By Alex Whiting
LONDON (AlertNet) - Donors responding to an emergency often ignore mental health care, although rates of mental illness can double during a humanitarian crisis, International Medical Corps said.
Mental illness affects between 15 and 20 percent of people in a disaster, a rise from 10 percent under normal circumstances, according to World Health Organization estimates. Rates of acute mental illness – which include disorders like severe depression, bipolar disorder and schizophrenia – rise from 2 or 3 percent, to up to 4 percent in an emergency.
“Every time an emergency happens, you have to advocate for the needs of mental health services and you have to fight for the resources," Inka Weissbecker, International Medical Corps’ global mental health and psychosocial adviser, told AlertNet while visiting London to speak at the March 26-27 Royal Society of Medicine conference “The world in denial: Global mental health matters”.
“It’s absent from the global public health agenda, and isn't something that comes to mind among donors,” she said.
“People don’t think about it because it doesn’t cause as much mortality ... as some other illnesses. But what it does cause is a lot of disability. Mental illness is the leading cause of global disability," Weissbecker said.
This disability means someone suffering from a mental illness may not be able to work or take care of their children, and such people find it particularly difficult to recover and rebuild after a disaster.
Conflicts are generally more likely to cause mental disorders than natural disasters – unless the disaster is sudden and huge – because wars involve violence and a growing mistrust between people, Weissbecker said.
In an acute crisis it is sometimes very difficult to distinguish between a normal stress reaction that will pass with time, and mental illness, and a tendency by aid agencies to assume that everyone in a crisis needs specialised help can be counterproductive.
“You shouldn't victimise them and say they are all damaged because this just further demoralises people who are affected – but really acknowledge the strengths and resources they have,” Weissbecker said.
Some interventions can do more harm than good.
A technique used by many organizations but strongly discouraged by international best practice guidelines, is called psychological debriefing where people who have been affected by a harrowing event are encouraged to share their experience in a group.
It was used in the United States after 9/11, but researchers found it often made things worse for people.
“Sharing with a group of strangers or even work colleagues can be pretty traumatic for people. They might not want to share, they might not be ready to share. What is most helpful for people is to share with those who are close to them,” Weissbecker said.
After the Japan earthquake of 2011, one organization took children out of displacement camps to spend weekends in Tokyo with a foster family, thinking this would give them a break from the stressful environment. But being away from their parents and put with strangers can cause more stress for children than anything else, Weissbecker said.
Many health workers – either local doctors or aid agencies – assume that a person who has experienced something terrible needs medical treatment. Anti-depressants and benzodiazepines – powerful drugs which help people calm down and sleep, but are very addictive – are “greatly over-prescribed” in most emergencies, the international guidelines say.
Both children and adults are naturally resilient, and most will not develop a mental illness. What’s needed, though, is a supportive environment that promotes mental health, Weissbecker said.
A crucial part of helping people recover is to help families and communities stay together, and trace missing relatives. Sports, families cooking together, henna painting, public spaces where people can meet to drink tea or coffee, can all help too.
Children need a sense of routine – especially in the midst of chaos – and to play with other children. Teachers and others working with children need training to recognise the ones who may need more specialist help.
Work can help too. Most people affected by a disaster don’t just want to be on the receiving end of aid, they want to contribute too, Weissbecker said.
When Weissbecker was in a refugee camp in Jordan last year, she saw a Syrian man sitting in front of his tent. “He was pointing across to a crane that was building a latrine. He said: ‘I'm so anxious, I'm thinking about my family at home ... (and) I’m just sitting here, doing nothing.’ And he pointed to the crane and said, ‘I could help build this place.’”
“We're always so focused on ‘what can we do, what can we give them?’, without recognising that the affected population brings so much strength to the situation … this is often a hugely untapped resource by humanitarian organizations,” Weissbecker said.