Batticaloa Community Context

Born in the late 90s, early to mid 2000s youth in Batticaloa often faced the worst of the war and also intergenerational trauma. They sometimes don’t even know why they experience certain kinds of trauma responses. Their parents (35-40 years of age) are the war generation - they grew up entirely in the war. They are now living with the resultant poverty and myriad forms of social disruption caused due to loss of life, limb, property and due to enforced disappearance.

A combination of poverty and the flooding of the Sri Lankan market with processed foods since the 1970s has led to bad childhood nutrition and its resultant physio-psychological effects. The youth are worst affected by layers of lack of attention, acceptance and love. They have almost always suffered through sexual, physical, emotional and verbal abuse primarily within the family and beyond. Through their teenage years and early adulthood, they often enter into unsafe relationships. Pregnancy is often imminent and abortion is illegal in Sri Lanka. This forces the reality of young motherhood on many of the cis-women who then raise their children even as they try to rebuild their own lives.

Disruptions in education are common in spite of the existence of free public education. Schools are not spaces where the realities and background of their lives are addressed. In fact, there is a deafening silence within educational materials and from teachers in Sri Lanka with regards to the history of conflict on the island. The pressure to simply perform in exams is not one that all students can withstand and excel at given their difficult background.

The medical system, including psychological care, while available as part of the public health system is embroiled in the same silences about the past and the moral judgement and suppression rampant within patriarchal societal structures. This means that people, especially youth are not able to access the health system with honesty. The psychological care is inadequate and is embedded with the same kind of social moralities and norms as the rest of society. This often means that psychological care is, first off, stigmatised and when accessed, clients are often ridiculed and blamed for their psychological state. The only ray of hope is the world of psychosocial care that emerged in the context of human rights work in the context of war. But this has not created a system with adequate mental health practitioners and also practitioners who are adequately trained to think beyond the norms of the society that they hail from.

All of this context applies to the emerging community of queer folks especially trans women, trans men and lesbians. While hormones are available in the public health system in Sri Lanka, this exists in a vacuum vis-a-vis social and psychological support. It is still possible to find psychology practitioners - psychologists, psychiatrists and counsellors - who by virtue of international level changes, for instance in the DSM guides, understand that homosexuality and trans-ness is not a mental illness. But apart from this basic understanding, there is little awareness at all levels within family and society. There are no reliable queer groups in this area. There is strain even within the queer community and their own relationships, which are often unhealthy and violent.

The youth have very little overall support.

In cases of extreme disruption, like with most if not all the queer and trans folks and in cases of extreme violence, unaccepted heterosexual romantic relations and pregnancy before marriage, they are rejected by their families and find themselves without a place to stay or food to eat.

There are two among the few institutions assisting the youth in Batticaloa.

1. Suriya Women’s Development Centre (Suriya):

• A grassroots feminist NGO with over 40 years of history.

• Provides holistic support including emergency frontline aid, safe spaces, financial assistance, and therapeutic care.

• Offers a non-judgmental environment where youth can spend time, receive guidance, and access various resources. Assisting communicating with family members in cases of conflict with them.

• The only accepting and safe space in Batticaloa for queer and trans individuals, despite ongoing internal efforts to overcome misconceptions about homosexuality and trans identities.

2. Church of American Ceylon Mission (CACM):

• Primarily focuses on educational support but extends to providing food, lodging, mentorship, and guidance.

• Assists youth in creating conditions conducive to pursuing their education.

• Now includes therapeutic care as part of its holistic support approach.

Presenting Issues:

• Anxiety, stress, depression

• Self-harm, suicidal tendencies

• Panic attacks, PTSD

In Batticaloa, mental health support must integrate the reality of unmet basic needs. Practitioners should:

1. Check Basic Needs: Regularly ask about food, shelter, and safety. Example questions: "Have you eaten today?" or "Where are you staying nowadays?"
   

2. Integrate Coaching: Assist clients in navigating opportunities for education or employment while holding space for the challenges these may present.
   

3. Timing and Sensitivity: Ensure therapeutic processes do not interfere with clients' immediate responsibilities. Deep explorations should be timed appropriately.
   

4. Holistic Approach: Recognize that therapy and fundamental needs are intertwined. Empower clients to manage their responses to their circumstances while acknowledging the reality of their situations.
   

5. Boundary Blurring: Carefully assist clients in seeking help from institutions like CACM or Suriya when urgent needs arise, maintaining a mindful approach to therapeutic boundaries.
   

6. Background Knowledge: Equip yourself with the historical and contextual knowledge of Batticaloa to better understand and support clients.

Digital Access Context:

• Smartphone and Data Access: Most youth have access to smartphones and use WhatsApp, which requires minimal data. Ensure privacy is maintained, with institutions facilitating this when necessary.

• Session Boundaries: Establish clear boundaries for contact outside of sessions to prevent therapy from being perceived as informal support. Emphasize the importance of the structured weekly sessions.