Disaster And Mental Health PDF

DISASTER AND MENTAL HEALTH I. Disaster Mental Health : Overview Disaster is a serious disruption of the functioning of a community or a society that entails widespread human, material, economic, or environmental losses and impacts, exceeding the ability of the affected community or so...

DISASTER AND MENTAL HEALTH I. Disaster Mental Health : Overview Disaster is a serious disruption of the functioning of a community or a society that entails widespread human, material, economic, or environmental losses and impacts, exceeding the ability of the affected community or society to cope using its own resources. Disasters are often described as a result of the combination of exposure to a hazard, the conditions of vulnerability that are present, and the insufficient capacity or measures to reduce or cope with the potential negative consequences. Disaster impacts may include loss of life, injuries, disease/s, and other negative effects on physical, mental and well-being of humans, together with damage to property, destruction, of assets, loss of services, social and economic disruption, and environmental degradation. Every city, province, and region in the Philippines has its own unique set of disaster risks. Some disaster risks are recurrent ( flood, infectious diseases ), some are seasonal ( typhoon, drought ), while some are infrequent and unpredictable ( earthquake ). The pattern of disaster and emergency situations in the country has been constantly changing, becoming more frequent and more destructive to communities, especially since the issues of urbanization and poverty have led more and more Filipinos to live in disaster-prone areas, such as along river system and coastal and landslide areas. The high vulnerability of the Philippines to natural hazards is primarily because of its geographic location. The Philippines is situated within the Pacific ” ring of fire, “ otherwise known as the Circum- Pacific belt or typhoon belt, which is a large region in the Pacific Ocean where the majority of Earth’s volcanic eruptions and earthquakes occur. There are many active faults and trenches in the Philippines. It has 200 volcanic landforms, 22 of which are active, making the country prone to volcanic eruptions. The Philippines, being located along the typhoon belt, experiences typhoons of varying severity every each year. In a year , approximately 80 typhoons develop above tropical waters. An average of eighteen to twenty tropical storms enter the Philippines each year, especially during the months of July, August, and September, with eight or nine of those storms making landfall. In recent years, most of the disasters in the Philippines that claimed the lives of many people and affected the properties and livelihoods of the most vulnerable (less advantage people, farmers) have been brought about by increased rainfall which causes massive flash flooding. However, human-made disasters and crises also cause public anxiety, loss of lives, and destruction of properties. Types of Disasters 1. Disasters from Natural Forces  Earthquakes and Volcanoes  Typhoons and Flooding  Drought  Infectious Diseases 2. Human-Induced Disasters  Bombings  Terrorist Acts  Industrial Accidents  Transportation Accidents   Fire Challenges and Perspectives in Disaster Response and Emergency Management In countries that are geographically or economically small, where key sectors are dependent on weather conditions, the impacts of disasters on the national economy can be very significant. Natural disasters generate significant social costs in terms of casualties, worsening food insecurity, and deterioration in human capital. The poor and socially disadvantaged groups, especially those residing in informal settlements, are usually the most vulnerable to the impacts of disasters. The lack of financial resources fortifies their vulnerability. The situation has been consistently seen, especially when disasters strike the Philippines. Disaster can happen anytime and anywhere, and by anticipating and preparing for a known occurrence, loss of lives and properties can be significantly reduced. Thus, both the Philippine government and civil society routinely urge the Filipino people to be prepared for worst-case scenarios should a major disaster hit the country. Despite the sheer costs of damages brought about by past events disaster preparedness is still not getting the urgent attention of the people. While government policies or regulations are implemented to mitigate the impact of disasters, the attitude of the people exacerbates their vulnerability to existing dangers, exposing them to increased disaster risks. Disaster cause a wide range of problems experienced as individual, family, community, and social levels. It affects thousands, even hundreds of thousands of lives every year. When disaster strike an unprepared community, the damage can be inconceivable. With no sense of urgency, disaster preparedness is rarely a priority among people. Disaster whether natural or man-made in origin, can cause extensive damage, injuries and deaths. Profound mental health consequences can also be expected as a result. Thus, it is very important to prepare people for the eventuality of a major disaster in the future. Aside from administrative support and medical interventions, effective disaster response Disaster Preparedness As reported in 2018, the Philippines had already been weathered by a total of 565 disaster events. In 2020 alone, the country ranked as the 9th most affected country from extreme weather events in the World Risk