After natural disasters such as hurricanes, earthquakes and floods, most survivors focus on physical needs first, such as food, water, shelter and electricity. However, psychological needs are just as important. This leads to the need for mental health relief and psychological first aid that addresses the initial mental health needs of survivors of natural disasters. Here is some information about the situation in six different places along with the organizations providing mental health care amidst natural disasters.
Puerto Rico is an island commonwealth located in the tropics and near a fault line that places it at risk for flooding rains, tropical cyclones and earthquakes. In 2017, hurricanes Irma and Maria affected the island chain, with the latter being one of the island’s most devastating storms in history. With health care workers leaving the island after the storm, resources squeezed tight, electricity out and pharmacies closed, issues such as anxiety, increased suicide rates and PTSD became heightened. After the storm, one-fifth of all residents were in need of mental health care. People leaving the island put a further strain on available health care resources, including mental health services. Predictions have determined that about 600,000 people will leave Puerto Rico by 2023. Additionally, about 7% of children met the criteria for PTSD.
While progress in building the mental health infrastructure has been slow since Maria, the island has made progress. When Hurricane Maria hit, the storm knocked out power to almost the entire island. According to The American Psychological Association, Hurricane Maria disrupted half of the island’s cellphone service and most internet connections. Pharmacies closed, meaning antidepressants were unavailable. Some rural towns experienced complete isolation so mental health professionals were unable to reach people in need. Moreover, staff with the Puerto Rico Psychological Association did not have full training prior to Hurricane Irma, and Hurricane Maria made PRPA aware of the various needs. Immediately after the storm, the PRPA sent psychologists to disaster areas, set up triage and provided counseling to people in need. The big things they focused on were listening to people’s stories of survival and focusing on a positive future outlook.
Organizations Providing Mental Health Care in Puerto Rico
Save The Children established the Journey of Hope project, and the organization worked to keep children on track through education, an important opportunity to support emotional wellbeing, in addition to coping with loss and anxiety. In the year after the storm, the project helped over 1,600 children. The Hispanic Federation provided solar lamps to people who lost power after the earthquakes since power outages triggered PTSD in Hurricane Maria survivors. The Hispanic Federation also teamed up with the University of San Juan to provide mental health services to people in both rural and urban areas. Direct Relief provided counselors and medications and hosted a workshop to address mental health needs.
Hurricane Maria also caused widespread devastation on the Caribbean island nation of Dominica. As with Puerto Rico, the storm caused catastrophic damage on the island. International Medical Corps, together with the Dominica Psychological Society and IsraAid, designed and hosted 15 one-day workshops with over 200 leaders between December 2017 and February 2018, where they learned about psychological first aid. The community leaders who participated in the workshop came from various NGOs, local government councils throughout the island and ministries in the government, including The Ministry of Health. In addition, the organizations hosted workshops for art-based psychological first aid.
The Caribbean Development Bank provided $1 million to the island chain nation after Hurricane Dorian to address the mental health needs of residents. This came after the organization announced a broader initiative with the Pan American Health Organization (PAHO) to provide counseling assistance, citing the need to address the link between natural disasters and mental health. International Medical Corps assisted the Bahamas Ministry of Health by providing mental health and psychosocial support services. Because individuals tend to focus on food, water and shelter needs first, issues such as anxiety, PTSD and depression could be major long-term health crises, since most people on the affected islands lost their homes or loved ones. As a result, the organization sent mental health counselors to Grand Bahama Island, trained officials in psychological first aid and supported community-based mental health initiatives.
The National Institute of Mental Health and Neurological Sciences in Bengaluru assisted flood victims in Kodagu after floods affected the region in 2018. A team of experts, which included psychiatrists and psychologists, went to the region where they trained people on the ground to help with local mental health needs and communication. Additionally, volunteer groups created the Kerala Floods Mental Health Support Group to connect survivors of the floods. In India, there are few resources that go to mental health care. A 2015 World Health Organization (WHO) report found that there were only three psychiatrists per million people, while the National Programme for Mental Health received less than one-tenth of 1% of the 2017-2018 budget.
After the 2018 Sulawesi earthquake and tsunami killed over 4,000 people, IsraAid provided mental health services and supportive activities to the communities the disaster affected. These included training individuals in the community to cope with and learn about the long-term effects of trauma. Doctors Without Borders partook in similar efforts, training volunteers on the ground to reach at-risk and remote communities. UNICEF worked to address the mental health needs of children, helping 4,500 at 60 different places through psychosocial support. More than 10,000 psychosocial kits went to children and teachers.
Cyclone Idai made landfall in Madagascar in March 2019, causing torrential flooding in Zimbabwe, Mozambique and Malawi and killing more than 1,300 people. In Zimbabwe, UNICEF and Childline Zimbabwe and the Regional Psychosocial Support Initiative provided counseling to the children the cyclone affected. The organizations also established a shelter at Ngangu Primary School to cater to the victims’ material and psychosocial needs. Near Chimanimani, UNICEF worked with eight different organizations to provide counseling and psychosocial support to those the disaster affected.
In Mozambique, more than 31,000 children received psychosocial support through UNICEF after Idai and Cyclone Kenneth, which impacted the country a month later. In Beira, Mozambique, Doctors Without Borders provided counseling to the storm survivors and health care workers, and also trained psychologists on psychological first aid. Additionally, the organization undertook a public health campaign to talk about the symptoms of trauma related to the cyclone and the flooding it caused in Buzi. Meanwhile, UNICEF reached 10,000 children in Malawi through an initiative that provided opportunities for psychosocial support.
Future efforts by organizations providing mental health care will need to focus on community-based efforts and in collaboration with local figures. These modes of care will need to be integrated into the healthcare infrastructure and focus on long-term outcomes.
– Bryan Boggiano