Youth and Mental Health in Samoa: A Situational Analysis - Funded by NZAID
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Youth and Mental Health in Samoa:
A Situational Analysis
Commissioned
by the FSPI
Regional Health
Funded by NZAID
Programme
O Le Siosiomaga Samoa Nurses
Society Inc. Association Foundation of the Peoples of the
South Pacific InternationalUSP Library Cataloguing-in-Publication Data
Hope, Eseta Faafeu
Youth and mental health in Samoa : a situational analysis / Eseta Faafeu Hope and Matamua
Iokapeta Enoka. – Suva, Fiji : Foundation of the Peoples of the South Pacific International, 2009.
40 p. ; 30 cm.
ISBN 978-982-9091-14-7
1. Youth—Mental health—Samoa 2. Youth—Samoa—Social conditions 3. Mental health – Samoa I. Enoka, Matamua Iokapeta II. Foundation of the
Peoples of the South Pacific International III. Title.
RA790.7.S3H66 2009 362.2099614
© 2009 Foundation of the Peoples of the South Pacific International, Suva, Fiji IslandsAcknowledgments
W
e sincerely acknowledge the contribu- groups that also emphasised the significance of
tion of our stakeholders and partners in working effectively with youth.
Samoa to progressing mental health To have had the opportunity to work directly
concepts and making them easier for Samoan with young people was made possible by the initia-
youths to relate to. They have also played an im- tive of the O Le Siosiomaga Society through its
portant role in highlighting the relevance of partnership work with FSPI, in particular Margaret
Leniston and the Regional Health team. We greatly
Samoan culture to maintaining mental health.
appreciate the opportunity to have started this
A big thank you must go to the school principals
very important development programme for the
who provided support and assistance during our
youths of Samoa. No doubt this contribution will
work with students. It is our hope that the stu-
promote better life skills, new mindsets and
dents who were trained as mental health advo-
healthier lifestyles among young people.
cates will help make a significant contribution to
We express our appreciation to the Govern-
the wellbeing of their peers.
ment of Samoa, which through the Ministry of
Our aim is to expand our advocacy work and
Health, envisioned the need to establish our Men-
awareness programmes to reach many schools so tal Health Act 2007 and Mental Health Policy 2006,
that more young people will develop as responsi- thus setting the scene for our work in mental
ble citizens who can contribute to building a safer, health.
stronger and healthier Samoa. Our commitment, as non-governmental organ-
When we began this programme, we tried to isations, to advocacy, awareness, education, re-
(1) see our contribution in terms of the big picture search and sustainable livelihoods through this
in our local context, and (2) present Samoan val- Youth and Mental Health Project aims to comple-
ues and practices in a conceptual framework of ment the hard work of the Mental Health Unit staff
mental health that grassroot-level communities of the National Health Services.
could relate to easily. Working out these primary We hope that through the combined efforts of
issues took a great deal of discussion and deliber- all those committed to promoting mental health,
ation and this was made easier by the commit- we will ensure greater physical and mental wellbe-
ment and support of the community groups we ing for the youth of Samoa.
worked with. We would especially like to acknowl- Finally, we gratefully acknowledge Mrs Kate
edge the contributions of the church leaders, Watson-Horoi, the editing consultant, and Mr Ri-
youth groups who worked with us and community cardo Morris, the communications consultant.
3
Youth and Mental Health in Samoa: A Situational AnalysisForeword
by the Honourable Minister of Health,
Gatoloaifaana Amataga Alesana Gidlow
Y
outh and Mental Health in better to start than with youths’ own experiences
Samoa: A Situational Analysis is and perceptions of the culture they live in and the
the result of collaboration be- values they hold? Our youth are a valuable re-
tween the Samoa Nurses Association source and are extremely important for the future
(SNA), O Le Siosiomaga Society Inc development of Samoa.
(OLSSI) and the Foundation of the This situational analysis draws on existing
Peoples of the South Pacific Interna- Samoan studies that highlight health, education
tional. These organisations came together in and employment issues as they relate to youth and
recognition of the fact that the mental health mental health. An important focus of this report is
needs of our youth must first be identified and un- on promoting the conditions that are conducive
derstood before they can be met. to mental health rather than only dealing with the
The Youth and Mental Health (YMH) project issue once problems occur.
supports the implementation of the Samoa Men- I must express our appreciation for the support
tal Health Policy 2006 and the Samoa Mental Health received from the Foundation of the Peoples of
Act 2007. The policy has a vision “for all people in the South Pacific International, which enabled this
Samoa to enjoy mental well being that is grounded situational analysis to be undertaken. My congrat-
in the ‘aiga’ and nurtured through a multi-sectoral ulations also to the Samoa Nurses Association,
approach that provides quality care that is acces- which co-ordinated this work and provided this re-
sible to all people while recognising that mental, port. It is hoped that the collaborative efforts ini-
physical, social and spiritual health is indivisible.” tiated by these organisations will continue.
(Samoa Mental Health Policy, 2006) It is my privilege to introduce this ground-break-
This report aims to shed light on those areas of ing work, which I trust will bring continuing bene-
need and through its recommendations, to re- fits to the young people of our nation.
spond in an effective and sustainable way and im-
prove the health outlook for all young Samoans.
The promotion of mental health is vital to the
welfare of our youth and gives due recognition to
the role of Samoan culture in supporting young
people to lead happy and productive lives.
Firstly, it is essential to measure the status of Gatoloaifaana Amataga Alesana Gidlow
youth mental health in order to determine and de- Minister of Health,
velop remedial measures where necessary. Where Samoa
4
Youth and Mental Health in Samoa: A Situational AnalysisMessage
from the Executive Director of
O Le Siosiomaga Society Inc.
