VANUATU

YOUTH AT RISK

BASELINE STUDY

2001
Completed by:
Patrick Little
Penumbra

on behalf of InterMinds
 VANUATU YOUTH AT RISK
BASELINE STUDY
Contents
1. Project Summary and Background Page 2-3

2. Baseline Study Page 3

2.1 The Key Task
2.2 The Key Outcomes
2.3 The Project Objectives Page 3-4
2.4 Methodology Page 4
2.5 Definitions Page 4-5

3. Summary of the main findings and recommendations Page 5-7

4. Report on the Baseline Visit Page 8

4.1 Introduction
4.2 The Visit Team
4.3 Agency Responses
4.4 Early Difficulty Page 8-9

5. Key Issues Arising from the Baseline Visit Page 9

5.1 Young People’s Experiences Page 9-10
5.2 Lack of Education- “A Lack Of Hope” Page 10-11
5.3 Schools and Colleges Experiences Page 11-12

6. Vanuatu- “A Changing Society” Page 12

6.1 Urbanisation
6.2 Support Systems Page 12-13
6.3 New Western Influences Page 13

7. Gender Issues Page 14

8. The Criminal Justice System Page 15

9. Mental Health Services Page 16-17

10. Data Collection and Measurements Page 18

10.1 Introduction
10.2 Objective 1-8 Page 18-24

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11. Finally Page 24

12. Appendix 1-Baseline Visit Schedule Page 25-26

13. References Page 27

VANUATU YOUTH AT RISK

BASELINE STUDY

1. PROJECT SUMMARY AND BACKGROUND:

The UNICEF State of Pacific Youth 1998 Report1 indicates that the Pacific Islands Countries
(PICs) have the highest suicide rates in the world for both males and females between the ages
of 15-24. The report also found increasingly high rates of other mental health related problems
among youth in this region, primarily depression, which was a principal causal factor to the
suicides.

Having very young populations - 40% under the age of 15 and 18% between the ages of 15-24,
Pacific Island Countries are severely at riski. This situation is particularly true for Vanuatu,
which had an estimated youth population of 20% in 1998. Contributing to this Pacific dilemma,
is that there are minimal and, in some cases (such as in Vanuatu), no existing or appropriate
mental health systems and/or service provision available principally for youth.

Recognising this, the Vanuatu Government Ministries of Health and Education with six key
developmental agencies (Just World Partners, InterMinds, Foundation for the Peoples of the
South Pacific (FSP) Vanuatu and International, Secretariat of the Pacific Community (SPC),
Vanuatu Council of Churches and UNICEF) have partnered to propose the development, and
subsequent implementation and evaluation of a model, community based and supported, mental
health system.

Proposed activities include:

• Partnership Building and Collaboration
• Youth and Community Mobilisation and Empowerment
• Baseline Data Acquisition
• Infrastructure and Capacity Building
• Youth-based Awareness, Education and Training
• Youth Friendly Mental Health Interventions
• Advocacy.
• Evaluation

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Expected outcomes include:
• Heightened awareness and knowledge of mental health related problems
• A more knowledgeable and responsive health care system
• More trained mental health providers
• A mental health awareness campaign
• A mental health 24 hour crisis intervention service
• Improved access to and availability of mental health information material
• Strengthened family and village support systems
• Recommendations for a national mental health policy
• Improved mental health for youth at risk.

It is envisaged that lessons learned from this project will serve as a cost effective,
culturally appropriate, and successful model to be replicated and adopted by other
Pacific Island Countries.

2. BASELINE STUDY
The Youth at Risk proposal acknowledged that, at present, “little or no quantitative or
qualitative data exists pertinent to Vanuatu youths mental health”

2.1 The key task of the Baseline Study therefore was to establish, as far as possible, what the
existing situation is in the target area, the capital Port Vila and the nearby communities of
Seaside (People from the islands of Paama, Tongoa and Fatuna) and the Mele community in
relation to the goals and objectives in the ‘Youth at Risk’ proposal.

2.2 The key outcomes of the Baseline Study were to:

 Establish baseline information in order to measure progress both during and at the end
of the project

 Inform the planning and the development of the project in relation to the project
objectives, particularly in its early stages.

2.3 The Project Objectives are:

• To reflect a decrease in the rates of mental health social exclusion and isolation,
morbidity (depression, anxiety, and other related illness), and mortality (suicide)
among Vanuatu youth at risk at the end of PY3.
• To increase awareness and knowledge of mental health related problems, (causes, risk
factors, signs and symptoms), and the appropriate care and treatment of these among
75% of the project’s targeted population, their families, and communities by end of
PY3.
• To improve awareness of and access to mental health services by 10% annually from
baseline for Vanuatu youth at risk during PY1-3;

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 • To increase knowledge and recognition of mental health related problems among
Vanuatu health and education providers by PY3;
• To increase the number of trained mental health care providers in Vanuatu by 10%
(from baseline) by end of PY3;
• To increase the number of youth mental health related problems recognized, referred,
and appropriately treated by Vanuatu public and private health care providers and
educators by end of PY3;
• To expand the number and types of mental health services (counselling, treatment,
crisis intervention) and delivery sites in Vanuatu by 5% (from baseline) by end of
PY3;
• To improve access to and increase the number of (by 10% from baseline) available,
culturally appropriate, youth based educational information materials, sources, and
sites in Vanuatu by end of PY3;
• To develop recommendations for a Vanuatu national mental health policy by end of
PY3;
• To establish a model mental health system that could be replicated in other PICs by
end of PY3;

2.4 Methodology:

In consultation with appropriate individuals and agencies I decided to proceed by:

I. Meeting with key groups of young people, agencies and individuals in Vanuatu
II. who could provide information on the existing situation and help inform the
framework for gathering information. In the process of doing this we hoped to
both encourage people to volunteer current information and to potentially
become involved in the project over the next three years.

III. Drafting questionnaires etc to be targeted at specific groups

IV. Collating, recording and analysing the information gathered including all
available reports etc in order to attempt to quantify data for future comparison.

