Prof. George Christodoulou
Chair, WPA Institutional Program on Disasters and Mental Health
The recent emergence of natural disasters around the world , i.e. the South Asian Tsunami, the Katrina Hurricane in the United States, the South Asian Earthquake, and the Central American Floods, point out a new reality, likely to continue in the foreseeable future, to be confronted by the world community at large, as well as by the WPA concerning psychosocial consequences. In line with this, is mounting a response coordinated by its Institutional Program on Disasters and Mental Health, with the participation of its Disaster Scientific Section and other relevant Sections, as well as Zone Representatives, and Member Societies in the affected area.
What follows is a report on the WPA response to natural disasters in recent months.
Athens, October 2005
The Katrina Disaster
The WPA Institutional Program on Disasters and Mental Health has communicated with the APA President Prof. Steven Sharfstein expressing sympathy to the APA and the survivors of the Disaster, and offering its services.
During the Sections’ Leadership Meeting in Cairo on the 12th September, a Committee composed of Sections’ chairs was appointed under the chairmanship of Dr Jack Mc Intyre to prepare a report and an action plan on the Katrina Disaster.
Dr Anthony T. Ng, chair of the Committee on Psychiatric Dimensions of Disaster of the American Psychiatric Association has recently reported with reference to Katrina that
• There is a long tradition of tension between the local mental health providers and the state agencies that inhibits provision of services
• Local encouragement and guidance as opposed to advocacy of what northern people in the US think is best is preferable as it does not violate southern pride and culture.
• On a more global level, Dr Wig believes that a unified medical response structure is needed, identification of who has the authority to bring resources in should be carried out, attention to long-term management is basic as long-term recovery can turn into some sort of opportunistic disaster as each group will try to promote their agenda and initiatives.
• There will be increasing need for coordination of the coordinators
The Honduras and Guatemala Disasters
The Presidents of the Psychiatric Associations of Honduras and Guatemala Dra Sara Murillo and Dr Romeo Lucas respectively, have been approached and have been asked to report on their needs with reference to the disasters in their respective countries
The Kashmir Disaster
The earthquake that hit South Asia (Kashmir area) on the 8th October has taken more than 30.000 lives in Pakistan and 2.000 lives in India.
The WPA Institutional Program on Disasters and Mental Health has contacted the Pakistani Psychiatric Association and the Indian Psychiatric Association expressing its condolences and has offered its services. It has also contacted the WPA Section on Disasters and Mental Health asking the chair, Prof. Moty Benyakar, to send the multi-media mental health guide of the section to our colleagues of the area and Prof. M. Maj to let our Pakistani colleagues have copies of the WPA Edition “Disasters and Mental Health” (request by Dr Mussarat Hussain).
Reports by our colleagues in Pakistan, India, Malaysia and U.K. indicate the following:
• One of the task forces formed comprise the following
- Dr Afzal Javed, International coordinator
- Prof. Abdul Malik Achkrai
- Prof. Haroon Rashid Chaudhry
- Prof. Khalid Mufti
• Two trauma centers in the most affected areas of the earthquake have been set up.
• The Task Force has opened a WPA Zonal account as follows:
Account No. 884-9
Account name: WPA Zonal Representative
Bank: Muslim Commercial Bank, Session Court Branch, Lower Mall, Lahore, Pakistan
Some donations have already been made, as follows:
October 13: Hellenic Psychiatric Association: 2.000 Euros
October 18: Italian Society of Biological Psychiatry. US $ 10.000
- Professor Deva has reported that financial, material and psychosocial support has reached Pakistan from nearby countries, notably Malaysia.
- A suggestion has been made to send a Kashmir psychiatrist to the Psychosocial Relief centre in Pukhet for an attachment of a week or two to learn the organization aspects of disaster management. The Thailand Government has responded positively to this and is offering accommodation to one or two Pakistani psychiatrists (as reported by Prof. Pichet Udomratu, President-elect, Psychiatric Association of Thailand).
- Dr Russell D’Souza has reported on a meeting in Phuket, Thailand organized by the WPA Section on Psychiatry in Developing Countries and the Royal College of Psychiatrists of Thailand. The Government of Thailand (Deputy Director General of Health) reported on the draft plans of the Thailand Government and WHO regarding Mental Health response in Disasters. Professor Bruce Singh will draft a statement on the priorities.
- Professor Afzal Javed has reported that the attention of mental health professionals will concentrate on the current medical relief work (Prof. Haroon Chaudhry will concentrate on Muzafarabad, Kashmir and Prof. Mufti on Balakot-Hazara area) and to training of mental health workers and volunteers at two training and counseling centres to be established. The needs that have been identified are mainly
a) the provision of experts to train professionals (in January when PTSD and other psychiatric complications are expected)
b) financial support.
