Introduction to Mental Health and Psychosocial Support

Disaster-affected communities experience various physical and mental health problems. Unlike physical symptoms, mental health problems remain unnoticed most often. However, it is a well-established and scientifically proven fact that physical and mental health issues are interlinked. Further, World Health Organisation (WHO) defined health as “a state of physical, mental, and social wellbeing and not merely the absence of diseases or infirmity. Also, the extent to which the individual or group is able to realise aspirations and satisfy needs and to change or cope with environment”.

According to WHO Mental health is “a state of wellbeing in which the individual realises his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community”. Mental health deals broadly with thoughts, emotions, and behaviour of the individuals. Psychiatry, as a branch of evidence based medicinal science deals with the promotion of mental wellbeing, prevention, and management of mental illnesses. Psychiatry seeks to analyse the causes of illness, conduct research on the psychosocial factors behind wellness and illness and attempts to provide holistic care and support to the persons with mental illnesses.

Providing timely mental health intervention or psychosocial support services facilitate the early identification of the issues and speedy recovery of the affected people. In the context of disasters Psychosocial Support (PSS) refers to “comprehensive interventions aimed at addressing a wide range of psychosocial problems arising in the aftermath of a disaster”. In the past, distributing relief materials and physical reconstruction (body and environment) were given the priority during disasters. In the recent decades integration of PSS along with other relief services has got attention of the stakeholders.

The Dynamic Interaction Between Thoughts, Emotions and Behaviour

Disturbances in thinking, mood and/or behaviour in an individual leads to mental illness. However, disturbances in these core domains does not predispose an individual to develop mental illness. When such disturbances affect the different areas of life (personal, social or occupational), it can be an indication of mental illness.

Most mental illnesses are conceptualised as a continuous degree from the ‘normal’ phenomenon. For example, following a sudden loss of job, everyone feels ‘stressed’ and ‘sad’. However not everyone develops mental illness like ‘Depression’. The degree of sadness varies from normalcy to distress to dysfunctional levels. Only among individuals in whom the dysfunction is significant, a diagnosis of ‘depression’ is determined. Similarly in disaster context emotional reactions such as fear, anger, grief, guilt, sadness etc, are normal. When it goes beyond a limit over a period of time causing dysfunction in the activities of daily life, it needs medical attention. Conceptualising illness as a continuum spectrum from normalcy, and understanding the illnesses as ‘deviation in the degree of suffering’provide a basis for educating the general public. This even helps in reducing the stigma in the society towards mental illness.

Psychosocial Determinants of Mental Health Disaster

Apart from the biological factors (genetics, infections, chemical imbalance in the brain etc.), psychosocial factors serve as the key determinants in maintaining health as well as developing diseases. Some of the important psychosocial determinants of mental health include:

Age: Children and elderly (extremities of age) are more vulnerable to disaster related impact, including the mental health impact. Individuals in this age group are dependent economically and socially on the other working age group and they are more prone to different types of abuses (psychical, sexual) and neglect. Lack of understanding about the situation, inability to control the events and cope with difficult situations make them more vulnerable.

“8 years old X witnessed his apartment catching fire, causalities and sudden chaos created around. From then he is extremely scared of fire, clingy, avoids going to school, and unable to sleep due to nightmares”.

Gender: The traditional gender roles make women and other sexual minorities (including LGBTQIA+) face societal hierarchy related challenges, discrimination, and social inequality. For instance, unequal access to resources and relief assistance, increased vulnerability to abuse/exploitation (domestic violence, physical, emotional, sexual abuse etc), privacy issues in the relief centres, increased caregiving responsibilities etc.

“28 years old K lost her husband in a terror attack. Even after 8 months of his death, she is grieving to the same extent. Because of her constant low mood, crying spells, fatigue, and bodily complaints, she is not able to care for self, 2 years old daughter and her parent in-laws”.

Caste, community, and religion: Social institutions like caste, community or religion influence the mental health of an individual. Sense of belongingness and togetherness, being in an identifiable group provide social support to the individual. On the other hand, social evils like., untouchability, discriminatory practices, religious hatred contribute to the ill health and poor access to the resources/services.