V. Producing an early written report, which would inform the development of the
project and provide baselines from which future outcomes can be measured.

2.5 Definitions:

The proposal does not identify an age group for “Youth”. For the purposes of the Baseline
Study I decided that I should concentrate on young people from secondary school age up to
the age of 24. This did not exclude me from looking at issues which might have affected their
mental health at a younger age.

Because the proposal for the “Youth at Risk” project acknowledged that at present “little of
no quantitative or qualitative data exists pertinent to Vanuatu youths mental health” I decided
that in writing the report I should be as inclusive as possible in examining issues which
might affect the mental health of the young people.

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For the purpose of the study I decided to use the definition of Mental Health adopted by The
Mental Health Foundation in it’s major recent report “Bright Futures”on the mental health of
children in Britain2 which was based loosely on Hill in NHS Health Advisory Service
(1995)3

A definition of children’s mental health:

We believe that children who are mentally healthy will have the ability to
• Develop psychologically, emotionally, creatively, intellectually and spiritually
• Initiate, develop and sustain mutually satisfying personal relationships
• Use and enjoy solitude
• Become aware of others and empathise with them
• Play and learn
• Develop a sense of right and wrong
• Resolve(face) problems and setbacks and learn from them

I was also keen to take into consideration the cultural context of mental health and
acknowledge that what is seen as mentally healthy behaviour may be differ from one culture
to another.

3. SUMMARY OF THE MAIN FINDINGS AND

RECOMMENDATIONS OF THE BASELINE STUDY
1. A clear pattern emerged of a growing number of young people experiencing
difficulties with a range of issues related to their mental health. This was reinforced
over and over again from people across all communities and services.

2. There is currently no Mental Health Service in Vanuatu. There are no qualified

psychiatric staff and only one general trained nurse who has developed an interest in
mental health and who provides a limited service from the General Hospital for the
whole of the country.

3. The only place at present where a patient with a mental health problem who is a “risk”
or “at risk” can be put is in a locked “cell” at the Port Vila General Hospital which is
in an appalling physical condition and which is completely unfit for human habitation.

4. There is an overwhelming need to look at options for caring for people who are
severely mentally ill.

5. Within the hospital, staff are doing their best to cope but acknowledge they have
neither the time nor skills to treat, counsel or support people with mental health
problems. The majority of the young people seen at the Outpatient Department were
described by an A & E Consultant as having “some kind of mental health problem”.

6. Little or no data currently exists in relation to young people’s mental health issues in
Vanuatu. There is a need to develop a common system of recording data across all

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 agencies in order to develop a clearer overall picture of the mental health needs of
young people.

7. Increasing migration of people to Port Vila has resulted in overcrowding and cramped
conditions in some villages. These conditions can have an adverse affect on young
people’s mental health. As the population of Port Vila is expected to continue to grow
for the foreseeable future this issue will need to be addressed as increasing
overcrowding will put further pressures on the mental health of communities.

8. There is evidence of an increased teenage pregnancies, sexually transmitted diseases,

prostitution, rape, incest and sexual abuse.

9. The status of women and children in many of the communities is low and there is
increasing evidence of domestic violence towards both groups.

10. All agencies recognise that there are fundamental changes going on in the country and
existing structures of support are not always seen as appropriate by young people.

11. New exposure to western influences has led to an increasing desire from young
people for different lifestyles and values that conflict with the traditional ones in their
communities. There is now a need to offer young people opportunities to discuss these
issues and to explore the different conflicts they experience. There is a need to
provide opportunities for civic discussions in schools to include Good Governance,
Good Citizenship, Rights and Responsibilities, Promoting Health and Well-being of
young people etc.

12. Within schools, teachers expressed concern at the growing numbers and range of
difficulties being experienced by young people. They felt teachers required further
training and support to deal with these issues.

13. Increasing unhappiness among some young people with their situation has led to a
rapid increase in anti-social behaviour including offending and alcohol and kava
misuse. The development of “Lifeskills” training could help young people to acquire
skills which could help them respond in more positive ways to their difficulties.
Young people from the Settlements appear to be more vulnerable, feel more
disenfranchised and are more at risk of developing problems.

14. Many people with mental health related problems are ending up in prison due to a
lack of alternative responses. There is a need for the project to enter discussions with
other agencies with a view to exploring alternative options for young people with
mental health issues.

15. Lack of education opportunities is leading to feelings of rejection, alienation and

social exclusion for many young people from a very early age. Senior officials within
the Education Department acknowledged the difficulties associated with this and
indicated that the Government has a policy to expand the numbers of school places
available in the coming years. The new young people’s project should contribute to
this debate.

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 16. Concerns were expressed that the current curriculum for Technical Training was not
always appropriate and was often training young people for employment that did not
exist and this ultimately resulted in frustration and unhappiness among trainees.

17. Frequent changes of Government, resulting in equally frequent changes of

Government Officials, have made it very difficult for policies on young people’s
issues to develop. There is a need to address this by bringing appropriate people
together in a planning process to develop a medium and long-term strategy for
tackling young people’s mental health issues. There was an expressed willingness
from all organisations and groups who took part in the study visit to become involved
in this.

18. Consideration should be given to providing a range of support services to young

people in one location. This might avoid any feelings of stigma attached to seeking
help with a mental health related problem. The provision of an “outreach” service
should also be explored.

19. Through involving young people in the project the Youth at Risk project should begin
to address the growing feelings that young people experience about their lack of status
and voice to express their views.

20. The benefit of using drama as a complimentary medium to take messages about
young people’s mental health issues into schools and communities should be
recognised and actioned.

21. Young people indicated that they were aware of growing numbers of young people
who were experiencing difficulties and who would benefit from a young people’s
support service.

22. Young people with disabilities feel particularly disadvantaged and do not feel they
have equal access to services.

23. There is a need to involve young people in producing age and culturally appropriate
material on mental health issues.

24. There is a need to engage parents in discussions and explore the development of
support programmes for them which could help them understand and deal with young
people’s issues in their communities.

