Key Topics

• What is Psychosocial• Mental Health, Psychosocial & Disaster• Psychological First Aid• Sence of Place• Stress & Crisis• FACT Team

What is psychosocial?

• The need to provide psychosocial support to victims of disasters was recognised in 1980s

• First consultation on psychological support was held in Copenhagen in 1991In 1993 the General Assembly recommended the IFRC to “give high priority to psychological support issues and strongly advocate the implementation of psychological support programs in National Societies” and- Reference centre for Psychological support was established

International Federation of Red Cross and Red Crescent Societies

"Underneath the relief blankets many people are still cold, not physically, but emotionally. In addition to their physical needs, people affected by disasters and other stressful life events have important mental (psychological) and social needs which frequently remain unmet ." ( From the first Consultation on Psychological Support, Copenhagen, May 1991)

• World Health Organization Definition of Health and psychosocial:

• “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

• Psychosocial refers to the dynamic, interconnected relationship among psychological feelings and social and cultural experiences.

Definition of Psycho-social

• PSYCHO (logical) refers to the mind and the soul of a person. This involves internal aspects such as feelings, thoughts, beliefs, attitudes and values.

• SOCIAL refers to a person’s external relationships and environment. This includes interactions with others, social

attitudes and values (culture) and social influences of family, peers, school and

community.

The World of A PersonRelationships, activities and spirituality are linked to build my person

and inner resources. The capacity to use these inner resources is my

RESILIENCE.

I CAN

I HAVE

I AM

RESILIE

NCE

Resilience is:

• The capacity to manage oneself when faced with difficult circumstances.

• The capacity to transform oneself in a positive way.

• The capacity to recover or rebound.

When I fall, I am able to get back up and

stand on my feet. This is resilience.

When there is a traumatic event the world of the

person is disrupted.

Relationships are affected

Activities are affected

Spirituality are affected

= Mistrust

and loss

= Insecurity

and fear

= Hopelessness

and Confusion

MY PERSON IS

DISRUPTED

I HAVE

I CAN

I AM

Psychological Social/Cultural

Emotions

Feelings

Thoughts

Beliefs

Perceptions

Behavior

Traditions

Values

Upbringing

Relationships

Obligations

Family

Community

Disaster is a major life stress of extreme severity

• loss of – Life (orphans, widows, widowers)– Livelihood– Physical functioning: Injuries and disability– Shelter , food, livestock– Access to health care– Access to education– Leaders and community structures

So, following a disaster

• We have to cope with– The pre-existing mental disorders in the general

population and within any hospital services in the area – Normal psychological responses to the disaster, – Additional mental disorders caused by the disaster

and its attendant physical and social effects

– Loss of pre-existing health, social and educational infrastructure and human resource

Therefore the common mental health problems in a disaster

populations include

• Universal normal response to the abnormal stress (disaster)

• Grief and Bereavement• Depression• Anxiety• PTSD-Post Traumatic Stress Disorders • Psychosis• Substance abuse• Mental retardation• epilepsy

Disaster Mental Health

• The goal is to prevent the development of long-term, negative psychological consequences of a disaster.

CYCLE OF DISASTERS(Quarantelli, 1968)

CYCLE OF DISASTERS(Quarantelli, 1968)

Cycle of Disasters

Event

Warning

Response

Disaster Mental Health

•Preparation for psychosocial response in time of disaster based on SPHERE standard/ISAC guidelines•Procedures and Protocols

•Rapid Response•Psychological First Aid•Crisis intervention•Information

•Assessment•Information•Crisis intervention•Psychological First Aid•Defusing

24 Hours

0-96 Hours

Basic Principles

1. Intervene immediately.2. Interventions are time limited and brief.3. The practitioner role is active.4. Symptom reduction is primary goal.5. Practical information and tangible support are

provided.6. Social support is mobilized.7. Expression of feelings, symptoms, and worries is

encouraged.8. Effective coping is supported to restore a sense of

competency as early as possible.9. Cognitive issues about reality testing and confronting

the experience are addressed.

