DISASTER IN SOUTH ASIA DISASTER IN SOUTH ASIA (SAARC REGION)(SAARC REGION)

Roy Abraham Kallivayalil MD, DPMRoy Abraham Kallivayalil MD, DPMGen. Secretary, Indian Psychiatric Society & Gen. Secretary, Indian Psychiatric Society &

Secretary General, SAARC Psych. FederationSecretary General, SAARC Psych. FederationAssociate Professor of PsychiatryAssociate Professor of Psychiatry

Medical College, Kottayam, Kerala, India.Medical College, Kottayam, Kerala, India.

““The mental health consequences of The mental health consequences of disasters have been the subject of a disasters have been the subject of a rapidly growing research literature in rapidly growing research literature in the last few decades. Moreover they the last few decades. Moreover they have aroused an increasing public have aroused an increasing public

interest, due to the dramatic impact and interest, due to the dramatic impact and wide media coverage of many recent wide media coverage of many recent

disastrous events”disastrous events”- - Disaster & Mental Health (WPA 2005Disaster & Mental Health (WPA 2005))

SAARC REGIONSAARC REGION

7 Countries7 Countries

IndiaIndia

PakistanPakistan

BangladeshBangladesh

Sri LankaSri Lanka

NepalNepal

Bhutan Bhutan

MaldivesMaldives

TSUNAMI DISASTER IN SAARC TSUNAMI DISASTER IN SAARC REGIONREGION

Brought havoc in the regionBrought havoc in the region

Thousands diedThousands died

Several thousands injuredSeveral thousands injured

Thousands of homes washed awayThousands of homes washed away

APPROXIMATE LIVES LOST IN APPROXIMATE LIVES LOST IN SAARC REGIONSAARC REGION

Sri Lanka – 30,000Sri Lanka – 30,000

India – 20,000India – 20,000

Maldives – 1,000Maldives – 1,000

Bangladesh - 3Bangladesh - 3

PROBLEM FACING THE REGIONPROBLEM FACING THE REGION

Huge number of bereaved families, who Huge number of bereaved families, who lost father, mother, son, daughter, sibling lost father, mother, son, daughter, sibling or the entire family.or the entire family.

All belonging lost for some All belonging lost for some

No place to live No place to live

No worthwhile occupation No worthwhile occupation

Limited means of livelihoodLimited means of livelihood

SOCIAL CONSEQUENCES – SOCIAL CONSEQUENCES – SAARC REGIONSAARC REGION

Poor social supportPoor social support

Families have broken up Families have broken up

The social fabric is lostThe social fabric is lost

Schools, markets, fishing, agriculture, Schools, markets, fishing, agriculture,

places of worship destroyed.places of worship destroyed.

Emotional Consequences seen Emotional Consequences seen commonly in the regioncommonly in the region

Acute grief regionAcute grief region

Acute psychotic episodesAcute psychotic episodes

Hysterical conversion Hysterical conversion

Depressive disordersDepressive disorders

Recurrence of psychosis Recurrence of psychosis

Suicidal ideation and DSHSuicidal ideation and DSH

PTSDPTSD

Existing Scenario In IndiaExisting Scenario In India1.1. Mental health policy formulated in 1982.Mental health policy formulated in 1982.

2.2. Substance abuse policy – absent.Substance abuse policy – absent.

3.3. National Mental Health Programme – 1982.National Mental Health Programme – 1982.

4.4. Essential list of drugs – Yes Essential list of drugs – Yes

5.5. Mental Health Legislation – MHA 1987.Mental Health Legislation – MHA 1987.

6.6. 0.83% of Health Budget on Mental Health.0.83% of Health Budget on Mental Health.

7.7. Disability benefits – YesDisability benefits – Yes

8.8. NGOs involved in advocacy, promotion, NGOs involved in advocacy, promotion, prevention, treatment and rehabilitation.prevention, treatment and rehabilitation.

Scenario – India Scenario – India (WHO Atlas 2001)(WHO Atlas 2001)

1.1. Beds (per 10,000)Beds (per 10,000) 0.250.252.2. Beds in Mental HospitalsBeds in Mental Hospitals 0.20.23.3. Beds in General HospitalsBeds in General Hospitals 0.050.054.4. Beds (Others)Beds (Others) 0.010.015.5. Psychiatrists (per 100,000)Psychiatrists (per 100,000)

0.040.046.6. Neurosurgeons Neurosurgeons 0.060.067.7. Psychiatric nursePsychiatric nurse 0.040.048.8. NeurologistsNeurologists 0.050.059.9. PsychologistsPsychologists 0.020.0210.10.Social workers Social workers 0.020.02

Scenario In Srilanka Scenario In Srilanka

1.1. Mental Health Policy is being developedMental Health Policy is being developed

2.2. Substance abuse policy is presentSubstance abuse policy is present

3.3. National Mental Health Programme–1966National Mental Health Programme–1966

4.4. Essential list of drugs – 1985Essential list of drugs – 1985

5.5. MHL – Mental Disease Ordinance (1960)MHL – Mental Disease Ordinance (1960)

6.6. 1.6% of health budget on Mental health1.6% of health budget on Mental health

7.7. No disability benefits for mentally illNo disability benefits for mentally ill

8.8. NGOs are involved NGOs are involved

SCENARIO – SRILANKA SCENARIO – SRILANKA (WHO Atlas (WHO Atlas 2001)2001)

1.1. Beds (per 10,000)Beds (per 10,000) 1.81.82.2. Beds in Mental HospitalsBeds in Mental Hospitals 1.41.43.3. Beds in General HospitalsBeds in General Hospitals 0.30.34.4. Beds (Others)Beds (Others) 005.5. Psychiatrists (per 100,000)Psychiatrists (per 100,000)

