Children play in a child-friendly space established by Save the Children’s local partner in Palu, Sulawesi.

How do disasters like the
Indonesia Tsunami impact mental health?

Prioritising emotional healthcare can
accelerate recovery

Disasters result in bitter memories. Psychological suffering manifests instantly and if left unaddressed, often remains for a long time.

If ignored, disasters may leave lasting scars on human minds and simple measures can go a long way to help the minds of those affected.

The tsunami and the earthquake in Indonesia remind us how quickly disasters can tear lives apart and leave thousands homeless.

Over 2,000 people are confirmed dead and government officials warn that the death toll is likely to climb, citing that nearly 5,000 people are reportedly missing.

Indonesians have a long history of dealing with earthquakes and other disasters, including the catastrophic Indian Ocean Tsunami in 2004. In recent years, Indonesia has increased efforts to improve disaster risk reduction and preparedness and to build resilient communities.

Immediately after a disaster, lifesaving aid flows in. Yet, while the armed forces, government, volunteers and humanitarian agencies are adept at dealing with the physical needs, they can miss the invisible needs of survivors – such as mental health and psychosocial support, especially for children.

Mind matters in disaster settings

There’s only so much a person can take, literally. Liken the mind to a balloon. If you keep pumping air into it and don’t let off the pressure, something will eventually give.

People affected by the tsunami, earthquake and other disasters experience distress. Anxiety levels go up, and levels of sleeplessness – and often nightmares – increase. Aftershocks amplify human anxieties.

During my work in Japan following the multiple disasters that hit Sendai, Fukushima and neighbouring areas, I heard stories of children scared to flush toilets as the sound and sight of the flowing water reminded them of tsunami waves.

At the community level, people are withdrawn and disengaged. Research in post disaster settings at a global level found significant increases in depression, anxiety and psychological distress among adults.

Children affected by disasters are extremely vulnerable and may face a variety of mental health and psychosocial problems.

This may cause adults to feel confused or nervous, especially when they see children regress to younger behaviors such as bed-wetting, or if they start to relive scenes experienced during the disaster or conflict when playing with others. Survivors also turn to substance abuse or alcohol.

It is possible to reduce the suffering and beat long term trauma through activities taken up during the early stages of disaster response. Emotional care and psychosocial first aid will help instill a sense of hope and speed up recovery efforts.

 

Anita, 12, and her family's home remained in tact during the earthquake that hit Sulawesi, Indonesia on the 28th September. She lives in the upper area of Balaroa Village but the lower area was completely destroyed.
Anita, 12, and her family’s home remained in tact during the earthquake that hit Sulawesi, Indonesia on the 28th September. She lives in the upper area of Balaroa Village but the lower area was completely destroyed. Photo credit: Antonia Roupell


What survivors, teachers, volunteers and health workers can do to
help

Promoting a sense of safety, calm, sense of self, community efficacy, connectedness, and hope are important ingredients for coping in difficult situations.

Receiving reliable and useful information (about relatives, friends and relief  supplies) is a key stress buster. Initiating  routine activities helps to bring a sense of normalcy – including through group, cultural and social activities.

Participating in activities which support families and communities  help disaster survivors to recover quickly, especially children.

Strong social networks help normalisation and healthy child development. Social networks help all, especially children. Having stable caregivers and caring adults around them help children’s mental health and psychosocial well-being.

Education and recreational activities for children are key elements to support their mental health and psychosocial well-being.

Children will have lot of questions when schools reopen – preparing teachers to answer their questions and reduce their anxieties is key. Teachers who are trained to be sensitive to such questions are best placed to help children overcome their anxieties.

A Psychological First Aid Guide for field workers

 

World Health Organization’s Psychological First Aid-Guide for field workers recommends “a humane, supportive response to a fellow human being who is suffering and who may need support”.

It recommends these pragmatic actions:

  • Protect tsunami and earthquake survivors from further harm
  • Provide practical care and support without intruding into the lives of the survivors
  • Keep assessing needs and concerns continuously. Contexts change quickly, as will needs.
  • Create safe spaces for children, women and others where they can come together, share their feelings and express emotions (if they wish to);
  • Organise play sessions and art sessions for children. Children often express their emotions through art work.
  • Listening to people if they want to talk
  • Proactively and routinely provide reliable, simple and scientific information.
  • Make sure there is caring for caregivers. This will help to avoid what is known as vicarious trauma (where the mental health workers often getting impacted after listening to stories of suffering)

Community-based care and support models are gaining momentum worldwide. It is cost effective, demonstrates ownership and is contextual.

Our Psychological First Aid programme/guidelines is based on the World Health Organisation’s programme but is also designed to be more aligned for use with children directly as well as providing guidance to parents and caregivers on recognizing signs of “when to worry” among their children and how to help them deal with their distress.

Media can also play a critical role to spread key messages on healing and recovery. Positive stories will help to inspire other tsunami and earthquake survivors to get back on their feet. Media can help to demystify matters of the mind, make it part of popular conversation and science.

Psychologists and mental health experts alone can’t beat trauma in post disaster settings. Mind is too important to be left with technical experts.

Popular celebrities can help make a difference by spreading messages of solidarity and collaboration through their medium. Such efforts help turn victims into survivors and active agents of recovery and social change.

Dr Unni Krishnan is Director Emergency Health Unit, Save the Children, a partner organization of Yayasan Sayangi Tunas Cilik. Dr Krishnan (@unnikru) contributed to develop Psychological First Aid- Guide for field workers.

Emergency Health Unit is Save the Children’s global capability to provide life saving health care and medical assistance (including mental health and psychosocial support) in humanitarian settings.

A donation to the Indonesia Tsunami Appeal will go straight to those affected by this terrible tragedy. Please give what you can.

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