Public health strategies and approaches Munia Islam School of Public Health Independent University, Bangladesh February, 2018 Session- 13&14 HSC 556 Psycho-Social Dimensions of Behavioral Health

Mental Health and Psychosocial Support in Emergencies “Disasters are defined as situatin whose impact can overhelmed the adaptive capacity of affected populations and groups, to a verifying extent and for more or less extended periods of time, depending on the circumtances”.

Major types of disaster Natural disaster- Tsunami, food, cyclone etc. Human made disaster- armed conflict, political unrest or other hazard, resulting from human action, whether internationally and locally

Psychosocial Impact of disaster Bring extensive loss of for the affected people/victim- Loss of loved ones Loss of physical integrity Material goods Places the have made their own. Sense of safety and security -

Psychosocial Impact of disaster Mental health and psychosocial problems in emergencies are highly interconnected. Significant problems of a predominantly social nature include: Pre-existing (pre-emergency) social problems (e.g. belonging to a group that is discriminated against or marginalised; political oppression); Emergency-induced social problems (e.g. family separation; safety; stigma; disruption of social networks; destruction of livelihoods, community structures, resources and trust; involvement in sex work); and Humanitarian aid-induced social problems (e.g. overcrowding and lack of privacy in camps; undermining of community structures or traditional support mechanisms; aid dependency).

Psychosocial Impact of disaster Similarly, problems of a predominantly psychological nature include: Pre-existing problems (e.g. severe mental disorder; depression; alcohol abuse); Emergency-induced problems (e.g. grief; non-pathological distress; alcohol and other substance abuse; depression and anxiety disorders, including post- traumatic stress disorder (PTSD)); and Humanitarian aid-related problems (e.g. anxiety due to a lack of information about food distribution).

The psychosocial impact of natural and human maid disaster are different as they are not similar in nature Natural disaster usually have a beginning and end- helps psychosocial recovery easier. However, disasters linked to human activity are more disturbing, particularly those are global in nature. Because they generate feelings of psychosocial threat and uncertainty about the associated threat. It may cause long-term reactions of stress and demoralization.

Categories of PSS victims Primary victims: Those who are primarily and personally affected The witness of the disaster and their traumatic effects, including emergency response service providers All those exposed indirectly to the victims themselves, or to the scene and consequences of the disaster through the media (e.g., friends, family and the general public)

Mental Health and Psychosocial Support Interventions The term ‘psychosocial’ denotes the inter-connection between psychological and social processes and the fact that each continually interacts with and influences the other. In the interventions, the composite term mental health and psychosocial support (MHPSS) is used to describe any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder. A common error in work on MHPSS is to ignore the existing resources and to focus solely on shortfalls- the weaknesses, suffering and pathology- of the affected group. It is important to know not only the problems but also the nature of local resources, whether they are helpful or harmful, and the extent to which affected people can access them.

Intervention pyramid for mental health and psychosocial support in emergencies Mental Health care mental Health specialists (psychiatric nurse, psychologist, psychiatric etc. ) Specialized services Basic Mental Health care by PHC doctors Basic emotional and practical support by community workers Focused (person- to person) non- specialized supports Activating social networks Communal traditional support Supportive child friendly spaces Strengthening community and family supports Advocacy for basic services that are safe, socially appropriate and protect dignity Social considerations in basic services and security

Coordination MHPSS activities should be coordinated within and across clusters/sectors. (e.g. Health, Protection and Education)

Assessment Rapid assessment a few weeks or few months later of emergency (need and resources and acting organizations) map ‘Who is doing What Where until When’