Mental Health Issues among Disaster Survivors

Mental health problems can affect anyone. Disaster might cause the mental health problems among certain individuals. All the disaster survivors need not necessarily develop mental health problems. Persons who have suffered significant loss (poor social support), victims of abuse and persons with inadequate coping resources or maladaptive coping strategies and vulnerable groups are more susceptible to mental health problems. Persons with underlying mental health conditions, persons who have stopped psychiatric medications due to non-availability or difficulty in accessing medicines during disaster phases are also more prone to develop mental health problems.

Knowing about the mental health complications post-disaster would help in early identification and prompt treatment. Ongoing assessments, periodic visits by the caregiver, sensitising the community on mental illness, help in early identification of persons with mental health problems, and facilitation of appropriate mental health services.

After any disaster, the mental health issues among disaster survivors can be viewed as one of these four ways.

• Blossomy flower : Survivors who experience psychosocial distress but are able to cope with it and do not develop any mental health problems.
• Withering floret : Persons who display elaborate mental health problems (chronic symptoms) during mental health assessments that happen at multiple time intervals.
• Slow bloomer : The survivor initially manifests the symptoms but gets better even without any intervention as time advances.
• Bud blast : The survivor does not display mental health problems for a long time and has delayed manifestation of symptoms (more than 6 months to one year).

Mental health problens post-disasters

The most common mental health problems post-disasters are shown below; 

Adjustment Problems

Disasters warrant significant adjustment and adaptation among survivors. Failure to adjust or adapt yields to adjustment disorders. They generally commence from three months to not more than six months of the disaster. It includes a group of emotional or behavioural symptoms that cause significant impairment in the survivors work or home functioning. The survivor experiences constant sadness, depressive thoughts (hopelessness, helplessness and worthlessness), reduced interest in work or other activities.

For instance, Mrs. S, 32-year-old female, lost her house in Tsunami. She was feeling low and did not talk to anyone, not even to her close friends. She felt helpless and hopeless. Even after 6 months of disaster, she had slowness in doing all her daily activities. She was not able to adjust and get along with the family members. The family members got back to their usual routine, but she was not able to resume normal life.

Along with referral to nearby mental health care facility, the caregiver can allow the individual to express freely on his/her difficulties. The focus of the intervention should be on creating adaptive coping strategies, problem-solving abilities, looking at the opportunities and solutions in spite of the threats, creating or rebuilding social support and building interpersonal skills.

Post-Traumatic Stress Disorder (PTSD)

PTSD is characterised by repetitive disturbing thoughts or images of the disaster (intrusion), avoiding persons/place/things related to the impact (avoidance), being hypervigilant and having low emotional alertness. The onset of the symptoms range between one month to three months. In rare circumstances, the survivor can also experience the symptoms more than three months and at times six months after the impact. The symptoms affect the daily functioning of the individual. The survivor may also experience nightmares or flashbacks, refrain from coming in contact with people/place/things related to the impact, being aloof and significant sleep disturbance. The survivor may also have anger outbursts, worry, fear, guilt and despair.

Mr. R, a 17-year-old male, after the air crash incident in Calicut lost his parents and sibling. After the loss, his paternal uncle took him into custody. Since then, he was getting repetitive disturbing thoughts and images of crash. He had nightmares often and was not able to sleep most of the times. Whenever he heard the sound of a flight, he would get disturbed. At times, he would shout and yell at the uncle without reason. The symptoms lasted for more than 4 months.

After referral to nearby mental health care facility, the caregiver can educate the person that the reactions s/he is experiencing is a product of the stress triggered by disaster, should strengthen support from family/friends/other social units, teach anxiety management techniques (relaxation techniques, yoga, breathing exercises, diversion techniques) and restart healthy routine (sleep, food, exercise) and curb unhealthy lifestyle. 

Anxiety related problems

The symptoms include increased worry and fear that last for six months or more. The survivors experience restlessness, difficulty in breathing, irritability, sleep problems, increased heartbeat, profuse sweating, and feeling dizzy. The individual experiences fear of forthcoming danger may be because of vulnerability or uncertainty. 

Mr. K, 38-year-old adult was evacuated with his family during the Chennai flood After reaching his home, he was sweating profusely. He experienced increased heartbeat restlessness and was irritable in doing activities. At times, he had disturbances in sleep and breathing difficulties. He is afraid that rains may come again and had constant worry and preoccupation about the same. 

The caregiver has to refer the person with the above-mentioned difficulties to the nearby mental health care centre. The care provider can do the following to help in the person's recovery: Help the person to create a healthy routine and follow it, teach relaxation techniques (yoga, breathing exercises), provide reassurances and instil hope and support. 

Depression

The survivor who is depressed shows persistent sadness, low energy levels, depressive cognitions, negative thinking, lack of interest in pleasurable activities, alteration in sleep and eating patterns and suicidal ideation or suicide attempt. They also might have low self-esteem. These individuals avoid social activities and have significant impairment in activities of daily functioning.

Ms. S, a 32-year-old female lost her husband who was working abroad, due to COVID. She got this news only two days after his death. It was very difficult for her to get the body. She was not even able to believe that her husband was dead. She does not have children and had no other support. She attempted suicide twice. She had feelings of hopelessness, helplessness and felt unworthy to live. She lost her appetite and could not sleep. She was not able to do any of her activities. She was weeping continuously and was thinking that life is miserable.