Psychosocial Support

Psychosocial Support is ….

• A multidisciplinary, community based process that promotes the restoration of social cohesion and infrastructure, as well as the independence of individuals and groups.

• An approach that serves to prevent pathological developments and further social dislocation.

Cycle of Disaster

Rehabilitation

Reconstruction

Psychosocial Care

•Assessment•Information•Informal schooling for children•Linking•Community consultation

•Psychological first aid•Information•Schooling for children and adolescents•Linking•Community resilience activities•Referrals

Cycle of Disasters

Mitigation

Preparation

Psychosocial Care

•Community resilience activities•Community income generation activities•Referrals and community based psychological interventions•National structure developed•National procedures and protocols.

•Capacity Building•School Plans•Family Plans•Community mapping•Community plans•Procedures and Protocols developed•Simulations

Definition of Psychological First Aid

Psychological First Aid is a first order response, of short duration, to a

person who is experiencing distress as a result of a disaster, an

emergency or a crisis to foster coping in the current situation.

PSYCHOLOGICAL FIRST AID

Who require PFA ?

Any person who is in crisis requires PFA. After a major stressful event (a disaster) it is not just the survivors who requires Psychological First Aid but also their relatives and the people who come to assist the survivors.

Five steps of Psychological First Aid

1. Meet the immediate needs.

• Providing a safer place without further threat.

• Providing physical First Aid, if needed.

• Offer something to drink or eat.

• Make the survivor feel comfortable.

• Be aware of people who are having self harming ideas or intentions to cause harm on others.

2. Listen, listen and listen• Share the reality of the person.

• Use appropriate body language.

• Provide key words to facilitate survivor’s expression.

• Use gentle touch, if appropriate.• Acceptance and taking time to listen.

3. Accept the feeling expressed by the survivor.

• Empathize and validate feelings expressed by the survivor.

• Accept the normal reactions after a major stressful event like feeling of fear, grief, guilt and anger.

• Listen non-judgmentally and without interruption.

• No advice; no false assurance.

4. Assist with next step• Provide factual information where they

could find specific recourses.• Encourage the survivor to plan a

personal action plan for the immediate situation.

• Help the survivor to develop ‘sense of place’.

5. Refer and follow-up.• Identify persons who need counseling

and intervention.• Refer persons who does not respond to

your intervention.• Link the person to a system of support.• Follow-up next day.

Table for sustainability of Sense of Place

SENSEOF

PLACE

SolutionOriented

Cultural

Ecological

HumanCapital

Problem Solving

Indicators for a Sense of Place • Attachment to the place

where a person lives.

• Spending a lot of time and effort into making a place my own.

• Feeling more relaxed when at home in the community.

• Community has things that

highlight your personality.

• Community is a secure place to live.

• Personal touches to the ecology of the place where I live.

• I take pride in the community where I live.

• I work with others at making our community a place my own.

Defining “Sense of Place”

• “Sense of Place” is related to the perceived relationship between the survivor and the environment.”

• “Sense of Place” represents a dynamic process by which a survivor manipulates the environment to reflect his/her self identity.

• “Sense of Place” is related with autonomy, acting on the environment, making space for meaning, creates a place, and gives the person a sense of autonomy.

Impact on Sense of Place

Once a “sense of place” is established life is relatively stable and resilient.

• When a traumatic life event disrupts the life of the survivor, the feeling of security, attachment, identity, familiarity, and resilience, the survivors self-identity is disrupted.

• To reestablish the “sense of place” the survivor may require more work and energy output. This requires building networks with family, peers, and significant persons in the survivor life.

• “Sense of place” has a strong familial, community, and environmental contributions to its development.