Index (WRI), on top of human-induced disasters. In the matter of climate, the Philippines is among the top countries at risk of adverse impacts of climate change due to sensitive ecological systems (reefs and marine fauna), large numbers of coastal populations, and exposure to frequent and constantly changing weather conditions. Climate change is considered to be a key factor in the occurrence of stronger typhoons, sea-level rise, and elevated storm surges in coastal regions. Climate change projections suggest that this trend is expected to continue and that weather-related hazard events will become more frequent and more volatile. ( United Nations Disaster Risk Reduction (UNDRR), 2019 ). These projections have driven the enactment of the Philippine Disaster Risk Reduction and Management Act of 2010 ( or R.A. 10121 ). It explicitly indicates the importance of disaster preparedness. It defines disaster preparedness as “ the knowledge and capacities developed by governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current hazard events or conditions. Preparedness action is carried out within the context of disaster risk reduction and management and aims to build the capacities needed to efficiently manage all types of emergencies and achieve orderly transitions from response to sustained recovery.” The act “provides for the development of policies and plans and the implementations of actions and measures pertaining to all aspects of disaster risk reduction and management, including good governance, risk assessment and early warning, knowledge building and awareness raising, reducing underlying risk factors, and preparedness for effective response and early recovery.” II. The Impacts of Disasters on Mental Health The impacts of a disaster on people can be much deeper than its physical effects. For instance, the consequent feelings of grief and sadness over sudden death or loss of a loved one during the pandemic crisis can trigger feelings of despair, helplessness and hopelessness; anxiety and fear; anger and frustrations; and other physical, emotional, and cognitive responses. Losing one’s home and/or family in an earthquake or landslide creates tremendous amounts of stress. A wide range of mental health problems or psychological consequences caused by a disaster has been documented. Persons are affected psychologically more than they are harmed physically. Disaster survivors usually exhibit various distress reactions. The intensity and variety of reactions are based on personal differences as well as the nature of exposure to disasters. While most victims of disasters recover easily, some may develop psychological and psychiatric disorders. Those who are most likely to experience severe psychological reactions, impairment of function, and potential psychopathology are those who have experienced: 1. Intense exposure 2. Loss of loved one 3. Major disruption of basic needs and services 4. Prior trauma 5. Major life stressors Stress and Physical Health Illness Psychologists define stress as the demand on an individual to adapt, cope, or adjust. Some stress can be healthful and necessary to keep people alert and occupied. However, intense or prolonged stress, such as that caused by a natural disaster, can overtax a person’s ability to adapt and may affect the person’s mood, impair his ability to experience pleasure, and harm his body. Continued exposure to stress can result in a decline in the body’s overall level of functioning as stress-related hormones are constantly secreted. Overtime, this can promote deterioration of body tissues and organs, such as the heart, lungs, liver, and kidneys. The effects of stress are illustrated in the General Adaptation Syndrome (GAS) model developed by Hans Selye. During stress, Selye explains that the body goes through three stages : 1) Alarm stage – a distress signal is sent to hypothalamus. The hypothalamus enables the release of hormones (e,g. corticosteroids corticosteroids, adrenaline, noradrenaline) that activate, energize, and help the body to cope with stress.  2) Resistance stage – if the stress continues the body goes through the adaptation/resistance stage. The body tries to counteract the biological changes that occur during the alarm reaction stage. As a result, the body becomes tense. 3) Exhaustion stage – if the stress still continues, the body is fatigued and burned out as it persist to combat the effects of stress, thereby developing physical manifestations such as viral infections, allergies, ulcers, hypertension, heart disease, diabetes, or cancer. Developing illnesses may be due to many factors, but it can also be emotion or stress-related. Stress and Physical Health Illness (cont.) Physical Health Illness Acute Stress Disorder (ASD) is a reaction that develop after a traumatic event. The symptoms are similar to those of post-traumatic stress disorder (PTSD). The latter has symptoms that persist beyond a month period, while the symptoms of ASD occur between three days and one month after the traumatic event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares, and may feel numb or detached from themselves. These symptoms cause major disruptions and problems in a person’s daily life and activity. Amnesia is the failure to recall events and it can be caused by head injuries such as during disaster event. Persons with amnesia may be somewhat disoriented and may even forget who they are. In dissociative amnesia, forgetfulness is selective as the affected person “ blocks out” certain details of memory that may be associated with a traumatic event. The person usually forgets about the severe traumatic event (e.g. death of a loved one, accident).  