25. The importance of interdepartmental and interagency co-operation is vital to create a

vision for the future which encompasses the health, education and social justice needs
of young people with mental health issues..

A recent study by UNICEF on The State of Health Behaviour and Lifestyle of Pacific Youth,
Vanuatu Report (UNICEF Pacific. Suva, Fiji, 2001) reported that levels of unhappiness,
loneliness and severe sadness among both students and out of school youth in Vanuatu are
very high.

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The feeling among young people and agencies working with young people in Vanuatu is
that there is an immediate need for a support service that will provide support, advice
and access to counselling to address young people’s mental health issues. One of
Vanuatu’s Chiefs said:

“You have to deal with the fire once you see the smoke- it’s too late when the fire is out of
control. The time for action is now”.

Patrick Little
InterMinds
Baseline Researcher

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4. REPORT ON VANUATU BASELINE VISIT
4.1 Introduction:

As part of the Baseline Study, I visited Vanuatu in May to meet with key individuals and
agencies that have contact with, or an interest in, the subject of young people and mental
health. Over ten days I had forty two meetings with representatives of a range of
organisations including:

Schools, Colleges, Young People’s Projects, N.G.Os, Government Officials, Chiefs,

Churches, Police and Judiciary, World Health Organisation, Women’s Groups, Disabled
Groups, Trade Unions, UNICEF, Health and Education Officials, Young People
(Appendix 1).

I visited several villages and settlements in and around Port Vila. and also the hospital and
prison.The primary aim of the visit was to hear at first hand from the different organisations
and individuals working with young people what they felt was the existing situation in
Vanuatu in relation to young people’s mental health and to use this information both for the
Baseline study and to inform the development of the Youth at Risk Project.

4.2 The Visit Team:

I was accompanied on my meetings by Elizabeth Mermer who had been employed by

FSP(Foundation for the South Pacific who are hosting the project) to arrange the visits and
who acted as my advisor and interpreter. Elizabeth was a well known, respected and
experienced community worker in Port Vila and her presence meant that people often felt
more comfortable and willing to volunteer information. We were also joined by Jack
Kaltamet the only nurse working in the mental health field in Vanuatu and we tried to work
as a team during the interview process to illicit the maximum amount of information from the
interviewees.

4.3 Agency Responses:

All the agencies and individuals interviewed were very forthcoming with contributions about
the issues (I only interviewed two people whom I felt were a little reluctant to acknowledge
difficulties in their communities which had been identified by others). All were keen to take
part as they felt they was now a desperate need for the type of project proposed to begin to
address the needs of young people in Port Vila.

4.4 Early Difficulty:

Two main issues became clear in the early visits to agencies-

1. All agencies were indicating an alarming increase in the number and range of
difficulties experienced by young people.

2. There was also a strong message given that over the past few years young people and
agencies had taken part in several studies relating to the needs of young people.

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 These included:
• The Young People Speak -A report on the Vanuatu Young People’s Project4 –
interviewed 1000 young people between the ages of 13-25 in Port Vila.
• 4596 young people were interviewed in the UNICEF Report- The State of
Health Behaviour and Lifestyle Of Pacific Youth (Vanuatu Report)1.

The feeling from workers was that young people would be reluctant to take part in further
surveys at this point and that most people now felt that it was the time for action and not for
further research.

As a result of this I decided to make maximum use of the relevant information supplied from
existing reports and minimise the use of questionnaires as much as possible as a means of
gathering the information I required for the Baseline Study.

There was much commonality in the issues identified by all agencies and young people as
affecting the mental health of young people.

5. KEY ISSUES ARISING FROM BASELINE STUDY VISIT

5.1 Young People Experiences:

We interviewed a group of young people at the Young People’s Drop In Centre. The main
issues identified by young people an affecting their mental health included:
• Being caught between an old and a new way of life
• New external influences
• Feeling rejected at a young age because of exclusion from education system
• Lack of social skills for dealing with life
• Unemployment
• Offending
• Unwanted pregnancies
• Isolation
• Homelessness
• Alcohol and Kava misuse
• Sexually transmitted diseases
• Sexual assaults
• Rape
• Incest
• Prostitution
• Domestic Violence
• Abuse by Police
• Peer pressures
• Feelings that parents don’t care
• Overcrowding
• Family conflict
• Females feeling second class citizens

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What was striking about the interviews with young people was that most of them had
experience several of the above issues and most of them knew a young person who was
experiencing some kind of sexual abuse. This confirms the findings in the AusAid Report on
Child Abuse in the Pacific5 which reported that examples given to the team were always
graphic and disturbing accounts of children of all ages subject to significant harm as result of
sexual abuse, physical abuse, emotional abuse and neglect. Some examples were also
provided of commercial sexual exploitation of children.

The current projects provided by FSP for young people have shown that if the right type of
service is provided for young people they will come forward to seek help. The last six month
report for YPDIC showed that 459 young people sought help from the Drop-In Centre and a
total 1520 young people have been directly assisted or benefited by the Youth to Youth Peer
Counselling Project for promoting Reproductive and Sexual Health. There was a strong
feeling that there is a need to build on the current services available to young people and a
particular need to broaden access and encourage more young people to come forward to seek
help.

Young people also expressed the need for their views to be heard as they felt that their voice
is not being heard at the moment. It is important that young people are encouraged to play a
leading role in the development of the Youth at Risk project.

Young people with disabilities feel even less respected and listened to as a result of their
experiences. The Vanuatu Society for the Disabled has begun consultations to develop a
national policy for respecting the rights of disabled and have a growing number of young
people involved in the society. It is important that the views and experiences of these young
people are also represented in the development of the project.

The State of Health Behaviour and Lifestyles of Pacific Youth found that a little over a
quarter of students reported they were generally not happy while a slightly lower proportion
reported they rarely or never felt confident. Around 1 in 8 reported they often felt lonely.
Feelings of severe sadness or depression were experienced by around 15% of students.
Almost one third of young people reported that they had a deliberate injury inflicted by
another person that needed treatment in the past 12 months.

