Youth and Mental Health in Tuvalu: a Situational Analysis

Youth and Mental Health in Tuvalu: A Situational Analysis

Commissioned by the FSPI Regional Health Funded by NZAID Programme Tuvalu Association of Non-Governmental Government Foundation of the Peoples of the Organisations of Tuvalu South Paciﬁc International USP Library Cataloguing-in-Publication Data

Morris, Teuleala Manuella Youth and mental health in Tuvalu : a situational analysis / Teuleala Manuella Morris . – Suva, Fiji : Foundation of the Peoples of the South Paciﬁc International, 2009. p. ; 30 cm. ISBN 978-982-9091-13-0 1. Youth—Mental health—Tuvalu 2. Youth—Tuvalu—Social conditions 3. Mental health—Tuvalu I. Foundation of the Peoples of the South Paciﬁc International II. Title. RA790.7.T8M677 2009 362.2099682

o the young people of Tuvalu who partici- Manuella, Lopati Samasoni, Reverend Tafue pated in the survey, we extend a special Lusama, Siosi Finiki, Melitagi Lifuka, Salilo Enele, thank you. It is our hope that by illuminating Melei Melei, Tefiti Malau, Tebau Sotaga, Captain Tmental health issues in this report, the future will Usugafono Tofiga, Eti Esela and John Herdsford, be brighter for all of you. from the ALPHA (Seamen Recruiting Agency); the This work is also dedicated to the memory of young people living with mental illness, and their Tiesi Livi Tapumanaia, a 15-year-old girl from the in- families and carers. digenous Funafuti community, who contributed Special thanks to Bateteba Aselu Esela for help- much to the research, but died before the report ing with the data entry and analysis and to Lupe was published. Tavita for providing an analysis of domestic vio- We wish to thank the following people for pro- lence against women in Tuvalu. To Nia Nakala, who viding much of the information for this Situational worked on the graphics for the front cover of this Analysis: Pulefenua o Vaitupu Lonitona Panapa report; the Staff of the Department of Community (Chief for Vaitupu Island); Reverend Kalahati Kilei, Affairs and the Ministry of Home Affairs, for assist- his Faletua, Oliula Kalahati, and te Talavou o ing with the logistics of the survey; and to Youth Vaitupu (Church Youth Organisation); Te Lima Mal- Officer Petueli Noa, who organised the focus osi (Youth Organisation for te Fenua o Vaitupu, the groups of young people from the islands of Tu- island community); the Principal of Motufoua Sec- valu. ondary School, Mosese Halofaki, and staff, espe- We are grateful to Margaret Leniston, Regional cially Kaboua Eli and Elaine Laupepa; Reverend Health Programme Manager, and Margaret East- Iosefa Mautinoa, his Faletua, Elenisi Mautinoa, and gate, Regional Youth Mental Health Project Co-or- Losiga Nelesone and the youth on Nukufetau; dinator, from the Foundation of the Peoples of the youth from Vaiaku Village, Fenua o Funafuti, South Pacific International (FSPI). Thanks must Fakaifou Village, Lofegai Village, all of the youth also go to Annie Homasi, the National Co-ordinator from the Tuvalu islands who participated, either for Tuvalu Association of Non-Governmental Or- in focus groups or in interviews, for the Knowl- ganisations (TANGO), for providing technical sup- edge Action Practice (KAP) survey and who helped port. to organise youths on their islands for research Our sincere appreciation to FSPI and to New work. Zealand International Aid and Development We gratefully acknowledge the key informants: (NZAID), for providing the funding that enabled us Dr Stephen Homasi, Dr Puakena Boreham Pasuna, to carry out this important study for Tuvalu. Dr Nese Ituaso Conway, Penehulo Hauma, David

3 Youth and Mental Health in Tuvalu: A Situational Analysis Foreword by the Honourable Minister of Health, Italeli Taeia

t is with a sense of honour and eagerness lives, regardless of our status, either as a par- that I present this report for all those ent, a community leader, a pastor, a civil ser- who are concerned with nurturing the vant or as a member of the private sector, mental,I spiritual and physical health of Tu- for the health of future generations. valu’s young people. Government will examine these issues se- Youth and Mental Health in Tuvalu Islands: riously and introduce viable measures to en- A Situational Analysis is the first report to analyse sure that mental ill health among youth is the mental health of this age group. The report will addressed through advocacy programmes that in- act as a guide to the development of our young crease awareness among all stakeholders. It is people, not only for the Tuvalu Government and vital that young people with mental illness receive non-governmental organisations, but also for the improved treatment and services from qualified regional and international donor community. medical personnel. It recommends a holistic and sustainable ap- With these words of encouragement, I would proach to fostering youth mental health and pro- like to commend everyone who helped to provide vides a checklist of the services available and those the new insights into youth mental health that are that are needed. This will serve as a valuable re- documented in this report. Special thanks to the source for families, the community, the Church, office of FSPI for kindly making this research pos- the Government and civil society. The report calls sible for Tuvalu by means of financial and technical on us to implement strategies and create an envi- support. ronment that will provide optimum conditions for Knowing is not enough, but working together the social, psychological, spiritual and physical de- to advance mental health will change the lives of velopment of our youth. our young people for the better. In this era of change and globalisation, our traditional way of life and our identity as Tuvaluans Fakafetai lasi and thank you very much. are being challenged. We Tuvaluans have been colonised and decolonised and are now subject to Te Atua mo Tuvalu, God is for Tuvalu. the many influences of the modern world. This report reminds us of the effects these challenges and influences have on mental health, particularly that of our youth. I would therefore like to encourage all of us to look deeply into our hearts and examine what it means to ‘give the best’ to our children and our Honourable Italeli Taeia, youth, who hold Tuvalu’s future in their hands. It Minister of Health, is our duty to contribute constructively to their Government of Tuvalu

4 Youth and Mental Health in Tuvalu: A Situational Analysis Message from the National Co-ordinator, Tuvalu Association of Non-Government Organisations

he Tuvalu Association of Non-govern- and implement the project in Tuvalu. mental Organisations (TANGO) be- We want to thank the island communities, lieves the future of a nation is its including the young people on Nukufetau, young people. Through this report, TANGO Vaitipu and the principal and staff of Motu- T foua Secondary School for organising the re- has aimed to provide a forum for our youth to voice how they are coping with the search work with the students; pastors on lifestyle changes they experience. Vaitupu and Funafuti especially for Lofeagai, Youth and Mental Health in Tuvalu spells out and youth on Fakaifou, Funafuti and Vaiaku for how young people feel about the kind of environ- being open and involved in the interviews. To the ment we are building and how it affects their men- island Chief on Vaitupu, the elders on Funafuti, pro- tal health. It reveals their struggles in coping with fessionals in Government and the various people social and economic problems and the demands who provided input for this report, we are deeply of parents and island communities that they do grateful. well in education and find employment. Some- Special thanks to Ms Teuleala Manuella Morris times young people are overwhelmed by the high for her interest in the work and for carrying out expectations placed on them and struggle with the research and the analysis. Also, for allowing aimlessness, alcohol abuse and financial hardship. staff within the Department of Community Affairs The two main pillars of Tuvaluan society, par- to assist in the formatting of this report and in the ents and island communities, need to be aware of data-related work. the challenges confronting young people in order Moreover, our sincere appreciation to the staff to ensure they can participate in and benefit from of FSPI for their editorial and technical support and the traditional way of life and modernisation. for the co-ordination of the publication of this re- It is of paramount importance that Govern- port, including the support of New Zealand Inter- ment, the private sector and non-governmental or- national Aid and Development (NZAID) for funding ganisations help members of civil society, such as this Youth and Mental Health Project in Tuvalu parents and elders, to understand the changing through FSPI. lifestyles of our young people. In order to ad- Our greatest hope is that the report will be vance their development, we must nurture their taken seriously by people at all levels of our society mental health through preventative measures and so that Tuvalu’s young people are cared for and also help them to understand and cope with life’s equipped to deal with these changing times. This demands. can only be done if we develop effective strate- TANGO has employed an officer to plan, imple- gies in our homes and communities that will sup- ment, co-ordinate, monitor and evaluate actions port and empower them to live in a harmonious that will advance mental health for young people relationship with society and the environment. in Tuvalu. The TANGO office is adamant about ed- ucating, advocating and assisting in the develop- Fakafetai lahi. ment of an integrated approach in which all stakeholders work together to improve services and help young people with mental health issues. At the same time, TANGO wants to encourage families, elders, pastors and the community to participate in designing a more strategic approach to maintaining a mentally healthy youth population. TANGO knows that such goals would not be ac- complished without support from our donor, NZAID, and the guidance of the Foundation of the Annie Homasi Peoples of the South Pacific International (FSPI), National Co-ordinator which have enabled us to conduct this research TANGO

5 Youth and Mental Health in Tuvalu: A Situational Analysis Table of Contents

Acknowledgments...... 3 Foreword from the Honourable Minister of Health, Italeli Taeia...... 4 Message from the National Co-ordinator of TANGO...... 5 Table of Contents...... 6 List of Tables and Figures...... 7 Abbreviations and Glossary ...... 8

SECTION 1: INTRODUCTION

SECTION 2: TUVALU : AN OVERVIEW

SECTION 3: LITERATURE REVIEW

SECTION 4: RESEARCH FINDINGS

6 Youth and Mental Health in Tuvalu: A Situational Analysis List of Tables, Figures

Table 1: Table 2: Table 3: Table 4: Table 5: Table 6:

Figure 1: Figure 2: Figure 3: Figure 4:

7 Youth and Mental Health in Tuvalu: A Situational Analysis Abbreviations

ADB Asian Development Bank BSS Behaviour Surveillance Survey CEDAW Convention on the Elimination of Discrimination Against Women CRC Convention on the Rights of the Child CTC Community Training Centres EKT Ekalesia Kelisiano Tuvalu FIT Fiji Institute of Technology FSPI Foundation of the Peoples of the South Paciﬁc International HIES Household Income and Expenditure Survey KAP Knowledge Action Practice LMS London Missionary Society MDGs Millennium Development Goals MMHV Masculinity, Mental Health and Violence NGOs Non-Governmental Organisations NZAID New Zealand International Aid and Development TANGO Tuvalu Association of Non-Governmental Organisations TMS Tuvalu Marine Services TMTI Tuvalu Maritime Training Institute TNCW Tuvalu National Council of Women TNYC Tuvalu National Youth Council TRCS Tuvalu Red Cross Society TuFHA Tuvalu Family Health Association STI/HIV Sexually Transmitted Infection/Human Immunodeﬁciency Virus WHO World Health Organisation

