Abstract
In
post-conflict Sri Lanka, community-based mental health systems are critical to
long-term psychosocial recovery, yet the roles and effectiveness of
non-clinical cadres remain underexamined. Drawing on interdisciplinary
collaboration between psychiatry and public policy, this study evaluates the
contribution of Community Service Assistants (CSAs) to mental health service
delivery in Mullaitivu District—a region heavily affected by war and structural
deprivation. Employing a convergent parallel mixed-methods design, data were
collected from 11 CSAs, 20 service users, and 12 mental health professionals
between March and July 2025. Quantitative data were analyzed descriptively,
while qualitative data were thematically coded and interpreted through
implementation science and community resilience frameworks. Results reveal that
95% of service users rated CSA support as “very helpful,” highlighting strong
relational effectiveness. However, systemic weaknesses were pronounced: 90.9%
of CSAs were diverted to non-mental-health duties and 81.8% experienced
transfers disrupting continuity of care. Three interlinked constraints emerged:
erosion of role identity through task drift, capability gaps due to
inconsistent training and supervision, and operational frictions limiting
outreach. The study proposes a reform-oriented Community Psychosocial Systems
Model grounded in capability strengthening, institutional recognition, and
intersectoral alignment. By integrating clinical insight with governance and
systems analysis, the paper advances a scalable framework for post-conflict
mental health recovery applicable to similar low-resource contexts globally.