Mental Health Services During Natural Disasters
Item
- Title
- Mental Health Services During Natural Disasters
- Creator
- K R Antony
- Date
- 2015
- extracted text
-
Mental Health services during Natural Disasters.
Dr.K.R.Antony*
My friend Albert, a social activist was visiting a coastal village in Orissa post Super-cyclone in 1999.He saw a
man staring at a human body floating in the paddy field, right in front of his house. He was supporting his chin
with his arm, with a blank distant stare and had no visible expression of any emotions or body response to the
greetings of an approaching visitor to his house. He had a tired look on his face and apparently not eaten or
drunk anything for the last couple of days. No tears in his eyes. Only upon repeated questioning about whose
body it was, he gave a terse answer-"my wife" For the previous two days he could not get over the shock of
losing everything in life, including his dear wife in the fast approaching high waves of sea water. And that dear
wife's body is decomposing right in front of him and he has not got up to give a decent burial and perform the
last rites due to her.
Well, that is the level of depression any victim of Natural disaster can go into. Often it is unrecognized and not
acted upon by the relief workers in many natural disasters due to low priority and due to lack of technical
experts to intervene. During the same post Super-cyclone period I have heard of children attending schools
from relief camps having symptoms of deafness and blindness who have these manifestations as a
psychological reaction to the shock of a deep trauma. These children were repeatedly experiencing the
howling and whistling of high velocity wind and the sight of approaching deadly high waves swallowing their
siblings and parents. These hysterical blindness and deafness can be considered an escape mechanism for a
traumatised mind
Similar anecdotes were heard during post-tsunami period from coastal Andhra, Tamil Nadu and Andaman
islands from my colleagues in UNICEF.
Acute Post Traumatic Stress Syndrome is a clinical entity well recognized in the aftermath of Natural disasters.
Justifiably, during any natural disaster the first concern of relief workers is to save lives and rescue all those
who are still alive and limit further loss of lives and physical damage.
Relief Commissioners and their government staff as well as voluntary organizations get busy with setting up
relief camps, telecommunication networks, power supply, approach roads, shelter camps, community kitchen
and toilets. Provision of drinking water, food, medical aid and prevention of communicable diseases all get
priority, but not mental health needs of the survivors and victims of disaster.
Many of the states do not have even absolute minimum number of Psychiatrists and clinical psychologists in
their government service. The nearest medical colleges also do not have enough persons on pay roll to satisfy
even the MCI Inspection teams. No wonder mental health needs of displaced communities in relief camps are
ignored or kept as last item in the priority needs.
When there is such a severe shortage of required health staff with clinical expertise, managers of disaster
relief operations are compelled to provide immediate Psychological First Aid (PFA) through volunteers and
paramedical staff. They may be coached to use simple psychological techniques to relieve mental anguish or
panic and possibly prevent any need of psychiatric intervention for majority of trauma victims.
The fundamental Principles of PFA that need to be adhered to, as described in the "Handbook of International
Disaster Psychology-Practices and Programmes-Gilbert Reyes and Gerard Jacobs 2006" are as follows:
1.
Protection-Damage control or stabilization to prevent worsening further from existing level. Gain
survivors attention and cooperation to move to safer places. Despondent and persons not
cooperating to move can endanger themselves and others who may benefit from moving location.
2.
Social support-Boosting the inherent coping mechanism-Every individual or community has some
endurance tor-hardships without external assistance. There are 3 categories of Social support-1.)
Tangible(material) support-Food, shelter, financial aid etc 2.(Emotional support-anything someone says or
does that helps another person to bear up. Even a caring and attentive companionship is an emotional
support. 3.) Informational support-sharing some valuable bit of knowledge or information that solves their
problem or gain access to resources that can reduce their misery or hardship.
Volunteers for PFA require good interpersonal skills-with active yet calming, comforting, confident presence,
listening more than talking, offering unreserved compassion without judgement or prejudice.
3.
Arousal reduction
Any life threatening situation like disasters can arouse fear and self protective emotions and stimulate nervous
system response for survival- the "flight /fight response". The consequent thinking abilities and emotional
functioning of victims during disaster may be altered and is a 'necessity' for a short period but debilitating in
the long run. PFA volunteer should soothe and reduce this "arousal phenomena" so that the survivor is calm
and mentally at rest; able to function at a higher level and even sleep well. Loss of or separation from near and
dear ones also stimulates "arousal". Hope of reunion and frantic search for the loved ones also increase
mental anguish. PFA provider can help in this search and effort for re-union of the survivor.
