Fostering Resilience in the Wake of Disasters
Every year, thousands across the globe are affected by natural disasters, armed conflict, or both. Because such events are unpredictable as well as highly destructive, they cause significant mental distress. Research indicates that such distress is two to three times more prevalent in disaster-affected communities than in the general population. Besides, disaster-related distress lingers for a long time. According to a study of disaster survivors from 80 countries, 25% reported that their distress impaired their ability to perform everyday tasks and fulfill family or employment obligations for years afterwards.
Despite available evidence of the impact on mental health, disaster response approaches have not, traditionally, included mental health services. Disaster preparedness and response activities focus solely on immediate humanitarian needs such as water, shelter, food, and physical safety and health. And yet, disasters tend to disrupt social networks, besides destroying livelihoods and community resources. In such circumstances, persons with mental health conditions may lose access to their support systems, modes of care, or medication – leading to further mental distress.
What of communities living in disaster-prone areas? Kerala experienced grave flooding and landslides in 2018, and again in 2019. The state’s mental healthcare program, housed in community health centers, saw patient numbers almost double, from 14,000 in 2017 to 25,000 in 2018. Many persons reported that the 2019 floods had intensified their post-traumatic stress, or increased their anxiety.
Employing a Psychosocial Lens
Typically, mental health services – when provided in the aftermath of disasters – take the form of mental health clinics within relief camps that follow a biomedical approach to diagnosing and treating mental distress. Such treatment has limitations and may be time-bound, failing to address the more long-term impact on mental health.
It is vital, therefore, that such initiatives employ a psychosocial lens. This would mean an inter-sectoral approach, with multiple agencies involved, and various levels of non-specialized and specialized support in terms of mental health interventions as well as basic services such as food, water, shelter, and physical health care.
Such an approach would consider, for instance, how overcrowding, and lack of privacy and safety, in disaster relief camps increases distress for vulnerable groups such as women and children. It would draw upon a community’s inherent resources – which might include the ways in which people have dealt with adversity previously, and traditional solidarities that provide mutual support. In situations of disaster, these networks and mechanisms for psychosocial well-being and mental health may face undue strain or break down, making it all the more imperative to revive them. Fostering a community’s ability to manage distress using its own resources is a sustainable, holistic approach. Disaster-response initiatives can foster resilience by tapping the knowledge, skills, resources and insights of community members themselves.
“Research indicates that such distress is two to three times more prevalent in disaster-affected communities than in the general population”
Fostering Resilience in Cyclone-Fani-Affected Communities
When Cyclone Fani devastated 14 districts in Odisha, early warnings and evacuations prevented large-scale casualties. The state government coordinated an immense mobilization effort, employing tens of thousands of volunteers, emergency workers and officials, and tapping civil society organizations, to evacuate 1.34 million people. It also leveraged the expertise of National Institute of Mental Health And Neuro Sciences (NIMHANS) to provide mental health services to affected communities. However, given that Odisha is repeatedly devastated by cyclones, it is at least as crucial to invest in fostering resilience among disaster-prone communities in the state.
Our partner, Basic Needs India (BNI), has worked for decades in some of the disaster-affected districts of Odisha, implementing community-based mental health programs. This includes interventions in six of the most affected blocks of Odisha, in coordination with its partner organizations Youth Council For Development Alternatives and Utkal Sevak Samaj. Its approach includes both, sensitizing government functionaries, and using community volunteers, to address the psychosocial needs of affected communities.
Select government functionaries from the departments of health, child protection, women and child welfare, Integrated Child Development Services, along with community leaders and representatives from community-based organizations, receive intensive training in psychosocial interventions. Efforts are made to include traditionally marginalized voices from across caste, class, and gender.
Volunteers informally associated with essential government services and community organizations are also trained in psychosocial intervention skills. These are volunteers from the affected communities, which they understand well, and so they are able to work directly with families and individuals. They are also trained to mobilize community members to take ownership of disaster-response efforts. The attempt is to involve persons from across social hierarchies in all discussions, decisions and actions – including resource-deprived marginalized groups that traditionally lack influence, and are usually silenced or isolated.
In order to facilitate genuine community participation, the community volunteers are sensitized to address social inequities and power structures. They strive to establish relationships of trust, work with the formal and informal local leadership, and offer psychosocial support to the community. They encourage individuals to share their experiences, anxieties, and other stressors. Thus, instead of relying on external support, the community begins to respond collectively to its own needs. The volunteers are also trained to re-establish the community support structures and self-help groups that may have been temporarily disrupted or disbanded in the wake of a disaster. In addition, they are ready to play a key role in reviving communal cultural practices and rebuilding communal bonds.
In the event of any disaster, both sets of trained groups are all set to work in tandem for four months, to address community distress. During this phase, BNI will offer refresher training to Training of Trainers, volunteers, and partner teams, and further support as required. Persons needing specialized care will be referred to mental health service centers. Over the next four months, the volunteers will phase out their active involvement, while the follow-up work is continued by partner organizations with a focus on people who require mental health services. In the final four months of the year-long project, identified individuals and families will be integrated into ongoing programs of partners. Throughout, partner organizations will coordinate implementation, and BNI offer constant technical support.
The idea is that when, after a year, BNI moves out of active intervention, communities are not adversely affected, because the intervention remains sustainable – it will, in fact, have built resilience and strength. Such interventions, that are sustainable and that build community resilience, have the potential to be scaled throughout India, in other communities and districts that frequently experience natural hazards.