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ADVANCES IN DISASTER MENTAL HEALTH AND PSYCHOLOGICAL SUPPORT Edited by Joseph O. Prewitt Diaz, M.D., PhD. Senior Advisor Psychosocial Support International Services American Red Cross R Srinivasa Murthy, M.D. Professor of Psychiatry (Retired) National Institute of Mental Health and Neuro Sciences Bangalore, India and Medical Officer Mental Health, Eastern Mediterranean Regional Office of World Health Organization Nasr City,Cairo, Egypt Rashmi Lakshminarayana, M.D., M.P.H. International Perinatal
  ADVANCES IN DISASTERMENTAL HEALTH ANDPSYCHOLOGICALSUPPORT Edited byJoseph O. Prewitt Diaz, M.D., PhD. Senior Advisor Psychosocial Support  International Services American Red Cross R Srinivasa Murthy, M.D. Professor of Psychiatry (Retired) National Institute of Mental Health and Neuro Sciences Bangalore, India and  Medical Officer  Mental Health, Eastern Mediterranean Regional Office of World Health Organization Nasr City,Cairo, Egypt  Rashmi Lakshminarayana, M.D., M.P.H.  International Perinatal Health Unit  Institute of Child Health London, England  VHAI -- Voluntary Health Association of India Press S-79 Okhla Industrial Area, Phase IINew Delhi, India 110020  Library of Congress Cataloging-in-Publication Data  Advances in Psychological and Social Support after Disasters (Editors) Dr. Joseph O. Prewitt Diaz,Dr.R Srinivasa Murthy, Dr.Rashmi LakshminarayanaCopyright C 2006 American Red Cross , India DelegationIncludes bibliographical reference and index. Section I: Theoretical Perspectives 1.Overview of the development of psychological support in emergencies 2.Disaster Mental Health-The World Health Organization Responses 3. Psychological Support within DisasterManagement in Asian CountriesSection II: Evidenced based case studies- Regional Perspectives 4. Disaster Mental Health Care in Sri Lanka 5.Disaster Mental Health Care in Lebanon 6. Disaster Mental Health Care in Iran 7. Institutionalizing PsychosocialCare in Disaster Management- the Philippine Experience 8. Mental Health in the aftermath of a complexemergency: the case of Afghanistan 9. Psychological Support in Palestine (Review of Palestinian MentalHealth in Gaza Strip during Al-Aqsa Intifada)Section III. Practice in Mental Health and Psychosocial Support. Psychiatry to psychosocial: 10. Lessons fromdisaster mental health in India. 11. The Kumbakonam School Fire Tragedy: A Disaster Mental HealthResponse by the Indian Red Cross Society and American Red Cross. 12. The American Red Cross psychosocialsupport tsunami response: A case study. Ms Anjana Dayal, IndiaSection IV: Planning, Implementing, Monitoring & Evaluation of Psychosocial Support Programs13. Ethnography: a tool for identifying community protective factors and activities that foster psychosocial well being 14. Measuring Resiliency in Two States in India: The Development of a Valid and Reliable Instrument15. Development Of A Psychosocial Questionnaire And A Worksheet For Teachers, Parents, Students AndOther School Personnel To Assess Educational Needs Of Survivors Of The Tsunami In Calang, Indonesia,16.Psychosocial support programs in disasters: American Red Cross Perspective All rights reserved. No portion of this book may be reproduced, by any process or technique, without theexpress written consent of the publisher. Disclaimer: The pages in this book aim to provide general information on the topic of psychosocial interventions. They are not intended to make statements concerning the official policies and practices and institutions unlessstated otherwise. A considerable effort has been made in good faith to ensure that material accessible fromthis book is accurate. Despite this effort, we understand that mistakes are inevitable.Consequently, no guarantees are expressed or implied as to the accuracy, timeliness, currency, or completenessof any information or accessible from any references that may be made in the book. Nor is any warranty madethat the information obtained from this document is valuable or useful for any purpose. A reader assumes fullresponsibility for any actions taken based on any information from this document. The use of information found in this book-- mail addresses, email addresses, or phone and fax numbers is notpermitted for any commercial purposes.  Preface Since the psychology of disasters was introduced in 1948, many have struggled with the concept of disastersand mental health. The last 30 years have seen a major shift of perspective from the treatment of “mentalillness” to “mental health care.” This has meant that mental health care providers have moved closer to thecommunity in there interventions and have, thereby, become psychosocial in their approach, using community resources and personnel. Although there has been an increasing acknowledgement of the need for mentalhealth interventions, the actual translation of this sentiment into action is far from adequate. Lessons learnedto date suggests that although this community approach is effective, programs suffer from not being able toreceive a commitment to long-term rehabilitation of survivors. There seem to be many challenges in strengthening disaster mental health policy at all levels of disaster management and in providing psychosocial support at allstages of disaster response. Meeting these challenges would ensure that psychosocial support following disaster would be a norm and not an exception in the affected country.Mental disorders are stigmatizing and walled off from the public health mainstream. Mental health needs tobe