**1. Introduction**

Stress in the lives of humans under different names has attracted myriads of studies and publications since World War I (WW I). One of the most compelling books in the field is Herman's publication [1]. Protracted, catastrophic, and lifethreatening events happen in daily life behind closed doors of families in the form of domestic violence, sexual abuse and defilement, political terror and wars, and natural disasters, and the diagnosis of terminal illness. Mental disorder in the form of post-traumatic stress disorder (PTSD) is so complex that misdiagnoses are common. Another influential book by Varmik Volkan [2] theorize that society accepts "*widespread violence,*" which begins with what Volkan has described *"chosen trauma."* The defeat of one of the groups involved in intergroup conflict carries the painful memories of their humiliation for centuries as a result of historical details passed on from generation to generation in the hope that a future generation might be able to avenge them. Likewise, the victor in intergroup conflict keeps alive their chosen glory for as long as history can tell to ensure that their victory remains in memory. The stark implication of this is that traumatic stress remains in memory for the entire lives of affected people. According to Volkan, mass psychosis and suicide may follow organized ethnic or political violence. Several traumatic stress-related psychiatric disorders appear in the two main diagnostic systems, namely the Fifth Edition of the Diagnostic and Statistical Manual of Mental and Behavioral Disorders (DSM-V) of the American Psychiatric Association [3], and the eleventh edition of the International Classification of Diseases and Behavioral Disorders (ICD-11) of the World Health Organization [4].

Though not strictly a disorder, but rather, a consequence of other medical and psychiatric conditions, suicide has come to take a central position as one of the leading complications and comorbid health and social problems of stress disorders, occurring together with post-traumatic stress disorder (PTSD), depression, anxiety disorders, alcohol and substance use disorders, and general medical conditions. The risk of suicide is higher than in the general population as reported in anxiety disorders [5, 6], general physical conditions (Dome et al., 2019), and bipolar disorder [7]. In Uganda, a landlocked country in East Africa, a violent war took place between the Uganda government armed forces, the Uganda People's Defense Forces (UPDF), and a rebel army of the Lord's Resistance Army (LRA) in Northern Uganda from 1986 to 2006. Several publications have documented varying prevalence rates for depression, suicide, suicide ideation, and other consequences of the decade long civil war in Northern Uganda [8–10], Ovuga and Wasserman [11, 12].

As would be expected, one of the main goals of trauma therapy should aim to help trauma-affected persons to recover from trauma, minimize mental distress, improve community resilience and psychosocial functioning, and prevent suicide in the aftermath of mass trauma exposure. Unfortunately, little or no attempt aims to prevent suicide among trauma-exposed people. In situations of mass trauma, psychosocial support to trauma-exposed persons is limited to the provision of social amenities, the provision of protection and security guarantees, and other actions that aim to promote community cohesion and resilience. Suicide prevention work, which should be a key component of trauma therapy and psychosocial support, should include the creation of an awareness of potential self-destructive behavior occurring in communities affected by trauma. Following this step is the institution of measures to provide psychological services to trauma victims; and recognizing, assessing, and offering quality counseling services and specialist mental health care to people showing symptoms and signs of psychological distress or mental illness. An optimal outcome of such an intervention occurs when suicide prevention work takes place at community level close to where trauma victims live, and with the full participation of war-exposed communities. To do this, trained laypersons will deliver the suicide prevention therapy as an integral component of generic psychosocial support services [13]. A setback to this approach is the potential resistance of trauma-affected communities concerning the role of laypersons to deliver psychological first aid in

*Lay Counselors' Mental Wellness in Suicide Prevention after Prolonged Mass Trauma… DOI: http://dx.doi.org/10.5772/intechopen.106620*

their own areas of abode. In the words of one community member, *"What can our colleagues do that we do not know? We live with them, they know our problems, and we have suffered with them. How can they help us?"*

The present chapter describes the outcome of training laypersons to deliver psychological support for distressed war-affected individuals in Gulu District in Northern Uganda. In doing so, we hypothesized that vulnerable members of traumatized people would show evidence of psychological distress even though they seem to *"function normally."* If this is the case, we expected that laypersons would offer psychological services to their colleagues more effectively if they themselves receive psychological care before they assume responsibility for the psychological wellness of their distressed colleagues. We therefore hypothesized that training distressed waraffected individuals would constitute the means to improve their mental health.
