(Information obtained in an interview with Psychiatrist, Mental Hospital Angoda Dr. Neil Fernando.)
Among the challenges in the post tsunami situations, the most complex is re-construction and re-planning of people's lives.
Girls and women may have certain special and biological needs that should be considered when providing them with support.
It is important to be mindful that many women and children could be exposed to vulnerable situations. Therefore we should take steps to minimize their risks and exposure to any circumstances which may lead to sexual and gender based violence.
Grief and mourning - lost of family members, relatives, friends, personal belongings, home and income - these are some ways in which mental health is affected. Many persons would have witnessed or suffered terrible experiences. Physical injury and illness - may have consequences for mental health.
They Live in an environment with no community network - camps are over crowded and with poor sanitation. People from different communities and social background may find difficulties in living together.
Bereavement (or grief) is the experience someone goes through when a loved one dies. Most people will experience bereavement at some point, in their lives. The death of someone we love is probably the most severe loss we have to cope with. This is the reason that bereavement can become a mental health issue.
Bereavement is similar to a wound which hurts. A person will need time to recover and to make the wound heal. Such as a wound, bereavement too can take a longer period of time to heal or become complicated.
Bereavement should be recognized as an intensely personal experience, there is no right or wrong way to grieve. In certain communities, bereavement can also be a collective experience involving many people grieving together. In such circumstances, the pain of loss can be shared with others.
Typically there are three stages in the human response to loss;
It cannot be true - the stage of denial - 1st 8 weeks
This happens just after the loss. Person concerned has a feeling that the loved one cannot be dead. When the death happens all of a sudden, this shock is most obvious. The bereaved person can be numb, as if in dream.
I feel miserable: the stage of sadness - up to 6 months
During this stage, the absence of the loved person is well noticed. Sadness and the feeling that the dead person is still alive are common experiences. Some may even hear their name being called or dream of the lost person.
Certain people blame themselves for not taking precautionary measures to prevent the death or may feel angry that the dead person left them. Crying, problems with sleep, loss of interest in activities and meeting with people and disinterest in living can be experienced during this stage.
It's time to move on: the stage of reorganization - up to 2 years
During this final period of bereavement, they accept the loss as a part of life and get on with the rest of their own lives. Believing and accepting that a loss is a gradual process, most of them think of the lost person very often.
However, sadness does not interfere with enjoying happy moments in life. The indication that he has moved from bereavement is that he makes plans for the future.
How to deal with bereavement?
* Talking about the loss may help him/her to reduce the feeling of distress. Should let the person share his/her feelings and thoughts.
* Reassure the person that experiences such as imagining that the lost person is still alive or searching for the relative are normal and that they are not signs of insanity.
* Educate them on the stages of grief so that they know what to expect and will not worry about feelings or thoughts.
* Encourage sharing feelings with friends and relatives. As far as possible, the person should not be alone for the first few days.
* Encourage them to participate in religious rituals associated with death; prayers may help to cope with grief.
* A few days after the bereavement, discussing feelings of loss or sadness may be helpful. Encourage the person to ventilate his/her emotions.
* Grief is a universal human experience and the ability to listen quietly and allow the sadness to be expressed is a treatment in itself.
* The person should have adequate rest and sleep. Sleeping problems should be treated.
* Encourage a gradual return to daily life so that activities can themselves be helpful in improving self-esteem.
* Identify people with suicidal risks and refer for further assessment.
Procedure for effective psychological support
* Develop a good rapport with the person
* Listen to the persons concerned
* Give information, explanation and advice
* Encourage the expressions of emotion
* Improve confidence
* Review and develop intact assets
* Encourage self-help
Basic steps in problems - solving counselling
* Basic techniques of effective psychosocial support
* Define and list the problems
* Choose a problem for action
* List alternative courses of action
* Evaluate the courses of action and choose the best
* Try the selected course of action
* Evaluate the results
* Repeat until the important problems have been resolved
Mental health promotion in a camp
One of the most disturbing experiences in being displaced is the sense of helplessness. A person who had been responsible and taking decisions in response to their needs before the disaster had occurred now finds himself/herself entirely dependent on relief workers.
By handing back responsibilities and assigning specific tasks to them, the relief workers would identify the strengths of each individual and then assign appropriate tasks. Task allocations should be done by keeping cultural norms in mind.
Persons living in camps can work in a variety of group activities such as helping to prepare food and caring for sick people. Support groups can help identify and solve common problems. Children should be given an opportunity to restore some semblance of normal life by going to classes and playing in groups.
Some refugees may need specific help. Counselling means listening to people's experiences, meeting them regularly, providing them with emotional support, practical help and advice and problem solving.
Sometimes a person may be found to be very depressed. This is a normal reaction in such stressful situation. However, using anti-depressant medicine may be helpful in specific cases, but this should be done with extreme caution, if absolutely necessary.
At other times, a person may be behaving in a disturbed manner where appropriate use of sleeping pills or tranquilizers for a short period of time may help in calming a person. Information could be obtained from a Medical Officer of Mental Health and should be made available in the camp.
* Accommodate persons living in camps as family units as far as possible, by providing each family a separate area, allowing every family a little privacy by either hanging clothes or mats between the spaces allocated to them.
* Select people among the displaced persons themselves to take responsibilities to provide security for their own camp.
* Select people among the displaced persons to plan, prepare and serve their own meals.
* Provide a place for religious activities.
* Invite religious leaders to conduct daily religious activities.
* Select support groups among the displaced persons and if they wish to, encourage them to share their experiences when they are ready for it. (Groups 8-10). These groups may be formed based on common issues, by age, gender, etc.
* Provide opportunities for displaced persons to earn a living using their livelihood skills; a mason helping to build a house, for instance.
When counselling a victim, it should include:
Finding out about the other members of the family. When family members are separated as a result of the disaster and bringing members of the families together can be a very useful task.
* Asking about the needs of the person, provide practical help.
* Asking what the person remembers of the disaster (only if he is willing to talk about it). Discussing and sharing traumatic experiences can help reduce the isolation and loneliness. But should not force people into discussions.
* Active listening to the person concerned can be therapeutic for him/her.
* A person may feel overwhelmed by the scale of problems he is facing. Helping him to select the main problems and then working out ways of tackling them can be important when empowering a person.
* Recognizing and treating common mental disorders such as depression.
* Identify people already on treatment for mental illness or with symptoms and continue treatment/refer for appropriate treatment. Children should be reunited to the best extent possible.
Those who have lost both their parents should be made to live with their siblings, relatives, neighbours or a person the child is comfortable with as a guardian, as early as possible. Children should be provided with facilities for outdoor play.
Involve children in story telling, drawing and painting (provide material for painting). Select people among the displaced persons to conduct classes for children during school hours."