Glossary Fakaala traditional feasting Falekaupule traditional meeting place Fonopule Island Council (terminology used during Colonial era) Kaupule Island Council (word changed from Fonopule after Independence) Limamalosi youth – the “strength of the island” Mafaufau thinking, the mind Mafaufau ola mentally healthy Matai o kaitasi head of the extended family Pulaka giant swamp taro (Cytosperma species) Talavou youth, youth group Taumalo becoming a young man Tauiti becoming a young woman Te ekalesia the Church Te fenua the island Te kaiga the family Te mafaufau ola mental health

8 Youth and Mental Health in Tuvalu: A Situational Analysis 1.0 Introduction

1.1 Project Description ii. Stakeholders, both in Government and civil he Youth Mental Health Project is co-ordi- society, identify appropriate strategies that are fi- nated by the Foundation of the Peoples of nancially and technically feasible, and are culture the South Pacific International (FSPI) with fi- and gender-sensitive; Tnancial assistance from New Zealand International iii. Contribute to the development of a National Aid and Development (NZAID). The first phase of Plan of Action on Mental Health for Tuvalu; and the project – from 2003 to 2006 - focused on Mas- iv. Stakeholders identify existing services that culinity, Mental Health and Violence (MMHV). Par- need improvement and recommend new services ticipating countries included Papua New Guinea, to improve mental health in Tuvalu. Vanuatu, Kiribati and Fiji. The current phase of the project concentrates on evaluating the status of 1.4 Research Methodology mental health among youth to help determine the Participatory methods of primary research future directions of the project and has been ex- were used to engage young people through indi- tended to four more countries, which include vidual and focus group discussions on issues relat- Tonga, Solomon Islands in 2006 and in 2007 to ing to their mental health. About 70 young people Samoa and Tuvalu. participated in the interviews and 65 youth were involved in the focus group discussions. A total of 1.2 Project Aim and Objectives 38 young people gathered together from all of the 1.2.1 Aim islands in Tuvalu and 10 youths on Vaitupu and an- The aim of the project is to understand, im- other 10 youths in Motufoua were involved. Young prove, strengthen and maintain mental health people identified the services available to them among young people in Tuvalu. and made recommendations. Some issues and recommendations were discussed with key stake- 1.2.2 Key Objectives holders in Government, the private sector and the i. To increase awareness among stakeholders of community to consolidate their ideas and provide issues related to youth and mental health and the technical input and advice. status of mental illness and disorders among Another seven young people formed a focus young Tuvaluans. group that worked on defining mental health in ii. To develop youth-focused, evidence-based re- the Tuvaluan context. The Cultural Officer and two search and information to guide decisions by pol- others – a male and a female – from the commu- icy makers and service-providers on sustainable nity were interviewed about the definition of men- services for mental illness. tal health and the latter interview was used for iii. To develop promotional materials on youth pre-testing purposes. mental health to improve the coping capacity of The Knowledge Action Practice (KAP) method people with mental health problems. This will be was used to interview young people from the four done by increasing access to community support areas of Funafuti and the outer islands of Nukufe- and mental health services; tau and Vaitupu. The questions focused on identi- iv. To increase support for mental health net- fying key issues that affected their mental health, works among stakeholders in Government, the pri- while discussions examined actions taken and rec- vate sector and in civil society in order to foster a ommended services to address the issues. Lastly, more integrated approach to mental health policy practices included identifying supporting agencies development; and and their recommended strategies for improving v. To co-ordinate the implementation of the the situation. Mental Health Project to ensure that mental In Funafuti, the main villages, Lofeagai, Fakaifou health initiatives for young people are effective. and Vaiaku, and the indigenous Funafuti youth, were interviewed. On Vaitupu, interviewers spoke 1.3 Expected outputs to village youths and students from Forms 3 to 6 at i. A better understanding of the causes and ef- the only Government-owned secondary school, fects of mental health and illness; Motufou, who were aged 13 to 17 years. On

9 Youth and Mental Health in Tuvalu: A Situational Analysis Vaitupu, there were two separate focus groups of alcohol use and abuse. The interviews and consul- five young men and five young women who dis- tations were aimed at exploring the root of the cussed issues related to mental health and identi- problem and during the process, sensitive, per- fied the causes of mental ill health they had sonal issues often came up. Counselling was pro- experienced. Focus groups of students at Motu- vided to ease mental stress that arose from the foua, consisted of 10 students: five girls and five discussions. boys from forms 3 to 6. In Nukufetau, information was gathered from interviews with 10 youth: five TABLE 6: Youth organisations in Focus Group boys and five girls. Discussions The four communities in Funafuti were chosen Youth organisations Males Females Total 2 1 3 for their unique sites and characteristics. These Nanumea Island Youth Nanumaga Island Youth 2 1 3 are Lofegai, Fakaifou, Vaiaku and the indigenous Niutao Island Youth 2 1 3 Funafuti community. The first three villages on Fu- Nui Island Youth 2 1 3 nafuti consisted of families from outer islands who Vaitupu Island Youth 6 7 13 had come to the capital to find work or were al- Nukufetau Island Youth 1 2 3 ready employed by the Government or private sec- Funafuti Island Youth 1 2 3 tor. Nukulaelae Island Youth 2 1 3 Lofegai is located in the far north of the main Church groups and other youth organisations 5 1 6 settlement of Funafuti and comprises a few fami- Youth from Island Communities on Funafuti 4 4 8 lies who actively participate in the Ekalesia Kele- Total 27 21 48 siano Tuvalu (EKT) church communal activities. Fakaifou consists of low-income settlers, mainly from the outer islands, who live on land owned by Funafuti’s indigenous people. Because there are no formal legal arrangements for their occupation of the land, their homes are built from temporary materials. Many of these families experience social and financial hardship and live in overcrowded conditions with poor sanitation. Vaiaku was the first settlement for Government workers and most families in the area are officials in permanent employment who stay in either Gov- ernment or privately owned homes. The indigenous Funafuti people live commu- nally. The younger generation feel the rapid social and economic changes more acutely than youth on the outer islands who are cushioned by distance and a more traditional way of life. Two outer islands, Nukufetau and Vaitupu, were chosen because they provided a contrast to Funafuti. Nukufetau has limited employment opportunities and its environment was considered representative of the other six outer islands. Vaitupu was chosen because most Tuvaluan children leave their home islands to be schooled at the secondary school there. Tuvaluan people prefer oral expression, either with discussion during interviews or group consul- tations. With this approach, the authors were able to provide clarification and explanation of the terms of the main issues underlying signs of mental ill health, for example, the distinction between

10 Youth and Mental Health in Tuvalu: A Situational Analysis 2.0 Physical and Social Background of Tuvalu

his section provides a brief outline of the ge- of surplus from resources, Tuvalu is very vulnera- ographic, social and economic conditions in ble economically. It is diﬃcult to compete with Tuvalu to illustrate the environment in neighbouring countries such as Fiji for tourism rev- whichT young Tuvaluans live. enue as transportation is limited and expensive. Fortunately, the nation does have its publicly 2.1 Tuvalu geographical background owned Tuvalu Trust Fund, which was set up In 1987, to safeguard the country against deﬁcits in Government income. The Government also relies heavily on the donor community to meet the costs of programmes and projects.

2.2 Family and the Falekaupule system The Falekaupule, known locally as the “house of knowledge’’, is the traditional place where the island community conducts meetings and celebrations. Young people in this setting are generally not allowed to speak or be involved in any decision-making as it is regarded as disrespectful to the elders. The traditional community structure comprises the chief and his advisers – his speaker, chiefly clans, healers and canoe builders – then the women and the young people (Fiji Times and Her- Tuvalu consists of nine low-lying atolls that ald Limited, Tuvalu - A History: 1983, p21). cover a total land area of 25 square kilometres. It The political powers of the Falekaupule were is situated west of Hawaii, north of Fiji and east of formally recognised by Government in the Australia. Falekaupule Act 1997. Under the Act, young peo- Since the islands are atolls, farming, particularly ple and women are allowed to voice their needs, crop cultivation, is difficult. Traditionally, root but only the elders are permitted to vote when de- crops such as taro and pulaka (giant swamp taro) cisions need to be made. The main purpose of the are planted in pits to reach the water pan. Other Act is to encourage full consultation with everyone plants grown and eaten on the islands include regarding the future development of an island. breadfruit, pandanus, pawpaw, bananas, and co- conuts, which are plentiful. The coconut tree has 2.3 Church influence on the traditional system been the tree of life for Tuvalu’s people as it is used London Missionary Society (LMS) was brought not only for food and drinks, but also for medicine, to Tuvalu in the mid-1800s by a Cook Islander building materials and other practical purposes. named Elekana who arrived on Nukulaelae, the Tuvalu relies heavily on the remittances sent by southernmost island in Tuvalu. Elekana was a dea- seafarers and other Tuvaluans working overseas. con, belonging to a Christian protestant church. About 75% of families on the outer islands are de- Each island has stories about the conversion of pendent on these remittances (Pacific Islands Re- the islands to Christianity and the chiefly powers gional MDG Report, SPC/UN, 2004). The nation is and privileges that continue to be accorded to pas- heavily reliant on imported foods and derives ex- tors, who remain highly influential at community port revenue from the sale of stamps. Because of level. the poor quality of its soil, its remoteness and lack When Tuvalu gained independence from British

11 Youth and Mental Health in Tuvalu: A Situational Analysis rule in 1978, the Ekalesia Kelisiano Tuvalu (EKT), which is protestant, became the national religion for Tuvalu. More than 90 percent belong to the EKT, the remaining 10 percent belong to other faiths and Christian denominations. Religion plays an important role in the life of a Tuvaluan. On every island, people look after the welfare of their pastor by providing his home and building a church. Each island appoints a family as guardians for the pastor’s children and they provide for the daily needs of food, clothing and money through gifts. The families also fund the EKT Administration in Funafuti. According to the Asian Development Bank report, Hardship in Tu- valu (2003), the main causes of hardship experienced by people are the fundraising activities imposed by the church.