accepted as integral to almost every aspect of health and development. The greatest obstacle to promoting mental health in developing countries is that it remains largely ignored by global health policies.Disaster Mental Health programs and the Disaster Psychiatry special interest group of the American Psychiatric Association have developed a body of literature, response protocols, and capacity building mechanism toprepare a group of professionals that will respond during a disaster and alleviate the distress caused by suchevents. Resource rich countries have identified teams of responders from with the Mental Health systemto provide assistance in longer term recovery while resource poor countries are struggling to increase thenumbers of mental health professionals. Providing Mental Health and psychosocial support during long termreconstruction and development is still an emergent field. In part because of a lack of professionals trainedin disasters and mental health, lack of evidence based literature, and lack of integrated disaster mentalhealth and psychosocial support plans. This book attempts to contribute to the body of knowledge on thetopic.Much can change in a decade and half. It is hoped that the misconceptions that are surfacing among theinstitutions and the practitioners, specialists, and policy makers regarding the terminology and the coreconcepts of psychosocial support will be clarified over time. The recent MHPSS working draft also statesclearly the fundamental guidelines for all people serving in the disaster scenario. This may be the opportunity for the humanitarian world to rethink its conventional modus operandi and to systematically view humanbeings holistically, in their physical, psychological, and emotional entirety. We cannot afford to stand on the sidelines and be uninvolved and detached observers, no matter how encouraging and respectful our approach. The extent of human suffering and the politics of trauma call forprofessionals to become active advocates for the victims. We need to do more than to speak for them wemust speak with them.     This book is divided into four sections. Section I presents the theoretical bases for mental health and psychosocialsupport activities following a major disaster. Section II provides the reader with six specific examples of how mental health and psychosocial needs of affected populations have been addressed in Sri Lanka, Lebanon,Iraq, the Philippines, Afghanistan, and Palestine. Section III moves from mental health and psychiatry into acommunity model of psychosocial support. These sections present a transition from psychiatry to psychosocialsupport in India and are followed by two case studies; one from Kumbakonam, Tamil Nadu, India, and theother addressing the tsunami response during the acute to early reconstruction phases of the disaster cycle inthe south and western provinces of Sri Lanka. Section IV proposes tools for monitoring and evaluation of community-based psychosocial support needs and interventions.Section I comprises three chapters, which present an overview of the development of psychological supportin emergencies, disaster mental health from the World Health Organization (WHO) perspective, and psychologicalsupport within disaster management in Asian countries. The initial chapter begins with an overview of the development of psychological support in emergencies anddescribes various models of interventions used to deal with disaster, stressors, traumatic stress, and othermanifestations of bereavements. A discussion of traumatic bereavement is presented and the chapterconcludes with suggestions for addressing post-disaster stress manifestations. The second chapter focuses on the WHO response to emergencies and presents the general principles thatguide the response mechanism from the acute emergency phase to the reconstruction phase of a disaster. Thechapter utilizes the 2004 South Asia tsunami as a backdrop to illustrate the capacity of WHO torespond to disasters. The third chapter e addresses the disaster mental health response strategies. The author recognizes that mentalhealth and psychosocial support are essential components in disaster response, because each of such eventsis capable of causing overwhelming traumatic stress to the survivors or the community. Some of the issuesrelated to delivery of disaster mental health services at disaster sites and over the long term, to provide acontinuum of care for recovering survivors and their communities over the course of days, months, and yearsare also addressed. The chapter concludes by describing some recent initiatives taken in some South Asiancountries to include mental health and pscyhosocial support as a part of the response to disasters.Section II presents six cases of psychological response in the Middle East, Asia, and the Pacific (Chapters 4-7). The interventions described in this section focus on mental health of populations impacted by disasters. The fourth chapter in this section addresses mental health and psychosocial support in Sri Lanka. The islandnation has been plagued by civil insurgencies and natural disasters in the past ten years. The chapter addressesthe mental health dimensions of both war and natural disaster, and recommends remedial measures. Theauthor reports that, in his experience, the mental health consequences encompass depression, anxiety, stressdisorders and somatization. The chapter reviews the mental health impact of the war, and the tsunami, at  About the Book 
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