As floods and landslides wreaked havoc across the country, the Sri Lanka College of Psychiatrists stepped in to help the thousands of men, women and children affected by these disasters. Pointing out that many studies in the past have reported a significant increase in psychological morbidity after the occurrence of a natural disaster, the college’s [...]


Enter the psychiatrists to comfort citizens following a natural disaster


As floods and landslides wreaked havoc across the country, the Sri Lanka College of Psychiatrists stepped in to help the thousands of men, women and children affected by these disasters.

Pointing out that many studies in the past have reported a significant increase in psychological morbidity after the occurrence of a natural disaster, the college’s Committee on Women’s Health explains that following natural disasters an increased prevalence of major depressive disorder, post-traumatic stress disorder and anxiety disorders has been reported. Multiple psychological problems were reported in those affected by the tsunami of December 2004, with studies detecting higher prevalence of depression, anxiety and post-traumatic stress in the affected regions of the country.

Stressing that a major role can be played by psychiatrists, the committee states that ‘psychological first-aid’ is considered as a humane, supportive response, in a time of crisis, to a fellow human being who is suffering and requires support. Psychological first-aid is not ‘debriefing’ which is considered harmful. This help includes providing practical care and support such as directing assistance to obtain food and shelter, without intruding on the survivors’ privacy and autonomy. The other aspects include assessing needs and concerns, listening to the traumatised individuals and communities, but not pressuring them to divulge sensitive information. It is also essential to comfort people and help them to feel calm and protect them from further harm during the recovery phase.

“Our people have lived through many disasters during the last few decades. Therefore, as a nation we have adapted to certain ways of coping after a loss event. Psychological first-aid does not mean implementing en bloc western psychology to heal the minds of the affected Sri Lankans. In contrast, support in Sri Lanka involves the facilitation of culturally-sensitive mourning in the context of social and spiritual rituals in a more organised manner. Nevertheless, the regional psychiatrist should be alert to any person requiring more than mere psychological support and those who may benefit from structured psychiatric care,” the committee states.

On the need for a psychiatrist, the committee points out that sometimes a person who is traumatised by a disaster may be helped more by a packet of rice rather than by receiving supportive psychotherapy. Providing shelter and food is not the direct responsibility of the psychiatrist, but lies with the government administrators. The psychiatrist brings numerous skills and expertise in preparing for and responding to natural disasters. At present there are consultant psychiatrists appointed to all of the districts of the country. In the aftermath of a disaster like landslides or floods, the medical knowledge and skills of the psychiatrist are immensely valuable. A regional psychiatrist from the district general hospital could provide a calm, professional approach in preventing panic in a person or a community as a whole.

“The psychiatrist could take leadership in coordinating and liaising with other sectors to organise the response and assistance at triage stations. The knowledge in internal medicine and general surgery would be useful in preventing major harm caused to patients due to misdiagnosis. Moreover psychological triage is essential to allocate the resources to the neediest,” the committee reiterates, adding that the psychiatrist would be able to distinguish between understandable reactions of hyper-arousal and pathological ones to ensure appropriate management of individuals. If the psychiatrist is not available for such services, the affected might be susceptible to exploitation or over- or under-treatment.

Addressing the role of psychiatrists in the recovery phase, the committee states that they are key professionals who could provide assistance to improve psychological as well as physical health. A psychiatrist would be able to detect pathological mental states which may coexist with other physical injuries — a head injury causing intracranial haemorrhage could present as delirium, which may be misdiagnosed as an acute stress reaction. The psychiatrist as a senior health-care professional could facilitate communication across a wide range of professional boundaries.

As the psychiatrist is a medical physician who is knowledgeable about the epidemiology of mental health problems, this knowledge is useful in identifying high-risk groups who may develop psychological consequences following exposure to trauma. The psychiatrist can also address the needs of vulnerable groups such as the elderly, women and children, according to the committee.