2.4 Government intervention and political changes Tuvalu became a British protectorate in 1892 (MacDonald; Cinderella of the Empire, 2001, p6). It was formerly known as the Ellice Islands, which were part of the British colony of Gilbert and Ellice Islands. The Gilbert Islands are now known as Kiri- bati. Tuvalu separated from the British Empire in 1975 and declared its independence on October 1, 1978. Since colonial times, the islands of Tuvalu were administered by the Island Council whose members were elected by the people. Before this, the EKT had been the only implementer of social development activities and programmes. When Tuvalu gained independence, the Falekaupule Act 1997 returned powers to the chieﬂy system and the community for the overall development of the islands. The Act deﬁnes the “falekaupule” as the supreme power on the island and “kaupule”, the local name of the Island Coun- cil, as the implementing arm of the falekaupule. Anyone who is 50 years or older can now vote on decisions concerning development proposed by the Kaupule.

12 Youth and Mental Health in Tuvalu: A Situational Analysis 3.0 Youth in Development 3.1 How existing societal structures relate to On some islands, there was an initiation cere- youth and their mental health mony for young men and women to mark their his section examines youth participation in transition to adulthood. For example, on the island the social and economic sectors and in pro- of Nanumea, the ceremony was held each year. On grammes provided by Government, the turning 16, young men and women would be churchT and non-government organisations. called upon to stand up and declare to the island It also examines Tuvalu’s societal, hierarchical community that they were considered young structures and youth perceptions of how they af- adults and were obliged to serve in island activi- fect the mental health of young people. ties. (Chambers: Origins, Customs and Identity of At the community level on each of the islands Nanumea, 2004, p73). This ceremony raised the there are two definitions of youth that relate to level of respect accorded to young people, how- the tasks they perform; youth who work for the is- ever, it is no longer practiced. land or the Falekaupule, and youth involved with Each island in Tuvalu has a distinctive way of church (EKT) activities. rearing children. Cultural practices are observed from the time the mother is pregnant until she 3.1.2 Youth Population gives birth. Traditionally, Tuvaluan society is pa- Based on the National Youth Policy definition, ternal, with the father’s cultural practices deter- there are about 2,576 youth in Tuvalu (Tuvalu Gov- mining how the child is raised until adulthood. It is ernment Population Census, 2002) and more than the responsibility of the paternal family and its half (732 males and 614 female) live in Funafuti. community to educate children to know the values The remaining 1230 live on the other eight islands. and the principles of their island and to ensure Below is the table extracted from the National they participate in family and community activities. Youth Policy 2005-2010 showing the youth popu- In Tuvalu, gender roles are clearly defined. Gen- lation in Tuvalu based on the 2002 Census. erally, both young men and women are expected to do household chores and much emphasis is 3.1.3 Youth within the traditional structure placed on preparing them for future roles as par- In the traditional structure, youth play an impor- ents. Girls are chaperoned until they are married, tant role in implementing island developments as they are expected to be virgins at the time of that have been decided on by the elders. marriage. Communities encourage their young people to These expectations are changing, however, as listen and follow directions from the elders in young people move away from home to attend order to gain experience and prepare to eventually boarding school or an overseas university. When assume the role of elders. This traditional arrange- they are in a different environment, without the ment, however, was challenged by the adoption social support of families and community, they of the Falekaupule Act 1997 under which young often experience a great deal of stress. This stress people had to decide for themselves what was was raised in focus group discussions and referred best for them and convey those needs to their eld- to the separation from family for education at ers. boarding school and or when leaving their country to study or for work as young seafarers . Their sense of isolation from family and friends and the TABLE 1: Total youth population by five-year age high expectation on them sometimes resulted in group and sex (2002 census) stress. Their education and work performance at times suffered, as a result Age group Total Male Female 15-19 862 474 352 3.1.4 Church services for youth 20-24 682 326 356 On all of the islands, the EKT has played a major 25-29 523 245 278 role in the lives of the Tuvaluan people. The 30-34 545 278 267 church encourages young people to be involved in Totals 2576 1323 1253 activities that would help them to adopt Christian

13 Youth and Mental Health in Tuvalu: A Situational Analysis values and principles in their daily lives. Recently, was submitted early in 2008 and is to be tabled to the EKT, in response to the many challenges faced the UN Committee in June 2009. Women’s poli- by young people, established a team of young pas- cies and strategic planning to guide implementa- tors to help parish pastors in their work with tion strategies for action (Tuvalu Government & young people. In addition, a National Youth Camp UNDP, 2007, Country Programme Action Plan, is conducted once a year for students. During 2008-2012). these camps, students are encouraged to reflect The Millennium Development Goals (MDGs) on themselves and how they relate to others and aim to: to work for their communities. Activities such as Eradicate extreme poverty and hunger; home visits for the elderly and disabled are Achieve universal primary education; arranged and they share their beliefs with the Promote gender equality and empower larger community through prayers, songs and women; plays. Reduce child mortality; The EKT believes such activities enrich young Improve maternal health; people and prevent alcohol abuse and other prob- Combat HIV/AIDS, malaria and other lems. diseases; Ensure environmental sustainability; 3.1.5 Government Services for Youth Develop a Global Partnership for The Ministry of Education, Sport and Youth ap- Development. pointed a one-person Youth Desk, which is ex- The MDG work in Tuvalu is assisted by UNDP pected to expand with two new staff in 2009. The funding with local personnel to assist implemen- mandate of this office is to implement the National tation. Youth Policy 2005-2010 and to co-ordinate, facilitate, monitor and evaluate youth activities. The ii) National Development Strategy Plan - Kakeega office works closely with the National Youth Coun- II and Youth cil and other stakeholders from Government and The Kakeega II, or the National Development non-governmental spheres. Strategy Plan 2005-2015, stated the need for youth The National Youth Policy highlights eight focal development. Key policy objectives for youth areas and these include: were to formulate a National Youth Policy and to spiritual development improve the welfare of and opportunities available education to young people (Tuvalu Government, 2005, Ka- culture keega II 2005-2015; p22). There are nine major pri- orities and strategies for youth and these are to: legal aspects for youth implement a National Youth Policy; health increase training; economic empowerment create job opportunities; better and safer environments for young educate youth on the value of living a healthy people lifestyle and the threat of HIV/AIDS; the stability of their families and community. educate youth on traditional knowledge/skills; i) Youth and Human Rights Instruments expand youth facilities on outer islands; Several human rights instruments have been increase the availability of credit; ratified by the Government and these include the provide a greater role for youth in the Falekaupule decision-making process; and Convention on the Rights of the Child (CRC), the Convention on Discrimination Against Women increase the role of NGOs and churches in (CEDAW) and the Millennium Development Goals addressing youth-related issues (Tuvalu (MDGs). Government 2005, Kakeega II 2005-2015; p22). The CRC is co-ordinated by the Department of The development projects for youth that are as- Education and was ratified by Tuvalu on Septem- sisted by overseas organisations through the Tu- ber 22, 1995. CEDAW was ratified by Tuvalu in Oc- valu Government cover the following areas: tober 1999 and is co-ordinated by the Department agriculture; sports; training in life skills and gender of Women under the Ministry of Home Affairs. The equality; HIV/AIDS and STI prevention; environ- Tuvalu report on CEDAW for the United Nations

14 Youth and Mental Health in Tuvalu: A Situational Analysis ment, and good governance. In Appendix 2: Youth (drunk). This type of offence is higher among Projects in Tuvalu, some of the projects imple- young people. mented since early 2000 are listed. They were Specific crimes reported in the 1998 Annual Re- mostly funded by overseas organisations such as port (Tuvalu Government) that were committed the Canada Fund, NZAID, SPC, UNIFEM, UNICEF TABLE 2: Number of crimes by type, offender and AusAID. gender and year

Penal Code By-laws Alcoholics Public Order Traﬃc Acts Other acts Total 3.1.6 Non-Governmental Organisations and Youth Year Services M FM FMFMFMFM F The Tuvalu National Youth Council (TNYC) con- 2000 296 100 338 377 210 3 17 1 990 565 72 13 2982 sists of eight island presidents and religious group 2001 476 62 321 313 114 0 98 0 143 82 67 24 1700 leaders. These presidents and leaders work closely 2002 358 71 293 435 60 3 27 1 680 329 97 16 2370 with the Government Youth desk. Annually, about 2003 444 40 205 386 93 3 43 0 657 386 83 5 2345

AUD$5000 is granted by the Government to the 2004 80 7 47 70 8 0 7 0 95 52 63 1 430

TNYC to support its activities. The Tuvalu National SOURCE: Social Data Report, 2005 Women’s Council (TNWC) employs a full-time Na- tional Co-ordinator to facilitate, monitor and eval- by young people included a murder by a 16-year- uate TNYC’s programmes. Youth projects and old male and AUD$22,000 bank robbery by a 22- programs are in the hands of Government under year-old male. the direction of the Youth desk. Other NGOs include the Tuvalu Association of ii) Divorce Non-Governmental Organisations (TANGO), which Table 3 indicates that separation and divorce is sources funds for projects requested by young high among young people. Unsuitable arranged people and conducts training on youth-related is- marriages and abuse were among the reasons sues. Tuvalu Family Health Association (TuFHA) cited for divorce. Alcohol use was a significant fac- works closely with young people, particularly in tor in domestic abuse, family breakdown and di- the area of sexual and reproductive health educa- vorce. Because of confidentiality provisions, tion. The Tuvalu Red Cross Society (TRCS) has information on age groups was not available. young volunteers whom it trains in disaster management and helps families that are experiencing The Population and Housing Census 2002 (Tuvalu hardship. These volunteers have played an impor- Government, 2002) indicated that divorce and sep- tant role in emergencies, for example, evacuating TABLE 3: Number of divorce cases by year – 2000 families during high-tide season at the beginning to 2004 of each year. At community level, every island has youth and church youth organisations. Though 2000 2001 2002 2003 2004 Magistrates 6 14 13 20 7 other organisations such as the Boy Scouts, Girl Court Guides, Boys and Girls Brigade are less active than Island 7 1 0 8 7 Council they were during the colonial period, but are rep- Total number 13 15 13 28 14 resented in the Tuvalu National Youth Council of divorces (TNYC). SOURCES: Island Council, Magistrates Office (extracted from the Social Data Report, 2005)