After facilitating mental health referral, the caregiver can make the person feel that s/he is available for the person to talk about his/her feelings, teach on adaptive coping strategies, establish routine, monitor for suicidal thoughts/ideation. The care provider also can encourage the participant to engage in constructive hobbies like listening to music, weaving, etc. 

Panic Disorder

This disorder is characterised by recurring panic attacks that spans between few minutes (rarely hours). The person experiences extreme anxiety and unreasonable fear. Some of the symptoms during the panic attacks are racing heartbeat, pain in the chest region, shortness of breath, shivering, giddiness, profuse sweating, vomiting sensation and abdominal pain.

Mr. R, a 35-year-old male, escaped miraculously from the Avalanche in Kashmir. Since then, he was feeling restless, anxious and had unreasonable fear. This attack used to last for few minutes. He would experience increased heartbeat, ache in chest region, breathing difficulty and pain in abdomen.

Along with referral to mental health care facility, the care provider can ensure safety and security, teach anxiety reduction strategies and provide reassurances.

Dissociative Reactions

After disaster, few people may have jerky movements in the body that might appear like fits (seizures). These episodes might occur when they meet specific persons or during specific situations. Here the person might not hurt himself/herself, does not lose consciousness and would express the views in an unusual voice. These indicate that the person is experiencing excessive distress and has certain unfinished desired goals. To achieve these secondary gains, the person might display such abnormal behaviour. It should not be considered that the person is acting.

During Latur earthquake, Mrs. L, a 50-year-old female, escaped from the collapsing building along with the family members. After the calamity, she had unusual jerky movements in the body. This happens whenever she meets her son or daughter. During such episodes, she falls and appears unconscious. She would speak in an unusual voice. During those times, family members give more attention to her.

Psychosocial Interventions would include interventions targeted towards the individual as well as the family members. The person needs to be oriented on the body-mind relationship saying how the repressed unconscious needs are manifested through bodily symptoms. Helping the person to talk about the feelings would help the person feel better. The family members need to be told to minimise giving attention to the person's symptoms without compromising the quality time. 

Other Mental health Implications

Loss of productivity

People, after losing everything feel empty and lack interest to work. When people lose their families in disaster, they feel meaningless in living and do not take efforts to make their lives better.

“I don't feel like doing anything”. (32-year-old woman)

Increase in substance use

Alcohol consumption is increasing day by day and many cultures encourage alcohol use. Disaster survivors, after the huge loss tend to increase the intake of alcohol, tobacco and other substances to cope with the loss. It acts as a temporary relief with lot of negative physical, psychological and social impact. The caregiver needs to sensitise the population on the ill-effects of harmful substance use.

“When I drink, I feel less for the loss of my loved ones”. (45-year-old man)

Suicidal thoughts, attempts and suicides

After losing the dear ones and all the property, some might have suicidal thoughts, tend to harm themselves or even attempt suicide. Repetitive thoughts to end life are most common in the rebuilding phase. The care provider needs to orient community in general on help available when individuals think of committing suicide, should give information about suicide help-lines and other suicide prevention strategies. As suicide is a cry for help, the caregiver should also develop crisis intervention plans for persons who wish to end their lives and hasten appropriate physical and mental health interventions in case of an attempt.

“I don't feel like living. God has taken all my dear ones. I feel lonely and I want to end my life soon”. (39-year-old female)

Marital discord and family problems

Emotional reactions that are subjective mostly shown as behavioural or relational reactions. Subjective distress is usually vented over the family. It leads to strained interpersonal relationship resulting in significant marital issues or issues with children or parents. The balance of the family system gets disturbed after the calamity.

“My mother and father are always fighting. I do not want to go home at all. I used to play with my sister. The waves took my sister. I am all alone now. My parents don't talk to me properly”. (9-year-old boy)

Somatisation

Subsequent to disaster, physical symptoms are common. At times even after a year of the disaster, few may experience continuous bodily symptoms such as headache, stomach pain, vomiting sensation due to ongoing stressors.

“My entire body aches. I feel weak and numb. I feel dizzy. I have consulted many doctors but the symptoms are not improving”. (37-year-old female)

Difficulties in restarting and managing livelihood

Disasters shatter the livelihood of the disaster-affected communities. Enormous work needs to be done to rebuild the lives of disaster affected communities. Survivors have trouble in restarting their jobs or business from the base, collecting monetary benefits or compensation, etc. If the survivor is not multi-skilled and has only one work profile, it limits him/her from getting a job. Limited vocational opportunities around the disaster neighbourhood or losses  incurred discourage restarting of livelihood.

“I lost my certificates and other important documents during the flood. It is very difficult to start a new life here. It would take months to get duplicate ones. I don't know what to do. I am now doing petty jobs which do not even match my education” (24 years old male).

Reactions to post-disaster can be delayed and manifested even after six months or one year. Researches provide evidence that almost 30% of the population affected during disaster are prone to one or more mental health condition. The caregiver needs to be watchful of the abnormal reactions and should educate the community to look for the reactions among the neighbours. As there is still stigma with respect to mental health treatment, it is essential to sensitise the community on the importance of mental health treatment and minimise or remove stigma with respect to seeking mental health intervention. The care provider needs to undertake ongoing assessments. This would help the care provider to know whether the person needs primary, secondary or tertiary mental health interventions.

Source : National Disaster Management Authority