The Challenge:

The unprecedented damage to people, property and the environment presents an immense challenge to the Nation.

As the needs for food, shelter, clothing, medicines and other needs are provided it is important to recognise the impact of the disaster experience on the mental health of all the persons in the earthquake affected areas.

The persons involved is so large that it requires all innovative efforts to meet the mental health needs of the population.

Lessons of Mental Health Work From the Past Disasters in India:

1. Mental Health Needs of the Population Experiencing Disasters is Real.

There is enough evidence from the many disasters that the population experiencing disasters has higher need for mental health care. For example the number who were found to have psychiatric illness was 139/1000 population in the Marathwada disaster population as compared to 68/1000 in the control population ,even five years after the disaster. This increased morbidity of various psychiatric illnesses has been reported from disasters all over the world. It is generally accepted that at least 30% have continuing need for mental health care.

2.Mental Health Care is a Need Of All of the Population:

The need for mental health care is by the total population experiencing the disaster. Though there is a direct correlation with the occurrence of psychiatric problems with the degree of exposure, even those who have lived in the disaster area without any losses are more vulnerable to psychiatric problems. Services should be provided to the total population and not only to those who have lost a family member or had loss of limb or other losses.

3.Local Resources are the Most Effective Way of Providing Care:

The best approach to mental health care is to work with and utilise the local population in the care programme. This can be done by sharing the skills of caring. The external personnel have limited role in view of the cultural, linguistic and social factors which can interfere in the interventions. These resources can be general physicians, health workers, teachers, community level workers, developmental workers and the volunteers.

4.Mental Health Professionals Have an Important Role:

The role of mental health professionals is important in terms of sensitising the planners of services, training of the different categories of personnel and supporting the work of non-specialists. They also have the responsibility of preparing educational material. In course of time they monitor the programme and evaluate the impact of the interventions.

5.Long-Term Plans are Needed:

Mental health care needs are to be planned with a long -term perspective. As the Marathwada earthquake experience has shown the increased need for mental health care can be seen even after 5 years. In view of this besides, emergency services, there is need to build long-term structures and positions for professionals to provide care.

6.There is Need for Continious Monitoring of the Needs.

The mental health needs are different at different points in time. There is need to continuous monitor the need and respond to them and not hold on to a single pre-fixed programme.

7.There is Need for Documentation of the Experiences:

In order to learn from the experiences, an essential point of intervention is the documentation of the experiences of the population, as well as that of the providers of care. These can provide information to meet future challenges. For example the current plans and ideas have come from the experiences of working with various disasters.

Resources Available for Mental Health Care in India

Two international/national organisations have been in the forefront of mental health care for the population experiencing a disaster , namely OXFAM INDIA and ACTION AID ,India. The special aspect of their work is in terms of continuously working developing a system of care, besides providing care. The currently available resources for mental health care to meet the needs of the Gujarat Earthquake are:

1.Video on Psychosocial Consequences of Disasters:

(prepared by OXFAM,INDIA and NIMHANS, Bangalore).This 20 minute video brings together the experiences of about two dozen experts and presents the information about the nature of mental health needs of the population, the variety of approaches, the role of different community resources, the need for professional involvement and the importance of the policy for disaster care. The video has visual footage along with interviews.

The video is useful as a resource for sensitising policymalkers and Managers of disasrter programmes.Available from oxfam india,bangalore-(Address given below)

2.Information Booklets on Mental Health Care .

Currently three booklets are available in ENGLISH. These were prepared in the setting of the ORISSA cyclone by ACTION AID ,India and NIMHANS, Bangalore in 2000.

These address the needs of

* Individuals
* Community Level Helpers
* Teachers.

These are self-help type of booklets with pictures and practical measures to care for self and others.
These need translation to local languages.

Available From Action Aid, India (Address given below)

3.ICMR New Delhi report on the Health Consequences of Marathwada
Earthquake Disaster with special reference to Mental Health.

This Report provides information about the methodology of studying the morbidity as well as the interventions developed in the Marathwada earthquake. This was the joint effort of ICMR,NEW DELHI and the Maharastra Institute of Mental Health, Pune.

4. Mental health consequences of disasters-a special issue of indian journal of social work, October 2000.(P.521-701)

This is a very valuable publication from the Tata Institute of Social Sciences,Mumbai. The issue has 12 articles on various aspects of the mental health needs of the disaster affected populations. It contains both theory and case studies of working with the different disasters in the country. This is valuable for the use of professionals.

5. Action Aid experience of working with persons who have become orphans,widows using a community based approach to integrate them into the community. This is a very new approach and is in contrast to institution based experiences.

6.Songs relating to mental health aspects of disasters developed as part of KUTCH cyclone by OXFAM, India.

 The above is not a comprehensive list of all resources but illustrative of resources available easily to meet the current need.

The most important aspect of care is to recognise that the emotional needs are as important as other needs.There is need build this component into the total care programmes.

Immediate Need:
1.Sensitisation of all leaders about the nature of mental health needs as well, as the approaches to providing the care. The video would be most useful

2.Translation of the booklets and distribution of the same to the total population as well as all care providers.

3.Provision of mental health professionals in the large hospitals/community tent hospitals to provide emotional support to the ill persons and their families.

4.Training programmes for the middle level care providers in mental health skills

5.Setting up of referral support from psychiatrists, clinical psychologists, psychiatric social workers and nurses. Such teams should be available for each 100 000 population to begin with.

6.Making the available manuals/ information booklets on the internet so that they can be accessed by anyone who wants to use it.

7.Using of the mental health information and the songs to create street plays, dramas to educate the public in an informal and entertaining manner.

8.Maintaining the community as the focus of care both as recipients as well as providers. A good example is what was done in ORISSA by Action AID India to meet the needs of the orphaned children. Communities should be strengthened in all of the efforts.

9. Use of mass media to share the information

Short -term measures (to be developed)

Long-term measures (to be developed)

Addresses for contact relating to disaster and mental health:

1. Action Aid India.
India Office,
No.71,Uday Park,
New Delhi-110049.
Tel/Fax. 91-11 6510316/51, 6510349.
Email: aaindia@actionaidindia.org

2. Oxfam,India,
Vijayashree,
4th A Main ,Near Baptist Hospital,
Hebbal,Bangalore-560024.
Phone: 91 80 363 2964/ 363 3274.
Mobile:UNNI.. 91 (0) 98450 91319.
Email: unnikru@vsnl.com

3. Tata Institute Of Social Sciences,
P.O.Box 8313,
Deonar,Mumbai-400088.

Phone: 91 22 556 3289/ 556 3290.
Fax: 91 22 556 2912.
Email: p_unit@tiss.edu

4. Maharastra Institute Of Mental Health,
Sassoon General Hospital Campus,
Pune-411001,.
Phone: 91 20 6127331.
Fax: 91 20 6123738

5. Indian Council Of Medical Research,
Ansari Nagar,
New Delhi-110029.
Fax: 91 11 6868662.
Email: icmrhqds@sansad.nic.in

6. National Institute Of Mental Health And Neurosciences,
P.O.Box 2900,
Dharmaram College P.O.
Bangalore-560029.

Phone: 91 80 6995250.
Fax: 91 80 6562121/6564830