I t is a pleasure to have been in- Samoa Nurses Association as our local implement-
volved in this very useful Youth ing partner. Their practical experience in this area
and Mental Health (YMH) project and their immense contribution to developing the
for Samoa. The process and method- Samoa Mental Health Policy (2006) and the Mental
ology used in the partnership be- Health Act 2007 made them the agents of change
tween FSPI, SNA and OLSSI in this project. Their focus on what works for
demonstrated the strength of a col- Samoa, ensured anchorage on areas of traditional
laborative approach in achieving a successful out- significance and cultural sensitivities. It will shape
come. the outcome of our situational analysis report and
The Prime Minister, in launching the project two serve as a basis to replicate its relevant experi-
years ago, highlighted this aspect and was appre- ences in other areas of Samoa.
ciative of the initiative taken by FSPI and OLSSI as We also recognise with appreciation the man-
community organisations to secure funding and agement role of FSPI Regional Health team and
help implement the Samoa Mental Health Policy the funding from NZAID that has helped us imple-
(2006) and the Samoa Mental Health Act 2007. ment this project. Their flexibility in allowing rele-
In the wake of the tsunami that hit Samoa in vance to be the defining factor for the Samoa YMH
September this year, the relevance of the Youth situational analysis. This has demonstrated FSPI’s
and Mental Health Project was brought to the willingness to have local experts drive the activi-
fore. The devastation caused by the natural disas- ties for an outcome that will be relevant to Samoa
ter highlighted the fact that youth mental health and can bring about the implementation of the
should be given a high priority in Samoa, with fu- components of the Samoa Mental Health Policy
ture resources being committed to continuing its (2006) and the Mental Health Act 2007.
important work. So far, the project has made a On behalf of the President and members of the
large contribution to helping people to deal with Board of Directors of OLSSI, I congratulate all
the traumatic effects of the tsunami. those who have been directly and indirectly in-
Those who received training and benefited volved in ensuring this report will deliver benefits
from the Youth and Mental Health project in the for all Samoans.
communities, schools, NGOs, civil society, and gov-
ernment have been called upon to assist many
peoples and communities to begin rebuilding their
lives.
I wish to commend the work of the two co-or- Fiu Mataese Elisara
dinators, Eseta Faafeu Hope and Matamua Executive Director
Iokapeta Enoka, for their work in representing the OLSSI
5
Youth and Mental Health in Samoa: A Situational AnalysisContents
Acknowledgments.....................................................................................................................................3
Foreword by the Minister of Health.................................................................................................................4
Message from the Executive Director of O Le Siosiomaga Society Inc......................................................5
Contents.................................................................................................................................................6
List of Tables and Figures...................................................................................................................................7
Acronyms and Glossary .............................................................................................................................8
EXECUTIVE SUMMARY...................................................................................................................................9
SECTION 1: INTRODUCTION
1.1 Background.................................................................................................................................11
1.2 Community mental health services in Samoa .........................................................................11
1.3 The YMH Project.....................................................................................................................12
1.4 Methodology..........................................................................................................................13
SECTION 2: SAMOA: AN OVERVIEW
2.1 The Samoan family....................................................................................................................14
SECTION 3: MENTAL HEALTH
3.1 Mental health in the Pacific......................................................................................................15
3.2 The Samoan perspective on mental health............................................................................15
3.3 Mental health policy and legislation.......................................................................................16
SECTION 4: ISSUES FACING YOUTH
4.1 Employment................................................................................................................................18
4.2 Poverty.......................................................................................................................................19
4.3 Education.......................................................................................................................................19
4.4 Disabilities......................................................................................................................................20
4.5 Health..........................................................................................................................................20
4.5.1 Teen pregnancy................................................................................................................21
4.5.2 Parenting responsibility...................................................................................................21
4.5.3 Sexual health....................................................................................................................21
4.6 Abuse.........................................................................................................................................22
4.6.1 Physical abuse..................................................................................................................22
4.6.2 Sexual abuse....................................................................................................................22
4.7 Suicide.............................................................................................................................................22
SECTION 5: YOUTH AND MENTAL HEALTH EDUCATION AND AWARENESS
5.2 YMH survey findings......................................................................................................................26
5.2.1 Self..........................................................................................................................26
5.2.2 Self respect and dignity...................................................................................................26
5.2.3 Decision-making...........................................................................................................26
5.2.4 Happiness and unhappiness...........................................................................................27
5.2.5 Coping skills..................................................................................................................28
5.2.6 Support systems............................................................................................................28
5.2.7 Lessons learned of YMH awareness and education.....................................................28
SECTION 6: CONCLUSION AND RECOMMENDATIONS
6.1 Establish a Mental Health Family Association.....................................................................30
6.2 Youth-friendly and gender-sensitive services...................................................................31
6.3 Producing Samoa mental health information, education and communication materials.......31
6.4 Research...................................................................................................................................31
REFERENCES.................................................................................................................................................32
APPENDICES.................................................................................................................................................34
6
Youth and Mental Health in Samoa: A Situational AnalysisTables and Figures
TABLES
TABLE 1: Persons 15+ by main activities and sex, 2006
TABLE 2: Population with multiple or single disabilities, 2002
TABLE 3: Age and number of mothers who gave birth in national health facilities, 1999-2004
TABLE 4: Reported suicide attempts, outcomes, deaths and deaths from paraquat injestion
FIGURES
FIGURE 1: Map of Samoa
FIGURE 2: Population 15+ by educational attainment
FIGURE 3: Ratios of school attendance 5-19, 2001 and 2006
FIGURE 4: How do you describe yourself?
FIGURE 5: How often do you seek help in making serious decisions?
FIGURE 6: Are you a quick decision-maker or someone who takes time and does not rush things?
FIGURE 7: When someone else is talking and you disagree with his/her views, what do you do?
FIGURE8: You came home and found your parents had gone to a village meeting. Do you wait until
they come back or do you take charge of house chores?