- The WPA Section on Disasters has reported that it has provided input to the management of disasters in Atocha (Spain) Tsunami, Cromanon (Argentina) and Katrina (USA) and that the multimedia “Preparedness and Intervention in Disasters-Mental Health guide” can be utilized with benefit.
- Prof. Roy Abraham Kallivayalil has reported that a special session on Disaster Management will be organized in the framework of the SAARC Psychiatric Federation Conference to be held in Agra, India, 2-4 December 2005. Prof. J.K. Trivedi who will participate in the above session has reported that although in India the behavioral complications of the Tsunami have been well managed, yet in some cases (like, for example, in the Andaman and Nicobar Islands) this does not appear to have been the case. Prof. Trivedi also points out that a disaster does not refer only to individuals but also to the populace as a whole as it represents a mass stress.
- Prof. Haroon Chaudhry has reported that in addition to money there is need for tents, blankets, jackets, socks and warm clothes as the winter is approaching and many of the hit areas in Pakistan are in high altitude.
- Disasters will always be with us. We must be prepared to deal with their psychosocial consequences at any time
- The WPA, as the leading professional organization in the area of mental health, must accept the responsibility to lead in the area of Management of the behavioral consequences of Disasters. The WPA Institutional Program for Disasters and Mental Health can be the coordinating arm of the WPA. For this purpose it must be enriched with collaborators with experience and willingness to devote energy and time to the scope of alleviation of suffering of the survivors of disasters
- The importance and symbolic significance of simply expressing interest and solidarity to the colleagues of the areas hit by disasters must not be underestimated. It is the beginning of everything.
Expressing sympathy and enquiring about needs (what can the WPA do for you?) is very much appreciated and improves the morale of our colleagues who feel that they are not alone. There will certainly be cases in which the WPA will be unable to provide substantial material help. Yet, the solidarity and interest of the mother organization will be a great consolation and will be remembered. Besides, such a move is within our social role as psychiatrists.
- Ethical issues concerning Disaster Intervention should be dealt with by the WPA and its member societies. For example it would be ethically and politically incorrect to intervene without prior communication with the local Psychiatric Association. Similarly, it would be ethically incorrect for an external organization to take advantage of a disaster situation for the sole purpose of carrying out research.
- There should be readiness to help, lead and manage at any time. The repetitive disasters that have occurred lately, have contributed to the development of an enthusiastic group of colleagues mainly in South Asia or from Asia who have acquired some expertise and have helped in the case of the Tsunami Disaster. The same people have been motivated again when the Kashmir Disaster hit. Thus, a group of experts has been formed and a network has developed assisted by WPA components agencies (like the Institutional Program, Sections, Zone Representatives, Member Societies and others).
This pattern of organization can be established in other parts of the world as training and intervention centers in cases of disasters. Alternatively (or additionally) a group of experts could be organized in one place to move to needful places (like a mobile unit) if needed. In the latter case collaboration with local mental health workers is essential in view of cultural differences from country to country and even from place to place within the same country.
- The question of funding of these centers or mobile units is of course important. However, these facilities could have dual function. In times of emergency they could be used as Disaster intervention units and in times of normality they would function as regular mental health facilities (and be funded as such). The only difference would be the orientation of the centers towards disasters psychosocial management (necessitating the life-long training of the staff).
We should take into account that, as pointed out by the WHO reports on the issue of Disasters intervention, the larger part of disaster psychopathology is pre-existing (psychotic disorders, recurrent affective disorders, epilepsy and other psycho-organic states) and that Disaster psychopathology is not limited to PTSD. Under this light the dual function of the proposed facilities seems to be appropriate.
In practical terms, each Government, following advice from the local mental health organizations and certainly from the WPA member society must designate some facilities as Disaster Intervention Centers and provide the means for training of the staff in prevention and management of the psychosocial consequences of disasters. The WPA can help in the training and act as advisor to the centers. Training of volunteers and mental health promotion should be an integral part of their mission. These centers will be the leading Psychosocial Intervention agencies when disaster strikes.
- For the purpose of practical management of the Kashmir Disaster, provision of clothing and donations (as requested by our Pakistani colleagues) would be desirable and the WPA components and member societies could be informed about this request. The book on “Disasters and Mental Health” is very useful and could be sent to the mental health leaders of the hit areas (once again to Asia). The same stands for the multimedia educational guide prepared by the Section on Disasters and Mental Health. Additionally, the Psychosocial Relief Centre in Pukhet, Thailand should be helped to fulfill its role as management and training center.