5.2 Lack Of Education - “A Lack Of Hope”-

Most agencies described a growing number of young people experiencing a lack of hope in
their future. Many reasons were given for this but the primary reason identified for this was
the early “drop out” rate of young people from schools. Like many other societies, parents in
Vanuatu place a high status on education and encourage their children to achieve in school.

Unfortunately restricted places in secondary schools means that only 45% of pupils have the
option at present to go on to secondary schools6 leaving 55% to feel they are failures at a
very young age. Rather than blaming the system which does not produce enough places for
young people in secondary school, they internalise this and blame themselves for not
studying enough or being stupid.

This may have a lasting impact resulting in low self-esteem, lack of confidence and may
determine their view of themselves for the rest of their lives.

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 “Failure in the formal system leaves negative feelings of no worth and low self-esteem.
Ability to take new opportunities becomes difficult because of this sense of failure. It is
difficult for them to motivate themselves again once they have lost a lot of their self-respect
and their fear of further failure holds them back.”
John Liu- Director Vanuatu Rural Development and Training Centres’ Association

This impact of so many young people becoming “Drop-Outs” (as they are described locally)
at such an early age cannot be underestimated on the growing numbers of young people who
are experiencing difficulties and whose response is often to involve themselves in various
types of anti-social behaviour and further disenfranchise themselves from their communities.

5.3 Schools And Colleges Experiences:

We visited 4 schools and colleges as well as officials at the Department of Education.

Despite their obvious interest in the welfare of their pupils, it was clear that there was great
concern among Heads and Officials about the rise in difficulties being experienced by young
people in schools and the growing lack of confidence and ability of teachers in schools and
colleges to deal with this growing need (see Fig 3).

Teachers reported that an increasing number of young people experiencing a “lack of hope”.

“Perceptions by many young people that parents and adults don’t care results in a
response ‘if they don’t care why should we?’”
John Niqua Head of Malapoa College

There was a strong feeling that teachers are not trained or equipped to deal with these issues
nor indeed did they feel they had the time to do so. There is no programme or training
procedures or systems for teachers, doctors or nurses to recognise or respond to child abuse.20
T here was unanimous support for the introduction of a mental health awareness programme
for pupils, teachers and parents.

“There is a need for a service which provides a support service to both pupils and teachers.
Currently the lack of an appropriate support service for pupils in distress is having a
detrimental effect on their development and is a barrier to their future learning”
Yvette Sam- Head of Lycee Secondary School

A recent European Union report on Mental Health Promotion of Adolescents and Young
People21 reported that:

“Mental Health is central to the pursuit of good education and evidence is growing that
people learn better if they have high self-esteem and feel valued and understood”

Concerns were expressed that some college training was not geared towards the reality of
Vanuatu’s employment situation. Two out of three Ni-Vanuatu listed as unemployed were
under the age of 24.

“Lack of opportunity leads to lack of motivation and some young people feel they are
‘training without a future. This can undermine young people’s value of themselves and
increase their feelings of hopelessness’”.
Daniel Henri Lamereaux Head of Institute National de Technologie

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The Sustainable Human Development in Vanuatu Report7 identified this as an issue when it
said that new ways of earning cash and sustainable livelihood creation must be learned as
well as skills and knowledge needed to identify and explore viable alternatives. A large
percentage of school leavers do not have adequate basic skills to secure waged jobs.

The Education Master Plan8 prepared by the World Bank is in its second draft at the moment
and provides for a broad strategy for development over the next 10-15 years and beyond. The
goals of the master plan include:
Access, Relevance, Quality, Equity, Language Policy, Partnerships, Management and
Sustainability.

It is important that the Youth at Risk Project contributes to this plan and attempts to influence
the provision of services to young people in schools.

6. VANUATU-“A CHANGING SOCIETY”

6.1 Urbanisation:

There is evidence that a rapidly changing society in Vanuatu in recent years is now having a
growing and severe impact on the lives of many young people. An increasing drift of people
into Port Vila has seen the population grow from 18,000 in 1988 to over 40,000 at the last
census. The expectation is that this pattern is likely to continue for the foreseeable future.

Some 30-40% of Port Vila’s population live in “Urban Squatter Settlements” Living
conditions are generally sub-standard with overcrowded housing, no water supply, poor
sanitation, dramatic rise in morbidity, increased violence, few education and employment
opportunities and apparent lack of concern by any level of government as these settlements
appear not to fall within any jurisdiction.9.

As more and more people move into Port Vila increasing pressures are being put on their
extended families who feel a responsibility towards them.

“Sometimes too much care for their extended family can lead to less care for the nuclear
one. Having to support increasing numbers of extended family members means some
families situation will only deteriorate”
Presbyterian Church Leader

This issue was raised by several young people we spoke to who described the pressures of
living in overcrowded conditions which often led them to stay out all night and only return
home to sleep during the day. When this goes on for any length of time they become more at
risk and their mental health deteriorates. The Young People’s Project reported that currently
Vanuatu has an urban population growth rate of approximately 7% and it has been estimated
that the economically active population of Vanuatu could increase between1991 and 2011 by
95%. This could mean the doubling of Port Vila’s population in just 10 years.10

6.2 Support Systems:

Within the traditional “Kastom” system there is an ingrained culture of responsibility for
supporting the extended family and indeed the community. But customary support systems

14
are changing. In the past extended family structures and the traditional Chief system managed
to provide support to families and young people experiencing difficulties.

