Table 3 Summary of community perceptions about current MHPS issues

Ex-combatants

Ex-combatants were described as displaying behaviours thought to reflect the long-term impact of trauma exposure including substance abuse; weakening of family responsibilities; conflict with spouses concerning the use of money to purchase alcohol; perpetration of violence (including sexual) against women and children; and the use of sex as a coping mechanism. Substance abuse and the perpetration of sexual assault by ex-combatants have been reported elsewhere [13, 14]. While the number of ex-combatants displaying these behaviours across Bougainville is unclear, in personal communication with DT, a local politician and Catholic Nun reported that 232 ex-combatants were identified in one of Bougainville’s 33 political constituencies as manifesting one or more of these problems

Lost generation

Those who were children/adolescents during the war are referred to as the “lost generation” in Bougainville. This group were described as being marginalized and alienated, having limited to no formal education, lacking engagement with traditional social values and roles and displaying aberrant behaviours

Some of this group continue to be impacted by their war experiences which include armed combat, witnessing human rights abuses and being displaced into care centres [14, 24]. While the number within this group who are adversely impacted by these experiences is unknown, a few years after the war an expatriate Marist Brother teacher/counsellor noted that most of 50 male students, who had been involved in combat, were impacted by post-traumatic stress including displaying a range of aberrant behaviours considered to be trauma related [24]

Substance abuse

Substance abuse (home brewed and commercial alcohol and marijuana) is considered a major problem and was reported to be associated with rape and unwanted pregnancies, fighting, criminal behaviour, the destruction of village values and drug induced psychosis. These detrimental impacts have also been identified in a number of reports [14, 23, 29]. Substance abuse has been linked with unresolved trauma [14, 23]

Gender violence

Gender-based violence including sexual violence is considered a significant issue in Bougainville. The view is that gender-based violence including sexual assault has continued at a higher rate compared to that prior to the war. Qualitative research has identified a high prevalence of gender-based violence including sexual assault in Bougainville [27, 28]. Gender based violence has been linked with unresolved trauma [14]

Missing persons

People continue to search for the remains of relatives, who are presumed to have died during the war, to return them to their clan for customary burial. It was reported that the inability to perform customary burial ceremonies complicates the grieving process and has implications for land ownership and use [14], The numbers impacted by their inability to locate the remains of relatives is unknown, but it was estimated that there are “many” ([14], p. 7). The importance of the issue however is reflected by the fact that in 2014 the Autonomous Government of Bougainville acknowledged the suffering of the relatives of the missing and adopted a policy to clarify their fate [33]

Police force

Senior police reported considerable difficulties for the police force generally coping with working in a post-conflict community impacted by a range of MHPS issues. They also reported that some officers who are ex-combatants continue to be impacted by their war experiences, and this impacts their work performance and families. The various issues contributing to the difficulties policing in Bougainville have been reported elsewhere [14]

Displacement

People continue to be displaced within and outside Bougainville. Some are living with relatives causing great strain on host families, while others are living insecurely squatting on land belonging to others [14]. Reasons reported for not returning to their villages include unresolved trauma, fear of rejection for past crimes and threats of violence [14]. The burdens of displacement include separation from families and traditional lands [14]. The numbers who continue to be displaced is unknown but in 2003, as many as 9000 who fled to the Solomon Islands had not returned [1] and it has been estimated that thousands of families continue to be displaced within Bougainville [14]

Trans-generational impact

A trans-generational impact of the war appears to be emerging among those born after the war. Reports indicate that this group have been impacted by their exposure to a range of trauma-related aberrant behaviours in parents and the society at large (e.g. excessive drinking, weakening of family and community structures, absence of customary guidance and role models previously provided by traditional authority structures)