4.
Assisted Coping
Coping is anything that people do to improve their lives or avoid losses in an adverse scenario like natural
disasters. Victims often find it difficult to function in a systematic and organized fashion.PFA volunteers should
assist in coping mechanism they display on their own and further empower them. Survivors should be treated
with respect and encouragement for their resilience, competence and dignity They must not be clinging on to
the aid workers with a dependency feeling. People tend to cope by either 1. Confronting directly or 2.enduring
a problem or 3.managing their thoughts in minimising the emotional impact of the problem.
Assisted coping is facilitating the selection of best option among the above three to solve their problem.
5.
Supervision
There is a limit to the resourcefulness or abilities of a PFA volunteer. At times they become helpless and timid
in confronting the field level issues. Supportive supervision by experienced PFA experts or mentors can solve
this limitation.
6.
Helping the Helper
Often humanitarian and philanthropic workers are very good, sensitive and idealistic personalities. They are
particularly vulnerable to daily exposure to traumatic experiences of fellow human beings who for no fault of
theirs have had to undergo such misery and hardships. Occupational hazards they face may include a sense of
helplessness, obsessive thoughts coming up repeatedly of suffering of your clients and difficulty managing the
level of involvement in the lives of others. In their enthusiasm they may feel they are not getting enough back
up and the organization they represent is inefficient, inadequate, insensitive and even corrupt. Practitioners
need themselves compassionate 'self care' to withstand 'burn out' syndrome. They must be encouraged to
avoid long shifts, take mandatory breaks during duty hours and compulsory home leave after continuous
working weeks for recuperation.
Screening and detection of those who need Psychiatric help.
Once the relief camps are established, certain group therapy and counselling services could be undertaken by
the deputed Clinical Psychologists or the paramedical workers trained specifically in management of grief. If
families are already disbursed from the camps and they are back at home or children are attending schools,
then paramedical workers can be trained to screen at home or neighbourhood, those requiring referral for
psychiatric treatment.
Psychiatric help through Primary Physicians.
If the ground reality is such that no psychiatrist is deputed or available for daily duty in relief camps or in the
vicinity of affected villages, a team of MBBS doctors can be trained on how to treat acute post trauma stress
syndrome. Algorithms of management of locally prevalent most common diagnosis, based on situation specific
signs and symptoms can be taught to those MBBS doctors. The options of medications like anxiolytics
(Diazepam, Alprazolam, Lorazepam) antidepressants (Imipramine, Fluoxetine) should be limited to absolute
minimum for common disorders. Those with severe breakdown may be psychotic and need antipsychotic
medication The medications prescribed must be made available in full at each camp site. Those prescribing
and dispensing the medicines must emphasize the need for correct and regular dosing, and it should be
underlined that many medicines take time, even upto two weeks to start producing the desired psychological
improvement. The psychiatrist who volunteers or is deputed to train these group of primary care physicians
should take "vicarious responsibility" and must be available for clarifications or consultation over phone or
internet; better still for videoconferencing if broadband connectivity is established at camp site. "Ready
reckoners" and handbooks for case management should be prepared, duplicated and distributed adequately
for medical and paramedical staff.
Conclusion
Psychological needs of displaced communities in transient shelters and victims and survivors of natural
calamities living in their homes are seldom addressed systematically by government or international donors.
Often it gets low priority and last attention by relief workers and civil society organizations. This also reflects
the extremely inadequate training in mental health given to undergraduates in the Indian medical curriculum.
Professional organizations of Psychologists and Psychiatrists must come forward to design protocols and
Handbooks for management and training modules for health staff in addition to drafting policy guidelines. One
such manual was created after the Bhopal Gas Leak disaster in the early 1980s but this may need updating.
National Disaster Management Agency must show stewardship to issue clear-cut directions to states to include
this aspect in their Disaster Preparedness plans.
■Acknowledge inputs from my classmate Dr.Ajit Bhide, Psychiatrist St.Martha's Hospital, Bangalore.
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