FIGURE 9: Obstacles to a happy life
7
Youth and Mental Health in Samoa: A Situational AnalysisAcronyms
ADB Asian Development Bank
CRPD Convention on the Rights of Persons with Disabilities
FSPI Foundation of the Peoples of the South Pacific International
IEC Information, Education and Communication
KVA Kolone Vaai & Associates
MESC Ministry of Education, Sports and Culture
MFHA Mental Health Family Association
MHCP Mental Health Care Professional
MHU Mental Health Unit
MoH Ministry of Health
MWCSD Ministry of Women, Community and Social Development
NGO(s) Non-Governmental Organisation(s)
NHS National Health Services
OLSSI O Le Siosiomaga Society Incorporated
SNA Samoa Nurses Association
TALAVOU Towards a Legacy of Achievement and Opportunity through Unity
WHO World Health Organization
WST (Western) Samoa Tala
YMH Youth and Mental Health
Glossary
Agaga spirit
Aiga family or extended family
Aitu thinking and thought process
Fa’alepō dreams
Fale house
Lagi e mama i lau afioga metaphorical language that wishes back good health like the clear
sky
Loto fuatiaifo intuition
Malo le soifua good health to you
Malosi strength
Masalo suspiciousness
Mauli inner being
Ola life, living elements, from birth to death
Soifua maloloina o le mafaufau mental health
Tagata oti absence of life will result in the person becoming deceased
Tagata vale deviation from any of the three parts will result in the person be-
coming altered in normal functions
Tofāloloto insight
Tofāmanino vision
8
Youth and Mental Health in Samoa: A Situational AnalysisExecutive Summary
S
amoan society encourages youth to develop communicate and increase understanding on
cultural competence in their roles and rela- these issues and the impacts on all their lives.
tionships and to make sound decisions that The Samoa National Youth Policy 2001-2010
will prepare them to become responsible citizens (2001) recognises that the key challenges facing
and future leaders. youth related to the impact of cultural change aris-
It is crucial that young people understand the ing from global influences and urbanisation. These
importance of the choices they make to their changes challenge traditional ways of living and
health and wellbeing, so they are able to cope with the resulting tensions can bring about a range of
change and adversity and be successful in their stresses and anti-social behaviours. The Strategy
lives. To this end, O Le Siosiomaga, the Samoa for Development of Samoa 2008- 2012: Ensuring Sus-
Nurses Association and the Foundation of the Peo- tainable Economic and Social Progress (2008) also
ples of the South Pacific International worked in recognises these factors and has developed indi-
partnership on the Regional Youth and Mental cators to assess the effectiveness of the imple-
Health project. The project was conducted in eight mentation of its policies. These indicators include:
Pacific Island countries: Samoa, Papua New a reduction in youth suicide, ‘youth offender
Guinea, Vanuatu, Solomon Islands, Kiribati, Tonga, crime’, violence and child sexual abuse.
Fiji and Tuvalu. Reducing sexual risk behaviour to prevent ad-
The SNA conducted youth mental health edu- verse impacts on youth health is another high-pri-
cation and awareness, youth-to-youth mental ority area. In particular, reducing the incidence
health promotion and advocacy to facilitate the sexually transmitted infections, HIV/AIDs-related
implementation of the Samoa Mental Health Policy conditions and teen pregnancy.
(2006), legislation and recommendations on im- The current Samoa youth and development
provement and access to gender-sensitive youth strategies aim to improve community develop-
services. ment and by advancing social, economic and gov-
This study explored the situation of youth and ernance programmes such as the capacity of
mental health in Samoa. It suggests that youths’ women’s committees, micro-credit and village
choices were not only strongly influenced by per- based development programmes. They also con-
ceptions of themselves but also of their peers, tain a commitment to parent education and the
their families, social and religions expectations and impact of divorce on young people. All strategies
cultural beliefs. relevant to youth development acknowledge and
While youths referred to friends, parents, family commit to an improvement in education and em-
and pastors to provide support or refuge for them ployment, facilities and services development.
in times of need, many youth did not appear to “Mental health is everyone’s business” (WHO,
seek advice. Youths were conscious of how their 2002). Social problems that result in or from men-
actions may reflect on their parents and families. tal instability and illness, need to be recognised
Sometimes, if a wrong choice was made with re- and referred to appropriate services early for con-
sulting negative social implications, shame is fre- fidential counselling, treatment and/or rehabilita-
quently apportioned more to the family rather tion. Mental ill health is costly to any person’s life.
than the individual. Family might even be punished If not treated effectively, it reduces a person’s abil-
by the village council. This situation creates stress ity to function well and to be productive. Families
and carers need to learn to recognise the signs of
for both parents and young people.
mental ill health. If well informed, they can man-
Mental health promotion needs to acknowl-
age, support and care for family members and re-
edge that while cultural strengths provide guid-
duce the risk of preventable mental illness.
ance and resilience it also may create additional
Samoa has a recently revised Samoa Mental
stresses. Future YMH work must not only consider
Health Policy (2006) and a Mental Health Act 2007.
Samoan context but address external influences
Mental health facilities include a small, specialised
and find constructive avenues and means to facil-
unit with a community mental health service and a
itate effective ways for youth and their families to
range of mental health services provided by NGOs,
9
Youth and Mental Health in Samoa: A Situational Analysisreligious organisations and traditional healers. and living elements, from birth until death. Devia-
These services provide a variety of programmes tion from any of the three parts will result in a per-
related to mental health care and support, suicide son becoming unbalanced in normal functions
awareness, abuse victim support and alcoholic (tagata vale). Absence of life will result in the per-
support services. There are also some general son becoming deceased – tagata oti. (Samoan Phi-
counseling services available. The informal serv- losophy of Nursing, 1990).
ices provide a significant component of the mental These beliefs underpin the teaching of mental
health support in both urban and rural areas, often health in a holistic sense, that is, mental health be-
filling the gap in the absence of sufficient specialist fore the appearance of mental ill health or illness.
and primary services (Hughes, 2005). The Mental It is important to understand the mental health
Health Unit does not record that NGOs refer peo- continuum – from wellness to mental illness or
ple to the MH Unit. It is recommended that these death – and its relationship to the aspect of the so-
groups form a network for Mental Health Family cietal influences within which we care and raise
Association to provide the much needed family children and manage relationships.
