Mental health assistance to the populations affected by the Tsunami in Asia
1. The destruction of the earthquake/tsunami has caused distress (traumatic stress, loss-related stress, etc.) in the majority of the population. Yet, WHO expects the increase in mental disorder to be about 5-10% across all mental disorders. This implies that:
- There is no justification to use psychiatric interventions for the majority of the population affected.
- There is no justification for a specific focus on PTSD over and above other trauma-induced mental disorders, such as (non-PTSD) anxiety disorders and depression.
2. WHO is advising tsunami-affected countries to urgently make available mental health care interventions in the health sector. People with mental disorder - whether or not disaster-induced - need access to basic mental health care, which should be provided through general health services or through community mental health services, within the health sector. It is WHO's role to work with the Ministry of Health to help coordinate such activities. WHO has selected partner organizations to work with governments to strengthen the mental health system in affected countries.
3. WHO is advising countries to make social and basic psychological interventions available to the population-at-large in the community through a variety of sectors in addition to the health sector. Such interventions may (a) address widespread psychological distress in people without disorders and (b) provide some support to those people with mental disorders who do not seek help within the health sector. Examples of social intervention would be (re)starting schooling, organizing child-friendly spaces, family reunification programmes, and economic development initiatives. An example of basic psychological intervention is teaching listening and psychological support skills to a community worker. (Many of these social and basic psychological interventions are included and described in Mental Health in Emergencies [WHO, 2003]). 4. http://www.who.int/mental_health/media/en/640.pdf 5. Social and basic psychological interventions occur typically in a range of sectors and tend to involve working with the school system and with other existing human resources in the community (e.g. community workers, leaders and traditional healers, etc.). Many of these interventions require a thorough understanding of the sociocultural context. Outsiders rarely have this understanding. Mental health professionals (especially those from affected regions) have a role to play in training and supervising basic psychological support interventions (such as psychological first aid and problem-solving counselling) even when they are implemented outside health and mental health services. Professionals from other disciplines (e.g., protection, communication, education, community development, and disaster coordination, etc.) tend to lead the implementation of relevant social interventions (restarting schools, organizing child friendly spaces, family reunification, economic development, etc.) are appropriately implemented. In terms of reaching many people, it is more efficient to use social interventions than basic psychological interventions. Collaboration among professionals and agencies is essential to make basic social and psychological support interventions available to the population at large. WHO provides advice on these activities (see Mental Health in Emergencies, WHO ), but is not seeking to lead the coordination of activities outside the health sector.
- WHO is concerned that many clinical interventions (e.g. PTSD-focused psychotherapy) that are not basic are being introduced outside the health sector in an uncoordinated and vertical, stand-alone manner in tsunami-affected areas.
- Also, WHO is concerned with many international aid initiatives that focus on training only - without an understanding of the culture, without proper follow-up supervision, and without integration on trained interventions into existing systems. Such initiatives may cause more harm than good. WHO advises outside international groups to carefully study the Guidelines for International Trauma Training by the International Society for Traumatic Stress Studies guidelines and the interagency document Psychosocial Care and Protection of Tsunami affected Children before initiating trauma-focused training initiatives. (see links below)
Guidelines for International Trauma Training by the International Society for Traumatic Stress Studies
WHO is one of the few agencies that are present before, during and long after an emergency in most countries. Mental health activities related to emergencies have an increasing role in WHO work as well as in the work of other agencies. WHO is planning to initiate the development of interagency guidelines on psychosocial/mental health interventions in emergencies.