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Thursday March 28, 2024

Mental health problems associated with terrorism, natural disasters on the rise

National Disaster Management Cell should incorporate a national task force of mental health professionals to deal with matter, head IoP

By Muhammad Qasim
March 14, 2015
Rawalpindi
The ever-growing problem of terrorism and natural disasters has given a great rise to the mental health problems within the past few years though the matter has not been given due attention as has been needed by any of the concerned authorities.
We have not planned any mental health policy on national level particularly in relation with impact of terrorism on general population including affected individuals. Also the impact on child and adolescent mental health has not been given attention in this context.
Head of the Institute of Psychiatry at Benazir Bhutto Hospital and World Health Organisation Collaborating Centre on Mental Health Professor Fareed Aslam Minhas expressed this while talking to ‘The News’ after organization of a clinico-pathological meeting on disaster and mental health.
The Institute of Psychiatry organized the Clinico-Pathological Conference (CPC) at the New Teaching Block of Rawalpindi Medical College with an objective of apprising the medical students, psychologists, and various physicians and surgeons in attendance, about the mental health problems associated with the ever-growing problem of terrorism and natural disasters.
The faculty of RMC and doctors serving at the three allied hospitals along with nearly 200 students of RMC attended the CPC that was formally commenced with the recitation of the Holy Quran by post-graduate trainee Dr. Yousaf Raza. The audience was then captivated with a short video clip, prepared by Dr. Zaidan Idrees, which visually depicted the major disasters, two natural and one man-made, over the past decade.
The pictorial representation of the 2005 earthquake brought back memories of how badly the nation was shaken. The pictures of the starving flood affectees lunging for packets of food moved the audience. Finally, the graphic depiction of the 16th December, 2014, terrorist attack on Army Public School in Peshawar, left most of the attendants in hall in tears. The pain the individuals unanimously felt on viewing the video clip reminded them of how much more horrifying it must have been for those who actually lived through those moments of terror, said Professor Minhas.
Assistant Professor of Psychiatry Dr. Asad Tameezuddin Nizami then shared the disturbing statistics of disasters afflicting Pakistan over the last ten years. There were two million people left homeless by the earthquake in 2005 with 87,000 deaths and over a hundred thousand left injured. The 2010 floods, he said, affected a flabbergasting 20 million people. Since 2001 the ceaseless wave of terrorism has taken the lives of over 45, 000 Pakistanis.
Dr. Asad informed the audience in the light of scientific evidence, how people inflicted with these disasters are twice as likely to develop mental illness. He then enlightened the audience of the reality of terrorism from an academic perspective. Terrorists, he said, induce terror through violence against non combatant targets and exploit the media to magnify the impact of their actions. He spoke about the psychology of the terrorist; how their economic deprivation is exploited and they are brainwashed into committing these acts. They are made to view themselves as “good and right” and the others as “wrong and bad”. He emphasized on how noble religious concepts are misconstrued and exploited for these evil ends.
Dr. Yousaf Raza then presented two case histories. The first case was that of a 31 year old teacher at Army Public School. She had developed symptoms of Post-Traumatic Stress Disorder; complaining of seeing blood and faces of martyred children in her dreams and even while awake, low mood, anxiousness, feelings of guilt for surviving where children had died instead, an inability to rationalize the catastrophe, palpitations, and excessive weeping spells. The second case was that of young girl, a student of 1st Year FSC, who had lost her brother to the terrorist attack. She had withdrawn from public interaction, not seeing people coming for condolence and had become irritable especially towards her family. She was an A grade student throughout her academic career but despite weeks having passed since the catastrophe, she still had not reconvened her studies. She felt frustration and anger towards the terrorists and the security forces for not being able to save her brother.
Assistant Professor of Psychiatry and in charge of Child and Adolescent Services Dr. Ayesha Minhas spoke about the impact of trauma on children and adolescents. Moved to tears herself by the preceding cases and video, she reminded the audience that their own emotional state after this brief exposure to disturbing images, can only give them a fraction of an idea of what the actual sufferers went through. Through presentation, she apprised the audience of who is more likely to develop psychological symptoms after exposure to these experiences.