Many family structures are now changing with more families separated or young people
living away from supportive families. Changing family structures and the reduction of the
influence of the Chiefs within the settlements in particular has greatly increased the problems
for young people.
“Psychiatry in Vanuatu has traditionally been the prerogative, privilege and responsibility
of the chief of every village, acting in a benign way, guiding and supporting those in his
‘extended family’. Sadly, as people move away from his sphere of influence, the control of
the chief becomes less, often leaving him and his ‘supporting team’ at a loss to know, to
understand, and to explain what is happening to a way of life which is totally ingrained in
custom in their lives, and those of their ancestors”.
Julian Boulnois Australian Psychiatry Vol 3 No 3 June 199511

“Traditionally, raising children was a joint responsibility involving the extended family that
ensured the child was properly cared for if the parents were unable to do so. Today child
rearing still remains the prime responsibility of the parents but with families becoming more
nuclear and dispersed they are fast losing the benefits of the help they once enjoyed. Because
traditional protections of an extended family are absent in the nuclear family there is an
increase in domestic violence. There is an increase in cross-cultural marriages so that the
previous rules are not so easily applied. Young people are increasingly choosing their own
spouses and the family investment in marriage is not as great as it once was”.9

Increasing breakdown of marriages has resulted in many young women living on their own
without the support of their families and the resultant financial pressures were seen as one of
the causes of the growing rate of prostitution in Port Vila.
“Over the years I worked as a mental health nurse in Vanuatu, the greatest increase in
difficulties I saw were related to depression as a result of family problems”
Tom Nalau- Former Mental Health Nurse

6.3 New Western Influences:

Exposure to western television programmes and videos are creating new expectations and
vision about life among young people which did not exist before, are vastly different than
before and that largely cannot be met. This can cause feelings of frustration and unhappiness
and can ultimately lead to young people responding through various types of anti-social
behaviour.
“Local values are being substituted with imported ones. Young people are grabbing for
opportunities that are not there. They see imported values as more valuable and end up
‘chasing the wind’”
John Liu-Director Vanuatu Rural Development and Training Association

There is now an urgent need to provide an opportunity for young people to debate the values
of various systems- Kastom, The Constitutional one and the new Western ones they are now
being exposed to.There is also a need to develop a process which builds on the strengths of
Kastom and embraces the aspirations, visions and rights of young people under the
constitution and engages all interested parties in providing support systems which adapt to
the changing needs of young people and families in Vanuatu society.

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7. GENDER ISSUES:
Since becoming independent in 1980, Vanuatu has adopted the UN Convention on Human
Rights and individual and communal rights are enshrined in its constitution. Although this
has contributed to a growing expectation of the role of women, there has not been the same
progress in real terms. The constitution often conflicts with the local “Kastom” laws and
practices which in many communities place women and children’s rights below those of men.
In many communities women are seen as inferior and their opportunities to contribute to
debate within the Kastom system is minimal. Many women who contributed to the study in
their roles as youth or health workers indicated they would not be allowed to contribute these
views if they were back in their own communities.

Young women feel particularly discriminated against in the traditional system of justice
which often does not treat them as equal. They report that Chiefs are more likely to believe
men and, because men know the system favours them, men are more and more subjecting
women to increasing forms of abuse.

“We need to encourage discussions and have the debate about the conflicts of Kastom and
Constitution in relation to women brought more into the open”
Virginia- Vanuatu National Council of Women

Young people and agencies report increasing evidence of domestic violence towards women
and children. Injuries deliberately inflicted by others was a prominent health issue identified
by young people who contributed to the State of Health of Pacific Youth Report. Staff at Wan
Smol Bag reported regularly seeing evidence of violence towards women.

More and more women are seeking assistance from the courts and the Women’s Centre thus
showing the increase in the number of reported cases of wife beating, adultery, incest and
family maintenance cases. Customary institutions, The Chiefs and the extended family
system no longer provide adequate social, economic and psychosocial support to women and
children.12

Teachers and youth workers commented on the lack of confidence and skills young people
had in dealing with the opposite sex. Many used alcohol or Kava to boost their confidence
which often led to increased sexual activity and resulted in unwanted pregnancies. There is a
relatively high level of teenage pregnancies (15-19y.o) in Vanuatu13and pregnancies in the
13-18 year old group more than doubled between 1998 and 2000.14

There are also gender specific issues to be addressed around the problems of young men.
There is evidence that many young men are also struggling with the changing society in
Vanuatu and find it difficult to articulate their distress which often translates itself into
offending and anti-social behaviour.

“There is a particular need to recognise the growing needs of young men in Port Vila for a
counselling service which addresses their needs”
Emily Niras- Young People’s Project

Assessing gender differences is a crucial issue for the new project as is addressing the
attitudes which prevent serious consideration being given to the views of youth.

16
8. THE CRIMINAL JUSTICE SYSTEM:
The Baseline Study included looking at young people and mental health issues in the
Criminal Justice System. We interviewed a number of Police and Court Officials and visited
the detention cell in Port Vila’s Police Station as well prisoners and staff at the main jail.

All agencies working with young people in Port Vila have seen an upsurge in criminal
activity among young people in recent years. For a society which has been used to very little
offending before, this increase is causing growing concern. The current system is not geared
for dealing with this increase and is under great strain.

The consensus among the agencies (including the Police) is that the increased offending is a
result of the rapidly changing society in Vanuatu. Increasing urbanisation, unemployment,
breakdown of customary support and influence of Chiefs are leading to increasing
disaffection by young people and a general feeling of hopelessness about their situation. This
lack of affiliation is leading to a range of anti-social behaviour and offending.

Although the Police Standing Orders provide that, in general, police officers ought not to
arrest “young children” there is no definition for “young child”.15 Young people are regularly
arrested for drinking, shoplifting and housebreaking. There are several sources of evidence
which indicate Police ill-treatment of young people.16*

“When young people eventually come before the courts they mostly don’t know their
rights, feel intimidated, say nothing or even plead guilty to offences just to get things out of
the way”
Rita Naviti Chief Registrar and Clerk to the Port Vila Court

There is no Probation Service or alternatives to prison so many young people end up in prison
because of a lack of other disposals. Young people experiencing mental health difficulties in
their lives have their situation exacerbated by a period in prison.

The Ombudsman of Vanuatu Sixth Annual Report17 reported that the treatment of prisoners in
Vanuatu does not meet minimum international standards in a number of areas including
medical examination of prisoners. The Ombudsman found that the physical condition of
prisons, in particular Central Prison, violated prisoners fundamental Constitutional right to
“security of person”, i.e. a safe healthy environment. Young people reported being
traumatised by prison experiences but being unable to access appropriate supports to get out
of the vicious circle they found themselves in.