Anxiety Disorder is a medical condition that entails extreme worrying, fear, nervousness, and inability to relax. Everyone has feelings of anxiety when faced with threatening or stressful situations such as disaster events. However, people with anxiety disorders have intense, excessive, persistent worry and fear about everyday situations. Thus, it prevents them from doing important things in their life, such as going to work or school. Therefore, it can significantly interfere with the ability of the person to function in daily life. AD includes both physiological and psychological symptoms. Post-traumatic Stress Disorder (PTSD) is a psychiatric disorder that can develop in people who have experienced a severe traumatic event such as natural disaster, serious accident, terrorist act, war, rape, or other violent personal assault. PTSD may occur in all people of any ethnicity, nationality or culture, and age. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness; fear or anger; and may feel detached or estranged from others. They may avoid situations or people that remind them of the traumatic event. They may also have strong negative reactions to something as ordinary as a loud noise or an unintentional touch. For a person to be diagnosed with PTSD, symptoms last for more than a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms appear later. For people with PTSD the symptoms can cause significant distress or problems in functioning. Somatoform Disorders people often complaint of physical problems such as paralysis, pain, or a persistent belief that they have a serious disease (e.g. cancer) even though no medical evidence can be provided. They may display extreme fear of illness, which may affect their functioning. Substance Abuse Disorder. Research shows that people traumatized by major disaster can be at particular risk for a substance abuse disorder. People use substance as a coping mechanism. Substance abuse is a harmful or hazardous use of psychoactive substances including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome, which entails an array of behavioral , cognitive, physiological occurrence. e.g. changes in a person brought about the repeated substance use. It may render a person the persistent urge or desire for the drug problems in controlling the use of the substance, and neglecting its possible hazard. Complicated Grief Disorder. It terms of symptoms CGD can be similar to depression. It is caused by a death of a loved one, such as from a natural or man-made disaster. It has much more relatively severe symptoms than normal or uncomplicated grief. Many people go through several stages of grieving after losing a loved one. In the case of CGD, the person may have trouble moving on from a traumatic event for months. Years, or even longer. For some individuals who are taking care of a loved one with a terminal illness (e.g. cancer), complicated grief can start even while their loved one is still alive. When loved one dies, it affects all members of the family. It takes time, sometimes slower and longer , to recover and accept the loss. For instance, the death of a child may cause a year, or more , of mourning before being able to move on. Usually, grief is especially severe when death of a loved one comes suddenly or before its expected time. Five Stages of Grief – The Kubler-Ross Model. Elisabeth Kubler-Ross summarized her findings of the grieving process that patients experience after learning about the terminal illness. She presented five stages : denial, anger, bargaining, depression, and acceptance. However, she suggests that some people may not necessarily experience all five stages or that they may occur in any order. The process of grieving can be different for individuals. During the first stage, denial is a coping mechanism that gives the person time to adjust to a situation that causes anxiety, pain, or sadness. The person refuses to believe or accept a painful reality or truth, such as having a terminal illness, sickness, loss, or death of a loved one. The person tries to avoid the existence of the event, which is triggering the negative emotions by focusing on other aspects of his/her life. This stage may last momentarily, or even for days or much longer. In the second stage, anger is especially experienced by those who are experiencing a loss or death of a loved one. Anger can also have a functional value for survival as it drives a person to protect him/herself. Anger temporarily protects people from dealing with sad , frightening or painful feelings. However, prolonged and severe anger can be detrimental to physical and mental health. In the bargaining stage, the normal reactions to helplessness and vulnerability of facing the loss or death of a loved one is the attempt to regain control of one’s life. Bargaining helps the person to regain control by telling him/herself what could have been done differently, better, or effectively to change or improve the circumstances or situations. Some people choose to bargain with God or any spiritual being they apparently believe in. Bargaining can help the person to have hope, focus on the positive, and continue life. In the depression stage, some people the grieving process can go on for a long time. Often, this happens when the grieving person is very close to the deceased. This may lead to complicated grief disorder. Thus, having social support can be the key to the person’s acceptance of the loss. In the last stage, acceptance, the