Helplines in Sri Lanka

posted in Note by Producer

Helplines in Sri Lanka

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Equal Ground, Colombo, July 2013. Photograph by Aamina Nizar

Decades of war, natural disasters, poverty, unemployment, inequality, changes in values and lifestyles, combined with misinterpretations of mental health and its causes and effects have left large segments of society stigmatised and isolated. It is a fact that a strong support system, including emotional support, is intrinsic to the recovery or rehabilitation of an individual suffering from any form of mental disease – temporary or permanent. Mental diseases are treatable and life goes on in spite of it. Identities are often mistaken as mental diseases. Sri Lanka’s helplines are providing a silent service in addressing these challenges. This feature explores 5 Sri Lankan helplines from the perspective of the counsellors and highlights their outstanding service. Insights into the kind of issues they deal with, the change they have seen over the last few decades, and their views on whether with the advent of affordable mobile telephony has allowed marginalised communities the access to their services all form this unprecedented visial presentation of the silent service Sri Lanka’s helplines are offering. What is significant about the featured helplines is that none of them function out of sophisticated call centre setups – the rooms these helplines are based during office hours are sparsely furnished. The helplines mainly use basic mobile phones, CDMA phones and landlines and even answer calls that come through after working hours from their homes, in buses, in public if very urgent, and ensure a calm and private environment to speak in no matter where the caller is.

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Women In Need, Colombo, June 2013. Photograph by Tara O’Hehir

23 years ago a group of 10 women formed Women In Need (WIN) in response to the anguish that they knew their sisters across the island were suffering. Their first steps were humble, but passionate. Without much more than support from each other they provided a female presence at police stations around Colombo, which are usually predominantly staffed by males. They wanted to ensure that women who experience trauma at the hands of their abusers had an empathetic shoulder in law enforcement to help them through. Today, WIN has operations in all 9 provinces of Sri Lanka from Jaffna to Matara, which provide far reaching support services to local communities through their crisis centres, safe houses, and counselling and resource centres. One of the key services introduced by WIN has been their flagship hotline service that allows women to call at any time of the day. WIN is now able to be on hand during their clients’ hour of need and have often been able to intervene at critical times. Their clients now know that an empathetic voice on the other end of the hotline can offer them support, and potentially save their lives, by engaging law enforcement in particularly dire situations.

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Women In Need, Colombo, June 2013. Photograph by Tara O’Hehir

Due to budgetary constraints there is no sophisticated technical set-up in place. One of the counsellors takes home a mobile phone on a roster basis. The hotline number is diverted to this mobile every evening after the close of office. The counsellor in possession of the mobile phone is then on duty until she returns to work in the morning and hands over to the next rostered counsellor. If an emergency call comes through during the night, the counsellor will offer crucial counselling on the spot, and in the worst-case scenario alert the authorities to an incident. Mobile phones have enabled counsellors to intervene within a much shorter timeframe than before. These services have become more accessible in recent times with the expansion of telecom connectivity. Clients feel more safe and independent in their ability to call WIN through their mobile phones. Phone counselling is conducted by counsellors in each province, allowing clients access to location-specific guidance.

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Women In Need, Colombo, June 2013. Photograph by Tara O’Hehir

WIN records show that calls have increased in recent years. When asked whether they believe this was because of easier access to make a call, counsellors said that they fear it was not because of this, but rather because of higher incidences of domestic violence. However, the WIN counsellors are confident that their efforts in building awareness around the issue and de-stigmatising the act of seeking help over a hotline is becoming incrementally more successful. Counselors and staff at WIN all look at their work as a ‘calling’ rather than a job. They are less concerned with their modest wages and more concerned with the welfare of their clients. Many clients are looked after by the same counselor at every point of contact and develop a very personal bond with WIN’s staff. Adopting more communication technologies is hampered by both a lack of funding and the result of the organisation historically working in a more traditional, face-to-face manner and therefore a lack of knowledge around what is possible using the internet and social media. As they have always been first and foremost dedicated to the service they provide they simply use the most direct methods of delivery available.