The staff we spoke to at the prison acknowledged these difficulties and were very interested
in the proposed “Youth at Risk” Project. They felt there was a need to educate prison staff
about the needs of people with mental health problems and how they should be cared for and
supported.

17
9. MENTAL HEALTH SERVICES:
“Mental Health is the foundation of all health. We must turn around years of insufficient
resources and support we’ve been offering to those living with mental disorders so they
may lead productive and fulfilling lives”.
Dr Shigeru Omi- WHO Regional Director for the Western Pacific

Although the Laws of the Republic of Vanuatu include a chapter under the heading “Mental
Hospital”18 there is in fact no mental hospital or any type of mental health service in Vanuatu.

There are no trained psychiatric staff working in Vanuatu. Within the general hospital in Port
Vila there is one general trained nurse who has an interest in mental health and who takes on
the responsibility for returning patients who have been admitted to the general hospital and
are found to have a serious problem related to their mental health, to their communities.

The only place where a person who has a mental health problem and who might be a risk to
themselves or someone else is placed is in a locked “cell” in the hospital which looks like a
prison cell but is completely unfit for human habitation, let alone caring for a person who is
mentally ill.

According to a consultant we spoke to at the Accident and Emergency Department at Port

Vila General Hospital, almost all the young people he saw at Accident an Emergency had
some kind of mental health problem.

With no trained staff to deal with mental health issues it is no surprise that there is no system
for recording mental health problems and therefore no way of accurately getting a picture of
the extent of the problem. Without a Mental Health Service it is difficult to establish the level
of clinical depression and serious mental health problems among young people in Port Vila.

“According to WHO projections, a minimum of 42 psychiatric beds would be required for

the current adult population of Vanuatu”
Dr Noel M. Wilton WHO Consultant
Mission Report WHO Regional Office for the Western Pacific 3-27 September 199719

The information we received from staff working in Youth, Education, Health and the Judicial
fields is that they have seen an upsurge in young people affected by mental health issues and
a growing need to begin to address this but until staff receive further training in mental health
it will be difficult for them to feel confident to quantify the issue.

There is an immediate need for a mental health awareness programme to raise awareness of
issues surrounding mental health in schools and the communities. In doing this the project
should consider involving the Wan Smol Bag Project who have an excellent record of
producing community theatre on social issues.

“People become very emotionally involved in community theatre. It makes people laugh-
but underneath the laughter the educational message is strong and clear, that people can
take responsibility for what happens to them, and their communities.
Peter Walker,Wan Smol Bag

18
At the moment communities have largely been willing to support people experiencing mental
health problems but, as the changes in communities become greater, so will their ability and
commitment to care for people who develop serious mental health problems.

It is important then that discussions take place at a government level to address these issues.
With frequent changes of Government and equally frequent changes of Government Officials
it is often very difficult for long-term policies to develop in Vanuatu. Therefore there is a
need to build a partnership of interested agencies to lobby the Government and interested
Members of Parliament in opposition parties with a view to an adequate policy service being
developed for people who experience mental health problems.

This should include the implementations of the 1997 WHO Mental Health Mission Report19
recommendations:

1. Specialist mental health workers should be trained.

2. A mental health services (including mental health promotion and mental illness
prevention) administration should be developed within the Department of Health.

3. Planning for mental health services should be co-ordinated as part of health planning
generally.

4. Training programmes on mental health issues should be planned and implemented.

5. A suicide prevention strategy, especially for youth should be developed.

6. Protocols and procedures for the identification and management of persons with
mental health problems and mental disorders should be developed and promulgated,
with associated training, to all personnel.

7. The lack of inpatient facilities should be addressed.

8. Strategies to increase the general community awareness of mental health issues

should be developed and implemented.

9. Data on mental health disorders and mental health problems should be included in
monthly reporting from health facilities.

There is now a need to encourage a dialogue between Agencies, Communities and the
Government to embrace what is best about the traditional system of supporting people
with a new professionalism in order to build an appropriate service to meet the needs of
the growing numbers of young people experiencing mental health problems.

19
10. DATA COLLATION AND MEASUREMENTS

The proposal for the Youth at Risk project acknowledged that “little or no data qualitative or
quantitative data exists pertinent to Vanuatu youths mental health”.
The Baseline visit confirmed this statement in relation to formal recording of mental health
issues. Despite attempts to unlock further existing quantitative information there was little
success because mental health issues are not recorded by agencies in Vanuatu. What little
information exists is unreliable because it has not been recorded consistently i.e. some
categories of mental health issues are recorded in Port Vila General Hospital statistics but they
are inconsistent from month to month and from year to year.
However, through using available existing reports to extract indicators and through information
received from interviews and questionnaires, I have attempted to identify material with which to
measure the progress of the project over its three years.
As well as the interviews with over forty agencies and individuals working with young people,
422 young people completed questionnaires- 253 in 4 different secondary schools in Port Vila
and 169 from Mele village and the Seaside Community. 23 Teachers and 15 Health workers
also took part in the questionnaire.

Project Objective 1

To reflect a decrease in the rates of mental health social exclusion and isolation, morbidity
(depression, anxiety, and other related illness) and mortality(suicide) among Vanuatu youth
at risk by the end PY3.
In the time available, this was the most difficult objective to measure at present as there are no
baseline statistics available to work with. Attempts should be made early in the project to agree
a recording mechanism to monitor this issue over the three years duration of the project.

The indicators of social exclusion are there at present- reports from teachers of young people
dropping out of the Education system, offending, anti-social behaviour and unemployment.
The main indicator though is the growing numbers of young people who perceive themselves
to be socially excluded and who do not feel part of the mainstream community.

In traditional communities most young people grow up to feel part of that community and
feel the community cares about them. Many young people are now living in Port Vila who
are dislocated from the communities they grew up in and are feeling less a part of traditional
mainstream life. As they become more socially isolated they are more likely to experience
problems related to their mental health.

The socially excluded group is not confined to young people living in the settlements. Young
people who live in the traditional communities whose experience of adults is one of abuse,
lack of love and care may even feel more isolated in their communities.

