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Saturday 1 January 2005

Guidelines for Psychosocial Support Efforts

From the Blog of the Psychosocial Support Program, Sri Lanka

Introduction

There are many reasons why people may be distressed and upset in the aftermath of the tsunami. Some of these reasons include the following:
Loss of family members, relatives, friends, personal belongings including the family home and property may sadden and shock people. This may be particularly upsetting for those who have lost their entire livelihoods.
Exposure to horrific events. Many people have witnessed or suffered very distressing and alarming experiences, which may cause shock, confusion, anxiety and alarm.
Ongoing risk of danger. Even in these last few days, there have been many alarms of further tsunamis, creating further panic and confusion amongst people.
Physical injury and illness to self or others. This may also cause people to be alarmed or worried. They may also not be able to take care of themselves or others as well as they would like to.
Living in a stressful and deprived environment. Refugee camps are often places without adequate food and water. They are often overcrowded and have poor sanitation facilities. People may be stressed because they have to share personal space with people they are unfamiliar with. There may quarrels or disagreements about how to share scare resources. Some people maybe left out because they are not as forceful as others or come from socially ostracised groups. Additionally, people from different communities and social backgrounds may find it difficult to live together.

It is important to note that people are normally expected to have stress reactions at this time. These are not signs of psychiatric impact or trauma and do not require psychiatric treatment. Most people are expected to have a normal recovery in the following weeks.

Psychosocial interventions should not interfere with the organisation of food, shelter, clothing, public health services and the control of communicable diseases in the areas affected by the tsunami. Apart from early psychosocial interventions, formal therapeutic activities geared towards recovery should not take place earlier than two to four weeks after the acute situation.

From the Blog of the Psychosocial Support Program, Sri Lanka

Suggestions for Supporting Psychosocial Wellbeing and Mental Health

People will benefit from having reliable information about their family members and loved ones as soon as possible.
Set up a system such as a registry to keep track of names of people who have been found, who are in hospitals, who are in refugee camps or who have found shelter with relatives or friends
Have names and/or details of the system/registry so that people know where to call or contact regarding the location of their families or friends
Concerning unaccompanied children, the elderly and vulnerable groups such as those who have lost all or most of their family, help them to locate family members or other known people
Information about the following should be made available in uncomplicated language:
What are tsunamis, how and why they occur will be helpful for people to understand what has happened. However, people’s understanding and explanation of the tsunami will also be linked to their religious and cultural beliefs regarding disasters and crises.
Signs indicating further tsunamis, and what to do in case these signs appear
Where to call or contact regarding reliable information on the possibility of further tsunamis

Information about the following should be made available in uncomplicated language:
Ongoing efforts to establish the safety of people in the tsunami-affected areas
Ongoing relief efforts, including what each organisation is doing and where they are located
Contact names and details of people to call regarding relief efforts, if people would like to donate things, bring relief, get relief or volunteer themselves

A good guideline for uncomplicated language is if local 12-year olds can understand the information.

From the Blog of the Psychosocial Support Program, Sri Lanka

Suggestions for People Working in Tsunami-affected Areas and in Refugee Camps

Encourage people working in the tsunami-affected areas to involve survivors in the relief and rescue efforts where possible, especially adolescents, orphans, widows, widowers and those without families. Do not treat people as passive and helpless victims. This is one of the most disturbing experiences for people who have been displaced or otherwise affected by disasters. Instead, involve them in concrete, purposeful and common activities
Older children can help look after younger siblings and children, or help in the preparation of food for cooking
Adults can help in preparing, cooking and distributing food, organising and constructing shelter, documenting information, organising family tracing, clearing and cleaning spaces for living, providing security for the camp, organising or supporting health services and healthcare, caring for the sick or teaching children
Provide opportunities for adults and adolescents with special skills to use their skills as much as possible for the wellbeing and functioning of the camp community and for earning their living, if possible. Masons, carpenters, teachers, nurses and others should be assigned to tasks that utilise their areas of expertise.

Encourage those who are working in tsunami-affected areas to organise living spaces such as refugee camps and other places in the following ways as this will help to maintain normalcy in people’s lives
Organisation and construction of shelter should keep members of same families and communities together
Provide as much privacy as possible for each family by hanging mats or cloths around the area allocated to them.
Provide religious, recreational and cultural spaces in the design of the camps
Involve the community in deciding where to locate religious places, schools and water supply in the camps
Establish schooling and play areas for children, as much as is possible
Ensure that sanitation and bathing facilities are accessible in areas that do not threaten people’s wellbeing or subject them to further harassment, particularly young girls and women
Re-establish normal religious and cultural activities and events. These may include daily prayers, lighting of lamps, and other activities
Invite religious leaders to conduct daily religious activities
Recognise the different needs of different groups of people; age, gender, ethnicity, religion, people with disabilities, people with special medical or health issues, etc.