support services. (Samoa Mental Health Policy, Adolescence is recognised as a time of change
2006). of rapid physical and emotional development, as
The Samoan expression for mental health is well as vulnerability to behaviours which may risk
“soifua maloloina o le mafaufau”, which means mental ill health and illness. The recommendations
that mental health is not simply the absence of contained in this report contain the common
mental illness, it is a holistic state of wellbeing. This theme of other Samoan reports: that meeting
perspective on mental health is rooted in Samoan youth needs in the education, employment and
cultural philosophy, which provides a basis for un- health sectors must be given a higher priority.
derstanding the essence of being a healthy Samoan society has an important role to play in re-
Samoan individual who is integrated in society and inforcing traditional cultural practices that support
includes the social, mental and physical aspects of the mental health of youth.
wellbeing in balance. This approach is also the The Samoan family, while it is the first social in-
foundation for nursing education and practice in stitution and the foundation of an individual’s be-
Samoa. haviours and attitudes, its stability and support is
In Samoan philosophy, it is believed that an in- important to provide have appropriate care and
dividual has three parts: mauli, aitu, and ola. Mauli guidance for youth. Therefore mental health
encompasses the inner being (tagata lilo); vision awareness is vital and the signs of mental ill health
(tofāmanino); insight (tofāloloto); dreams and mental illness need to be recognised early and
(fa’alepō); intuition (loto fuatiaifo); spirit (agaga); referred to appropriate to youth and gender sen-
and suspiciousness (masalo). Aitu encompasses sitive services for confidential counselling, treat-
the thought process (manatunatuga, fatua’iga o ment and/or rehabilitation, to ensure young
manatu, ma mafaufauga). Ola encompasses life people’s safety.
10
Youth and Mental Health in Samoa: A Situational Analysis1.0 Introduction
I
1.1 Background 1.2 Community mental health services in Samoa
n many countries, mental health has been given The Samoan Ministry of Health has 149 regis-
a low priority as a public health issue and as a tered cases of people suffering from mental illness
result, the burden of mental illness continues and about 70% of them are in the productive age
to grow throughout the world. group of 14-40 years (Mental Health Policy, Situa-
When people living with mental disorders are tional Analysis, MoH, 2005).
unable to access adequate care and treatment, In Samoa, as in other Pacific Island countries,
they become less productive and often have little communities, churches and families play an impor-
sense of fulfillment. The World Health Organiza- tant role in care of the mentally ill.
tion (WHO) and global and regional partners have Samoa moved away from institution-based care
been working to address this area of need by im- two decades ago and now has a system where
proving the quality and number of programmes families and nurses share responsibility for the
and training available for health workers, updating care and treatment of people with mental disor-
mental health legislation and formulating new ders within their families and communities.
policies and plans and encouraging their imple- The disadvantages of the previous model of
mentation. These organisations are working both care were:
in communities and at the national and regional Dressing patients in a uniform of green
level, but there is still a long way to go before the and/or blue hospital trousers and tops led
quality of life for the mentally ill improves to stigmatisation
markedly. On-the-hour schedules of medication and
In 2007, the Pacific Islands Mental Health Net- meals
work (PIMHnet), funded by NZAID, was launched On-the-hour schedule of sleep
during the Pacific Islands Meeting of Health Minis- On-the-hour schedule of time-out-walks
ters in Vanuatu. Countries in the network have around the hospital compound
pooled their collective experience, knowledge and Some patients were continually locked up
resources to promote mental health and develop in small, dark rooms due to uncontrolled
systems that provide effective treatment and com- violent behaviour.
munity mental health and care. In consultation with According to the SNA, the move from institu-
countries in the region, PIMHnet has identified a tional to community based care has been benefi-
number of priority areas, including advocacy; human cial to people with mental illness. The Ministry of
resources and training; mental health policy, plan- Health has a Mental Health Unit, which is central
ning, legislation and service development; access to to the care of the mentally ill in Samoa. The unit’s
psychotropic drugs; and research and information. family outreach service employs nurses who make
Network countries meet annually to develop work home visits. During the visits, which lasted 1 to 1.5
plans that address these priorities, to be officially en- hours, an initial general health assessment is car-
dorsed by their Pacific Islands ministers of health. ried out and the patient’s daily activity patterns are
PIMHnet has also developed strategic partner- discussed with carers and/or family members. The
ships with NGOs and other agencies working in the nurses note signs and symptoms of relapses and
Pacific region to build more co-ordinated and effec- review medication compliance, efficacy and/or
tive strategies to address the treatment gaps, im- side-effects. If the patient is functioning well; tak-
prove mental health care and end stigma, ing their medication and showing no signs of side-
discrimination and human rights violations against effects; is contributing to family life by doing
people with mental disorders. chores and is communicating well with others, the
The Samoa Nurses Association (SNA), through nurse will recommend continuing with the same
the Youth and Mental Health Project, under the aus- care plan until the next visit. If a patient becomes
pices of O Le Siosiomanga Society Inc and FSPI Re- unwell before the next visit, families must notify
gional Health Team, has supported mental health the Mental Health Unit clinic. When an assessment
education, awareness and advocacy to improve the shows the patient needs medical attention, they
support services for Pacific youth. are taken to hospital, either by a visiting nurse or
11
Youth and Mental Health in Samoa: A Situational Analysisby the family. The SNA reports that community The aim of the YMH project is to improve the
based care has resulted in better outcomes for mental health of Pacific youth. It includes aware-
people living with mental illness, which are evidentness, education and sustainable livelihoods, applied
in the following ways: research on the situation of YMH, youth-to-youth
better recovery due to early improved mental health promotion and advocacy to improve
communication with family and nurses policies, legislation and gender-sensitive youth serv-
medication compliance is better ices.
interpersonal relationships with family are Culture and family were identified as being sig-
not disrupted and therefore, there is no nificant factors in how young Samoans viewed life.
need to be hospitalised Therefore, mental health in the Samoan context
being useful and contributing to society is was explored an evaluated alongside international
better observed at home than in locked theories of mental health. This method allowed
psychiatric facilities the researchers to identify and understand the
less introduced western methods of care, unique values of the culture and how youths can
more chance of the ill person’s care being utilise them to live a productive and happy life.
