Kerala, After The Flood: Importance of psychological first aid and how 'help' must be more than just monetary

Editor's note: Described as one of the worst since 1924 by Chief Minister Pinarayi Vijayan, the rains in Kerala have left over 350 dead and rendered thousands of people homeless. According to the latest tally, 80,000 have been rescued so far. Over 1,500 relief camps have been set up across the state that currently house at least 2,23,139 people. In a multi-part series, Firstpost will attempt to analyse the short-term and long-term impact of these unprecedented floods on the lives of the people, economy of the state, and the environment.​

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During a training session in Bengaluru with 34 volunteer participants, Dr Aravind E Raj, Associate Professor, National Institute of Mental Health and Neuro Sciences (NIMHANS) tells the motley group assembled that self-care is important when you are volunteering in a disaster zone. He also talks about the importance of listening.

Dr Aravind and his fellow trainers — psychologists from Training and Research Initiative (TRI), Bengaluru — are no strangers to the importance of empathy and support during a disaster situation. The result is a training session for volunteers working in flood ravaged Kerala and Kodagu on Psychological First Aid. The training session is much needed, given the importance of psycho-social care in the aftermath of a disaster.

While professionals from the mental health industry have always known that, what makes this PFA training stand out are the participants from non-psychology backgrounds. They believe that being trained in PFA will equip them better as volunteers.

PFA for volunteers

Dr Aravind E Raj, Associate Professor, National Institute of Mental Health and Neuro Sciences at a training session for volunteers working in flood ravaged Kerala and Kodagu on Psychological First Aid. Image by Reshmi Chakraborty

Dr Aravind E Raj, Associate Professor, National Institute of Mental Health and Neuro Sciences at a training session for volunteers working in flood ravaged Kerala and Kodagu on Psychological First Aid. Image by Reshmi Chakraborty

What is Psychological First Aid? According to experts, Psychological First Aid covers both psychological and social support. "PFA is meant to aid individuals in the immediate aftermath of a disaster. Even after surviving, the person is struggling to cope with new challenges. It is designed to try and reduce initial stress and help people with short and long-term adaptive functioning and coping," says Nisha Menzies Rao, director, TRI.

As relief trucks with aid materials rush to disaster zones, emotional distress, which isn't always visible, is often overlooked. But the impact can be long drawn. Kerala has already reported three cases of suicide. Given the scenario, disaster relief work needs to make psycho-social aid as important as physical and financial one.

Thankfully, the lack of awareness around this seems to be changing.

In Kerala, volunteer groups which include experts in social work, bioinformatics and psychology have pooled in resources to create the Kerala Floods Mental Health Support Group, to provide emotional support and psychological rehabilitation for the flood survivors.

The response to the TRI workshop was overwhelming. "Our participants included teachers from Kerala, a nun who is managing a shelter for evacuated people in Kerala and members of Civil Defence already involved with rescue and relief work in Kodagu," says Dr Shailaja Shastri, founder of TRI. Dr Shastri sees the response as a welcome acknowledgement that we are finally discussing the importance of mental health support during a crisis.

So how can training in PFA help volunteers go a step further?

"Volunteers have the right intention but PFA trains them in the right technique to deal with people in emotional distress," she adds.

Help doesn't just mean rescuing someone from a flooded house or getting them clean clothes and food, though that is often a matter of life and death. Sometimes, it also means finding a safe and private space for a lactating mother or looking after children whose parents have gone out to collect aid materials.

At other times, it could be assuring them that the support you are providing comes from a place of true empathy, as two teachers volunteering in Kerala found out. After sharing a meal with some of the survivors, they were looking for a place with clean water to wash their hands, when they realised people were simply rinsing their hands in the gutter. They shared their experience in the training session: "We had never done that before but went ahead and did it, to show our support and empathy".

"These are different aspects of psycho-social care," says Dr Aravind. "Sometimes volunteers need to learn how to address people who are crying; sometimes it is just listening empathetically rather than talking."

It takes a village

PFA training can be done at the community level and doesn't require the participants to have a background in psychology. Rao and Shastri both clarify that PFA is not counselling. "It's about assessing the persons' current mental state and helping them with what they are going through. We also asses if they are able to take care of themselves," Rao adds.

PFA training can be done at the community level and doesn't require the participants to have a background in psychology. Image by Reshmi Chakraborty

PFA training can be done at the community level and doesn't require the participants to have a background in psychology. Image by Reshmi Chakraborty

Training the community helps it to reach a wider section. In Andaman, teachers were trained to provide psycho-social support to traumatised students after the December 2004 Tsunami. "Just like physical efforts have three stages - rescue, relief, rebuild; psycho-social care has to be more of long term services than short term counselling," Dr Aravind insists.

Training sessions for PFA at community-level includes experience sharing and role playing. Participants are asked to work with local NGOs so that they can provide actual on ground support. It could mean helping someone get back their lost documents, an action that could significantly reduce their anxiety and help their psychological condition. In fact, one of the suicides in Kerala was by a 19-year-old who lost all his documents.

"The idea is to orient them with available support and give them useful information, whether it is about documents, or the water receding in their area or the availability of anti-venom in their nearby hospital. Anything that can take care of their anxiety and emotional needs can make them feel better," Dr Aravind points out.

The need for care

Psychological effects of disasters remain a largely ignored aspect in India, where there is a severe paucity of mental health professionals (a 2015 WHO report said that there are only three psychiatrists per million people in India). Mental health isn't a big part of the conversation here. In fact, the National Programme for Mental health received only 0.07 percent of India's 2017-18 health budget.

Despite the dismal numbers, the open conversations and psycho-social interventions in the aftermath of Kerala and Kodagu floods is a step forward, especially when you compare it to the Bhopal Gas Tragedy, the first disaster in India to be studied systematically for mental health effects. Back then, mental health professionals got involved only after eight weeks, according to a paper by R Srinivasa Murthy in Industry Psychiatry Journal.

Given that scenario, we seem to have covered some ground since then, both Dr Raj and Dr Shastri agree. "There is lack of awareness," says Dr Raj, "but the situation has improved." He points towards the guidelines on psycho-social care produced by the National Disaster Management Authority in collaboration with NIMHANS in 2009. "We need to train and equip government workers in PFA to take away the stigma from mental health problems and address emotional distress."

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"This time I see a mobilisation of psychological support," Dr Shastri adds. "E.g., there is a WhatsApp group in Kerala that enables you to register your organization as a community of mental health workers, apart from other initiatives. The response to our training from people with completely non-psychological backgrounds is also a positive factor."

"Not every team that goes for relief work can have a psychologist," says Dr Raj, "but it is great if they can have the mindset of a psychologist. Developing this mindset is most important now."


Updated Date: Sep 03, 2018 14:38 PM

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