20
Project Objective 2
To increase awareness and knowledge of mental health related problems, (causes ,risk
factors, signs and symptoms) and the appropriate care and treatment of these among 75% of
the project’s targeted population, their families, and the communities by the end of PY3.

Information gained from questionnaire:

Fig 1. Knowledge of mental health problems

(scale 0-low knowledge…10- high knowledge)
Numbers of people scoring 0 i.e. acknowledging no knowledge whatsoever:

SCHOOLS COMMUNITIES TEACHERS HEALTH

CAUSES 20.9% 27.5% 26.1% 6.1%
RISK 22.0% 22.4% 26.1% 6.7%
SIGNS 14.2% 46.3% 26.1% 0.0%
SYMPTOMS 18.0% 38.5% 30.4% 13.3%

Fig 2:
Numbers of people scoring 5 and below:
SCHOOLS COMMUNITIES TEACHERS HEALTH

CAUSES 69.3% 73.9% 73.9% 60.0%

RISK 57.9% 69.5% 69.5% 53.3%
SIGNS 45.3% 60.8% 60.8% 46.6%
SYMPTOMS 41.6% 56.4% 56.4% 59.9%

Fig 3:
Teachers reporting observations of
young people with mental health difficulties.

Depression 70%
Psychosis 57%
Eating problems 65%
Anxiety & panic attacks 52%
Suicide attempts 57%
Self harming 43%
Substance misuse 70%
Phobias 43%
Sexual issues 43%
Others 13%

Others include:
• Loneliness
• Accident which caused disability and disease

21
 • Young people feeling they are not being treated properly

Fig4:
Percentage of health workers interviewed who observed mental health related
difficulties in the last 12 months.

AGE 15-24
Depression 46.7%
Psychosis 33.3%
Eating Problems 26.7%
Anxiety and panic
attacks 33.3%
Suicide Attempts 73.3%
Self harming 46.7%
Substance Misuse 53.3%
Phobias 26.7%
Sexual Issues 20.0%

Other mental health related difficulties reported:

• Unwanted pregnancies - over 100 for all ages. Fifty plus for age 15 - 24.
• Wife bashings: over 80 for all ages, 12 for ages 15 - 24. These lead to a lot of mental
health problems including depression, anxiety, suicide attempts, self-harming,
substance misuse, and sexual issues.
• Social problems.
• Loneliness, accident and diseases can all lead to mental health problems if they are
not treated properly.
• Running away from their family to another island.

Fig5:

HEALTHCARE AND TREATMENT:

Treatment: In what percentage of cases did you use the following:

%
a) Drug treatment only 34

b) Drug treatment and counselling 40

c) Counselling only 36

d) Referral on to other agencies (Please detail types 28

below)

Other:
Traditional medicines and doctors.

22
Project Objective 3:
To improve awareness of and access to mental health services by 10% annually from
baseline for Vanuatu youth at risk during P1-3

Fig 6:
KNOWLEDGE OF MENTAL HEALTH SERVICES:
Yes
Schools Y.P 26.4%
Communities 8.0%
Project Objective 4:
To increase knowledge and recognition of mental health related problems among Vanuatu
health and education providers by PY3:
See objective 2

Project Objective 5:
To increase the number of trained mental health care providers in Vanuatu by 10% from
baseline by end of PY3:
There are no trained mental health staff at present and only one general trained nurse who deals
with all serious cases.
Over the course of the project there is a need to involve the Government in discussions to
recruit new trained staff and increase training for existing staff.

Project Objective 6:
To increase the number of youth mental health related problems recognised, referred and
appropriately treated by Vanuatu public and private health care providers and educators by
PY3.
In order to move to meeting this objective, there is an immediate need to develop a mental
health awareness programme for young people, parents, teachers and health practitioners in the
first instance- See Objective 2 answers

Project Objective 7:
To expand the number and types of mental health services (Counselling, Treatment, Crisis
Intervention) and delivery sites in Vanuatu by 5% (from baseline) by end of PY3.
There are no formal mental health services to access at present although a few young people’s
agencies provide counselling and crisis support (particularly the YPDIC). There is some
validity in providing a range of young people’s services under one roof but consideration should
also be given to providing support services at “Outreach” venues.

Project Objective 8:

23
To improve access to and increase the number of available, culturally appropriate, youth
based educational materials, sources, and sites in Vanuatu by 10% from baseline by end
of PY3.

Fig 7:
% of young people who have seen Educational material on mental health:

SCHOOLS 36.4%
COMMUNITIES 58.0%

Fig 8:
Who produced these materials?
SCHOOLS COMMUNITIES
Health 25% 29.3%
Wan Small Bag 25% 6.8%
Vanuatu Women’s Centre 5% 3.4%
FSP 5% 8.6%
Education 6% 6.9%
Church 1% 0.0%
Community 2% 0.0%
Media 3% 0.0%
Others 8% 13.7%
Don’t Know 20% 31.3%

Fig 9:
What type of materials?
Type Schools Communities
Books 17.3% 8.2%
Video 23.3% 11.8%
Poster 18.5% 6.5%
Drama 37.9% 4.7%

Fig 10:
Was the information relevant?
Schools Communities
Yes 72% 82%

Fig 11:

24
Was the information suitable for your community?

Schools Communities
Yes 89% 86%

Fig 12:
Where did you get the information?

List of places Schools Communities

Community 7.9% 7.5%
Church 2.7% 8.8%
Wan Small Bag 18.2% 13.8%
Health 34.7% 56.0%
FSP 9.4% 7.5%
Vanuatu Women’s Centre 1.9% 0.0%
Media 5.13% 6.00%
Other Country 1.9% 0.0%
Education 16.2% 0.0%
Police 0.7% 0.0%
UNICEF 0.7% 0.0%

Fig 13:
Would you welcome more information on mental health issues?

Schools Communities
Yes 81.8% 58%
No 7.9% 3.5%
No comment 10.2% 38.5%

Fig 14:
If yes what would you like to have?