tailored to specific needs within a family Youth acknowledged that the family can play a
setting positive role in enculturation and socialisation,
In order to provide specialised staff for these however, the Samoan Family Health and Safety
Study (2003) reveals this is not always the case. For
services, Mental Health and Mental Illness studies
example, parental violence can cause extreme
were introduced to the undergraduate nursing
stress and impair a young person’s mental health.
programme at the National University of Samoa in
As part of the project, youths were encouraged
1993 and this was followed by a Post Graduate
to reflect on and interpret their way of life and tra-
Diploma of Nursing in Mental Health, which was ditions and to identify the support systems avail-
run once in 2004. There were six graduates from able to them. Difficulties in voicing concerns
the course, three of whom are working in the Men- related to emotional issues such as uncertainty,
tal Health Unit. lack of self-confidence, unresolved anxieties, sui-
In accordance with the Mental Health Policy cidal thoughts and all forms of abuse were ad-
(2006) and the Ministry of Health Act 2007, Mental dressed. The YMH project is designed to build their
Health Care Professionals (MHCP) are registered resilience, coping strategies and ability to make
and appointed by the Minister of Health. All sound, safe and healthy choices. (Refer 5: YMH Ed-
MHCPs undergo a Credentialing Programme every ucation and Awareness).
three years to ensure the quality and safety of The Samoa Mental Health Policy (2006), the
their practice. Two mental health care profession- Mental Health Act 2007 and the Strategy for the De-
als are court officials who are appointed by the velopment of Samoa – 2008-2012 were used to
Minister of Health to advise the magistrate in guide the work of the YMH project. The project
cases between a mental health professional, such used the FSPI Mental Health Resource Kit (2007)
as a psychiatrist or nurse, and a person who has and drew from a pool of resources to conduct ad-
been diagnosed as having a mental disorder, but vocacy and education programmes.
refuses treatment. There were four focus areas identified:
1. To explore the status of youth mental
1.3 The Youth and Mental Health Project health in relation to knowing oneself and how to
The Youth and Mental Health (YMH) Project is make optimal choices;
co-ordinated by the Foundation of the Peoples of 2. To highlight the key gaps in youths’ capac-
the South Pacific International (FSPI) with financial ity to access traditional avenues for support and
assistance from New Zealand International Aid and empowerment;
Development (NZAID). The first phase of the proj- 3. To identify root causes of the gaps; and
4. To recommend solutions and actions to ad-
ect – from 2003-2006 – focused on Masculinity,
dress the gaps in families, villages, schools and at
Mental Health and Violence (MMHV). Participating
the individual level.
countries included Papua New Guinea, Vanuatu, Kiri-
This situational analysis describes the current
bati and Fiji. The second and current phase (YMH)
situation of youth mental health in Samoa and es-
added four more countries to the project: Tonga,
tablishes a platform for work in this area.
Solomon Islands, Samoa and Tuvalu.
12
Youth and Mental Health in Samoa: A Situational AnalysisThe Samoan Government recognised the need
to steer the focus of youth towards their culture
because it is through the already existing avenues
of culture that young people can achieve a produc-
tive and happy life.
As part of the project, youths were encouraged
to reflect on, interpret and critique their ways of
life and their traditions and practices as a means
of support. The reason being that, at the end of
the day, the Samoan youth goes back to his or her
family where all the nurturing, caring and coun-
selling occurs.
The Youth Mental Health Project took the policy
statements of intent and incorporated principles,
methods and practices recognised by government
strategic planning as attracting positive support
from other community groups. Samoa’s approach
to mental health is integral and intra-dependent
with its stakeholder partners in the public sector
and non-governmental organisations.
Youths explored ways of making relevant
choices in their families, schools, social environ-
ments and/or workplaces.
1.4. Methodology
1.4.1 Sample Population
Youths aged 12 to 29 years were recruited to par-
ticipate in group discussions and/or were given a
semi-structured questionnaire to provide individual
responses to questions. An additional number of
people aged 29 to 39 years were accepted as re-
spondents because they were active members of
youth groups reached by the YMH project. In all,
there were 250 young people in the sample group.
The response rate was 82% (205 out of 250 distrib-
uted questionnaires were completed and returned).
A semi-structured questionnaire was developed
by the first trainee group of nurses and was piloted
during school pupils’ mental health work and semi-
nars for improvements and finalisation.
1.4.2 Data collection and methods
YMH co-ordinators and nurses were the main
enumerators of information, conducting focus
group discussions and semi-structured question-
naires. The returned instruments were analysed
using data analysis programs for tabulations of
quantitative data, while information collected
from group discussions was classified and sorted
to identify common emerging themes.
13
Youth and Mental Health in Samoa: A Situational Analysis2.0 Samoa: An overview
S
amoa is an independent country made up of in line with the Convention on the Rights of the
10 islands in the central Pacific Ocean. Its Child (CRC). Both of these policies will be imple-
main islands are Upolu, Savai’i, Manono and mented by Ministry of Women, Community and
Apolima. According to the 2001 census, Samoa’s Social Development (MWCSD) in collaboration
population was close to 180,000, with 25 per cent with the ministries of Health, Justice and Courts
living in the capital, Apia, and the rest living in vil- and Administration, and Education, Sports and Cul-
lages. Samoan people are strongly community ori- ture. Areas of possible disadvantage of children
ented and the need to belong to and respond to covered in the policy are health, particularly in re-
the needs and demands of the social group is very gard to mental health, children with special needs
important to them (Samoa Family Health and or disabilities, violence and exploitation, education
Safety Study, 2007). and a range of other environmental and health
The Asian Development Bank reported in 2007 needs.
that the political situation continued to be stable
FIGURE 1: Map of Samoa
under the hegemony of the Human Rights Protec-
tion Party, which has ruled Samoa for the past 25
years. The government has engaged actively in
public sector reform and the country is no longer
classified as a Least Developed Country (LDC).
“Samoa has achieved a relatively high level of
sustainable economic growth and human develop-
ment and has emerged as a leader in economic
and public sector reform in the Pacific.” (ADB,
2007).