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Professional Psychological Counselling Centre, Batticaloa, June 2013. Photograph by Seshanka Samarajiwa

The people of the Batticaloa district have undergone immense suffering over the last few decades. Currently, the district records the highest poverty rate – unsurprising given that it is one of the few districts in Sri Lanka that is both war- and tsunami-affected. While there is visible change taking place since the end of the war, especially with regard to infrastructure, the healing of its people continues at a slower pace. The area is rife with people suffering from various mental health issues and substance abuse. As a result there many have taken their lives and in other instances homes have been torn apart by domestic violence. Moreover, in post war Sri Lanka we have seen an increase in inter- and intra-religious tension between communities. So the fear of violence and all its by-products are ever present in the psyche of Batticaloa’s people. The Professional Psychological Counselling Centre (PPCC), started in 1978 by Father Paul Satkunanayagam, is playing its part in addressing these challenges. With its long-standing history in the region, it is well respected and loved by the communities in Batticaloa.

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Professional Psychological Counselling Centre, Batticaloa, June 2013. Photograph by Seshanka Samarajiwa

The counsellors that work for PPCC have all experienced horror and hardship in their lives first-hand and have, through the power of their spirit, overcome them and become the valued counsellors that they are today. The counsellors talk of the gamut of issues that their clients are dealing with, from violence to poverty, oppression to broken families. Among the services offered at PPCC, people have the choice to drop into the centre in times of need or receive counselling over the phone. Much of the time the conversation over the phone is simply a precursor to a counsellor actually going out to the person in need and helping them deal with their problems first-hand.

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Professional Psychological Counselling Centre, Batticaloa, June 2013. Photograph by Seshanka Samarajiwa

PPCC now has a toll free hotline, which allows people to ring up a counsellor at any time of day in emergency situations. This service has only been running for two years, and in that time PPCC counsellors say that they have prevented almost 50 suicides. The PPCC process is heavily reliant on interpersonal interaction between counsellors and the people they serve. To fully serve the area, the counsellors travel long distances into remote communities and meet with residents of Batticaloa in their own homes. The ‘Barefoot Counsellors’, as they are affectionately called, arrive in these areas everyday at mid morning in pairs and systematically check on the mental health of the residents. The residents that they identify as needing counselling have a minimum of 5 sessions with the one counsellor who takes them on board. The pair does not leave a locality until they are sure that the residents are of a sound and productive mind. This can sometimes take years.

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Professional Psychological Counselling Centre, Batticaloa, June 2013. Photograph by Seshanka Samarajiwa

The counsellors at PPCC target high-risk areas where statistics show have increased social unrest such as domestic abuse, alcoholism, or high suicide rates. They also target areas that have been affected by conflict and/or natural disasters. It is here that these counsellors engage the use of communication technologies to gather and collate this data. Their communication needs extend to emails and web access to government records collated by each village’s government representative. The counsellors observed that this information gathering stage of their activities has become much faster and easier in recent times, with the use of ICTs. For a country in a post-war context, mental health issues do not seem to be high on the priority list of challenges to be tackled. PPCC, with their hotlines and home visits, are playing an important role in helping address this societal need.

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Courage, Compassion, Commitment, Colombo, June 2013. Photograph by Tara O’Hehir

Sri Lanka’s suicide rate is one of the highest in the world – statistics from 2012 indicate that approximately 11 people take their lives every day in Sri Lanka. Suicide is an extreme measure that those with suicidal thoughts and often additional mental health issues suffer deeply from. The stigma that envelopes suicide results in families and loved ones of victims of suicide suffering further. Archaic cultural ideologies and misinterpretations of predominant religions practiced in Sri Lanka aggravate the situation. It is not surprising that suicide prevention is the main priority of the Courage Compassion Commitment (CCC) Foundation. The brainchild of Jetha Devapura, the CCC Foundation was founded in 2003 and it main focus was to help cancer patients gets the best treatment at the National Cancer Institute in Maharagama. In 2009, the CCC Foundation decided that there was a burgeoning need for support and guidance to people struggling with mental health issues and, the CCCline was born.

