Disaster, Emergencies, and Mental Health (PDF)

I. DISASTER, EMERGENCIES, AND OTHER CONCEPTS LEARNING OUTCOMES At the end of this module, you should be able to: 1. Define disasters and emergencies; 2. Describe the impact of disasters and emergencies on individuals, families, and communities; 3. Describe the impact of disasters and emergencie...

I. DISASTER, EMERGENCIES, AND OTHER CONCEPTS LEARNING OUTCOMES At the end of this module, you should be able to: 1. Define disasters and emergencies; 2. Describe the impact of disasters and emergencies on individuals, families, and communities; 3. Describe the impact of disasters and emergencies to mental health and wellbeing, basic knowledge in humanitarian principles and process in relation to MHPSS; 4. Demonstrate knowledge of the basic concepts of disaster mental health and psychosocial support; and 5. Demonstrate understanding of issues regarding the protection of the rights of all the affected popu-lation with consideration to at risk groups in emergencies and disasters, with particular emphasis on MHPSS. It is important to look at and understand the universally-accepted and legal definitions of these terms. We need them to establish a common language, which will facilitate the quick delivery of the appropriate response. The importance of understanding DRRM technologies 1. Established common language 2. Gain deeper comprehension of the disciplines and capacitates us in the planning What are hazards? A hazard is a process, phenomenon or human activity that may cause loss of life, injury or other health impacts, property damage, social and economic disruption or environmental degradation (UNISDR, 2017). Natural hazards are naturally-occurring events or phenomena originating from the following: Geological processes: involve the movement of the earth, soil and tectonic plates. Examples: volcanic eruptions and earthquakes. Hydro-meteorological factors: involve weather disturbances occurring in the air or water. Examples: thunderstorms, tornadoes, coastal storm surges, hailstorms, La Niña, El Niño. Biological phenomena: involve exposure to pathogenic microorganisms, toxins and bioactive substances. Examples: bird flu, severe acute respiratory syndrome (SARS) and Ebola pandemic. Human-induced hazards may be categorized into: Technological hazards: damaging human-induced events originating from technological or industrial accidents, dangerous procedures, or infrastructure failures. Examples: oil spills that destroy marine life, nuclear meltdowns, train accidents, and fire resulting from an explosion whether industrial or mechanical or even a chemical spill in a school laboratory. Armed conflict: dangerous conflicts between or among armed groups, tribes, or states, causing widespread fear and destruction, and forcing many people to flee to safe places. Examples: terrorist activities and mass killings. Everyday hazards and dangers particularly to children. Examples: items in the home that are labelled as hazardous, open electrical outlets, and small toys that may cause choking. Can you identify a hazard from your own locality/community? While hazards do not automatically lead to loss of life or economic disruption, steps must be taken to reduce the vulnerabilities of the threatened communities, to build their resilience and minimize the damage to them. A hazard results into a disaster when it leads to loss of life and livelihoods, injuries, displacement and homelessness and/or damage to infrastructure and property. e.g. A typhoon in an uninhabited island will not result in a disaster What is a disaster? Republic Act 10121 or the National Disaster Risk Reduction and Management Act of the Philippines, defines disaster as a serious disruption of the functioning of a community or a society involving wide-spread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources. It is the result of the combination of: the exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity or measures to reduce or cope with the potential negative consequences. Impacts may include loss of life, injury, disease and other negative effects on human, physical, mental and social wellbeing, together with damage to property, destruction of assets, loss of services, social and economic disruption and environmental degradation. Are earthquakes, floods and cyclones disasters? Not necessarily. They become disasters when they adversely and seriously affect human life, livelihood, and property. What is disaster risk? The potential disaster losses when hazards occur. Disaster risk is dependent on the strength of hazard; and extent of exposure, vulnerability, and capacity of a community to withstand the onslaught of the hazard. The relationship may be expressed as follows: R = Hazard x Vulnerability x Exposure ______________________________ Capacity Vulnerability characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard. Exposure is the degree to which a community is likely to experience