3.1.7 Background on Youth Issues aration increased from the age of 15 until 39 and i) Youth and Crime then declined with age. Crime is an indicator used to analyse social in- teraction. It has many negative impacts on the iii) Single Parents wellbeing and livelihood of individuals and com- Young girls who have children out of wedlock munities. Alcohol is a key factor in criminal activity. in Tuvalu face losing respect and being stigmatised Most offences were reported in the Social Data by families and the community. The children of sin- Report 2005 (Esela A.B., 2006). gle-parent families are usually raised by the Table 2 shows that the highest number of of- mother’s family. Most men who father children fences were traffic-related. The Social Data Report out of wedlock do not take primary care, however, 2005 (Esela; 2006) shows these offences involved there are some cases when the care of a child is many young people driving without a license shared between the families. and/or driving with excessive levels of alcohol

15 Youth and Mental Health in Tuvalu: A Situational Analysis Table 4 indicates that most of the pregnancies activities and do contribute toward meeting their among young women occurred between 20 and basic needs. 24 years. Eight teenage (15-19) pregnancies oc- Despite living traditionally, the cash economy is curred over the four-year period, ﬁve in one year dominant in Tuvalu and this places pressure on (2003). The education system does not make al- many young people to search for paid employ- lowances for young girls who become pregnant ment. Those who are unable to achieve good aca- while still in secondary education to stay in school demic results or earn an income have reported a to continue their education. The fathers of these sense of insecurity, failure and low self-esteem. children are not aﬀected in this way. According to the Social Data Report 2005 (Tu- valu Government, 2006), those who are perma- iv) Employed and Unemployed nently employed comprise 37.5% of the population. TABLE 4: Number of single mothers by year and Only about 1% of youth are self-employed, involved age group in family businesses or run private businesses. Youth employment is about 38.4%. A total of 44.4% 15-19 20-24 25-29 30-34 35-39 Total 2000 1 10 3 3 17 of those temporarily employed are seafarers who

2001 1 2 3 2 3 11 work on contract in the private sector. Approxi- 2002 1 5 4 4 14 mately 17% of this group are studying and 1% are 2003 5 8 1 1 15 disabled. As there is no loan service to enable young people to establish their own business ven- SOURCE: Health Department (extracted from Social Data Report, 2005) tures, they rely on employment in the Government For statistical purposes, employment in this re- and private sectors to earn an income. port refers to the involvement of young people in YOUTH VOICES 2: A GIRL OF 20 YEARS OF AGE ON NUKUFETAU paid work, while unemployed refers to those who ISLAND EXPLAINED HER SITUATION ON THE ISLAND are not economically active. The latter term is ob- scure since Tuvalu’s young people who are not offi- “I had my education at Motufoua for forms 3 to 4 cially employed are still involved in subsistence and then continued to Fetuvalu for forms 4 to 5. Now I am living with my mother and my grandmother. My father died when I was 2. I tried to find The youth stories depicted in the shaded boxes some employment, but [it was] very difficult to find highlight the importance of early educational jobs on the island, so I sell ice-cubes from home and counselling and organisational support to engage snacks during school breaks at the primary school. I youth in educational decisions to identify the sup- even helped my grandmother to make local ciga- port required by students. rettes and handicrafts and sell them. This had made me to support my family financially and meet my YOUTH VOICES 1: A 23-YEAR-OLD WOMAN ON FUNAFUTI IS EN- personal needs especially when I could join youth ac- JOYING HER SOCIAL LIFE SO MUCH THAT SHE FINDS STUDYING TIR- ING YET HER PARENTS ARE PAYING FOR HER STUDIES AT THE tivities because now I could contribute what I [was] UNIVERSITY OF THE SOUTH PACIFIC EXTENSION CENTRE IN THE asked for by the island youth organisation.” CAPITAL. SHE WAS ONE OF THE HIGH ACHIEVERS IN SECONDARY SCHOOL AND WAS AWARDED A SCHOLARSHIP TO NEW ZEALAND: The Household Income and Expenditures (HIES) (2004-2005) reflects the extent of financial hardship “Mixing with the young people, I learned so much in Tuvalu. The HIES expenditure requirement to about people and how I could relate to them. At meet basic needs is $291.16 a week per household. home, my father does not keep his word so I had lost However, based on the findings of the National Sur- my trust of him. I also do not believe that God would vey on the Elderly, Disabled and the Employed (2007), respond to one’s needs. Now I could only cope on a after loans were deducted, most households on daily basis with the pressure from my parents, but outer islands managed with an average income of fortunately, my mother does understand my situa- AUD$90.80 per fortnight. Those living in urban areas tion and does not restrict me that much so I could be lived on AUD$301.90 per fortnight (Esela, B., 2008; with my friends as much as I wanted. Now [there is] no one that I could trust and there is no place for p 11). The average number of people in a household counselling that I could go to for help [about] how I is about 6-7 people. Based on these figures, most feel about my life. At this moment, I just do my stud- families, both on outer islands and in urban areas, ies because my parents forced me to, but I really do could not manage the current cost of living. Hard- not care whether I pass or not.” ship in most families is obvious.

16 Youth and Mental Health in Tuvalu: A Situational Analysis v) Suicide among young people Of the 400 women in the 15 to 34 group, about The Police Crime Section has no data on suicide 173 (43%) were victims of “physical abuse”. so information for this report is based on annual “Emotional abuse” was common with 40% of records of crimes from 2005 to September 2008. women respondents, who stated their spouses in- Suicides do not seem to be well recorded or inves- sisted on knowing their whereabouts and women tigated. However, an investigation of statistics whose husbands were jealous of them talking to held by the police force indicated that there were other men (30%). About 160 (40% ) of the 15-34 four cases of suicide and one attempted suicide in age group were victims of “emotional abuse” the period 2005-2008. All were aged between 15- (Tavita, 2008). 26. The survey found that about 12% of females had According to the police, the main contributing been forced to have sex or perform other sexual factors were relationship issues between parents acts (4%). and their teenage or young adult children. Meth- ods of suicide used by young people were hang- vii) Education ing, stabbing one’s self with a knife, drifting on a Most Tuvaluan families invest a lot in their chil- canoe and crashing a motorbike. dren’s education. Pre-school education starts at 3 A report on a national youth workshop in March to 4 years; primary education, at 5 to 10 years and 1999, co-ordinated by the Department of Commu- junior secondary at 11 to 12 years. At the end of nity Affairs, Living in a World of Change, highlighted two years’ junior high education, students sit a na- the factors that led to young people committing tional entrance exam to Motufoua Secondary or attempting suicide. School on Vaitupu Island where they board until The main reasons young people gave for be- finishing their studies. coming suicidal were: a lack of understanding and At Motufoua, Form 4 students sit for the Fiji support from families and friends. Problems re- Junior Certificate, in Form 5, the Tuvalu School Cer- lated to suicidal feelings or behaviour included: tificate, and in Form 6, the Pacific School Certifi- distortion of relationship between two people; cate. At the other secondary school, situated on family problems; unwanted teenage pregnancies; pressures from community obligations; problems Funafuti and owned by the Ekalesia Kelisiano Tu- related to education; wanting to be needed; prob- valu (EKT), students are prepared for the Cam- lems in relation to cash; lack of recognition; prob- bridge Certificate. Students from outer islands lems related to workplaces; and problems related who attend EKT Secondary School on Funafuti, to Government procedures (Tuvalu Government, stay with families there. 1999). At tertiary level, there is the Tuvalu Maritime The workshop recommendations on suicide Training Institute for boys, although it is intended prevention were to: this will change. About 60 young men enrol in seek advice from pastors and families and accept the advice respect elders TABLE 5: Number and percentage of students conduct workshops for youth that enable withdrawn in second semester from 2000-2008 them to discuss their problems, and (USP Extension Centre, Tuvalu). produce media materials on youth issues Year Number of Number of Percentage of students students students related to suicide prevention. (Tuvalu enrolled withdrawn withdrawn Government 1999; p 5-6). Total Male Female Total Male Female Total Male Female

2000 100 27 27 vi) Domestic Abuse 2001 138 54 39

In 2007, a National Demographic and Health Sur- 2002 96 16 17 vey was the ﬁrst to include domestic violence. 2003 108 50 46

There are three categories of domestic violence: 2004 162 78 48 physical, emotional and sexual. The analysis on do- 2005 152 23 15 mestic violence below is extracted from the National 2006 190 41 23

Demographic and Health Survey 2007 (Tavita, 2008). 2007 180 6 3

Overall, the most common form of physical 2008 177 46 26 abuse against women is “being slapped by a SOURCE: Second semester report 2008, USP Centre Tuvalu, November 2008 (unpublished). spouse” (18%). The sex disaggregated data was not available. If sex disaggregated data is not available it prevents gender analysis to identify if there is a speciﬁc impact on females and males. It is recommended that this data be made available and be analysed for diﬀerential impacts on males and females.

