dAfter the disaster the despair
View(s):Leading Psychiatrist Prof. Malcolm Hopwood from Australia warns of the possible rise of mental illness as people affected by the recent devastating floods and landslides try to get back to their normal lives
By Kumudini Hettiarachchi and Minushi Perera
Prof. Malcolm Hopwood
The flood waters not only from the Kelani River in and around Colombo but also other parts of the country have receded, while in Aranayake, the scene of the tragic landslide, there has been a commemoration in memory of all those who succumbed.
It is about a month after these twin-tragedies and men, women and children who faced the wrath of the rains and landslides are attempting to hobble back to normalcy.
This is the time, around one to two months after a disaster, that a close eye should be kept to catch mental illness that may grip some of the people who have been in these situations and treat them.
These are the words of wisdom which come from the President of the Royal Australian & New Zealand College of Psychiatrists, Prof. Malcolm Hopwood who was in Sri Lanka at the end of May for the 13th Annual Academic Sessions of the Sri Lanka College of Psychiatrists and the International Congress of the Asian Federation of Psychiatric Associations in Colombo.
“Major disasters are capable of affecting people’s mental health and days and weeks immediately after a disaster, about 80% who have been affected would have psychological distress,” says Prof. Hopwood in an exclusive interview with MediScene, pointing out that the key is to restore safety and harmony in their lives initially.
He explains that the support available for disaster victims should be delivered in an organized manner. Sometimes many attempts at supporting these people may ‘mean well’ but they should be without chaos and confusion. They also need to be provided with information.
Citing the example of a landslide, Prof. Hopwood says that in its aftermath, people need to be told whether it could happen again and their worries about where their families and communities are and whether they would be able to join them if they have been separated, should be addressed adequately.
“As the survivors of a disaster are stressed out, the ability to process new information takes a while and the initial actions should be to provide shelter, food and money to them. All this would help in the natural recovery of a large number of the victims,” he says.
Once that is taken care of at the outset, lingering psychological distress has to be looked at in a month or two, MediScene learns.
Around 20% would be distressed then and the chances are that this distress is less likely to go away, points out Prof. Hopwood, underscoring that it is important to identify this group and offer appropriate mental health support, for symptoms persisting after a month are serious, disabling and potentially chronic and lifelong. They require appropriate clinical intervention.
The commonest problems are:
Depression
Anxiety
Substance abuse and increased alcoholism
Post Traumatic Stress Disorder (PTSD)
Aranayake: A man looks at the devastation in the aftermath of the landslide. Pix by M.A. Pushpa Kumara
“These generally strike the most vulnerable who include children, young adults, people who have suffered more direct trauma such as losing a family member or members or seen dead bodies, people who have had mental illness before and also the very old who are often forgotten in such situations,” he says. “Many, who have been thus traumatized, don’t think about seeking treatment. Sometimes they don’t even recognize the symptoms or are too embarrassed to seek help. They could even be putting the welfare of other people before their own.”
Prof. Hopwood reiterates that PTSD is one of the most common of these problems and left for too long will not go away, even with treatment. It is very important to seek help for conditions such as PTSD which involves symptoms including intrusion (re-experiencing); negative alterations in arousal and reactivity (hyper-arousal); avoidance of reminders; and negative alterations in cognitions and mood.
“This is why people need to be educated and armed with information to see the signs in themselves or in others. They need to be able to identify what ‘a normal response’ is to ‘an abnormal situation’, while also identifying when there is ‘an abnormal response’ to ‘an abnormal situation’,” he says.
Usually, about 1 in 5 would have such a reaction and in countries like Sri Lanka where families are close-knit, people can spot the danger signals which include:
• Being anxious
• Being worried or tense
• Not sleeping well
• Having bad dreams and flashbacks
• Being depressed – low in mood and losing interest in life
• Having feelings of guilt or hopelessness that life is not worth living
According to Prof. Hopwood in responding to this major public health challenge, communities and governments need to recognize the impacts of trauma not only ‘obvious trauma’ such as a natural disaster or war but also other common traumas such as interpersonal violence and accidents. For, these types of events frequently lead to new onset of mental health problems or worsen existing ones, with often devastating and even life-threatening consequences.
Referring to experiences developed back home in Australia in dealing with natural disasters such as bush fires in Victoria or cyclones in Queensland, he says that they would be happy to share their knowledge of how to respond to disasters.
“I think in Sri Lanka, your strong links of family and community are very helpful and protective against the development of mental health problems after trauma. It is so necessary when so many people have been displaced,” he adds.
| Sri Lanka College of Psychiatrists steps in In the aftermath of the recent disasters, the Sri Lanka College of Psychiatrists, under the leadership of Senior Prof. Samudra Kathriarachchi, promptly responded in supporting the government to look after the mental health needs of those affected. While putting out guidelines, the college has been actively working at ground level. | |