Are we well-equipped to restore the mental health of the traumatized in emergencies?

Dear Sir,

Globally, lives of almost 80 million people are jeopardized by the humanitarian emergencies resulting from natural disasters (cyclone Pam in Vanuatu, earthquake in Nepal, etc.) or armed conflicts (namely, Syrian Arab Republic, South Sudan, etc.). ^[1] It is a proven fact that prompt and sustained delivery of psychosocial support and mental health services plays a crucial role in restoring the health of the traumatized both during and after emergencies. ^[1],[2] In fact, the recent estimates released by the World Health Organization (WHO) suggested that close to four to eight million people worldwide suffered from a mental health condition that was secondary to a public health emergency. ^[1]

Mental health impairment is a very common phenomenon in the modern world, with most of the people (adults or kids or elderly) across the globe being exposed to grief, stress, and other mental disorders. ^[3] It is a well-acknowledged fact that a major section of people with mental illnesses have to counter the challenge of accessibility to specialized health professionals, especially in low- and middle-income nations. ^[4],[5] These existing gaps in the field of mental health and psychosocial support get further widened in case of an emergency. ^[4],[5] This is attributed to the consequences that are generally associated with an emergency-like displacement of a large number of people, massive damage to the health care establishments, interruptions in the supply of logistics including drugs, shift in the attention of the health workers toward the current emergency with minimal attention to the mental health component, breakdown of the referral system, and limited availability of specialists in the higher centers. ^[1],[6] Furthermore, those who already have a preexisting mental disorder (such as psychosis, intellectual impairment, and epilepsy) are much more vulnerable to the psychological ailments than their normal counterparts. ^[7]

Secondary to the exposure to emergency conditions, such as depressive disorder, post-traumatic stress disorder, and other mental illnesses, have been precipitated that seriously questions the ability of the person to perform routine functions. ^[2],[5] From the policy makers’ perspective, it is very important to realize that in order to ensure restoration of mental health, prolonged psychosocial support is required. ^[6] There is no doubt that immediately after a disaster or such emergencies, humanitarian relief is provided by various nations or international agencies; nevertheless, this assistance is often short-lived. ^[8] Now, the question that arises is about what we have done to ensure restoration of mental health (that actually necessitates the implementation of a comprehensive mental health policy) after the immediate relief phase. ^[6],[8] This is something that all the concerned stakeholders have to respond to and work together to develop an effective response.

It is very much true that generally emergencies are associated with all types of negative things; nevertheless, from a managerial perspective, it does offer an opportunity to correct the shortcomings of the health system. ^[9],[10] For instance, the simultaneous presence of a team of experts from international welfare agencies and allocation of monetary support could have never been achieved under normal circumstances, especially in low-resource settings. ^[9],[11] Furthermore, because of the destruction of the health infrastructure due to the emergency, the stakeholders can now redesign and implement more efficient and people-centric systems of care. ^[9],[12] In addition, as mental health is more often than not a priority for most of the policy makers (as it does not result in acute adverse consequences), such emergency forces the stakeholders to think otherwise and even the media and emotional support from people across the globe play a crucial role in changing their mind-set. ^{[9],[10],[11],[12]}

Furthermore, realizing the massive impact of emergencies on the mental health of millions of people, the WHO in collaboration with other agencies has formulated a “Mental Health Gap Action Programme Humanitarian Intervention Guide.” ^[1] This guide has been developed with an aim to assist the nonspecialist health workers to not only identify promptly the mental health needs but even thoroughly assess and manage the identified needs, as very often specialist services do not reach those regions where they are needed the most. ^[6] Simultaneously, this guide even empowers the team of health professionals to address the concern of substance abuse in emergency situations. ^[1],[6]

However, in order to ensure sustained benefit it is very much essential that political attention is sought and all measures are taken to integrate the mental health services with primary health care so that it can reach even the remote areas. ^[13],[14] Innovative approaches such as mobile health clinics in Nepal for the victims of earthquake, psychological first aid to the cases of Ebola virus disease in West Africa, and the training of nonspecialist health workers in the Syrian Arab Republic have been implemented in heterogeneous settings to address the rising concern of mental impairment. ^{[15],[16],[17]}

To conclude, in order to ensure the sustained global development it is essential to implement a strategic and comprehensive policy to address the mental health needs of the traumatized individuals in each incident of emergency. Responding to the mental health needs of people will not only improve the mental health indicator but even enhance the pace of recovery of the community from such public health emergencies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.162620