She further highlighted specific trauma focused therapy: directly addressing children’s traumatic experience, including parents in treatment recognizing their importance as agents of change, specifically building their effective parenting skills, and most importantly focusing not only on symptom improvement but also on enhancing functioning. Also included in trauma focused therapy was the importance of psycho education, teaching the children relaxation skills to cope with the anxiety, cognitive processing and changing negative thoughts and distortions, graduated exposure to feared stimuli if avoidance has developed, and addressing safety concerns related to prevention of future trauma. She concluded by reminding the audience to “let the children be children; let them move at their own pace.”
The final presentation of the CPC was by Professor Minhas who remarked that a distinct pattern can be ascertained in our response to disasters. This reaction was first observed by him during the aftermath of the 2005 earthquake and has since been repeated after the floods of 2010 as well as the recent tragic events of the terrorist attack on the Peshawar Army Public School.
He said that in the immediate aftermath of a disaster a raised interest can be seen in all concerned stakeholders. National departments as well as international agencies come forward to offer their help in the form of financial aid, logistic support and technical assistance for the rehabilitation of the affected. However, this raised interest and concern proves to be short lived and quickly abates over the ensuing period. Professor Minhas lamented the fact that till now we have not been able to convert this short lived energetic response into something sustainable.
He highlighted that the psycho-social rehabilitation of those affected by disasters is not a task of weeks and months but of years and so far our half hearted and misdirected efforts have not been able to achieve the desired results.
Professor Minhas, further stated that psycho-social rehabilitation should be an essential component of our response to disasters and that the National Disaster Management Cell should incorporate a national task force of mental health professionals who are able to provide these services to the communities affected by disasters in a systemized and sustained fashion.
He described the internationally verified tools which are available to help with the psychological rehabilitation of the people affected by disasters. The first of these interventions is known as Psychological First Aid (PFA) was developed by the National Centre for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs. This tool provides a modular approach to help in the immediate aftermath of disaster or terrorism. It is designed to reduce initial distress and foster short and long-term adaptive functioning and coping. The components of PFA include protecting the individual from further harm, presenting him with an opportunity to talk without pressure using the principles of active listening and compassion.
Professor Minhas proudly mentioned that the Institute of Psychiatry at RMC was the place where the field guide for Psychological First Aid was first translated into Urdu. At this juncture, copies of the translated PFA were distributed among the audience.
He also discussed another psychological intervention Problem Management plus, developed by Dr Mark Van Ommeren (World Health Organization) and Dr Katie Dawson (University of New South Wales, Australia). This tool has been specifically designed for poorer settings such as Pakistan.
At the end of his presentation, Professor Minhas discussed the ways forward for the management of mental health issues related to disasters in our country. He proposed a multi tier model that extends from policy making at the national level, strengthening of existing mental health services and capacity building by training and incorporating non mental health professionals to deliver psychosocial rehabilitation modules in their communities.
He said that the current lack of a clear national strategy to deal with the mental health issues related to disasters should serve as a wake up call to the policy makers and other stake holders sitting in the corridors of power that it was high time for the development of a national strategy for mental health and psychosocial support in emergencies and disasters.
He said that psychiatry has now entered the era where task-shifting and task-sharing have become the buzz words and psychiatrists alone will never be enough to combat the psycho-social issues of communities affected by disasters. Realizing this fact, the Institute of Psychiatry, which also serves as the WHO Collaborating Centre for Mental Health Research and Training, has already conducted workshops to equip mental health professionals with the necessary skills for these psychological interventions and is now about to conduct theses workshops for all the medical students of the Rawalpindi Medical College.
Professor Minhas said that in the coming days, the Institute of Psychiatry plans to train other member of the community including teachers and social workers to deliver these necessary psychological interventions.