person is finally able to accept the loss or death of a loved one. In this stage, the person is able to find meaning, purpose, and direction in his/her life after the loss. Major Depressive Disorder. It is a serious medical illness that negatively affects how a person feels, thinks, and acts. Depression causes feelings of sadness, hopelessness, worthlessness and guilt, frequent crying, irritability, anger or hostility, withdrawal from friends and family, and loss of interest, enthusiasm, and motivation which can interfere with a person’s daily functioning. Physical symptoms of depression include changes in physical appearance, weight, appetite and sleeping pattern and energy. It can magnify minor aches and pains and worry about health condition. Symptoms of depression may also include recurring thoughts of death or suicide. A person diagnosed with clinical depression exhibits a depressed mood for the most part of the day and displays five or more of the indicated symptoms every day for a period of at least two weeks. Suicide is a serious problem. Someone who is suicidal may threaten to take his/her own life, or say that he/she wishes to die verbally or in writing. The manifestations of a suicidal person can be very direct or evident but sometimes subtle. A suicidal person may behave in life-threatening or self- destructive ways such as cutting, poisoning or hitting their heads against the wall. Some signs are dramatic changes in mood, behavior, appearance, use of alcohol and some drugs. However, previous suicide attempt makes it more likely that a person will do it again. Having a family member or close friend die by suicide increases the risk.  Schizophrenia is a psychotic disorder in which a person losses contact with reality. Its name literally means “split or broken mind” ; hence the person split from reality. If left untreated, the symptoms can become persistent and disabling which include distorted perceptions, disorganized thoughts, inappropriate behaviors, hallucinations and delusions. Thus, person’s environment could play a role in the development of schizophrenia, that may include conditions of living in poverty and stressful surroundings. DISASTER MENTAL HEALTH : OVERVIEW Mental Health The World Health Organization (WHO,2005) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. As an integral component of a person’s well-being, mental health refers to a health state in which the individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and able to make contributions to his/her community. In this sense, mental health is the foundation for the well-being and effective functioning of the individual and community. Determinants of Mental Health: 1. Biological Factors. It include pathogens, age , sex, and genes. Behaviors, habits, and lifestyles affect health and sense of well-being. Unhealthy habits such as drinking alcohol and smoking, poor diet and stress have all linked to health problems. Regular exercise has been found to be beneficial for mental health as well as physical health. Stress-inducers that have physiological effects in the body involve activities directly affecting the hormonal, autonomic, and immune systems. Although these stress are systematically handled by the body, severe kinds can have adverse effects on the organs, immune system and mental health. 2. Psychological Factors. Behavior and cognition play a vital role in mental health Cognitive factors may influence a person’s decisions to develop a healthy or unhealthy behavior, and this could be based on self-efficacy. Bandura defines self-efficacy as a person’s confidence in his/her capabilities to have control over events that affects their lives. In the context of health psychology, self-efficacy refers to beliefs about one’s abilities to withstand stress, thus it could play a major role in disaster management and recovery. In a psychological perspective, personality factors can directly and indirectly, affect health and illness in many ways. Personality can play an important role in mental health and certain personality trait can contribute to the development of certain behavioral disorders. Among those who take control and cope with stress successfully are people who possess hardiness. Hardiness consist of three components: commitment, challenge, and control. Commitment is the tendency of people to involve themselves in whatever they are doing with a sense that what they do is important and meaningful. Challenge has been observed in people who believe that when things go wrong in their lives , they do not see it as a problem but a normal part of life, hence a challenge to be met and solved. Hardy people have a sense of control in their lives and thus could have good physical and mental health. Humor is another trait that can affect mental health and well-being. Optimistic people, who are known to exhibit humor tend to take care of their health by preventive measures (relaxation, meditation, exercise) because they believe their actions make a difference in what happens to them. They also possess some features of hardy personality.  