougainville Government in 2014. Recommendations include: (1) undertaking research on MH&PSS needs and current services (formal and traditional); (2) establishing a comprehensive community-based model of mental healthcare and treatment, piloting the model in one region, then rolling it out across Bougainville; (3) initiating steps to develop a comprehensive mental health policy and legislation; and (4) raising awareness and promoting advocacy aimed at highlighting MH&PSS issues.

Although systematic data are limited, observations from Bougainville coincide with those derived from the post-conflict field internationally in identifying the need for core community mental health services, skills to address traumatic stress reactions, and community strategies to address family and broader psychosocial issues arising from the Crisis (Silove and Steel, 2006). Australia has a long history of providing expert support, training and resources to our island neighbours in developing mental health systems and capacity, for example, in Timor-Leste. A program of support for Bougainville would be timely given the level of unmet needs in the territory and the strong commitment among indigenous leaders and stakeholders to address MH&PSS issues.