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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Policy Implications

Many forms of violence and suffering arise from structural barriers and social entrapment. If young Afghans are to become more resilient to the challenges they face, we argue that a better understanding of resource provision and social aspirations is needed, both to alleviate suffering and to foster building hope. How young people in Afghanistan cultivate resilience could be greatly assisted by listening to their accounts of their experiences.

Afghans tell us of suffering engendered by ongoing political violence, frustration with the lack of economic momentum, a dearth of service infrastructure, poor governance, and fraught relationships played out at the family and community level. In the Afghan context, a culturally relevant mental health intervention would be a structural intervention to strengthen families and sever the insidious linkages between political insecurity, economic instability, domestic crowding, and domestic violence that threaten wellbeing. These efforts would provide structural, social, and economic resources to families who struggle with everyday stressors. To accomplish this requires efforts to revitalize the economy in order to give dignity to men, providing better housing and reducing overcrowding which would make families feel more secure and alleviate considerable stressors for women; in schools, increasing the quality of education would help children thrive in an environment they greatly value, and in particular, paying teachers a decent wage which would mean they would not be compelled to hold down two jobs.

Policies that address the ‘structural’ determinants of resilience would enhance a sense of safety, a sense of coherence, a sense of moral order, a sense of hope, and a sense of family connectedness—all of which are essential elements of intervention efforts and principles at the heart of mental health and psychosocial resilience. While specialized psychotherapy is needed for individuals with trauma-related problems such as post-traumatic stress disorder, resource provision is needed to strengthen and revitalize communities, providing psychosocial support to individuals and families whose major problems are not solely the consequence of trauma. What is important is concerted action to address the structural causes that debilitate wellbeing (Panter-Brick et al. 2014).

Finally, our work leads us to emphasize an important ethical issue inherent in intervention efforts to ‘build hope’ in humanitarian areas. In Afghanistan, a program of massive refugee repatriation promised hope to returnees but largely disappointed their expectations. A massive Back to School campaign was launched in 2001, after the fall of the Taliban regime, to provide hope for children and their families in the form of state-sponsored free education. But searching for hope brings disillusionment in societies where there is a shrinking configuration of social opportunities, widening inequalities, poor distribution of capital, and inequitable state policies. Our data show that hope for the future is central to resilience, but that access to school has raised aspirations to the point of certain disillusionment, as families anchor their children to school despite significant socioeconomic impediments, to achieve the promise of a school-leaving certificate, a good job, and socioeconomic advancement. Paying close attention to resource provision and social processes is important: social policies and intervention programs that build up hope and raise expectations must not promise more than they can deliver.

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