The Samoan Government recognises that en-
gaging youth in the workforce and in communities 2.1 The Samoan family
is vital to ensuring the continuing economic devel- “The traditional culture of Samoa is a commu-
opment of the nation. For youth to utilise their nal way of life. In the Samoan culture, all activities
most productive years, they must be equipped are done together.” (Watson, 1919). The three as-
with knowledge and skills that will enable them to pects of Samoan culture that are strongly main-
make a positive contribution. tained are religious faith, family and societal
The government’s TALAVOU (Towards a Legacy organisation. Family is viewed as an integral part
of Achievement and Opportunity through Unity) of a person’s life. The aiga, or extended family,
initiative is an integrated youth development pro- lives and works together. In Samoa, everyone has
gramme that aims to strengthen self-esteem, pro- a unique place in the subdivided guilds of society
vide employment opportunities and encourage and each guild has a societal role that reflects the
youth to be involved in the development of their status of each individual within it.
families and communities. The participants learn The traditional fales (houses) have no walls and
about family communication, enhanced economic 10 or more people may sleep in them. During the
development and strengthening traditional struc- day, the fale is the sitting and meals room and a
tures to address social issues affecting communi- place for relaxing and talking, while at night, it be-
ties (Strategy for the Development of Samoa, comes the prayer and sleeping room. Following
2008-2012) hurricanes and cyclones in the islands, many fam-
The National Policy for Women of Samoa 2007- ilies replaced their damaged oval-shaped,
2017 aims to expand opportunities for women and thatched-roof fales with aluminum-roofed houses,
ensure progress is made in implementing the Con- but retained the design of one large room for all
vention on the Elimination of Discrimination Against family purposes.
Women (CEDAW); while the National Policy For Chil- While new influences are adopted into the
dren 2007-2017 outlines the planned direction for Samoan lifestyle, the cultural values and beliefs re-
the care, protection and development of children main largely intact.
14
Youth and Mental Health in Samoa: A Situational Analysis3.0 Mental Health
T
he World Health Organization defines men- supported by technical advice and assistance.”
tal health as “the foundation for the well- (Samoa Commitment: Achieving Healthy Islands,
being and effective functioning of World Health Organization, 2005). The PIMHNet
individuals. It is more than the absence of a mental was launched at the next Ministers of Health
disorder. Mental health is the ability to think and Meeting held in Vanuatu in 2007.
learn, and the ability to understand and live with “There is a wide range of informal mental
one’s emotions and the reactions of others. It is a health services. These include NGOs, religious or-
state of balance within a person and between a ganisations and traditional healers. These services
person and the environment. Physical, psycholog- provide a variety of programs related to mental
ical, social, cultural, spiritual and other interrelated health such as suicide awareness, abuse victim
factors participate in producing this balance. The support and alcoholic support. There are also
inseparable links between mental and physical some general counseling services available. These
health have been demonstrated.” (World Health informal services provide a significant component
Organization Regional Office for the Western Pa- of the mental health care in both urban and rural
cific Region, 2002). areas, often filling the gap in the absence of suffi-
cient specialist and primary services”. However,
3.1 Mental Health in the Pacific there are insufficient services to available to meet
In its Regional Strategy for Mental Health (2002), the needs of young people.
the World Health Organization noted that in the It is recommended that these groups form a
Western Pacific Region, physical health had im- network for a Mental Health Family Association to
proved significantly in the past 50 years, however, provide the much needed family and youth sup-
mental health had worsened. This region has a port services. (Samoa Mental Health Policy, 2006).
higher rate of mental and neurological disorder
compared to other parts of the world and mental 3.2 The Samoan perspective on mental health
health services are often scarce and poorly re- The Samoan expression for mental health is
sourced (Hughes, 2005). “soifua maloloina o le mafaufau”, which means
In 2003, at a meeting of Health Ministers from that mental health is not simply the absence of
the Pacific Island countries in Tonga, mental health mental illness, it is a holistic state of wellbeing.
emerged as a ‘major issue’ requiring urgent atten- This perspective on mental health is rooted in
tion. “The increasing incidence of suicides, sub- Samoan cultural philosophy, which provides a
stance abuse, etc., all point to the need to increase basis for understanding the essence of being a
availability of services. The training of health work- healthy Samoan individual who is integrated in so-
ers in mental health is inadequate.” It was decided ciety. The Samoa Mental Health Policy 2006 refers
that the training of nurses for mental health and to a multisectoral approach which involves part-
psychiatric care required urgent attention as did nerships with government and non-governmental
the development of policies and legislation (Tonga agencies. It recognises that quality of care to be
Commitment to Promote Healthy Lifestyles and Sup- “accessible to all people while recognising mental,
portive Environment, World Health Organization, physical, social and spiritual health are indivisible.”
2003, p20). This approach is also the foundation for nursing
When the Pacific Island Health Ministers met education and practice in Samoa. In Samoan phi-
again in Samoa two years later, the meeting report losophy, it is believed that an individual has three
summed up the region’s mental health situation in parts: mauli, aitu, and ola. Mauli encompasses the
a few lines: “Countries and areas should inner being (tagata lilo); vision (tofāmanino); in-
strengthen action on mental health and regional sight (tofāloloto); dreams (fa’alepō); intuition (loto
agencies should develop and sustain a Pacific is- fuatiaifo); spirit (agaga); and suspiciousness
land mental health network as one means of pro- (masalo). Aitu encompasses the thought process
viding support through an alliance of mental (manatunatuga, fatua’iga o manatu, ma mafau-
health workers sharing mutual experiences and fauga). Ola encompasses life and living elements,
15
Youth and Mental Health in Samoa: A Situational Analysisfrom birth until death. Deviation from any of the Ensure essential drug procurement and
three parts will result in a person becoming unbal- laboratory support
anced in normal functions (tagata vale). Absence Build capacity for leadership and advocacy
of life will result in the person becoming deceased Quality improvement
– tagata oti. (Samoan Philosophy of Nursing, 1990). Improved information systems for more
informed care
These beliefs underpin the teaching of mental
Strengthened research, monitoring and
health in a holistic sense, that is, mental health be- evaluation.