3. Social Factor. It is by definition the provision of assistance or comfort of others, typically to help them cope with biological, psychological, and social stressors. The support may come from any of the individual’s social network, involving family, friends, neighbors, religious institutions, colleagues, caregivers and support groups. It may take the form of practical help (doing chores, offering advice), tangible support that involves giving money, food, or other direct material assistance, and emotional support that allows the individual to feel valued, accepted, and understood. Cultural factors also contribute to mental health. People living in poverty is stressful for many reasons and thus, impact adversely on their health. Marginalized, indigenous and minority groups have a little social support system to help them deal with both everyday stresses and major life changes. Culture has significant impacts on the many aspects of mental health, ranging from the ways in which health and illness are perceived, health-seeking behavior, attitudes of the people as well as mental health systems. For many Filipinos, a strong belief in God or having an established religious faith can be a source of strength in times of stress such as before, during, or after a disaster. Most of these people belong to a religious community and attend religious activities such as church gatherings and prayer meetings. In turn, this could be the source of social support and can enhance mental health and well-being. PHILIPPINE MENTAL HEALTH LAW The World Health Organization (2017) recommends to member states to lead and coordinate a multisectoral strategy that combines universal and targeted interventions for promoting mental health and preventing mental disorders, reducing stigmatization, discrimination and human rights violations, and which is responsive to specific vulnerable groups across the lifespan and integrated within the national mental health and health promotion strategies. Thereupon on June 20, 2018, President Rodrigo Duterte signed into law Republic Act No. 11036, otherwise known as the Philippine Mental Health Act. This Law provides policy for national mental health services to promote mental health and protect the rights of persons with mental health conditions. Mental health services refer to the psychosocial, psychiatric or neurologic activities and programs along with the wide range of mental health support services, including promotion, prevention, treatment, and aftercare, which are provided by mental health facilities and mental health professionals. The Philippine Mental Health Law incorporates the rights of patients, including their relatives and mental health professionals. It highlights the need to provide psychosocial support to the family members of patient consent to include them in the planning of treatment for the patient. The rights, roles, and responsibilities of mental health professionals are also clearly spelled out in the Law. The Law requires mental health service providers to develop appropriate policies and programs on mental health issues and provide support for individuals with mental health conditions. Brought about by sudden , extreme, prolonged, cumulative stressors in their physical or social environment (e.g. disasters). There are pertinent sections in the Law that require the inclusion of mental health policies and standards in schools, workplaces, and communities, underscoring the basic rights of all Filipinos to mental health. Disaster Mental Health (DHM) Disaster Mental Health is the condition or state of well-being in which disaster survivors are able to cope adequately and display resilience during or immediately after a disaster. It also includes the state of well-being of DMH professionals and other DMH workers who are taking the lead or front line in providing mental health services to the needy in the midst of a disaster and emergency situation. Its goal is to make resources available so that survivors who may be at risk for difficulty with coping can receive support , employ their coping skills, connect with social supports, and obtain information that facilitates healthy psychological responses. Disaster Mental Health Services It is primarily directed toward normal people responding normally to an abnormal situation, and to identifying persons who are at risk for severe psychological or social impairment due to the shock of the disaster. Aspects of disaster intervention services are similar to the crisis work of mental health agencies and practitioners, which include the evaluation and treatment of persons whose pre-existing psychiatric disorders are exacerbated by the stress or trauma of the disaster. However, most of the work of the disaster mental health professionals occurs in nonclinical settings (shelters, crisis centers, community centers, schools) and is delivered in the form of stress management education, problem-solving, advocacy, and referral of at-risk or severely impaired individuals for more intensive clinical evaluation and care. The goal of DMH is to respond to the psychosocial needs of people affected by disasters. When delivering the services, mental health professionals and workers must understand the assumptions of DMH services. The American Red Cross (2012) offers assumptions od DMH services. 1. DMH services are based on the assumption that many people are resilient. However, a significant minority are at risk of developing a new or aggravated clinical disorder. Services should alleviate immediate emotional distress and mitigate long-term consequences. Most individual and families function adequately during and after a disaster, but their effectiveness in daily activities may be diminished. 2. Services should augment the community’s mental health resources, not replace them. The clients will be individuals, families, neighborhoods, community groups, and other disaster responders who are experiencing stress related to the impact of the disaster. 