In disaster aid, include mental health

When humanitarian emergency strikes, are we really prepared to offer a complete response that takes care of not only the immediate needs of the people affected but also often the long-lasting impact on their psychological well-being?

We need to ponder over this question as we deal with an increasing spate of 'disasters' in India and around the world. While people are still recovering from severe drought of the last two years, monsoon-related flooding across the country has claimed more than 1,200 lives.

Though various agencies are fully involved in providing humanitarian assistance of basic life-saving and sustaining needs like food, temporary shelter, hygiene and sanitation facilities, what is largely missed out in the overall response process is the focus on providing 'Psychological First Aid' (PFA).

This may largely be due to a commonly built understanding of 'emergency response', which is a 'normal response to an (ab)normal situation', but which overlooks the need for psychosocial care for some individuals even after providing basic services.

Disasters affect everyone in one or the other way with some feeling overwhelmed and others having mild reactions. Each individual has strengths and abilities to help them cope with challenges. However, some are particularly vulnerable and may need extra assistance due to their pre-existing vulnerabi ­lities (age, mental/physical disability, or belonging to a particular group which may be marginalised or targeted by violence). Other factors like poverty, stigma, shock, societal supportive structures are also significant.

Children, close to 40% of India's population, experience normal to acute distress at the time of a disaster. Not used to the sudden change in known environment, children are at a loss because they are unable to com-
prehend the situation and express themselves, unlike adults.

Save the Children's experiences during humanitarian crises in Uttarakhand, Kashmir, Chennai, Cyclones Phailin and Hudhud and, most recently, the South Asia Floods, show that it was quite common for children, including adolescents, to report having sleepless nights, nightmares of rivers gushing into their homes, houses collapsed and waiting for deceased family members to be found.

While disaster itself creates panic, the initial distress may continue for a longer period if left untreated. The demise or missing of family members, immobility due to physical injury, loss of contact with peer groups and teachers, loss of personal belongings, inability to maintain personal hygiene, and the fear of unforeseen future are a few of the reasons which build up psychological stress among children.

Many studies and experiences reveal cases of girls (and boys) getting sexually harassed in shelter camps, transitional shelters and toilets, further increasing the trauma. A few children may engage in self-blame for bringing 'disaster' to their families.

Limited research on the psychological well-being of children during and after disasters have found that a majority of children develop symptoms of post-traumatic stress disorder (PTSD) in the first six months of the disaster, further increasing their risk for other disorders and permanent impairment
of psychological functioning.

Recognising its significance, Save the Children is developing an approach to bring the concept of 'Psychological First Aid for children and caregivers in emergencies' in its overall humanitarian assistance framework. PFA is globally acknowledged as a simple, efficient method to provide initial support in crisis situations, and is included in the Minimum Standards for Child Protection in Humanitarian Action.

The PFA approach is suitable for disasters and in daily crisis or shocks and involves coordination among multiple resources available within the community and outside. Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings also calls for the implementation of a set of minimum multi-sectoral responses, especially social supports and selected psychological interventions.

For these interventions to be effective, it is vital to invest in community preparedness and strengthening systems to increase the coping capacity after a disaster and reduce the stigma attached to psychological problems among people.

This brings us to the need of continuous dialogue among humanitarian agencies, counsellors, mental health experts, academicians and, importantly, the government authorities to bring the focus on psychological well-being and create a culture of knowledge by developing common operational tools, methodologies and interventions for an effective multi-layered response mechanism.

(The writers are part of Save the Children's humanitarian response team)