Psychosocial Care during Emergencies

Emergencies can be psychologically and socially draining for people, families, and communities. Not only do people endure horrors before or during escape, but their living circumstances once they have achieved safety also place a heavy burden on them. The way that refugees and other individuals of concern deal with and respond to loss, suffering, disturbance, and violence has a substantial impact on their psychosocial well-being, mental health, and susceptibility to mental health issues.
Boys and girls of different ages, as well as men and women, may experience and express distress in different ways. With time, they frequently learn to control their reactions to upsetting circumstances. If a supportive family and community context is present, most people can deal with challenging situations and may even grow more resilient.

However, certain people are more prone to distress, particularly those who have lost family members, have been estranged from them, or have experienced violent crime. In such cases, psychosocial support services become necessary.

What is Psychosocial Support?

Psycho-social support” refers to broad interventions designed for addressing a variety of psychosocial and mental health issues in the aftermath of a disaster. These interventions aid people, families, and groups in developing three main purposes:

• their potential,
• reestablishing social infrastructure and,
• preserving their autonomy, cultural integrity, and sense of self

In the disaster-affected community, psycho-social support aids in lowering the degree of actual and perceived stress as well as in averting negative psychological and social effects. Additionally, psycho-social support interventions target the community in disaster-affected areas’ mental health and psychological well-being as well as promoting and preventing the occurrence of psychological and psychiatric symptoms.

In times of disaster, the continuum of interventions that make up general health services should include psychosocial support and mental health services. The general interventions that address the bigger challenges of promoting or safeguarding psycho-social well-being through relief efforts, satisfying basic needs, repairing social bonds, increasing coping mechanisms, and fostering harmony among survivors will make up psycho-social support. Interventions for either the prevention or the treatment of psychological and psychiatric indicators or disorders shall be a part of the mental health services. Both these interventions aim to help restore the well-being of the community affected by disasters.

Why is this Important?

Extensive family systems and unofficial community networks are two examples of typical and conventional community institutions that frequently govern community well-being that may fail in the event of mass displacement. This can result in or intensify social and psychological issues, which can then lead to the emergence of new leadership structures and mechanisms that may or may not be representative of a community’s diversity of age and gender.

The way aid providers deliver and provide services for refugees can also influence the level of stress experienced by the populations. Some at-risk individuals could adopt harmful coping strategies that put them at higher risk. While most people do not develop mental problems, some may, and those who already had them may see an increase in their symptoms. If people of concern can no longer use the traditional systems for doing so or if those systems have become less effective, they might leave without proper care or support.

Psychological First Aid (PFA)

Psychological first aid (PFA) is a primary disaster response strategy that aims to enhance safety, stabilize catastrophe survivors, and link them with resources and assistance. First responders, including mental health specialists, provide PFA to affected people. Instead of providing on-site care, PFA evaluates a person’s immediate concerns and requirements in the wake of a disaster. As a result, it is a crucial part of psychosocial support in an emergency.

PFA includes components such as prevention of harm, open expressions, compassion, addressing and acknowledging issues in hand, and providing coping strategies and referrals. In general, PFA consists of eight steps which are:

1. Contact and participation
2. Comfort and security
3. Stabilization
4. Gathering information
5. Real-world assistance
6. linking to social supports
7. Information for coping
8. Connection to services

The Phases of Mental Health and Psychosocial Support (MHPSS)

According to WHO estimates, almost 1 in 6 adults (10–15%) would experience a mild to serious mental disturbance following an acute onset catastrophic emergency. A mental condition that is so severe that it impairs a person’s capacity to operate and thrive in a chaotic emergency affects roughly one in thirty people (3–4%). The major steps taken by the health sector concerning mental health and psychosocial support (MHPSS) during the phases of emergency readiness, response, and recovery, according to the WHO research article are outlined below.

The following recommendations are made for the MHPSS emergency preparedness phase, which is a stage of the overall national emergency plan:

Preparedness, Phase (Planning)

• Integrate MHPSS into emergency preparedness plans and national health policies and initiatives;
• Map the current MHPSS resources and methods, including official and informal;
• Teach community workers and employees in the health, protection, and other sectors “psychological first aid“;
• Employing appropriate manuals and guidelines, instructing and overseeing healthcare workers in the management of urgent mental health disorders;
• Stock up on crucial psychiatric drugs for emergencies. Amitriptyline (or fluoxetine), phenobarbital (or carbamazepine), biperiden, haloperidol, and diazepam ought to be readily available at the very least;
• The inter-agency standing committee (IASC) guidelines dictate the creation of emergency plans for individuals with severe or persistent mental illness who are housed in institutions.

Response Phase (Action)

Assessment of Needs:

In the assessment of MHPSS needs throughout the response phase, it is important to include mapping of current assets and capacities, such as organizations’ accomplishments and how impacted persons are coping. You can perform resources and needs assessments for MHPSS using available tools.

Coordination of Services:

Creating a cross-sectoral MHPSS task team that has strong operational ties to (sub) clusters or sectors for health, security, child protection, sexual and gender-based violence, and learning, and is jointly headed by a health agency and a protection agency is advised to prevent dispersion of MHPSS over different clusters or sectors in emergencies. By mapping the situation, for instance using the 4Ws method (Who is doing What Where and Until When), carrying out cross-sectoral, multi-agency assessments, and planning collaborative workshops and training, the group can serve as a venue for information sharing.

Provision of Interventions:

In every emergency, it is recommended to have four aspects present during the application of MHPSS interventions. First, every healthcare facility during emergencies should have at least one staff member who can identify and deal with mental health problems in both adults and children. Second, lay professionals may be able to execute some evidence-based psychological interventions (such as cognitive behavioural therapy, interpersonal therapy, and stress management) if they have received proper training and supervision.

Thirdly, mental health services at greater levels of the health system must provide continuing supervision from professionals and referral options to support mental health interventions at lower levels of the health care system. Lastly, psychological first aid, protection of needs and rights of people with severe mental illness, collaboration and information sharing, community support and plans for early recovery are a part of the MHPSS response process.

Recovery Phase (Opportunities)

In times of crisis, the psychological health of those impacted receives significant attention and resources, and decision-makers are more open to exploring alternatives to the status quo.

The media regularly highlights the psychological suffering of survivors, which can boost the willingness and financial capacity of national and international organizations to support mental health and psychosocial aid for impacted individuals. Therefore, humanitarian crises may present special chances for more effective and long-lasting mental health care.