3. During the disaster response, DMH interventions are short term and can range from as little as ten minutes of support to a much longer period. The likely engagement with a client is once or twice but no more than three times. The most effective contact will often involve problem- solving and task-centered activities to address basic needs and the reduction of stress. MENTAL HEALTH LAW AND THE ETHICAL ASPECTS OF MENTAL HEALTH SERVICES The primary purpose of the Philippine Mental Health Law is to provide a moral framework and generic ethical standards for good practice, especially among mental health practitioners and workers in the Philippines. The Law adopts and builds on the core principles of the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergency Settings: respect for human rights and equity; participation; do no harm; building on available resources and capacities; integrated support systems; and multi-layered support. I. Respect for Human Rights and Equity Mental health practitioners shall respect the rights of persons with mental or psychological conditions, including persons who require or undergoing psychiatric, neurological, or psychosocial care. Persons with mental or psychological conditions, as defined in this Law, shall enjoy, on an equal and nondiscriminatory basis, all rights guaranteed by the Philippine Constitution. The rights include: 1. The right to be free from social, economic, and political discrimination and stigmatization; 2. The right to exercise all their inherent, civil, political, economic, social, religious, educational, and cultural rights; 3. The right to evidence-based treatment 4. The right to affordable essential health and social services; 5. The right to mental health services at all levels of the national health care system; 6. The right to comprehensive and coordinated treatment integrating holistic prevention, promotion, rehabilitation, care, and support. 7. The right to psychosocial care and clinical care treatment in the least restrictive environment and manner; 8. The right to humane treatment free from solitary confinement, torture and other form of cruel, inhumane, harmful or degrading treatment and invasive procedures not backed by scientific evidence; 9. The right to aftercare and rehabilitations; 10. The right to adequate information on available multidisciplinary mental health services; 11. The right to participate in mental health advocacy, planning, legislation, service provision, monitoring, research and evaluation; 12. The right to confidentiality of all information, communications, and records; 13. The right to inform consent before receiving treatment or care; 14. The right to participate in the development and formulation of the psychosocial care or clinical treatment plan; 15. The right to designate or appoint a person to act as legal representative; 16. The right to send or receive uncensored private communication; 17. The right to legal services; 18. The right to access clinical records; 19. The right to information of admission to a mental health facility; and  20. The right to file complaints, improprieties, and abuses in mental health care. These rights are particularly important for people with mental or psychological conditions. Mental health professionals are not only responsible for providing the most effective assessment procedures, and treatment, but they are also acknowledge the rights of their patients. These rights are enforceable rules, and therefore, they should guide mental health professionals’ actions, decisions, and recommendations. II. Participation Mental health professionals have a clear ethical duty to continuously participate in their professional development. They are not just to practice their expertise but to participate in educating the public about mental health. Their membership in professional organizations is expected to adhere to these standards. III. Do No Harm Mental health services have the potential to cause harm because it deals with highly sensitive issues. The duty of care to “Do No Harm” is an ethical standard that set forth the responsibility of mental health professionals to protect the lives of their clients. The Mental Health Law articulates the various ways to reduce harm. Mental health services shall be: 1. Based on medical and scientific research findings; 2. Responsive to the clinical, gender, cultural and ethic, and other special needs of the individuals being served; 3. Most appropriate and least restrictive settings; 4. Age appropriate 5. Provided by mental health professionals and workers in a manner that ensures accountability. IV. Building on Available Resources and Capacities The Mental Health Law recognizes the inherent rights of all Filipinos to mental health as well as the strengths, abilities, and potentials of people to make a positive contribution to their community. It articulates the integration of mental health into the curriculum at all educational levels as well as policies in the workplace to raise people’s awareness on mental health issues, use their resources, develop their capacity to cope adequately with the normal stress of life and display resilience in the face of extreme life events such as disasters. In the community, the Law states the importance of capacity building of barangay health workers and volunteers on the promotion of mental health through and improve training programs and information dissemination. V. Integrated Support System The Law articulates the duties and responsibilities of professional health workers to coordinate with relevant government agencies and private institutions (e.g. schools, workplaces, establishments) to create a framework for mental health