Discourage unceremonial disposal or burial of dead people as survivors need to have the possibility to conduct ceremonious funerals and if not mutilated or decomposed, see the body in order to say goodbye. Also, if no record of the dead is there, then there will be unnecessary financial and legal difficulties for the survivors. Dead bodies carry no or extremely limited risk of communicable diseases.

From the Blog of the Psychosocial Support Program, Sri Lanka

Promoting Psychosocial Wellbeing and Mental Health

People will need to have access to emergency or public healthcare for those people who are in extreme shock, who have lost contact with reality, and who want to harm themselves or others as a result of their losses. To respond to these, encourage people working in these areas to undertake the following:
Establish a care unit within the public health care system, whether run by state or non-governmental organisations.
Organise mobile clinics where possible as people and infrastructure does not allow mobility
Ensure availability of essential psychiatric medications, in case of need, especially as there will be people who have been taking medications prior to the tsunami.
Antidepressants, anti-psychotic medication, and tranquillisers may be useful, but should be avoided as far as possible.

People will also benefit from the organisation of good hygiene and sanitation as this will support their sense of wellbeing and prevent vulnerability to disease and additional distress.
People need access to appropriate sanitation facilities.
Keep sanitation areas clean.
Boil water before consumption to avoid contamination and disease as far as possible.
Have separate areas for bathing, if possible.
Set up a garbage disposal system through out the camp. Assign an area for garbage disposal. Bury perishables in an appropriate place. Have an appropriate system for sanitation needs of menstruating girls and women.
Follow the principles of brief psychological first aid to provide emotional care and support to others in this difficult time.

Listen
Convey compassion and caring
Assess practical needs
Provide practical help as and when required
Ensure basic physical needs are met
Do not force people to talk. Listen to what they want to share with you.
Support people in solving or handling problems. The problem management techniques involve identifying the problem, looking at causative factors, listing courses of action to alter causative factors, evaluate courses of action and choosing what seems to be most feasible and appropriate under the circumstances. Help the person in carrying out what action they have chosen, although this may not be in line with what you’ve thought about.
Point out how well they have coped and how they have been resourceful during the crisis, where appropriate
Do not give simple reassurances to people such as “it is God’s will” or “at least you have your children” or “look how others have suffered”.
Provide or obtain company for people, preferably family or known people
Encourage social support but do not force this
Protect people from further harm
Do not organise single sessions where people are forced to talk deeply about their personal experience, especially beyond what they would naturally share.
In these circumstances, many people are forced to talk repeatedly about their experience to all those who want to know about people’s particular experiences. This will get repeatedly difficult for those concerned. Discourage people being forced to talk about their experiences again and again for the benefit of the curious.

The loss of loved ones is one of the most difficult experiences for people who have survived the tsunami disaster. It is important to recognise that this is an extremely personal experience and that there is no right or wrong way for people to respond or react to their loss. People need time to recover from this loss, and their expressions of grief at this point in time should not be seen as signs of mental health illness or as irrecoverable grief. People’s capacities for recovery and resilience have been found to be very strong. Some of the ways of supporting people through this may be:

Listening to the person talking about the loss or the lost persons
Reassuring the person that imagining the person is still alive or searching for the person is normal and not signs of insanity.
Tell the person that different people respond in different ways and that there is no right or wrong way. Some people find it difficult to believe in the loss, others may be angry or guilty that the person is lost, and others may feel extremely sad and lonely.
Crying, having sleeping difficulties and loss of interest in activities and other people are normal reactions to loss.
Performing activities such as prayers or religious functions for the lost person may be helpful. Funerals or ceremonial burials are very helpful, if they can be performed.
Encourage person to be in the company of those whom they know or trust.
Those who have lost all or many of their family members are at risk of self-harm. Ensure that they are adequately supported and involved in different activities.

From the Blog of the Psychosocial Support Program, Sri Lanka

References:
Mental Health in Emergencies: Mental and Social Aspects of Health of Populations exposed to Extreme Stressors, Department of Mental Health and Substance Dependence, WHO Geneva, 2003
The above document also contains elements of from guidelines prepared by the Directorate of Mental Health Services, Ministry of Health, Sri Lanka on 30th December 2004. This document will be made available online as soon as possible.

Compiled by the Psyschosocial Support Programme of the IWTHI Trust
Translated versions will be made available shortly
31st December 2004

From the Blog of the Psychosocial Support Program, Sri Lanka

3 Comments Post a Comment
Blogger Jeremy said :

My friend and I have experience working with trauma survivors and would be interested in going to South Asia to assist with relief (at our own expense of course) and think we might be especially helpful to traumatized westerners does anyone have any ideas who to contact to go about doing this?

Sat Jan 01, 09:57:00 PM IST  
Blogger Bala said :

Jeremy,

Send us your info. We will post it on the helpoffered section.

Sun Jan 02, 12:01:00 AM IST  
Blogger web4health said :

We try to collect good information and links for trauma support for victims of the disaster at http://web4health.info/en/answers/psy-acutetrauma-help.htm or my German language blogger (http://web4health.blogspot.com/)

Martin

Mon Jan 03, 01:38:00 AM IST