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Our partners OpenLearn works with other organisations by providing free courses and resources that support our mission of opening up educational opportunities to more people in more places. Support us. The role of cognitive behaviour therapy CBT in mitigating the mental health morbidity appears to be promising. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively.
Thus, now it is time to integrate public health principles into disaster mental health. In the contemporary world, disasters are inevitable truth of our life, preventable but completely unavoidable and they are part of our living in this complex globalised, industrialized and civilized world. Disasters are as old as mankind. Disaster is a very a broad term, which implies a diverse set of circumstances from an act of terrorism manmade disaster to natural calamities like earth quake.
Developing countries are at high-risk for disaster proneness and also they have to face challenges like poverty, meager resources, illiteracy, poor infrastructure, corruption, lack of trained manpower and poor knowledge of disaster mental health. Can a railway accident be a disaster? Terrorist attack? Religious Riots? Rapid spread of Ebola virus? Difficulty to define a disaster has been further accentuated by the inconsistent use of terminologies such as calamity, catastrophe, crisis, emergency, misfortune, tragedy, trauma and stress.
Disasters cannot be avoided completely but we need to learn how to prepare, respond, recover, rehabilitate and re-integrate. There is a need to understand the effects of disaster on health so that precautionary measures can be adopted to mitigate the suffering. Hence, this article attempts to define, classify and discuss the management of disasters from mental health perspective.
Boolean operator AND was also employed in combination of the above key words. In addition, the reference sections of major articles, and reviews were also screened. We employed the usual hierarchy of evidence to write the review. Systematic reviews and meta- analyses of randomised controlled studies RCT were considered the best evidence base followed by RCTs, open-label studies, case series and case reports. In addition, we also considered clinical, consensus and disaster guidelines in writing this educational review.
The Disaster Management Act of India[ 8 ], disaster is defined as a catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or manmade causes, or be accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of property, or damage to, or degradation of, environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area.
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From above various definitions it is clear that there is no one single acceptable definition of disaster. However, there are some common characteristics across all definitions. They are:. Disaster can be classified as natural and manmade ones. This attribution has positive consequences in terms of coping and negative consequences by way of hindering planning and preparedness. This is well-known in war and terrorist attack. Community's and individual's reactions to the disaster usually follow a predictable phase as shown in Figure 1.
They are heroic phase, honeymoon phase, disillusionment phase and restoration phase. Hence this phase is called as heroic phase.
Disasters, Ever Increasing, Take Their Toll on Mental Health. How Can We Fight Back?
This phase usually lasts from a day to weeks depending upon the severity, duration of exposure and availability of the relief sources from various agencies. Once the relief agencies step in, survivors are relocated to safer places like relief camps. Hence this phase is called honeymoon phase, which usually lasts for weeks.
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Depicts the various phases of disaster and role of mental health professionals. Immediately after the disaster, heroic phase sets in this is followed by honeymoon phase. Disillusionment phase is the longest and prevalence of mental health morbidity is high during this period.
Natural Disasters Take a Toll on Mental Health
Sources: Modified from Young et al. At the end of weeks, relief materials and resources start weaning. VIPs and politicians visit stops. Media coverage reduces. Administration, relief agencies and NGO's involvement start fading.
This brings the survivors to the ruthless world of post disaster life. The reality of complex process of rebuilding and rehabilitating appears a distant dream because of administration hurdles, bureaucratic red tapism, discrimination, injustice and corruption. This harsh reality of the disillusionment phase provides a fertile soil for breeding mental morbidity which lasts for months before the community restores to harmony. The role of mental health workers is immense during this phase. Grief is the response to any loss.
Grief reactions are normal responses to abnormal situations. Its intensity is directly proportional to the severity, duration and intensity of exposure to the disaster. Grief process occurs through various stages[ 16 ] and are often experienced in waves or cycles or episodes with periods of intense and painful emotions. Usually normal grief follows the above phases with a possibility of some variation and resolves over a period of few months.
Remember, survivours are normal people in abnormal situations. This issue needs to be kept in mind.
Disaster Behavioral Health Services
The validation of their emotions needs to be done during the therapy to address the issue of:. Death wishes and suicidal ideas.
By validation of emotions a sense of justification is provided to the overwhelming emotions. A recent study reported that the existence of complicated grief in more than two-thirds of the survivors of the earthquake. Hence, the mental health professional needs to liaison with the disaster relief administration, educate them regarding proper closure of the missing people and to facilitate the mass grieving through cultural-religious death rituals of grieving.
Prevalence of mental morbidity in disaster affected population varies from 8.
Along with the diagnosable mental disorders, affected community also harbors large number of sub-syndromal symptoms population. Majority of them report of medically unexplained somatic symptoms, and unusual symptom clusters are classically seen.
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Common disorders are: Adjustment disorders, depression, post traumatic stress disorder PTSD , anxiety disorders, non-specific somatic symptoms and substance abuse.