Dr. R. THARA takes a look at the emotional and psychological support provided to those affected by the tsunami.
Quick Focus On Mental Health: Disasters have long-term implications on traumatised children.
TWO months have passed since the tsunami struck our lives. Faces of shock, horror and despair are still fresh on our minds. Not a day has passed without some news about the tsunami and related developments. As a mental health professional, I have been accosted by several persons, including friends from the media, on the increased importance given to mental health in this disaster.
Are we faced with more emotional and mental health problems than before? Will the tsunami leave a permanent emotional and psychological scar on the entire community? What are the long-term implications on traumatised children?
All this prompted me to collate some facts and figures, opinions and impressions on this issue. The Schizophrenia Research Foundation (SCARF) is an NGO that has been working in the field of mental health for over two decades and is a Collaborating Centre of the World Health Organisation for mental health research and training. SCARF was one of the earliest agencies to get on to the field (post-tsunami) and start training. Today, over 20 NGOs and several UN agencies and international organisations are in the fray. More wish to join the bandwagon. Financial aid for counselling, training and psychosocial support is pouring in from all over the world.
Why mental health?
All disaster relief packages have a strong mental health component. But this has truly come to the fore with the tsunami, much more so than in Bhopal, Latur or Gujarat. Ironically, this could have happened just by default the tsunami did not leave in its wake too many physical health problems, or injuries and accidents. In fact, even large-scale infections that are common after such a disaster were rare. The public health machinery mobilised itself in the shortest possible time and most injuries were well attended to. Therefore, it is no surprise that the attention of medical specialists, public health experts, epidemiologists, international relief teams and NGOs quickly shifted to mental health. The media also vividly portrayed the emotional sequel of the disaster reiterating the importance of emotional support and psychological interventions.
Women who were with their children when the tsunami struck but were unable to save them have suffered the most. Staggering under the weight of a mixed bag of emotions as guilt, grief, hopelessness, they have either attempted suicide or developed psychotic reactions. Some young, healthy men have developed symptoms of anxiety and have problems in sleeping. Many mental health professionals feel that those who were under high stress on the verge of decompensation even before the tsunami have all developed full-blown clinical syndromes after tsunami.
Among children, anxiety and panic, feelings of insecurity, refusal to leave their parents and go to school have manifested themselves in the form of nightmares and disturbed sleep. Many children expressed these feelings when asked to draw or paint. Those who saw their siblings or friends washed away, or lost close family members, or those orphaned and shifted are especially vulnerable.
The mental health support and interventions have been as varied as the problems encountered. We met Kamala from the fishing community in Cuddalore. She had lost both her parents and had the role of a parent thrust on her overnight. She was torn between her desire to look after her two younger brothers and the option of sending them to foster homes. Spending sleepless nights, she attempted suicide twice. Constant support and counselling by the SCARF staff helped her to make a decision. There are many like Kamala who require only this non-intrusive, empathetic and non-judgmental "human touch".
There are others like John who lost his wife and children and began drinking soon after the tsunami. He developed acute psychosis and had to be admitted in order to initiate treatment.
Most people have tided over the acute phases of disaster. Initial grief reactions are abating and there is a decrease in such referrals. Acute psychotic reactions are seen mostly in persons who have lost their children or parents. In general, women seem more affected by depressions and psychotic states, while men turn to alcohol as the coping mechanism.
There are pockets in remote villages where little help has reached, unlike areas closer to big towns. Initiation, and more importantly maintenance, of psychosocial support in these areas is important.
Many children are back in school and look happy there. However, their ability to concentrate and focus attention and performance in exams needs to be monitored.
The greatest villain now seems to be wild and baseless rumours, which often bring back terrifying fears about recurrence of the tsunami. Rumour mongers, even if well intentioned, should be sensitive to the fact that such repeated feelings of anxiety and panic can permanently scar the minds of the vulnerable, especially women and children.
The tsunami has certainly equipped a number of people with the skills to handle post disaster emotional and psychological sequels. It has provided increments of knowledge, improved awareness, sharpened sensitivity of the community and policy makers and planners to the importance of sound psychological well being.
Mental Health has finally found its rightful place in the well being of humanity, albeit in the wake of one of the worst disasters to affect mankind.
* * *
HELPING survivors cope with the trauma needs knowledge and tact. But not many are experienced in handling such problems. Manyvolunteers and organisations keen to take up this responsibility and all require proper training. Hence this is being offered to counsellors, trained and untrained, relief workers, women's self-help groups and staff of NGOs. What will be critical are:
An evaluation of the training to ascertain how many trained persons have actually applied their skills on the field to provide mental health support.
Offering emotional support and counselling to those who require it as in the case of Kamala; medication for those intensely depressed, suicidal.
Those with mental illness before the tsunami have reacted badly and many have relapsed. Reassessment of their condition is also being done.
The writer is the Director, Schizophrenia Research Foundation (SCARF), Chennai.
The writer acknowledges inputs from Dr. Lakshmi Vijaykumar (SNEHA), Dr. S. Nambi (IMH), Dr. Manorama (CHES), Koteeswara Rao, Kirubakaran and Sujit John (SCARF) and the Joint Director of Health, Cudalore District.
Send this article to Friends by