0.20.26.6. Neurosurgeons Neurosurgeons 0.030.037.7. Psychiatric nursePsychiatric nurse 1.81.88.8. NeurologistsNeurologists 0.060.069.9. PsychologistsPsychologists 0.020.0210.10.Social workers Social workers 0.070.07

SCENARIO IN MALDIVESSCENARIO IN MALDIVES

1.1. Mental Health Policy – absent Mental Health Policy – absent

2.2. Substance abuse policy – 1977Substance abuse policy – 1977

3.3. NMHP – Absent NMHP – Absent

4.4. Essential list of drugs – YesEssential list of drugs – Yes

5.5. No Mental Health Legislation No Mental Health Legislation

6.6. Disability benefits - YesDisability benefits - Yes

7.7. NGOs are not involvedNGOs are not involved

SCENARIO – MALDIVESSCENARIO – MALDIVES (WHO Atlas 2001)(WHO Atlas 2001)

1.1. Beds (per 10,000)Beds (per 10,000) --2.2. Beds in Mental HospitalsBeds in Mental Hospitals --3.3. Beds in General HospitalsBeds in General Hospitals --4.4. Beds (Others)Beds (Others) --5.5. Psychiatrists (per 100,000)Psychiatrists (per 100,000)

0.360.366.6. Neurosurgeons Neurosurgeons 0.360.367.7. Psychiatric nursePsychiatric nurse 008.8. NeurologistsNeurologists 009.9. PsychologistsPsychologists 1.21.210.10.Social workers Social workers 00

What has been done in Sri What has been done in Sri Lanka?Lanka?

Relief measuresRelief measures

Mental health workers involvedMental health workers involved

Multi disciplinary approachMulti disciplinary approach

NGOs involvedNGOs involved

Support from WPA/WHO/other countriesSupport from WPA/WHO/other countries

Many other important measurersMany other important measurers

What has been done in India?What has been done in India?

Union and State Government involved in Union and State Government involved in

combined relief efforts.combined relief efforts.

Psychiatrists and mental health workers Psychiatrists and mental health workers

are part of the team.are part of the team.

Indian Psychiatric Society in the fore-front. Indian Psychiatric Society in the fore-front.

NGOs involvedNGOs involved

Media supportMedia support

Role of Indian Psychiatric SocietyRole of Indian Psychiatric Society

Formed a special task force for Tsunami Formed a special task force for Tsunami Disaster relief on 29-12-2004. Disaster relief on 29-12-2004.

Chairman – Dr. S. NambiChairman – Dr. S. Nambi

Co-Chairmen – from all the five zonesCo-Chairmen – from all the five zones

Convenor – Dr. P. Joseph VargheseConvenor – Dr. P. Joseph Varghese

Co-convenor – Dr. Varghese P. PunnooseCo-convenor – Dr. Varghese P. Punnoose

Members – Presidents and Secretaries of Members – Presidents and Secretaries of affected states.affected states.

The IPS Task ForceThe IPS Task Force

Mobilized country wide effortsMobilized country wide efforts

Co-ordinated the relief measurers Co-ordinated the relief measurers

Encouraged participation by allEncouraged participation by all

All the zones and the states participatedAll the zones and the states participated

Co-ordinated by IPS President and Gen. Co-ordinated by IPS President and Gen.

Secretary.Secretary.

IPS – Technical Advisory IPS – Technical Advisory CommitteeCommittee

Members who had valuable experience in Members who had valuable experience in

disastersdisasters

– Dr. Mohan K. Issac (NIMHANS)Dr. Mohan K. Issac (NIMHANS)

– Dr. N.G. Desai (IHBAS, Delhi)Dr. N.G. Desai (IHBAS, Delhi)

– Dr. K. Shekhar (NIMHANS, Bangalore) Dr. K. Shekhar (NIMHANS, Bangalore)

– Dr. R.H. Bakre (Gandhi Nagar, Gujrat)Dr. R.H. Bakre (Gandhi Nagar, Gujrat)

– Dr. Mohan Agashe (Pune)Dr. Mohan Agashe (Pune)

Contributions to PM’s FundContributions to PM’s Fund

IPS Members –mobilized IPS Members –mobilized

contributions to the Prime Minister’s contributions to the Prime Minister’s

National Relief Fund (PMNRF).National Relief Fund (PMNRF).

Kept in touch with PMO.Kept in touch with PMO.

Role of SAARC Psychiatric Role of SAARC Psychiatric FederationFederation

Mobilized support for relief measurers in Mobilized support for relief measurers in

the region.the region.

Provided technical expertise Provided technical expertise

Encouraged members to work in other Encouraged members to work in other

countries.countries.

Enlisted regional cooperation and Enlisted regional cooperation and

participation.participation.

The South-Asia Region The South-Asia Region - Looking Ahead - Looking Ahead

Dearth of trained psychiatrist and mental Dearth of trained psychiatrist and mental

health professionals.health professionals.

Time consuming rehabilitation measurersTime consuming rehabilitation measurers

The notorious “red-tape”The notorious “red-tape”

Media interest is waning Media interest is waning

Paucity of resources.Paucity of resources.

Plan for the FuturePlan for the Future

Involvement of all stake holdersInvolvement of all stake holders

Mobilizing National and International Mobilizing National and International expertiseexpertise

Equitable distribution of resources within Equitable distribution of resources within each country.each country.

Rehabilitation holds the keyRehabilitation holds the key

Mental health needs higher priority Mental health needs higher priority

““A Disaster is an empirical A Disaster is an empirical falsification of human action, the falsification of human action, the

proof of the incorrectness of proof of the incorrectness of human beings’ conceptions on human beings’ conceptions on

nature and culture”nature and culture”

- - Juan J. Lopez - IborJuan J. Lopez - Ibor