Stress Reactions

Physical Reactions of STRESS

• Fatigue, exhaustion

• Appetite change

• Tightening in throat, chest or stomach

• Worsening of chronic conditions

• Somatic complains

Emotional Reactions of STRESS

• Depression

• Irritability, anger

• Anxiety, fear

• Despair, hopelessness

• Guilt, self-doubt

• Unpredictable mood swings

Cognitive Reactions of STRESS

• Confusion, disorientation

• Recurring dreams or nightmares

• Preoccupation with disaster

• Trouble concentrating or remembering things

• Difficulty making decisions

• Questioning spiritual beliefs

Self Care

What is Self Care ?

• Self Care is a method of reducing stress, which the individual himself / herself can apply on self.

Who can do Self Care ?

Self-care activities are for people who have some degree of control on themselves and are aware that they are under stress.

Build your energy levels  • Walk, swim, play sport on a regular basis, jog.

Eat a balanced meal      • Alternate work with pleasure activities.• Sleep sufficient time to feel rested.• Take time off when sick.• Get enough sleep.• Wear clothes you like.• Take vacations.

Keep your emotional reserves

- Develop gratifying personal relations.

- Seek emotional support.

- Formulate realistic goals for yourself.

- Prepare yourself for frustrating moments, allow yourself not to be perfect.

-  Give yourself affirmations, praise yourself.

-  Allow yourself to cry.

- Find things to make you laugh.

Psychological Self-care

• Make time for self-reflection

• Say no to extra responsibilities sometimes.

• Let others know different aspects of you.

• Notice your inner experiences – listen to your thoughts, judgments, beliefs, attitude and feelings.

Psychological Self-care

• Do something at which you are an expert or in charge.

• Engage in activities, which you enjoy. (For example, play some games, go to the cinema, take part in song and dance activities.)

• Be curious about learning and absorbing new things.

Spiritual Self-care

• Be aware of the non-material aspects of life.

• Identify the meaningful aspects of your life and value its importance.

• Contribute to causes that you believe in.

• Meditate.

• Pray,

• Participate in spiritual communes.

Techniques to Reduce STRESS

• Relaxation

• Deep breathing

• Visualization

• Affirmation

1. Verbal cues

2. Non verbal cues from the person

3. Surroundings

4. People in immediate contact

Identification of a Crisis

Common reactions to Crisis

• Tiredness and exhaustion

• Sleeplessness• Helplessness

• Disorganization, affects functioning within family, at work and in social relationships.

• Anxiety expressed by headaches, stomach aches, palpitations and muscular tension.

•Irritability towards social network

•Depression.

•Confusion

Conditions of Referral

• Behaviour out of context.

• Behaviour crossed the limits of context demands.

• Behaviour harmful to self or others.

• Evidence of suicidal talk or low self care.

• Overdose or withdrawal of substances of abuse.

The common causes of stress in children are:

1. Death of a dear one. E.g. Parent, sibling, relative or

friend

2. If a child suffers from physical injury or handicap

3. Memories and thoughts of a crisis or disaster

4. Dear one injured or physically disabled

5. Loss of a favorite toy or any other object

6. Displacement from the house

7. Fights between parents, violence at home

8. Poverty

9. Examination

10. Corporal punishment by the teachers

COMMON STRESS REACTIONS IN CHILDREN

1. Inactive. Not able to follow daily routine.2. Fear of the dark, fear of being alone.3. Not able to speak.4. Disturbed sleep (nightmares, fear of going to

sleep, fear of being alone at night)5. Clinging, not wanting to be away from parent

or teacher, bed-wetting. 6. Anxieties about the dead person that s/he will

return.7. Fears triggered by the event.

FACT TEAM• Should assess the individual and social

capacity of resilience of the Disaster population.

• Should look in to whether the Sence of Place of the population has been disturbed

• Coordinate the referral system.• Look in to relief and recovery • Please read Page 291-293 of SPHERE.

(non communicable Diseases)

Thank You!