title: The mental health and psychosocial impact of the Bougainville Crisis: a synthesis of available information.
abstract: BACKGROUND
  The Bougainville Crisis (1988-1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis.
  
  
  METHODS
  A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues.
  
  
  RESULTS
  The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage; and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues.
  
  
  CONCLUSIONS
  The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs.
authors.affiliation: St. John of God Frankston Rehabilitation Hospital, 255-265 Cranbourne Rd, Frankston, VIC Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tierney
authors.affiliation: Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolton
authors.affiliation: Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea.
authors.forename: Barnabas
authors.initials: B
authors.lastname: Matanu
authors.affiliation: Nazareth Treatment Centre, Chabi, Autonomous Region of Bougainville, Buka, Papua New Guinea.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Garasu
authors.affiliation: Buka Hospital, Autonomous Region of Bougainville, Buka, Papua New Guinea.
authors.forename: Essah
authors.initials: E
authors.lastname: Barnabas
authors.affiliation: Psychiatry Research and Teaching Unit, Academic Mental Health Unit, University of New South Wales, Southwest Sydney Local Health District, Sydney, Australia.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
keywords: Bougainville Crisis; Civil war; Mental health and psychosocial impact