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Courage, Compassion, Commitment, Colombo, June 2013. Photograph by Tara O’Hehir

From the very beginning the CCCline has been completely toll-free. The importance of a toll-free number is to ensure that anybody can contact them and that there is no worry that the call – often a long one – will be a high cost to the user. The CCCline averages 70 calls a day, which is operated between 3 phones and counsellors during the day, and 2 at night. The lines are operated by Sinhala and English speaking counsellors. While CCC recognises there is a need to extend their services to the Tamil population they, are yet to find Tamil-speaking counsellors. Through the hotline, people can ring and speak to a counsellor about any problems or mental health issues. The calls can range from a small issue that may have upset them to suicidal thoughts. Counselling can become a very ‘dependent’ exercise and counsellors are acutely aware of this. They don’t want to see the problem ‘shifted’ but rather help callers overcome them. Most people who call just want someone to listen to them with an open and non-judgmental ear. The average ages of callers are between the ages of 20-35 years and 35-50 years. According to the counsellors, majority of callers are those who are employed. The counsellors use questions to direct them into thinking about how they can move forward from the issue and resolve it.

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Courage, Compassion, Commitment, Colombo, June 2013. Photograph by Tara O’Hehir

The CCC line is a purely phone-based system to ensure access to as many people as possible given that most people now have a mobile or at least access to a landline. In a situation where the caller’s issues are more intense, there is a referral to organisations or services that deal specifically with certain issues and conditions. This can range from drug and alcohol rehabilitation to counselling clinics. From its inception, the CCC line has worked closely with one of Australia’s main helplines – Lifeline. Trainers from Lifeline come to Colombo on a yearly basis to train and review the process and services at CCC line. The helpline is operated by volunteers who are contractually bound to work 8 hours a day, but most times the number of hours spent at the CCC line goes well beyond these hours. Currently, there is a desperate need to expand the helpline by recruiting and training more counsellors and installing more telephone lines. The foundation seeks funding to do this, and in their experience have discovered that raising funds for cancer patients and the CCC house are a lot easier than raising funds for mental health issues and the CCC line.

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EQUAL GROUND, Colombo, June 2013. Photograph by Tara O’Hehir

An archaic, colonial law, which refers to same sex acts as “acts against the order of nature”, effectively criminalises homosexuality in Sri Lanka. This has left the Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning (LGBTIQ) community vulnerable to be stigma and discrimination based on the basis of sexual orientation and gender identity. It is a fact that this community is often subjected to different forms of violence that begins in their own homes. Rosanna Flamer-Caldera founded EQUAL GROUND in 2004 with a vision to protect the human rights of all sexual orientations and gender identities in Sri Lanka. Their counselling line was pioneered by the late Nigel De Silva a prominent LGBT and HIV/AIDS rights activist and is the first of its kind in Sri Lanka. Volunteers and staff operate the trilingual helpline dedicated to LGBTIQ persons grappling with issues in the home or workplace stemming from stigma and discrimination. Today, the organisation hosts a dedicated helpline for lesbian and bisexual women and a dedicated line for transgender people. It serves as their first ‘touch point’ with often scared and traumatised young men and women who protect their identities by using mobile phones or landlines to contact EQUAL GROUND. The helpline also serves as a referral service to long standing clients who call to access information about health service and legal aid.

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EQUAL GROUND, Colombo, June 2013. Photograph by Tara O’Hehir

Trained volunteer counsellors answer calls on a daily basis. Their mandate is to listen to everything the caller has to say and ask open ended questions allowing the caller to resolve their issues. Counsellors maintain a soft tone and at no time react adversely to what the caller talks of. They also continuously assure scared and traumatised callers of their anonymity. Upon receiving a call, counsellors immediately begin to establish a relationship of trust with callers, assess immediate needs and plan next steps to assist the caller. If counsellors feel that the caller could be a danger to themselves or others they transfer the call to senior counsellors that supervise each counselling shift. These counsellors are experienced to offer face to face counselling or any immediate intervention. The counselling line has also opened up EQUAL GROUND to hateful and abusive calls. In other instances callers have attempted to solicit sex from counsellors. Meanwhile, due to prevailing laws, namely Section 365A of the Penal Code which criminalises homosexuality, EG is prevented from acquiring a toll-free line, which would ensure that their callers would not be charged when contacting them.

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