17 Youth and Mental Health in Tuvalu: A Situational Analysis YOUTH VOICES 3: A YOUNG GIRL AGED 14 COPING WITH SOCIAL YOUTH VOICES 4: A 22-YEAR-OLD WOMAN RELATED HER EXCLUSION BECAUSE OF MENTAL HEALTH: STORY ABOUT THE ARRANGEMENT OF HER SCHOLARSHIP TO NEW ZEALAND IN 2006 “It is very stressful to have such sickness as it is both- ering me that it might prevent me from my studies. “My scholarship was meant to start in 2005, but be- Otherwise, I enjoyed watching what was happening cause of the lateness of organising my documents, around me in the school despite that most of the the university terminated my scholarship. The Gov- school activities I could not participate [in]. I could ernment therefore sent me to continue in 2006. This not attend to morning duties, neither play sport and time, my accommodation was poorly organised and I have a special diet by the school.” I had to contact my relatives in New Zealand to organise my accommodation, but then I was late to the TMTI each year and about 40 actually graduate an- orientation period and the beginning of classes. On nually. After graduation, they await employment my way to New Zealand, I was held up in Fiji to organ- from four recruiting agencies for seamen. ise my visa and waited for two whole weeks to or- An interview with a class of young recruits at ganise my visa, but my other colleagues got their the TMTI revealed they had insufficient prepara- documents processed and left earlier. I learnt that tion or awareness to cope with their recruitment the officer who was dealing with my visa got sick at away from the island. the time. The University of the South Pacific Extension, When I arrived, my family picked me up at the air- based on Funafuti, provides extension courses for port. The next day I went to do my registration at students who have dropped out of secondary the university. The lady who dealt with international school or tertiary education or who did not win students told her that ‘these people from Tuvalu told scholarships from the Government. The number her that she is not the right person for the scholar- of students who enrol in the course annually for ship’. I felt ashamed because they might think of me second semester ranged from 96 to 190 from year as someone bad. I felt a lot of anger, depressed and 2000 to 2008. hopeless about what had been done to me. I really More young females than young males take ex- lost my enthusiasm for my studies. tension courses at the USP Centre. Some students Now, I am unemployed and don’t have an educa- withdrew because their families could not afford tion. I hope that in the future, our young people are not treated as such, but with respect. Selections of their tuition fees or the course materials were sent those with scholarships [should be fair] to avoid such late from the main USP campus in Suva, Fiji. Table a problem that I went through. I would like to men- 5 (below) shows the number of students enrolled tion not to compare fruits with vegetables because for second semester from 2000 to 2008. Less than all are important for health. 50% withdrew. diseases (NCDs) are also common due to “poor viii) Health diet, obesity, lack of fitness, smoking and alcohol”. HIV and other Sexually Transmitted Infections (A Situational Analysis of Children and Women in Tu- pose a threat to young people in Tuvalu because of valu; Tuvalu Government & UNICEF, 1996, p21 -22). their exposure to the transient populations of sea- Most young women are prone to iron defi- farers and people who study and work abroad. ciency caused by inadequate nutrition. This prob- About 10 people are infected with HIV and another lem will likely cause complications in pregnancies three are awaiting confirmation (Tuvalu National and is associated with prenatal deaths and low Strategic Plan for HIV and STI 2009-2013; 2008, p4). birth weight and premature babies. The UNGASS 2008 Country Progress Report for In 2006, Tuvalu participated in the Adolescent Tuvalu cited the 2005-2006 Behavioural Surveil- Health Development project on life skills and peer lance Survey (BSS), which reported that 43.6% education, which was implemented by the Secre- youth were sexually active. Though knowledge tariat of Pacific Countries (SPC) and the United Na- about HIV/AIDS was high among youth aged 15-24 tions Family and Parenthood Association (UNFPA). years, this is not reflected in reducing risk practice. Since 2006, medical officers and youth peer edu- Alcohol use was common – 42% among young peo- cators from the Tuvalu Red Cross Society (TRCS) ple – but there was no reported use of intravenous have conducted youth camps for Form 2 students drugs (UNGASS 2008 Country Progress Report for to prepare them for leaving home to attend sec- Tuvalu; p 9). ondary education in boarding school. So far, A UN study highlights that non-communicable about 10 primary schools in Tuvalu have partici-

18 Youth and Mental Health in Tuvalu: A Situational Analysis pated in this programme. The project was reported to have been very successful and there are plans to provide trainers at community level.

19 Youth and Mental Health in Tuvalu: A Situational Analysis 4.0 Mental Health 4.1 Definition of Mental Health they determine behaviour towards others and rec- he World Health Organisation (WHO) 2002 iprocity between people. definition of mental health is:“...the ability to A mentally healthy person in Tuvalu would be think and learn, and the ability to understand able to take on their responsibilities and obliga- Tand live with one’s own emotions and the reactions tions and participate actively within their family of others. It is a state of balance within the person and community. They would anticipate and plan and between persons and the environment. Physi- and be able to make decisions with confidence for cal, psychological, social, cultural and spiritual and themselves and their families. other interrelated factors participate in producing Spirituality is important for Tuvaluans and most this balance. The inseparable links between mental have a strong belief in God to provide spiritual and physical health have been demonstrated.” guidance and support for friends, the community, Tuvaluan culture and traditions influence men- colleagues and others. tal health in young people. Several elderly people were involved in defining mental health in the Tu- FIGURE 3: Tuvaluan processes in mental health valu context and a number of young people were SUPPORTING consulted about their understanding of mental ENTITIES health. Youth organisations, health, church, education, island communities, NGOs, agriculture, transport, etc 4.2 Tuvaluans’ understanding of Mental Health (Te mafaufau Ola)

Tuvaluan society revolves around the family, is- Provide and contribute land community and church. The social structures services to Participate by carrying out have the potential to provide a social, psychologi- develop family and community responsibilities; cal, spiritual and physical safety net for most peo- An ability to make in- formed life decisions with conﬁ- ple. It is believed that a Tuvaluan person maintains dence; THE SELF Assimilate tradition and his or her mental health through participating in culture with modernisation; Gains sound characteristics and abilities to function eﬀectively Think actively, work for the activities and obligations of the family, island the wellbeing of the family and community, enable to use exist- community and church. ing resources; Mental health is known by Tuvaluans as “Te Apply sound principles and values, e.g. through religious mafaufau Ola”. “Mafaufau” means the mind or the Be able to create faith and human rights stan- and sustain dards. thinking, and “ola” means “active’’ or “thinks for supportive the other’s wellbeing’’ or is “able to sustain one- relationships self by using existing resources”. A person with

“mafaufau ola” is someone who thinks about the TRADITION & CULTURE Participate actively in family, wellbeing of the family and makes the most of communities, development and what is available around them to meet the family’s decisions basic needs. According to youth, the “self” is the individual person who can only gain his/her “mafaufau ola” A range of other agencies and Government and (mental health) through the assistance of support- non-governmental organisations have evolved to ing systems. These include ‘te kaiga’ (the immedi- assist through modernisation and globalisation. ate and the extended family), the community, They aim to help Tuvaluans to assimilate social and which includes ‘te fenua’ (the island), and ‘te psychological changes and to be competitive eco- ekalesia’ (the church). Belonging to these three nomically. These agencies also represent signifi- main systems is imperative for every Tuvaluan. cant foreign influences and are connected with the Each person is continuously engaged with others outside world. by carrying out their gendered roles and obligations as young people within a family and in their 4.3 Regional Mental Health Perspectives island community. The traditions and cultures Statistically the is an increase in mental and be- practiced are essential for mental health because havioural disorders in the Western Pacific region

20 Youth and Mental Health in Tuvalu: A Situational Analysis exceeds the world average. This increase for men- YOUTH VOICES 8: A MARRIED MAN OF 22, ON THE ISLAND tal and behavioural disorders from the total dis- OF NUKUFETAU, WHO HAS TWO CHILDREN AGED 6 AND 1, ease burden of 11% in 1990 is projected to be 15% in SPOKE OF THE STRESS OF HAVING TO WORK AWAY FROM HIS FAMILY: 2020. Depression was the fourth largest mental disorder that contributed to the disease burden “I have to go back to work because there is no for 1990 and expected to be the second largest in work opportunity on the island. However, I en- 2020. The five leading mental disorders that con- joyed being at home for I know very well what my tribute to the disease burden include depression, children are eating and that we have the same schizophrenia, bipolar disorder, alcohol abuse, and food. While being away at sea, it usually very difficult for me to keep thinking for my children about obsessive compulsive disorders. what they have to eat. This had caused me much People at risk of mental ill health are those who stress at work, but I have to leave my family to get “experience social relative disadvantage” (WHO, some money to educate my children and to meet 2002, p9) from depression, substance abuse, family obligations to the island and the Church.” epilepsy, schizophrenia and related psychotic dis- important support to provide quality of life for the orders. patients and their families. While it is well recognised that physical health is Based on these factors, countries in the region vital for the development of young people, the should take action in six areas to prevent mental ill area of mental health is seriously lacking in re- health. These include: sources and services. There is no Tuvaluan mental health policy to address the provision of psycho- advocacy through the use of the media and training; social services to prevent mental ill health and to support those who are ill. It is recommended that provision of services at national and local levels; consultation on the development of mental health policy occur. promotion of mental health through improved awareness of social connection, reducing 4.3.1 Effects of the social and economic environ- discrimination, improving economic participation ment on mental health in the Pacific and addressing the needs of vulnerable populations; Rapid social and economic changes increase stress levels for many people. According to the review and develop policies and legislation to advance mental health; WHO Asia and Pacific Regional Health Strategy (WHO, 2002), the factors contributing to mental ill encourage national initiatives to develop research culture and capacity; and health include: “disasters, military invasions and violence, unwanted pregnancy, displacement, ur- take suicide prevention measures (WHO banisation, migration, unemployment, work 2002). stress, family disruption and social isolation”. It also states that as the social structure deterio- 4.4 Background information on Mental Health rates, moral support declines and this results in Status in Tuvalu more dissatisfaction, crime, intolerance and dis- The draft report, Elderly, Disabled and Employ- crimination. People’s coping strategies need to be ment 2007 (Esela, 2008), reported there were 29 improved to stay healthy in rapidly changing envi- people receiving treatment for mental illness. ronments. Adolescents and young adults face risks There were two beds for this purpose in the main of increase in mental ill health and mental illnesses hospital in Funafuti, however, they were not used such as schizophrenia, depression and the impacts because they needed repairs after being damaged of substance abuse. In many cases, it is assumed by a patient. Patients with mental illness are not that families can care for those with mental ill included in monthly patient and visitors committee health, however, they often lack the assistance of reports within the main hospital and so assess- support services to provide care in their homes. ment of records for such patients is difficult. Most health clinics in Tuvalu’s islands look after If required, mentally ill patients are therefore the public’s general health as well as mental detained in police cells and cared for by their fam- health. Clinics attended, however, lack the capac- ilies and the prison warden. ity and support of health services to manage men- A medical doctor is appointed to look after tally ill patients. Psychosocial health care is an mentally ill patients. One nurse was trained in men-