fore the appearance of mental ill health or illness. (Samoa Mental Health Policy, 2006)
It is important to understand the mental health In 2007, at the meeting of Pacific Health Minis-
continuum – from wellness to mental illness or ters in Vanuatu the report The Vanuatu Commit-
death – and its relationship to the aspect of the ment, World Health Organization, 2007), noted
societal influences within which we care and raise that Pacific Island countries were making progress
children and manage relationships. towards implementing mental health strategies
Adolescent health is a high priority as it is a time and action. An example cited was that Samoa in-
of change and emotional development, which may troduced a national mental health policy and sup-
involve risk behaviours. (Refer 3.3). For this reason porting legislation.
adolescent mental health must be given a high pri- There are several factors that have a significant
ority. Ideally, the Samoan values of love, respect external and societal influences on the increasing
and spiritual ethics are taught early in children’s prevalence of mental ill health in Samoa. They are:
lives and can provide a strong foundation for them Increasing urbanisation: More people are
to negotiate the risks and challenges of adoles- moving away from villages and therefore, away
cence. from their traditional support structures of family
Samoan youth are encouraged to be culturally and community.
competent in their roles and relationships with
Hardship: While Samoa’s ranking on the
others, their responsibilities and in making sound
Human Poverty Index is favourable in comparison
judgments. To help youths to become good citi-
to other Pacific Island countries, a significant num-
zens and future leaders of Samoa, it is crucial they
ber of people are suffering economic hardship. It
understand the importance of mental health and
can be both a cause and a consequence of mental
thinking positively so they are able to cope with
illness and disorders. The stress caused by eco-
change and adversity and be successful in life.
nomic insecurity can lead to a mental disorder,
while the periods of unwellness that often charac-
3.3 Mental health policy and legislation
terise mental illness may prevent a person from
The August 2006 introduction of the Samoa
holding down a job.
Mental Health Policy was an encouraging sign of
Substance abuse: The abuse of substances,
the Government’s commitment to giving a higher
particularly alcohol and marijuana, is increasing
priority to this area of public health. It outlined 11
within the community, particularly among the
key areas for action. They were:
young. Both alcohol and marijuana use are associ-
Ensuring appropriate financing of
prioritised services ated with a higher prevalence of mental disorders.
Legislation and human rights Migration: With the loss of productive peo-
Organisation of services ple through migration, there are fewer people to
Human resources and training support older and disabled family members. The
Facilitate and provide supports to affected increased stress on the remaining carers can result
families in them developing a mental disorder or illness.
Areas of focus for promotion, prevention, Samoa is also losing experienced health workers
treatment and rehabilitation are: through migration and this has an impact on the
i. Suicide prevention
health system’s ability to care for people with a
ii. Drug and alcohol abuse
iii. Sexual abuse: Child and adolescent mental illness.
abuse
iv. Early recognition and management 3.3.1 Mental health services in Samoa
of mental disorders Samoa’s acting head of the Mental Health Unit,
v. Domestic violence Dr Ian Parkin, was quoted as saying in the New
vi. Dignity of the family Zealand Herald that there were only three nurses
16
Youth and Mental Health in Samoa: A Situational Analysisworking specifically in the field of mental health
and only one psychiatrist to help those with men-
tal problems. (NZ Herald, June 14, 2007). The Men-
tal Health Unit, which comes under the Ministry of
Health, provides support for people suffering
from a wide range of illnesses including long-term
mental disorders such as schizophrenia, bipolar
disorder, drug-induced psychosis and epileptic psy-
chosis as well as some cases of depression, anxiety
disorders or dementia. Staff levels in the unit have
remained the same for the past five to six years.
As of 2009, there were three full-time mental
health nurses; three other mental health nurses
working at different locations and one part-time
psychiatrist.
The Mental Health Unit receives three to four
referrals a week for mental assessment and con-
sultation from the Tupua Tamasese Meaole (TTM)
hospital, families and individuals. A four-bed ward
was built at TTM hospital so that people with men-
tal disorders could be treated as inpatients, how-
ever, the beds have not been officially opened. The
hospital still does not offer inpatient care for the
mentally ill. They may be placed in general hospital
beds or for serious cases, in police cells. The unit
has no structured rehabilitation programmes and
there are no dedicated open beds for people with
mental disorders. Families sometimes ask tradi-
tional healers to come and treat a relative who is
believed to be mentally ill (Samoa Mental Health
Policy, 2006). (Refer appendices II - Status of Men-
tal Health Services 2005-2009and refer 1.2 ‘Com-
munity Mental Health Services in Samoa’ for an
account of the Samoa Nurses Association’s vital
role in the deinstitutionalisation and maintenance
of community mental health services in Samoa.)
17
Youth and Mental Health in Samoa: A Situational Analysis4.0 Issues facing youth
S
ince the 1980s, there has been a significant situation is seen as normal in Samoa.
change in the age structure of the Samoan An individual’s contribution is not measured in
population. The fastest growing age group terms of money earnings, but rather, what they do
is 15-19 years (Samoa National Human Development to support the family. Gender roles are specifically
Report 2006). Samoa’s youth population – 12 to 29 defined. For example, the male is consider malosi,
years – is 57,505: males – 30,178 and females – meaning the strength of the family. The transition
27,327. There are two-thirds more youth living in of a young person to adulthood is marked by ma-
urban areas than rural areas (Bureau of Statistics, ture judgement and not just by age. For young
2006). Youth are young people, ‘not yet married’ men, physical strength, service to elders and in-
who are not full adults in terms of responsibility creasing judgement and responsibility are indica-
(Shore, 1965). The Samoan Government defines a tors of maturity. A young man of 21 years may be
“young person” as someone aged from 14 to 21. unemployed, but he cooks and plants banana and
However, the Samoan Youth Policy 2001-2010 de- taro in the backyard or goes fishing to feed the
fines youth as 12 to 29. family. For young women the expression ‘teine ta-
The Samoa National Youth Policy 2001-2010 iden- lavou’ makes reference to the girls’ virginity as well
tified the main issues facing youth as: as to her unmarried, youthful status. While tradi-
cultural change tionally and culturally, girls are perceived to have
at-risk sexual behaviour a special role as sisters ‘under the protection of
alcohol and substance abuse their brothers’, Samoa ratified the CEDAW in sup-
youth suicide port of women human rights in 1992 (UNIFEM,
juvenile delinquency 1995).