“A group of socio-economically oppressed community did not have their identification documents even prior to disaster. This affected them in having access to the relief services, post-disaster”.

Environment: Growing in an environment with prevailing social problems such as; poor opportunities for education and gainful employment, violence, abuse/exploitation, etc determine the coping ability and resilience of an individual. These factors further make the people vulnerable to disaster.

“After losing his 15 years son on a mob attack, S alcohol consumption increased. He goes for work irregularly and not contributing to his family financially. This triggers frequent arguments between him and his wife. After every fight he hits her. However, she and people from neighbourhood is not taking active step to make him stope abusing her physically, as it is considered acceptable to hit wives”.

Schooling and education: Unequal distribution of educational opportunities, inadequate learning experience, bullying/abuse experience, and overall educational attainment of the community play significant role in the psychosocial development of the individual. At the time of disasters, it influences the vulnerability and resilience of the people.

“After the COVID-19 restrictions, the online classes affected the children who are not having resources to attend classes, especially from rural communities and/or children from economically weaker sections”

Poverty and financial status: Poverty is a social evil that inadvertently leads to malnutrition, lack of resources, poor social support, discrimination, poor living condition etc., that affect the mental wellbeing of the people and make them even more susceptible to the impact of disasters.

“46 years old Somasekhar, lost all his crops due to stampede by elephants. Even after approaching community leaders, he did not get any help. Thinking of the debts and financial crisis in the family he attempted suicide”

Employment and job security: The resources in the community either help or hinder an individual in getting and maintaining a job. Having a secure employment enhances the social security of the people. It also moderates an individual’s mental health.

“A group of migrant workers lost their job due to the COVID-19 pandemic. The unavailability of job, not being able meet the basic necessities of the family caused them significant distress, helplessness, hopelessness, worthlessness, and death wishes”.

Accessibility to health resources: Equal distribution of health-related resources is a basic necessity. Primary health centres, sub centres and wellness centres across the nation play this essential role in the community. Wherever there is poor access to mental health care, the illness and suffering go unnoticed and the treatment gap becomes wider.

“After the flood, 54 years Anthony stopped his medicines for OCD. Now his symptoms have worsened, however he is not able to go for the follow-up as his family is preoccupied about their livelihood, aftermath of flood.”

Stigma: Stigma is a social evil that leads to discrimination based on illness and excludes the individual from community participation. It is also identified as a crucial factor in increased treatment gap and poor treatment adherence.

“People hailing from an area where the Nipah was prevalent, were treated different by others in public spaces. This influenced the people when they had early signs of infection to maintain the secrecy, causing panic/anxious reactions”.

Culture and indigenous practices: Indigenous knowledge form its base from the advanced understanding of a group of people on local environment. Beyond understanding, the indigenous practices are a way of life in the adaptation process or means of survival from the crisis. Such body of indigenous knowledge helps the community to reduce the risk, adapt and thrive from the impact of disasters.

‘Change in weather, pattern of wave, behaviour of the weather, smell of the sea etc are the indication of environmental hazards like tsunami, flood etc., in many of the communities in India’

Along with the above-mentioned determinants, it is essential to understand the determinants that moderate the level of risk among disaster survivors. It includes:

• Physical closeness (distance between the person and epicentre)
• Emotional closeness (closeness of the person to the affected individual)
• Individual vulnerabilities (pre-existing health conditions, frustration tolerance level, sense of optimism, socio-economic vulnerabilities)
• Environmental vulnerabilities (number of members in the family, family coping, family functioning, health conditions in the family, family resources)
• Instant and ongoing stress reactions (stress reactions and its intensity)
• Individual coping patterns (positive or negative coping pattern).

These determine the risk for mental health complications among disaster survivors. Understanding mental health, mental ill health and psychosocial indicators of mental health, help Primary Care Doctors (PCDs) to integrate mental health services with routine medical care while working with disaster survivors.

Source : National Disaster Management Authority