21 Youth and Mental Health in Tuvalu: A Situational Analysis tal health for three months and was attached to 2008). This had not improved since the WHO re- St Giles Psychiatric Hospital in Fiji before returning port 2005 on Situation Analysis of mental health to Funafuti Hospital. This nurse, however, is now needs and resources in Pacific Island countries. undergoing training as an anaesthetist and the De- Volunteers for the Tuvalu Red Cross Society (TRCS) partment of Health plans to train another nurse in visit mentally ill people as part of their home visit mental health. programs for the disabled, elderly and bedridden. Families with mentally ill young people who During these visits, they give advice to the families have become violent have had to seek help from on how to look after mentally ill family members the police to detain them in police cells. Most and provide toiletries such as bathing and wash- young people live with their families and mix ing soaps. Churches and island communities occa- within the community. Most of them do not re- sionally do likewise. ceive medication, apart from sleeping pills, since The Department of Community Affairs, in affili- medication is considered too expensive for the ation with the Ekalesia Kelisiano Tuvalu (EKT), Government to supply. Some patients are able to does provide counselling for young people with buy medication from overseas, however, the cost mental health problems. Counselling is provided may place it beyond the reach of most families. on a one-to-one basis or in workshops with target Some mentally ill people were referred abroad, groups such as young people, seafarers and their particularly to St Giles Hospital in Fiji. Most families families. reported an improvement in the condition of the ill Mental illness and related issues, however, person when medication was used. Unfortunately, have not been adequately addressed in Tuvalu and most mentally ill patients do not continue medica- there is a need to identify the causal factors to pre- tion or following up with medical personnel as vent young people from becoming unwell. scheduled. There is a lack of public awareness of mental ill- 4.5 Issues related to youth mental health ness and the needs of those affected by it. They This section describes the social, financial and are often labelled as being “crazy, an idiot, stupid, family environments of the young people involved retarded, or mental” and the families of those with in this study. The study found that the leading mental ill health tend to be stigmatised also. Gov- cause of stress for young people was the attitudes ernment legislation defines a mentally ill person as of parents and families toward them. one of “unsound mind’’ and “insane”. Tuvalu has The second highest problem among young peo- not used terminology for mental illness that is re- ple was the expectation placed upon them to do spectful and acceptable to the mentally ill. well academically. The third most significant stress Clearly mental ill health in Tuvalu has not been problem was unemployment. adequately addressed and lacks professional sup- The interviewees represented all of the age port. It is therefore important for families to re- groups according to the definition for youth in Tu- ceive enough assistance to enable them to take valu; that is, from the ages of 15 to 34 years. care of those who are unwell. Policies for mental In analysing the situations and environments health and legislation need to be established and that affect the mental health of young people, management improved (refer to Appendix 3 for a urban areas were compared with rural areas. status report to WHO on mental health for Tuvalu FIGURE 1: Number of youths interviewed, the types of families they live with and the stress problems YOUTH VOICES 5: A YOUNG MAN OF 23 YEARS ON VAITUPU they face. SPOKE OF HIS FORMER GIRLFRIEND AGED WHO MARRIED A , 19, 20

MAN 20 YEARS HER SENIOR 18 Parents 16 Parent “It had been very diﬃcult for me to handle this situ- Relatives 14 ation because it is an arranged marriage. Moreover, Boarding 12 Number of youths I lost her to an older man and this saddened me very 10

much. I hardly drink, but I have to in order for me to 8 go through this experience and to share my feelings 6 about what is happening between me and my girl- 4 friend to my family. At some stage, I felt suicidal, but 2 0 my family and friends helped me to unburden myself Parents and Unemployment Peer pressure Education Community Alcohol abuse Others Family expectations and to handle my situation better.’’ Types of stress problems

22 Youth and Mental Health in Tuvalu: A Situational Analysis Vaitupu and Nukufetau islands were selected to Most young people in Tuvalu live with their par- represent the rural areas. In the urban areas, the ents, even after marriage, so relationships between study focused on young people living in the capital family members have a signiﬁcant bearing on the who had come from the four main villages on Fu- wellbeing of individuals. nafuti: Lofeagai, Fakaifou, Funafuti community Young women are subject to stricter controls as and Vaiaku. parents feel it is their duty to protect, guide and prepare them for marriage. Young men, on the other FIGURE 2: Types of stress problems hand, generally have more freedom, but are obliged Peer to comply with whatever their parents and families Community pressure expectations 3% decide for them, including the choice of a wife. 4% FIGURE 4: Causes of stress by gender Alcohol abuse 7% Not stated

Others 8% Community Female Parents’ activities Male

and family Youth roles attitudes Friends’ 38% inﬂuence Unemployment Education 18% impacts

Employment Education conditions Health 22% problems Types of stress causes Types Family problems Financial problems In all, 118 people were involved in this study on 0 2 4 6 8 10 12 14 the mental health of young people in Tuvalu, Number of youths which is 5% of the country’s total youth population (Census, 2002). While young people are expected to obey their FIGURE 3: Causes of stress elders’ decisions, this is challenged by the new environments they encounter through study and work. Not stated Friends’ Health 3% While away from their families and communities, problems influence 1% they must make decisions for themselves. As a re- Youth roles 3% Community 4% activities & sult, when they return home to a traditional setting, responsibilities 1% Financial it can be difficult for them to readjust. problems 6% Family FIGURE 5: Types of stress effects problems 30% Health Education problems impacts Not stated 3% 23% 4% Employment None 4% conditions Social 29% problems 6% Personal problems Family 34% The situational analysis found there were six problems main causes of stress among youth in Tuvalu. They 13% were: the attitudes of parents and families toward Education them; the demand to perform well in education; un- impacts 14% Financial problems employment; peer pressure; community expecta- 22% tions, and alcohol abuse. Other causes identified included financial hardship, aimlessness, poor physical health and being overcommitted with activities.

23 Youth and Mental Health in Tuvalu: A Situational Analysis FIGURE 6: Types of coping strategies The lack of opportunities in education and employment, combined with high expectations from Study Not hard 4% stated 4% parents and communities and a lack of services to Sacriﬁce personal needs 4% provide for those with mental ill health make the young people of Tuvalu more vulnerable to men- Ignore Sharing with problem 4% family/friends/ tal illness. colleagues The recommendations section suggests actions Others 6% 17% Self that could be taken to address and prevent the employment causes and risks of mental ill health and mental ill- Time out 6% 17%

management Seek spiritual ness.

10% employment guidance 13% Follow parents’ Time

advice 6% Seek YOUTH VOICES 6: AT MOTUFOUA SECONDARY SCHOOL, A 16- 12% YEAR-OLD GIRL RELATED HER FEELINGS ABOUT BEING IN A BOARD- ING SCHOOL: “I felt homesick and wanted to be with my mum. My Education is regarded as a necessity by Tuvalu- parents are from the island of Vaitupu, but my father ans to ensure a good future for families and com- has a job that he travels around the islands in Tuvalu. munities, but the expectations placed on young I used to feel very homesick when something hap- pens to me in school or when someone bullies me in people to do well academically often cause signifi- school. I hope that Motufoua would allow day schol- cant stress. In Tuvalu, education is geared more ars so I could be with my parents.” toward academic results and white collar work rather than vocational training. Those not suited to higher-level jobs have limited options in the workforce and the jobs available favour the liter- ate and academically sound. The experience of being unable to earn an income is difficult for most young people, particularly young men, who are expected to provide for their families. For youth on the outer islands, the lack of employment can prevent them from participating in activities with their peers or contributing to meeting their family’s needs for education or basic commodities. Young people living in urban areas who cannot find work are also unable to rely on a subsistence lifestyle as they do not have land to cultivate. The scarcity of jobs available on the islands has forced many young fathers to go into seamanship, which takes them away from their homes and families for more than nine months at a time. The mental health of young people in Tuvalu is also affected by the social environment they live in and land resources and activities available to them in their communities. Their relationships with their parents, families, friends and community are very important. Physical illness can also have an adverse affect on mental health. For example, young people who have heart problems may become socially isolated as they are unable to participate in sport and other youth activities which is a primary source of social- isation in Tuvalu.

24 Youth and Mental Health in Tuvalu: A Situational Analysis 5.0 Conclusion and recommendations

he analysis of youth and mental health issues velopment of Mental Health services is advised to in Tuvalu indicates an imperative for parents, facilitate planning resource allocations, implemen- youth and communities to seek ways under- tation, co-ordination, and to monitor and evaluate standT the stresses on youth and advocate to im- the provision of mental health services in Tuvalu. prove social services in Tuvalu. The types of A Mental Health working committee could be es- support required to improve their mental, physical tablished to co-ordinate such programs and activ- and social well being include family and youth ities. counselling support, more community health serv- Alcohol abuse is a social issue that affects many ices and increased support and advice on educa- young Tuvaluans physically and psychologically tion choices and more employment opportunities. and new creative incentives and strategies to pre- Financial hardship and aimlessness are shown to vent excessive alcohol consumption and the neg- result when youth lack sufficient skills to permit ative consequences of this practice, are needed. them to be productively engaged and employed Peer pressure usually affects young men more in support of themselves, their families and in com- than young women since they are able to mix munity development. more freely with other young people, unlike girls The family is a foundation of Tuvaluan society who are discouraged from much involvement with which both creates and facilitates a sense of com- their friends. Teenagers and young women who munity. If the family is communicating or function- are the primary care givers ought to be able to ac- ing well, the health of young people and the cess second chance education and have flexible community is less likely to be compromised. The education policies to support them to continue social problems and sources of stress described by with their education and learning. youth in Tuvalu indicate the high importance of YOUTH VOICES 7: A BOYOF 13, WHOALSOATTENDS families, community leaders and government serv- MOTUFOUA SECONDARY SCHOOLANDDESCRIBEDHOWHE ice providers partnering to improve their under- MISSED HIS FAMILY: standing of youth issues and involve youth actively in support of their future and their com- “I miss my grandmother and my parents. I cried munities development. ``Community’’ includes the whenever someone died on my home island. I love traditional structure of “te fenua”, or the island, my family so much and I do not want them to die, and “te lotu”, which is the Church. The church pas- too. I usually go to my older brother for consolation tors bear a large responsibility and have a strong and my older brother encourages me to be strong influence on island development as they assist and concentrate on my school work and he told me young people with their mental ill health and so to accept our situation. I have to be strong because require guidance to set standards for this work. I want to get a good education so I could get a good Investment in human resources, for the provi- job to support my family financially and so I could have a better life.” sion of community based mental health support and counselling services, are required. More men- There is an urgent need for leaders and island tal health trained workers and medical profession- communities, Church groups, stakeholders in als are needed to assure correct diagnosis, Government and the private sector to sponsor en- medication and care services are provided. Most gage youth in the countries future sustainable de- of the responsibility for the care of people with velopment and to encourage them to lead the mental ill health rests with the family, particularly development of their sport and creative activities the women. Mental health awareness education and programs to facilitate improvements in com- and training is required to enable families to un- munity health. The following recommendations encourage the derstand their relative’s condition and to be able direct involvement of families, government, civil to provide appropriate support, care and to re- society and youth to support and improve health, duce discrimination and stigma of mental ill health. education and employment services for young The development and approval of a Tuvalu people. The recommendations give voice to youth Mental Health Policy, strategic planning and concerns and from those working to support human rights compliant legislation to guide the de- youth and mental health in Tuvalu.