lack of parent care and impact of divorce TABLE 1: Persons 15+ by main activities and sex,
lack of skills training centres 2006
not enough sports and recreational ECONOMICALLY ACTIVE TOTAL MALE PERCENT FEMALE PERCENT
facilities. Paid job 28,179 17,714 63 10,465 37
Subsistence for sale 1219 749 61 470 39
4.1 Employment
Subsitence for family use 15,652 10,324 66 5328 34
Subsistence for sale and family use 8878 7691 87 1187 13
Last year, the Asian Development Bank (2008) Look for work – employed between 2005-2006 46 31 67 15 33
reported that the nation had made significant Look for work – employed before 2005 199 138 69 61 31
progress towards achieving the Millennium Devel-
Look for work – never employed before 462 249 54 213 46
opment Goals, but the creation of formal employ-
Total 54,635 36,896 68 17,739 32
ment and income-generating opportunities was a
NOT ECONOMICALLY ACTIVE
Attending school 13,358 6617 50 6741 50
critical issue for communities in both urban and Unable to work – old/disability 5315 2367 45 2948 55
rural areas. These issues were explained in an eco- Domestic work/housework 34,042 9444 28 24,598 72
nomic study by KVA Consultants Ltd (2007), which
Total 52,715 18,428 35 34,287 65
stated that “7.6 per cent of families were under
Not stated 2454 1329 54 1125 46
109,804 56,653 52 53,151 48
the food poverty line”.
This estimate was based on the cost of a mini- Twice as many men as women were classified
mally nutritious diet, with a daily energy value of as actively employed. The unemployed were gen-
“approximately 2,200 kilocalories per adult per erally not considered a burden because of their
day.” In addition, the Population Census (Samoa contribution and the performance of assigned
Statistics Dept. 2001) stated, “about 49 per cent roles in the family.
of the population in Samoa is economically inac- For the unemployed people 15+, 89% were
tive, while about 5 per cent of the economically ac- young adults aged 15 to 34 and 11% were in the
tive population is unemployed”. older age group. The sex distribution in Table 1
This information reflects the aiga as the social shows that more than twice as many men as
security of individuals where in many cases, only women were employed. This suggests that males
two or three people in a family of eight to ten earn may be more likely than females to seek and find
wages. The rest of the family is taken care of by employment or that females may be responsible
the few people with a source of income and this for more unpaid work. It is likely that women have
18
Youth and Mental Health in Samoa: A Situational Analysisless access to paid employment. This requires employment, material wellbeing, markets, job se-
more research and analysis to understand the dif- curity and social freedom. Youth suicide is known
ferences in employment opportunities between to be linked to the expectations of young people
men and women and the impacts of these differ- and their parents in relation to education. “Each
ences. year, a new group of school leavers try to join the
The YMH survey of youth indicated there was a labour force, many of them prepared for white-col-
lack of understanding about the contributions lar jobs that do not exist.’’ (Samoa National Human
made by men and women through their defined Development Report, 2006).
roles in village councils and in village women’s While extreme forms of poverty such as desti-
committees. tution and starvation are not evident in Samoa,
The Samoan National Human Development Re- there is significant hardship. The basic needs
port (2006) found that many students were leav- poverty line is estimated to be highest in Apia,
ing school with inappropriate skills to secure their while it is lowest in Savai’i. In urban areas, the rel-
own sustainable livelihoods. Parents’ expectations atively poor are mostly people who live on leased
often focused on academic attainment rather than land with insufficient area to grow crops who live
vocational skills. It is important that a range of in flood-prone areas or on traditional lands with lit-
both technical and academic education and train- tle access to transport, communication and water.
ing opportunities exist so school leavers may sup- In rural areas, the relatively poor are most likely to
port themselves and their families. be youth, the elderly and people living inland who
Young people leaving school are faced with lim- have limited or no access to market produce and
ited options for formal employment and as a re- basic services. These types of hardship can give
sult, many rely on subsistence farming for survival, rise to social problems and there is a need to pro-
particularly those who were unsuccessful in their mote mental health awareness in high-risk settle-
final-year exams. There is a need to strengthen ment areas.
trade, technical and vocational education at sec-
ondary schools and at tertiary level. 4.3 Education
Youth want improved health, education and In 1959, formal education was made compul-
employment opportunities. One of the recom- sory for children aged 5 to 14. The cost of having a
mendations in the Strategy for the Development of child at school – WST 100-150 for primary and WST
Samoa 2008-2012 is to improve access to life skills 200-400 for secondary students – is beyond the
and continuing education for adults and youth. A means of some parents and a large number of chil-
priority is to develop a strategic approach to post- dren from disadvantaged families drop out of
school education and training in the tourism, hos- school (ibid, pp 63). A review of schools found that
pitality, technology, community and health most junior secondary schools were inefficient and
services. This will improve the mental health out- that few students were able to move on to senior
look for young people as they will have the oppor- secondary school (ibid, p 63).
tunity to learn skills to enable them to support
themselves.
FIGURE 2: Population 15+ by educational
4.2 Poverty attainment, 2006
Health-specific and social policy research find- Not Less/None
ings may directly or indirectly inform us of risks re- stated
10%
2%
Primary
lated to mental ill health such as alcoholism and 22%
smoking. “Hardship is both a risk factor for and a Tertiary
consequence of mental disorders. For example,
11%
the stress associated with economic insecurity
may precipitate a mental disorder. Similarly, the
chronic and relapsing course of many mental ill-
nesses may disrupt a person’s ability to maintain
employment and earn an income.” (Ministry of
Health, 2007).
There is a growing realisation that “poverty of
opportunity” is a serious problem. This type of
poverty relates to access to education, health care, Secondary
55%
19
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