Dealing with the psychological trauma of disasters

Disasters often cause shock and despair, especially when homes and possessions are heavily damaged or destroyed. — Filepic

Disasters are a complex global problem and an inevitable fact of life.

Every year, individuals and communities are affected by natural disasters that disrupt their economic and social development, as well as jeopardise their mental health and wellbeing.

The recent floods in our country, which are nothing short of a national calamity, are no exception.

The United Nations International Strategy for Disaster Reduction defines disaster as “a serious disruption of the functioning of a community or a society, causing widespread human, material, economic or environmental losses, which exceed the ability of the affected community or society to cope using its own resources”.

There is a superficial categorisation of disaster in terms of it being either natural or man-made.

However, the truth is that both natural and social factors cause disasters.

The flooding might be the result of a combination of poor urban planning, deforestation, climate change, and something as simple as the drainage system being clogged by debris and concrete.

Impact on mental health

Modular tents help to provide some privacy to flood victims staying at relief centres, which can help reduce some of their psychological stress. — FAIHAN GHANI/The StarModular tents help to provide some privacy to flood victims staying at relief centres, which can help reduce some of their psychological stress. — FAIHAN GHANI/The Star

Disasters may put the victims in a state of despair and shock.

This traumatic experience disrupts the normal functioning of the victims and severely impacts individuals, families and communities.

Families face a loss of their identity by being placed in temporary shelters.

The loss of privacy, resources and social support, and the lack of control over one’s own possessions, are all associated with elevated levels of acute psychological distress.

Additionally, family separation, lack of safety and loss of livelihood, also contribute towards this decompensation.

Most people affected by emergencies will experience feelings of anxiety, sadness, hopelessness, fatigue, irritability or anger, as well as difficulty sleeping.

This is normal, and will, for most people, improve over time, especially with the help of effective post-intervention techniques.

However, the prevalence of common mental disorders such as clinical depression and anxiety disorder is expected to more than double in a crisis of this magnitude.

People with severe mental disorders can be especially vulnerable during and after emergencies, and they need access to basic needs and clinical care.

Individuals with preexisting mental disorders are at increased risk of relapse and require special consideration in any disaster preparedness, response and recovery.

As the flood waters recede, people may suffer from physical health effects like a cold, cough, throat infections, headaches, skin rashes, gastrointestinal illness, high blood pressure and asthma, which can all cause even more psychological stress.

Adding on to this stress in this current time is the increased potential for the spread of Covid-19.

Even those not directly affected by floods can also be affected.

Take the case of Asha (not her real name) who was away from her house, which is situated on high grounds, and had a panic attack when it started raining.

Asha feared for her two teenage daughters left at home.

Research shows that anxiety during subsequent rainfalls is the most common psychological impact after a major flood, even among those who were unaffected directly by the high waters.

Don’t forget distress

Apart from interventions and assistance focusing on the socioeconomic situation of disaster victims, psychosocial interventions should also be emphasised.

Such interventions assist victims in normalising their mental health despite their loss and prevent the development of post-traumatic stress disorder (PTSD), anxiety and depression in the affected population.

Generally, the impact of disasters is measured by the cost of social and economic damage, but that is no comparison to the emotional sufferings a person undergoes during and after the disaster.

Evidence-based treatments should first be made available to disaster victims with active psychiatric disorders.

But psychosocial interventions such as psychological first aid (PFA), crisis counselling, and psychoeducation for individuals with distress have also established their benefits in disaster settings.

PFA offers firstline emotional and practical support to people experiencing acute distress.

In the recent floods, this form of first aid was made available by the Health Ministry, the Malaysian Red Crescent Society and the National Coalition for Mental Health, as well as other NGOs.

Protecting and promoting the rights of people with severe mental health conditions and psychosocial disabilities is especially critical in humanitarian emergencies.

This includes being watchful for neglect and ensuring such individuals are not left out in receiving benefits like everyone else.

Even in emergencies, links and referral mechanisms need to be established between mental health services, general healthcare providers, and community-based support and other services, to meet basic needs.

Currently, the Malaysian Mental Health Association and the Green Ribbon Group are collaborating to rollout long-term psychosocial interventions for the recent flood victims.

The psychological effects of the disaster are likely to linger on, even after the basic needs of the victims are met.

Let’s learn and prepare

The Health Ministry, with the assistance of NGOs, has provided PFA and psychoeducation in the wake of the recent floods. — Health MinistryThe Health Ministry, with the assistance of NGOs, has provided PFA and psychoeducation in the wake of the recent floods. — Health Ministry

Unlike physical injuries, adverse mental health outcomes of disasters may not be apparent.

Therefore, effective interventions should be given during and after the disaster period to mitigate mental health effects on the victims.

An inadvertent gap in the current disaster has been the visible absence of a multisectoral, inter-agency framework that enabled effective aid coordination.

Such an approach would have been useful to identify good practices and flag potentially harmful ones in the overall relief efforts, not limited to mental health and psychosocial support.

While emergencies have a detrimental effect on everyone, they have also been shown to provide opportunities to build a more robust response system in the period following the event.

Instead of finger-pointing, now is the best time to get together to improve on our disaster preparedness response.

For this to be comprehensive, mental health should be a visible component of any national disaster preparedness plan.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist, Green Ribbon Group policy advisor and Malaysian Mental Health Association president. For more information, email The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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