25 Youth and Mental Health in Tuvalu: A Situational Analysis Family support To establish, strengthen, set standards and The aim of the family support recommenda- promote counselling institutions in both the com- tions are to encourage and maintain constructive munity and the Church. relationships and respect between the different age groups, to build communication and resilience Youth support to reduce risk and mitigate the impact of such risks That the Government adopt and resource the taken by young people: Tuvalu Youth Policy which is developed to To provide parent education and youth to strengthen the role of youth as contributors to youth forums and sessions/classes to enable par- their own and the countries future development: ents and youth to facilitate discussions and nego- To encourage young men to feel responsi- tiate family meetings where both young people ble and respectful about their actions in particular and parents are able to express and exchange to young women and to reduce the risks of vio- ideas about healthy living and choices in a respect- lence and abuse; ful way; To learn to show respect of themselves and To encourage families, elders, Kaupule and other young and older men; stakeholders in the Government, NGOs and the To develop programs in community work churches, to promote youth development to pre- for young people who have dropped out from ter- pare young people for leadership and decision- tiary level education, with Government and stake- making roles; holders by providing technical and financial To discourage parents and families from assistance for second chance learning and/or to marrying young girls before they are able to make learn skills for trades, business development and appropriate choices and seek parental advice; self employment; To families be encouraged to pass onto Youth leaders in organisations on the is- their young people, the traditional family skills that lands to organise lower-cost activities to enable would enable them to value their Tuvaluan iden- young people from vulnerable families to partici- tity, build resilience and sustainable livelihoods. pate actively in development on the island; To encourage young people to have a voice Legal services and reviews and be heard, while they also traditionally are re- The Ministry of Justice and Health facilitate the quired to implement of the elders’ decisions; following legal reform to review the following To be encouraged to develop programmes Acts: in schools and communities and in church and civil The Mental Health Act and revise Mental society programmes to facilitate ‘good leader- Health Policy and include analysis of the People’s ship’, build confidence and encourage self-accep- Advocate and their recommendations of reform; tance between among young people. The Marriage Act and make provision for counselling support young couples before mar- Employment – youth, women and vulnerable fam- riage and dispute resolution; ilies The Education Act to allow young mothers The Kaupule and the financial and business sec- to return to school for further learning and formal tors to facilitate employment opportunities: education and certification. To create business development and access to markets on and between the islands and Counselling services – marriage, parent and youth in Funafuti; support To facilitate and develop opportunities and The Ministry of Health, Education and Commu- encourage women, particularly those from seafar- nity Service Organisations collaborate to support ing families, whose partners are away for long the development and set standards for confiden- stretches to participate in employment opportu- tiality: nities to stabilise family income; To increase training for counselling services; To establish financial support systems and To establish, strengthen and promote avail- micro-finance, to be accessible particularly to vul- ability counselling services to help individuals and nerable families e.g. single parent families, youth families address marital problems, relationship and women to facilitate self-employment ven- problems, youth and parent communications; tures;

26 Youth and Mental Health in Tuvalu: A Situational Analysis To ensure the private sector complies with tion to help young people cope with their studies working conditions that meet ILO standards. An and manage their time effectively; assessment of working conditions for young peo- To establish vocational training centres on ple in the private sector is needed; all islands and to negotiate to establish vocational To provide Personnel and Training in gov- institutions which encourage flexible but support- ernment service orientation for young civil ser- ive distance learning; vants on how to work with older clients and To encourage young people to learn skills appropriately respectful including traditional that would allow them to be self-employed or to methods to be able to facilitate community partic- find employment. ipation and consultation in community planning; To provide training in financial literacy and Improved learning environment for boarders business skills for sustainable livelihoods; To establish counselling and training for To liaise with the Australian Pacific Training peer educator support systems (individual or Centre to enable young people from Tuvalu to ac- group activities) to help young people in boarding quire internationally recognised certificates and schools to reduce their feeling of isolation and to those relevant for Tuvalu; encourage them to develop resilience, for exam- To establish supporting agencies for job va- ple, homesickness, relationship issues, decision- cancies, for example at island level, Kaupule to es- making; tablish a list of skilled young people and a job desk To implement an academic result standard and to encourage and broker employment oppor- for sports. In the long term, to develop sports in tunities. affiliation with overseas institutions to enable qualified young people to represent Tuvalu in regional Education and international sports events; Young people ought to be encouraged to value To encourage a two-year program - forms 5 learning and education as a means to improve and 6 - for the Pacific Secondary School Certificate their opportunities and choices in life. In order to (PSSC) and to cease using the Tuvalu School Cer- do this the barriers, to their learning must be as- tificate in form 5, to ease the schedules for form 6 sessed and evaluated and gender sensitive re- and moreover, reduce the stresses young people sponses and strategies to remove them face; developed. Their performance can be encouraged To improve and build better school facili- in the following ways: ties, classrooms, dormitories and recreational To support the development of early edu- areas and to establish a school bookshop, so stu- cation and day care centres for the children of dents can buy their own textbooks; working parents; To develop teamwork among students in To develop creative arts and recreational sports and cooperative team work. This will nur- activities for example, community drama, tradi- ture a spirit of care and responsibility for each tional arts, traditional crafts and skills for livelihood other and reduce bullying. support; To create an environment that gives young people access to technology to that would assist their livelihood; To improve transparency of scholarship awards system and a transparent and fair interview system to be included in selection procedures for scholarship awards; To establish support services for special learning skills for example: provide special classes and tutorials for students who need extra help in individual subjects; teach time management, especially for young people in boarding and day scholar secondary education; and to provide educational counselling services in schools and tertiary institu-

27 Youth and Mental Health in Tuvalu: A Situational Analysis FIGURE 7: Types of advisers for youths FIGURE 8: Service providers

Brothers Education 1% Dept 1% Husband/ Not stated Community 2% Teachers wife 1% 1% 4% Kaupule 3% Guardian 1% Family 3% Sisters 4% Not stated 4% Parents 4% Mother 20%

Pastor 6%

Father 6% Relatives 19%

Colleagues 6% No one Friends None 86% 12% 19%

FIGURE 9: Youth recommendations

Improve working conditions 3% Good time Improve support management 3% for migrants 1% Need ﬁnancial Discourage support 3% urbanisation 1% Improve youth facilities 4% Improve conditions for seafarers 4% Need parents/ family support 4% No recommendation Improve 51% environment for study 6% Not stated 7%

Training for youths/ parents 13%

28 Youth and Mental Health in Tuvalu: A Situational Analysis 29 Youth and Mental Health in Tuvalu: A Situational Analysis 30 Youth and Mental Health in Tuvalu: A Situational Analysis References Agnew F., F. K. P.Endermann, G. Robinson, T.S.Sauni, H. Warren, A. Wheeler, M. Erick, T.Hingano, H.S. Sopoaga, 2004. Pacific Models of Mental Health Service Delivery in New Zealand Project. Health Research Council of New Zealand, Auckland, New Zealand. Asian Development Bank, 2003. Hardship in Tuvalu, ADB. Chambers A, K. Chambers, T. Kilei, 2004. Origins, Customs & Identity of Nanumea. Funafuti (new revised version). Collingwood Ian, 2008. Tuvalu Education Sector Scoping and Design Mission, AusAID Department of Community Affairs, Ministry of Home Affairs, Tuvalu Government 2001, Social Development Policy for Tuvalu. Department of Community Affairs, Ministry of Health, Women and Community Affairs, Tuvalu Government. Annual Report for Women and Community Affairs 1998 (unpublished). Department of Youth Affairs, Ministry of Home Affairs and Rural Development, 2006. National Youth Policy. Tuvalu (unpublished). Esela Aselu Bateteba, 2006.Report on Social Data for Tuvalu 2005: Ministry of Home Affairs and Rural Development; Tuvalu Government. Bateteba, Esela A, 2007. Draft Report on the Elderly, Disabled and Household Employment in Tuvalu. Ministry of Home Affairs, Tuvalu Government (unpublished). Laracy, Hugh. & Faaniu, Simati. 1983, Tuvalu : a history / written by Simati Faaniu ... [et el.]; with assistance from Hugh Laracy ... [et al.] Institute of Pacific Studies and Extension Services, University of the South Pacific and the Ministry of Social Services, Government of Tuvalu, [Suva, Fiji] Hughes, Frances, M. Finlayson, P. Firkin, M. Funk, N. Drew, T. Barret, X. Wang and K. Fritsch K. 2005 Situational Analysis of Mental Health Needs and Resources in Pacific Island Countries: Centre for Mental Health Research, Policy and Service Devel- opment, University of Auckland and the World Health Organisation. IPPF, EU, Tuvalu Family and Parenthood Association, Tuvalu 2007. Annual Report on Vision 2000 Fund Co-ordination Project for 2007 – Services for Adolescents in Tuvalu (unpublished). Jourdan, Christine, 2008. Youth and Mental Health in Solomon Islands: A Situational Analysis. FSPI, Fiji. MacDonald, Barrie, 2001. Cinderellas of the Empire. Institute of Pacific Studies, University of the South Pacific, Institute of Pacific Studies. Manuella, Teuleala, 1999. Tuvalu Report on the National Youth Workshop: Living in a World of Change. Department of Com- munity Affairs, Ministry of Health, Women and Community Affairs, Tuvalu Government (unpublished). Ministry of Finance, Economic Planning and Industries, Tuvalu Government, 2005. Te Kakeega II National Strategy for Sustain- able Development 2005-2015. SPC/UN, 2004. Pacific Islands Regional Millennium Goals Report 2004. SPC, New Caledonia. Tuvalu Government, 2002. Population and Housing Census 2002. Tamasese K., Peteru C. and Waldegrave C., 1997. A Qualitative Appropriate Services Investigation into Samoan Perspectives on Mental Health and Culture. New Zealand. Tavita, L., 2008. Tuvalu National Demographic and Health Survey, Tuvalu Government. Tuvalu Government, CEDAW – UNGASS 2008, Tuvalu Country Progress Report, 2008. Tuvalu Government, 2007. Climate Report 2007, Meteorological Department, (unpublished). Tuvalu Government, Ministry of Home Affairs and Rural Development, Tuvalu. Falekaupule 1997. Tuvalu Government, Household Income and Expenditure Report 2004 and 2005, Department of Statistics. Tuvalu Government and UNICEF - Suva, Fiji, 1996. A Situational Analysis of Children and Women in Tuvalu 1996. Tuvalu Government, 2008. Tuvalu National Strategic Plan for HIV and STI 2009-2013. Tuvalu Government, 2007. Te Kakeega II National Strategy for Sustainable Development 2005-2015. World Health Organisation, 2002. Regional Strategy for Mental Health, Western Pacific Region, Philippines.