It adds: “The psychiatrists need to be vigilant for the ‘vectors’ of psychological disease such as communication of fear via rumour or local media. It is the responsibility of the psychiatrist to ensure that the correct psychological explanation is offered at media briefings and breaking news items. They should ensure the clarity of information about relief, possible compensation and available services to the general public. We must avoid creating unrealistic expectations and prevent creating long-term dependencies. The prioritisation of planning and implementation of recovery programmes ought to be based on up-to-date needs assessment.

“We should lead the way in supporting the resumption of normal community structures and activities such as schools, religious practices and village committees. The mental health team needs to pay attention to pre-disaster vulnerabilities for psychological problems such as serious mental illness, disability, extreme poverty and complex social dynamics. If these are not addressed fully, there is a risk of long lasting psychological consequences which can impair the functional capacity of those affected. As team leaders the psychiatrist must mobilise the local resources for mental health and psychosocial support. The Medical Officer of Health, the Public Health Midwife, the Public Health Inspector or the Social Service Officers in the Divisional Secretariat can all be mobilised for help.”

Focusing on the mental health of women during a disaster, the committee states that all human beings are susceptible to trauma, abuse and exploitation during a crisis period, regardless of their social or economic status. However, women are more vulnerable than men in such situations and are known to be more vulnerable to developing post-traumatic stress disorder after a mass disaster. Due to displacement caused by the floods, many families have been shifted to temporary lodgings such as camps. In the Sri Lankan context, these camps would usually be based in government schools. Therefore, it is important to ensure the safety, dignity and rights of the women staying in such places. Simple necessities such as providing a covered area to change their clothes and privacy during sleep should be emphasised.

“Any breach of women’s rights need to be reported to the judicial system and the psychiatrist should be actively involved in the process providing necessary clinical expertise. The psychiatrist would need to stand out as a professional who provides services to a wider range of mental health problems apart from the major psychiatric illnesses,” it adds.

  • Do’s and don’ts to be observed
  • The do’s and don’ts in the best interests of those affected by a major disaster as laid down by the Sri Lanka College of Psychiatrists. 
  • Do’s 
  • We need to respect people’s right to make their own autonomous decisions. 
  • Provide information on how to access help in the future to those who do not say that they need help at present. 
  • Ensure privacy and keep the person’s accounts confidential. 
  • Try to find a quiet place to talk and minimise outside distractions and ensure privacy. 
  • Provide a friendly approach but maintain appropriate boundaries depending on their age, gender and culture when helping traumatised individuals. 
  • Engage in active listening and show empathy appropriately. 
  • Be honest and do not offer false hope. 
  • Divulge relevant information in a way the person can understand, taking into consideration potential hyper-aroused mental states. 
  • Acknowledge the person’s internal and external strengths and how he/she has coped with adversities in the past. 
  • Be sensitive to the ongoing grief process and allow for silence from the person where appropriate. 
  • Take action to protect rights and privacy of vulnerable groups such as women and children. 
  • Liaise with local-level administrators, health professionals and politicians in a professional manner. 
  • Identify vulnerable groups such as those with a history of psychiatric illness, women, children and the elderly. 
  • Don’ts
  • Do not force assistance or help on communities and do not be intrusive. 
  • Do not inflict pressure on people to talk to you and relate their stories. 
  • Do not share the affected person’s story with others verbally or electronically. 
  • Do not judge a person on his/her beliefs and actions. 
  • Do not touch the affected persons to offer comfort. It may be counter-productive due to their hyper-vigilant state. 
  • Do not state that the traumatised person is ‘lucky’ to survive or should not feel sad. 
  • Do not tell them someone else’s story as an example. 
  • Do not act as if we should solve all problems for them as inappropriate dependency could be harmful in long-term recovery. 
  • Do not allow the use of any psychoactive substances including liquor in the premises where the displaced are housed. 
  • Do not overburden yourself with the multiple problems of the survivors, always liaise and share responsibilities. 
  • Do not overreact to the situation, be careful not to disturb the affected individuals.

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