Presentation Schools Communities

Talks school 19.7% 13.4%
Talk community 19.7% 30.0%
Video school 19.7% 15.0%
Video community 19.7% 21.7%
Leaflets schools 11.8% 7.9%
Leaflets community 9.09% 11.8%

Fig 15:

25
Other suggestions

Schools Communities
Awareness 14.6% 4.1%
Wan small bag/Drama 21.6% 16.5%
Workshop 0.3% 0.0%
Media 1.5% 0.0%
Poster 12.6% 3.0%
Health 4.7% 0.0%
FSP 8.3% 3.0%
Community 0.3% 1.0%
No comment 35.5% 72.8%

11. FINALLY
I would like to say thank you to all the people who took part in the Baseline Study both in
answering questionnaires and taking part in interviews. Their honesty in volunteering what
was at times difficult information about their communities augurs well for the future when
the Youth at Risk project will engage with these communities about the issues. I was hugely
impressed on my visit by the interest of all the agencies in the needs of young people and
their commitment to be part of the future project.

Thank you to Morgan and the staff at FSP who made me so welcome. Thank you to Maria
Coady from UNICEF who provided us with several useful reports.

I would finally like to say a special thank you to Elizabeth Mermer and Jack Kaltamet for
accompanying me on my visits and who gave me a closer insight into their communities than
I could possibly have hoped to get in such a short visit.

Patrick Little
Baseline Researcher

26
APPENDIX 1:

Program schedule for Baseline Study Visit- Patrick Little

Date: 3 to 11 May 2001
Day & date Appointment-Time
Organization Contact Person
Thur 3/05/001 9.00a.m FSP Morgan Armstrong
2.00 pm Young People's Project Miss Emily Niras
3.15 pm Youth Drop In Centre Miss Josephine
4.00 pm Youth to Youth Miss Ordina
Fri 4/05/001 8.30 am Institut National de MR Daniel .Lamereaux
Technologie Vanuatu
9.30 am Lycee School Miss Yvette .Sam
10.30 am Malapoa Collage MR John Nirua
11.15 am Port Vila City Collage Principal
4.15 pm UNICEF Maria Coady
Sat 5/05/001 8.00 am Mele Village Chief, youth leader, Woman
leader.
Sun 6/05/001 2.00 pm Erakor Village MR Kalmet .C
Mon 7/05/001 9.15 am Ministry of Education Mr Thomas Simon .
10.00 am Dept of Youth Mr Evan & Edgel Tari
11.00 am Wan Small Bag Staff, Volunteers, and Y.P
1.30 am Cultural Center MR Joe
2..30 am Vanuatu National Council MRS Virginia. B
of Woman
Tue 8/05/001 8.30 am Vanuatu Society for MRS Elizabeth. Mael
Disabled People
9.30 am Rural Skill Training Miss Marie
Project
11.00 am Vanuatu Family Health Mrs Blondine P
Association
3.00 pm Youth Drop in Center MR Manu Nafui
3.45 pm Youth Drop in Center Young People
Wed 9/05/001 8.00 am Seaside Chief Charley Tom
Leitapang Malas
10.00 am Mele Village Chief Sam
12.00 pm Tanna MR Richard
2.00 pm Ombudsman MR Ephriam Kalorib
3.00 pm Port Vila Courthouse MRS Rita Naviti
Thur 10/05/001 8.30 am Director General of MR Johnson Wapaiat
Health
10.00 am Ministry of Health Mrs Lilly Andre
10.30 am Vila Central Hospital Mr Honore
1.30 am Vila Central Hospital Visits
2.00 pm Police Station Vake Raka

27
 3.00 pm Visit to Prison Vake Rakau
4.00 pm National Lebour Union Mr Ephriam .K
8.00 pm Mele Village Mrs Leitapang .M
Fri 11/05/001 9.00 am Tom Nalau Former MH Nurse
9.30 am World Health Director
Organization
10.30 am Vanuatu Rural John Lieu
Development Training
Center Association
(VRDTCA)
11.00 AM Vanuatu Christian Pastor Pakoa
Council
Friday 2.00 pm Violence Against Meeting
11/05/001 Children's
4.00 pm Police Station

28
References:

1.The State of Health Behaviour and Lifestyles of Pacific Youth-Vanuatu Report

(UNICEF Pacific. Suva,Fiji, 2001)

2.Bright Futures- Promoting children and young people’s mental health-

The Mental Health Foundation 1999
3.Hill in NHS Health Advisory Service (1995)-Together We Stand. The Commissioning Role
and Management of Child and Adolescent Mental Health Services HMSO London

4.Young People Speak… Vanuatu Cultural Centre April 1997 to June 1998

5.Child Abuse Feasibility Study/Project Identification Mission in the Pacific-

Report to AusAid 1999
6.National Census 1999, Summary of Official Results

7.Government of the Republic of Vanuatu-Sustainable Human Development in Vanuatu 1996

8.Government of the Republic of Vanuatu, Education Master Plan 2000-01

9.Vanuatu 5th Ministerial Conference Country Report Beijing China 2001

10.Planning the Future Melanesian Cities in 2010-John Connell and John Lea

11.Australian Psychiatry-Vol 3 No3-June 1995

12.Government of the Republic of Vanautu, UNICEF,A Situation Analysis of Children and

Women in Vanuatu 1998

13.The Reproductive Health Programme for Vanuatu, Mid Term Report 2001

14. Vila Central Hospital Statistics 1998-2000

15.A Needs Assessment of Juvenile Justice Issues in Fiji and Vanuatu Oct-Dec 2000

16. Fifth Annual Report to Parliament by the Ombudsman of the Republic of Vanuatu 98/99

17.Sixth Annual Report to Parliament by the Ombudsman of the Republic of Vanuatu 99/00

18. Mental Hospital Act

19.World Health Organisation, Mission Report. 1997.

Subject: Mental Health. Dr Noel Wilton

20.Pacific Children’s Programme- Protecting children from violence in Samoa, Fiji, and
Vanuatu 2001

21.Mental Health Promotion of Adolescents and Young People- Mental Health Europe 2001

29
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