hazard events of different magnitude. It also refers to the physical location, characteristics and population density of a community that “exposes” it to hazards. Capacity is the combination of all the strengths, attributes and resources available within a community, society or organization. Vulnerability in this equation, is defined as the characteristics and circumstances of a community, sys-tem or asset that make it susceptible to the damaging effects of a hazard. Vulnerability may arise from various physical, social, economic, and environmental factors such as poor design and construction of buildings, inadequate protection of assets, lack of public information and awareness, limited official recognition of risks and preparedness measures, and disregard for wise environmental management. In every community, there are Vulnerable and Marginalized Groups. These individuals and groups face higher exposure to disaster risk and poverty including, but not limited to, women, children, elderly, differently-abled people, and ethnic minorities. The standard approach to DRRM is it must be disability-inclusive, engaging individuals in consultations, planning and delivery of DRRM strategies and activities.5 What then, is an Emergency? An emergency is an unforeseen or sudden occurrence, especially danger, demanding immediate action. Can emergencies become a disaster? If a small emergency, when not immediately attended to, causes and leads to serious disruption to the functioning of a community, then yes, emergencies can become a disaster. According to the UN, an emergency is an event that can be responded to using the resources available at hand, implying that there is no need to request external assistance. A disaster, on the other hand, is characterized by impacts that overwhelm the capacities of local responders and place demands on resources which are not available locally. Hence, an event is declared as a “disaster” when there is a need for external assistance to cope with its impacts. A national government declares a state of disaster or national calamity as a way to request international humanitarian assistance and the support of the international community to cope with the impacts of the disaster. What is Disaster Risk Reduction?7 The UN Office for Disaster Risk Reduction (DRR) defines DRR as a concept and practice of reducing dis-aster risks through systematic efforts to analyse and reduce the causal factors of disasters8. This prac-tice includes other concepts such as preparedness, mitigation, and sustainable development. Every gov-ernment has its own way of practicing DRR, depending on the risks and hazards that they have identified in their own territories. II. MENTAL HEALTH IN DISASTERS The impact of emergencies and disasters cover a wide spectrum of categories: from the physical effects such as damaged houses to the non-tangible effects like grief. During emergencies and disasters, af-fected population become recipients of goodwill and passionate humanitarian actors who respond to these effects in our different capacities: some of us provide medical services, others build shelters, and still others establish hygiene and sanitation facilities. Whatever role we are playing addresses needs of the individual, families, and communities called for by the disaster situation. In this part of the lesson, we will focus on disaster mental health and go through some key concepts that will allow us to understand better how disasters impact the mental health of the affected population and even responders. What is our understanding of mental health? Mental health is a state of wellbeing in which every individual realizes own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community, as defined in the National Guidelines on Mental Health and Psychosocial Support which we will discuss in Module 2. Mental health and psychosocial support is any type of local or outside support that aims to protect or promote psychosocial wellbeing and/or prevent or treat mental disorder. Mental health and psychosocial support in the Context of Filipino Ang MHPSS ay mga gawaing naglalayong mapagaan ang bigat ng KALOOBAN ( isip, damdamin, katawan, kilos at pananampalataya) at mapatibay ang ugnayan sa KAPWA - kapamilya, kaeskwela, kapitbahay, gobyerno, pati na ang kalikasan atbp. Layunin din nito na mas maging GANAP o BUO ang WELLBEING / GINHAWA ng tao kaugnay ng Karapatan, Kultura, Kalusugan, Kakanyahan niya. Ito ay para sa lahat ng tao, hindi lang para sa may mabigat na problema. Halimbawa ay ang Peer Faci training na ito na para sa mga dati nang mahusay na Kabataan na lalo pang paghuhusayin ang dunong sa pag-agapay sa kapwa kabataan. Ang lawak, ang lalim, ang tayog ng saklaw kaya naman ang papangarapin lang natin ay kung ano ang ABOT-KAYA. Hindi mo naman kailangan i-solve ang problema sa lahat ng aspeto. Kahit may isang bahagi lang na mapagaan ay sapat na ito. Grief and loss Grief is defined as the psychological-emotional