DISASTER IN SOUTH ASIA (SAARC REGION)

1. DISASTER IN SOUTH ASIA (SAARC REGION) Roy Abraham Kallivayalil MD, DPM Gen. Secretary, Indian Psychiatric Society & Secretary General, SAARC Psych. Federation Associate Professor of Psychiatry Medical College, Kottayam, Kerala, India.

2. “The mental health consequences of disasters have been the subject of a rapidly growing research literature in the last few decades. Moreover they have aroused an increasing public interest, due to the dramatic impact and wide media coverage of many recent disastrous events”- Disaster & Mental Health (WPA 2005)

3. SAARC REGION 7 Countries • India • Pakistan • Bangladesh • Sri Lanka • Nepal • Bhutan • Maldives

4. TSUNAMI DISASTER IN SAARC REGION • Brought havoc in the region • Thousands died • Several thousands injured • Thousands of homes washed away

5. APPROXIMATE LIVES LOST IN SAARC REGION • Sri Lanka – 30,000 • India – 20,000 • Maldives – 1,000 • Bangladesh - 3

6. PROBLEM FACING THE REGION • Huge number of bereaved families, who lost father, mother, son, daughter, sibling or the entire family. • All belonging lost for some • No place to live • No worthwhile occupation • Limited means of livelihood

7. SOCIAL CONSEQUENCES – SAARC REGION • Poor social support • Families have broken up • The social fabric is lost • Schools, markets, fishing, agriculture, places of worship destroyed.

8. Emotional Consequences seen commonly in the region • Acute grief region • Acute psychotic episodes • Hysterical conversion • Depressive disorders • Recurrence of psychosis • Suicidal ideation and DSH • PTSD

9. Existing Scenario In India • Mental health policy formulated in 1982. • Substance abuse policy – absent. • National Mental Health Programme – 1982. • Essential list of drugs – Yes • Mental Health Legislation – MHA 1987. • 0.83% of Health Budget on Mental Health. • Disability benefits – Yes • NGOs involved in advocacy, promotion, prevention, treatment and rehabilitation.

10. Scenario – India (WHO Atlas 2001) • Beds (per 10,000) 0.25 • Beds in Mental Hospitals 0.2 • Beds in General Hospitals 0.05 • Beds (Others) 0.01 • Psychiatrists (per 100,000) 0.04 • Neurosurgeons 0.06 • Psychiatric nurse 0.04 • Neurologists 0.05 • Psychologists 0.02 • Social workers 0.02

11. Scenario In Srilanka • Mental Health Policy is being developed • Substance abuse policy is present • National Mental Health Programme–1966 • Essential list of drugs – 1985 • MHL – Mental Disease Ordinance (1960) • 1.6% of health budget on Mental health • No disability benefits for mentally ill • NGOs are involved

12. SCENARIO – SRILANKA (WHO Atlas 2001) • Beds (per 10,000) 1.8 • Beds in Mental Hospitals 1.4 • Beds in General Hospitals 0.3 • Beds (Others) 0 • Psychiatrists (per 100,000) 0.2 • Neurosurgeons 0.03 • Psychiatric nurse 1.8 • Neurologists 0.06 • Psychologists 0.02 • Social workers 0.07

13. SCENARIO IN MALDIVES • Mental Health Policy – absent • Substance abuse policy – 1977 • NMHP – Absent • Essential list of drugs – Yes • No Mental Health Legislation • Disability benefits - Yes • NGOs are not involved

14. SCENARIO – MALDIVES(WHO Atlas 2001) • Beds (per 10,000) - • Beds in Mental Hospitals - • Beds in General Hospitals - • Beds (Others) - • Psychiatrists (per 100,000) 0.36 • Neurosurgeons 0.36 • Psychiatric nurse 0 • Neurologists 0 • Psychologists 1.2 • Social workers 0

15. What has been done in Sri Lanka? • Relief measures • Mental health workers involved • Multi disciplinary approach • NGOs involved • Support from WPA/WHO/other countries • Many other important measurers

16. What has been done in India? • Union and State Government involved in combined relief efforts. • Psychiatrists and mental health workers are part of the team. • Indian Psychiatric Society in the fore-front. • NGOs involved • Media support

19. Role of Indian Psychiatric Society • Formed a special task force for Tsunami Disaster relief on 29-12-2004. • Chairman – Dr. S. Nambi • Co-Chairmen – from all the five zones • Convenor – Dr. P. Joseph Varghese • Co-convenor – Dr. Varghese P. Punnoose • Members – Presidents and Secretaries of affected states.

20. The IPS Task Force • Mobilized country wide efforts • Co-ordinated the relief measurers • Encouraged participation by all • All the zones and the states participated • Co-ordinated by IPS President and Gen. Secretary.

21. IPS – Technical Advisory Committee • Members who had valuable experience in disasters • Dr. Mohan K. Issac (NIMHANS) • Dr. N.G. Desai (IHBAS, Delhi) • Dr. K. Shekhar (NIMHANS, Bangalore) • Dr. R.H. Bakre (Gandhi Nagar, Gujrat) • Dr. Mohan Agashe (Pune)

22. Contributions to PM’s Fund • IPS Members –mobilized contributions to the Prime Minister’s National Relief Fund (PMNRF). • Kept in touch with PMO.

23. Role of SAARC Psychiatric Federation • Mobilized support for relief measurers in the region. • Provided technical expertise • Encouraged members to work in other countries. • Enlisted regional cooperation and participation.

24. The South-Asia Region - Looking Ahead • Dearth of trained psychiatrist and mental health professionals. • Time consuming rehabilitation measurers • The notorious “red-tape” • Media interest is waning • Paucity of resources.

25. Plan for the Future • Involvement of all stake holders • Mobilizing National and International expertise • Equitable distribution of resources within each country. • Rehabilitation holds the key • Mental health needs higher priority

26. “A Disaster is an empirical falsification of human action, the proof of the incorrectness of human beings’ conceptions on nature and culture”- Juan J. Lopez - Ibor

30. Thank You