1. Mental Health Aid Program to Tsunami Affected Countries Mental Health Aid Program to Tsunami Affected Countries Japanese Society of Psychiatry and Neurology Tsuyoshi Akiyama

2. Inter-governmental Conference Inter-governmental Conference  April 4, 5  Jakarta  India, Malaysia  Thailand  Sri Lanaka, Indonesia

3. Inter-governmental Conference Inter-governmental Conference  America, Australia,  Iran, Japan, Turkey  WHO, UNICEF  UNESCO, IOM

4. India India  Death: 10,697  Missing: 5,811  Affected: 2,880,468

5. Malaysia Malaysia  Death: 68  Affected: 7,827

6. Thailand Thailand  Death: 5,309  Missing: 3,810  Injured: 10,000

7. Sri Lanka Sri Lanka  Death: 2,846  Missing: 1,027  Injured: 2,375  Affected: 250,000  Displaced: 70,000

8. Indonesi a Indonesi a  Death: 126,915  Missing: 93,063  Injured: 2,375  Displaced: 795,385

9. India India  Psychiatric Symptom 60-80%  Grave Psychiatric Disorder 2,250  Training 110  Trainee4,387  Trainee4,387  Session35,000

10. Thailan d Thailan d  Psychiatric Symptom 100 %  Grave Psychiatric Disorder 2,325  Client9,015

11. Indone sia Indone sia  Psychiatric Symptom 90 %

12. Indonesia, Sri Lanka  Lack of Psychiatrist  Lack of Primary Mental Health System Mental Health System  Huge Disaster  Lack of Aid

13. Number of Psychiatrist 2001  Population 100,000  United States: 10  Japan: 8  Indonesia: 0.21  Sri Lanka: 0.2

14. Lack of Primary Mental Health System  District: No Psychiatrist  Coordination with General Primary Health Care (-) Primary Health Care (-)  Local Policy (-)  Lack of Psychiatric Care

15. Lack of Aid in Aceh  Conflict  Safety  Language Difference  Malaysian-Indonesian

16. Aid Program Trauma: Once Stress: Continues Few Years Systematic Aid Program Trauma: Once Stress: Continues Few Years Systematic

17. Recommendation Inter-ministry Cooperation Inter-sectoral Coordination Public Awareness Recommendation Inter-ministry Cooperation Inter-sectoral Coordination Public Awareness

18. Psychosocial Support Mental Health Care Psychosocial Support Mental Health Care

19. Psychosocial Areas  Formal Education  Non-formal Education  Social and Economic  Cultural and Religious  Environmental

20. Formal Education  Group Activities Children & Parents Children & Parents  Teacher Support / Training  Curriculum on the Issues  Student Guidance Center

21. Non-formal Education  Community Center  Youth Center  Drop-out – Reintegration  Life Skill  Vocational Training  Peer to Peer Support

22. Social and Economic  Media Campaign  Community Participation  Income Generating Program Program  Culturally Appropriate Support Services Support Services

23. Social and Economic Continued  Commemorative Activities Activities  Training of Support Service Providers Service Providers  Lost Documents  Legal Support

24. Cultural and Religious  Training Religious Leaders Religious Leaders Community Leaders Community Leaders  Traditional, Religious Healing Healing  Community Activities

25. Environmental  Resettlement On Higher Ground On Higher Ground  Protection Re-planting of Mangrove Re-planting of Mangrove Natural or Artificial Natural or Artificial Reefs Reefs

26. How to Strengthen Mental Health Care  Access to Basic Care All People All People  All Kinds of Problems General Mild Severe General Mild Severe

27. Important Issues  Anti Stigma  Inter-ministry Cooperation  Integration with General Health Care System Health Care System  Protection to Workers  Information System

28. 1 Specialty mental health services 2 Primary health care 3 Community care 4 Self and family care low high Need Cost Frequency of need MIX OF SERVICES Adapted from WHO (2003) WHO Dr. Van Ommeren, modified by Akiyama, 2005

29. Specialty Sector MEMBER  Psychiatrist  Psychologist  Psychiatric Nurse  Clinical Social Worker

30. Specialty Sector ROLE  Inpatient/Outpatient Treatment Treatment  Outreach  Community Treatment

31. Specialty Sector RECOMMENDATION  Acute Treatment Ward  Community Mental Health Team Health Team  Training to PHC

32. Primary Health Sector MEMBER  General Physician  Nurse  Midwife  Assistants

33. Primary Health Sector ESSENTIEL ROLE  Early Detection  Referral  Basic Mental Health Care  Case Follow-up

34. Primary Health Sector ADDITIONAL ROLE  Counseling  Psychosocial Education  Prevention  Inter-sectoral Linkage

35. Primary Health Sector RECOMMENDATION  Referral System Family Folder Method Family Folder Method  Training  Supervision

36. Community Sector MEMBER  Counselors  Teachers  Self-help Group  NGO Workers  Community Leaders

37. Community Sector ROLE  Early Detection  Referral  Basic Support  Prevention  Health Promotion

38. Community Sector RECOMMENDATION  Guideline Development  Training  Supervision  Prevention  Linkage

39. Self and Family Sector MEMBER  Self  Family  Relative  Friend

40. Self and Family Sector ROLE  Basic Knowledge Disaster Disaster Mental Health Mental Health  Networking

41. Self and Family Sector RECOMMENDATION  Information  Education / Basic Training  Peer Support Activity  Self-help Group

42. Japanese Society Aid Program Japanese Society Aid Program  Fund: Initial Phase  Training  Primary System  Trauma Care Center

43. F und in Initial Phase F und in Initial Phase  Malaysian Psychiatric Association Association  Japanese Business Federation Federation

44. Training  Key Persons  Disaster Preparation  WHO Model  Specific Program

45. Specific Program Specific Program  According to the Interests  Cognitive Therapy  Industrial Mental Health  Psychiatric Nursing

46. Primary Mental Health System Primary Mental Health System  8 Districts in Aceh  Coordination by WHO  1, 2 Districts by Japan?

47. Trauma Care Center Trauma Care Center  Center of Excellence  Coordination Center  Selected Sites

48. Collaboration with World Bank Collaboration with World Bank  Training: Community Sector  Primary Mental Health System?  Trauma Care Center?