experience following a loss, while loss is the sense of sadness, fear and insecurity we feel when a loved person is absent. It can also be felt for things and place. Why do we grieve? We grieve because we love. Loss is the central experience of any disaster: everyone has lost someone or something they love. Mourning Mourning: culturally appropriate processes that help people to pass through grief All cultures mourn but in different ways Involves acknowledgement and acceptance of the death, saying farewell There are “prescribed” time periods for grieving Processes to continue attention towards the dead and to move beyond and make new attachments How does disaster affect mourning practices? Disaster disrupts the possibility of appropriate mourning Normal rituals are impossible to carry out because of lack of resources and facilities Bodies are treated inappropriately There is uncertainty over missing people There may be mass graves The absence of markers The practice of mourning might have reduced significance given the context The social networks are destroyed There is desire to remain connected Massive losses that affect whole communities deprive the individual of the normal support received from their community if their loss had been a singular occurrence. Mental Health and Disasters Emergencies erode normally protective supports, increase the risks of diverse problems and tend to amplify pre- existing problems of social injustice and inequality. For example, natural disasters such as floods typically have a disproportionate impact on poor people, who may be living in relatively dangerous places. Here are the general principles of Disaster Mental Health: 1. Everyone who sees a disaster is affected by it. 2. Target population is primarily normal. 3. How people have coped with crises in their past will be a good indicator of how they will handle the disaster. 4. People do not disintegrate in response to disaster. 5. Disturbance is transitory. 6. Disaster relief procedures have been called the “Second Disaster.” 7. Disaster stress reactions may be immediate or delayed. 8. People respond to active interest and concern. 9. Informed early intervention can speed up recovery and prevent serious or long-term problems. 10. The family is the first line of support for individuals. 11. Support systems are crucial to recovery. These are the mental health and psychosocial concerns that need to be addressed in emergency response: Social Pre-existing (pre-emergency) social problems (e.g. extreme poverty; belonging to a group that is discriminated against or marginalized; political oppression); Emergency-induced social problems (e.g. family separation; disruption of social networks; de-struction of community structures, resources and trust; increased gender-based violence); and Humanitarian aid-induced social problems (e.g. undermining of community structures or tradition-al support mechanisms). Psychological Pre-existing problems (e.g. severe mental disorder; alcohol abuse); Emergency-induced problems (e.g. grief, non-pathological distress; depression and anxiety disor-ders, including post-traumatic stress disorder (PTSD)); and Humanitarian aid-related problems (e.g. anxiety due to a lack of information about food distribu-tion). For children, the impact of disasters can cover a wide range11 (UNICEF Philippines, 2018): a. Individual Child Basic Needs are not met Normal Routine and relationships are disrupted Psychological Disturbance Exposure to danger b. Child in the Family Helplessness of Heads of families and reversal of roles Inability to provide proper guidance Inability of the parents to protect their children Separation due to death Increase of Domestic violence 11 From DepEd-DRRMS Harmonized MHPSS: Module 1. Disaster and Emergencies: Impact on Individuals, Families, and Communities 11 c. Child in the community Community values are change Inability to go to schools and other damaged facilities Social roles and relationships are changed Unintended loss of access to services due to sanction on government and rebel groups For adolescent: They feel a strong responsibility to the family. They may feel guilt and shame that they were unable to help those who were hurt. They may feel intense grief. They may become self-absorbed and feel self-pity. They may experience changes in their relationships with other people. They may also start taking risks, engage in self-destructive behavior, have avoidant behavior, and become aggressive. They may experience major shifts in their view of the world accompanied by a sense of hopelessness about the present and the future. They may become defiant of authorities and parents, while they start relying on peers for socializing Reference: Harmonized Mental Health and Psychosocial Support. Department of Health. IASC Guidelines on MHPSS in Emergency Settings, 2007 Manual on Psychosocial Interventions for Secondary School-aged Students During Disasters and Emergency Situations