awareness programs among Filipinos and improve service delivery, promotion, and prevention strategies in the country. VI. Multi-layered Supports The key to organizing mental health and psychosocial support is to develop a layered support system. In the face of extreme life events, people are affected in different ways; hence they require different kinds of services. And the first step to helping people to heal and recover from traumatic events is to talk with trustworthy people such as family members, friends, teachers, or mental health providers. GUIDELINES IN GIVING MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT The Inter-Agency Standing Committee (IASC-2007) offers essential advice on good practice in providing mental health supports especially in emergency settings. Dos Don’ts Establish one overall coordination group on Do not create separate groups on mental health mental health and psychosocial support or psychosocial support that do not talk or coordinate with one another Support a coordinated response, participate in Do not work in isolation or without thinking coordination meetings, and add value by about how one’s work fits with that of others. complementing the works of others. Collect and analyze information to determine Do not conduct duplicate assessment or accept whether a response is needed and if so, what preliminary data in an uncritical manner kind of response Tailor assessment tools to the local context Do not use assessment tools not validated in the local, emergency-affected context Recognize that people are affected by Do not assume that everyone in an emergency is emergencies in different ways. More resilient traumatized, or that people who appear resilient people may function well, whereas others may be need no support. severely affected and may need specialized support. Ask questions in the local language(s) and in a Do not duplicate assessment or ask distressing safe, supportive manner that respects questions without providing follow-up support confidentiality Pay attention to gender differences Do not assume that emergencies affect men and women in exactly the same way, or that programs designed for men will bw of equal help or accessibility for women. Check references in recruiting staff and Do not use recruiting practices that severely volunteers and build the capacity of new weaken existing local structures. personnel from the local and affected community. After training on mental health and psychosocial Do not use one-time, stand-alone training or very support, provide follow-up supervision and short training without follow-up if preparing monitoring to ensure that interventions are people to perform complex psychological implemented correctly. interventions. Facilitate the development of community- Do not use a charity model that treats people in owned,-managed, and -run programs. the community mainly a recipients of services. Build local capacities, support self-help, and Do not organize supports that undermine or strengthen the resources already present in the ignore local responsibilities and capacities affected groups Learn about and, wherever appropriate, use local Do not assume that all local cultural practices are cultural practices to support local people. helpful or that all local people are supportive of particular practices. Use methods from outside the culture where it is Do not assume that methods from abroad are appropriate to do so. necessarily better or impose them on local people in ways that marginalize local supportive practices and beliefs. Build government capacities and integrate mental Do not create parallel mental health services for health care for emergency survivors in general specific sub-populations. health services and if applicable in community mental health services. Organize access to a range of supports, including Do not provide one-off, single-session psychological first aid, to people in acute distress psychological debriefing for people in the general after exposure to an extreme exposure populations as an early intervention after exposure to conflict or natural disaster. Train and supervise primary/general health care Do not provide psychotropic medications or workers in good prescription practices and in psychological support without training and basic psychological support. supervision. Use generic medications that are on the essential Do not introduce new, branded medications in drug list of the country. context where such medications are not widely used Establish effective systems for referring and Do not establish screening for people with mental supporting severely affected people. disorders without having in place appropriate and accessible services to care for identified persons. Develop locally appropriate care solutions for Do not institutionalize people ( unless an people at risk of being institutionalized. institution is temporarily an indisputable last resort for basic care and protection ) Use agency communication officers to promote Do not use agency communication officer to two-way communication with the affected communicate only with the outside world. populations as well as with the outside world. Use channels such as the media to provide Do not create or show media images that accurate information that reduces stress and sensationalize people’s suffering or put people at enable people to access humanitarian services. risk. Seek to integrate psychosocial considerations as Do not focus solely on clinical activities in the relevant to all sectors of humanitarian assistance absences of a multi-sectoral response.