31 Youth and Mental Health in Tuvalu: A Situational Analysis Appendices APPENDIX 1: Tuvalu youth organisation contacts

NAME ORGANISATION ADDRESS CONTACT Fagatoa Hale Seinanumea Youth Association Haumaefa Village, Nanumea Island. Nil

Antelea Patea Seinanumea Youth Association Lolua Village, Nanumea Island. Nil

Atalota Semeli Seinanumea Youth Association Lolua Village, Nanumea Island. Nil

Melei Melei Seimeana Youth Association Fakaifou Village,Funafuti Island. [email protected]

Pologai Talafai Youth Tonga Village, Nanumaga Island. Nil

Fatuivi Osie Talafai Youth Tonga Village, Nanumaga Island. Nil

Numau M Talaua Talafai Youth Tonga Village, Nanumaga Island. Nil

Imo Fiamalua Talafai Youth Fakaifou Village,Funafuti Island. Phone: 688 20896

Limaalofa Fialiki Niutao Youth Kulia Village, Niutao Island. Nil

Kateline Teigoa Niutao Youth Kulia Village, Niutao Island. Phone: 688 28111

Peloti Lotolua Niutao Youth Tekavatoetoe Village,Funafuti Island. Phone: 688 20687

Ema Iopu Motu o Kai Youth Fakaifou Village,Funafuti. [email protected]/ [email protected] Melosi Matoan Lotonui Nui Island. Nil

Maliomea Ulia Matoan Lotonui Nui Island. Nil

Tebii Shuster Matoan Lotonui Nui Island. Nil

Simeon Tanentoa Matoan Lotonui Funafuti Fakaifou Village, Funafuti Island. [email protected]

Kalepo Maputoka Lima Malosi Vaitupu Tumaseu Village, Vaitupu Island. [email protected]

Kalasipa Tuilimu Lima Malosi Vaitupu Tumaseu Village, Vaitupu Island. Nil

Taloline Takuo Lima Malosi Vaitupu Asau Village, Vaitupu Island. [email protected]

Kulene Sokotia Lima Malosi Vaitupu (Funafuti) Vailiki Road, Fakaifou Village, Funafuti. [email protected]

Akesa Maneota Tamanuku Youth Nukufetau Island. Nil

Sama Fuafanua Tamanuku Youth Nukufetau Island. Nil

Lakena Tefoto Tamanuku Youth Nukufetau Island. Nil

Suzanne Eliesa Tamanuku Youth (Funafuti) Fakaifou Village, Funafuti Island. [email protected] Phone: 688 20 362

Selifa Numia Funafuti Youth Fakaifou Village, Funafuti Island. [email protected] Phone: 688 20 637 Bruce Taai Funafuti Youth Senala Village, Funafuti Island. Phone: 688 20 475

Suiga Nasona Funafuti Youth Senala Village, Funafuti Island. Phone: 688 20 674

Aloama Sikela Funafuti Youth Senala Village, Funafuti Island. [email protected] Phone: 688 20 912 Luisa Leeke Nukulaelae Malosiga Lofeagai Village, Funafuti Island. Phone: 688 20 390

Tokasi Leeke Nukulaelae Malosiga Lofeagai Village, Funafuti Island. Phone: 688 20 390

Telava Folitau Nukulaelae Malosiga Alapi Village, Funafuti Island. Phone: 688 20 066

Tolongu Nafatali Nukulaelae Malosiga Alapi Village, Funafuti Island. Phone: 688 20 066

Tela Pelosa Seventh Day Adventist Youth Senala Village, Funafuti Island. [email protected]

Ringamoto Ligovasa Vaiaku Youth Vaiaku Village, Funafuti Island. [email protected]

Teaunu Lopati Fakaifou Youth Fakaifaou Village, Funafuti Island. [email protected]

Maleko Logo Lofeagai Youth Lofeagai Village, Funafuti Island. Phone: 688 20 362

Baniani Nakala Nia Baha’i Faith Youth Fakaifou Village, Funafuti Island. Nil

Sandy Solomona Kilogatasi Drama Group, Tuvalu Fakaifou Village, Funafuti Island. [email protected] Family Health Association

32 Youth and Mental Health in Tuvalu: A Situational Analysis APPENDIX 2: Youth projects in Tuvalu

DONOR YEAR DETAILS FUNDS ?AUD@ SITES Canada Fund 2000-2003 Training Centre for $6,400 Nui Island Women and Youth Canada Fund 2003-2004 Construction of 18 $22,493 Niutao Island chicken sheds for Teava Youth Canada Fund 2003-2004 Construction of 30 pig $19,350 pens for Tafemai Asso- ciation

Canada Fund 2005 Moeaki Sewing Group $5,267

Canada Fund 2005 Youth Leadership $3,280 Project

SPC 2005 Gender Support Facility $3,996 Funafuti.

UNIFEM 2005-2007 CEDAW workshop $18,048 Nationally

NZAID 2004 Tuvalu Scout Handbook $2,500 Funafuti

NZAID 2004 Sports Gear for Niutao $2,946 Niutao Community NZAID 2004 Sports Gear for Talafai $1,089 Association UNICEF 2003-2007 Youth Lifeskills & $50,729 Funafuti HIV/AIDS Training 2004 Sports ﬁeld $200,970 Funafuti

NZAID 2007-08 TANGO/FSPI/YMH $27,410 Funafuti

NZAID 2007-08 $27,000

WSSCC 2007-09 FSPI/WSSCC/Water san- $22,000 Funafuti itation and hygeine in Niutao schools

APPENDIX 3: Youths interviewed by age group and gender

AGE GROUP MALE FEMALE TOTAL 13-14 1 1 2 15-19 12 13 25 20-24 12 12 24 25-29 6 7 13 30-34 4 2 6 Total 35 35 70

33 Youth and Mental Health in Tuvalu: A Situational Analysis APPENDIX 4: Update report on Tuvalu’s Promotionof Mental Health 2008 for WHO

PROGRAMME STATUS IN 2005 UPDATE STATUS IN 2008 POLICIES & LEGISLATION Mental Health Policy Formulated in 1978 None, using WHO guidelines Substance Abuse Policy Absent Absent National Mental Health Programme Absent Not active National Therapeutic Drug Policy/Essential Absent & not oﬃcially adopted ED List & National Therapeutic Drug Com- List of Drugs mittee in place

Mental Health Legislation Have Mental Treatment Law Not reviewed in 1999 Latest legislation enacted in 1978 MENTAL HEALTH FINANCING No budget for MH, no expenditure on MH No budget speciﬁc to mental health. available. MH ﬁnances from tax-base, families and patients.

PSYCHIATRIC BEDS & PROFESSIONALS Total number of psychiatric beds per 1.8 2 beds available specifically for psychiatric 10,000 population patients. Psychiatric beds in M/hospital per 10,000 0 2 beds available at M/hospital on the cap- Psychiatric beds in general hospitals per 1.8 ital. 10,000 0 Psychiatric beds in other settings per 0 None in other clinics on the outer islands. 10,000 0 Number of psychiatrists per 100,000 pop. 0 0 Number of neurosurgeons per 100,000 0 0 population. 0 Number of psychiatric nurses per 100,000 0 population. 0 0 Number of neurologists per 100,000 pop. 0 0 Number of psychologists per 100,000 pop. 0 Psychiatric patients are managed by med- No. of social workers per 100,000 pop. Psychiatric patients are managed by medical officers. ical officers. NON-GOVERNMENTAL ORGANISATIONS NGOs involved in promotion, prevention Tuvalu National Red Cross Society gives and rehabilitation. assistance through visits and provision of basic needs.

INFORMATION-GATHERING SYSTEM No reporting system in place. Not included in CMR. No data collection system. Centralised all Data (Admission, Diagnosis of Cases &Referral ). No epidemiological study on MH. Data. No study done.

PROGRAMS FOR SPECIAL POP. There are no special services available. Elderly Scheme in place in 2008.

ADDITIONAL SOURCES OF INFORMATION Government of Tuvalu (2000). Tuvalu Essential Drug List.

More tables containing data from the surveys conducted for this report can be obtained from TANGO on Tel:+ (688) 20758, Fax: + (688) 20419, Email: [email protected].

34 Youth and Mental Health in Tuvalu: A Situational Analysis 35 Youth and Mental Health in Tuvalu: A Situational Analysis Foundation of the Peoples of the South Paciﬁc International Victoria Corner Building, PO Box 136, PO Box 18006, Suva, Fiji Islands. Funafuti, Phone: +679 3312 250 Tuvalu. Fax: +679 3312 298 Tel: +688 20758 Email: [email protected] Fax: +688 20419 www.fspi.org.3 Email: [email protected]