PSYCHOSOCIAL CARE SERVICES PROVISION FOR THE EARTHQUAKE AFFECTED AREAS

1. PSYCHOSOCIAL CARE SERVICES PROVISION FOR THE EARTHQUAKE AFFECTED AREAS Dr. Saeed Farooq Head Department Of Psychiatry And Director Research PGMI Lady Reading Hospital, Peshawar

2. THE BURDEN OF PSYCHOSOCIAL DISORDERS • PSYCHOLOGICAL DISTRESS • Mild psychological distressperhaps • 20-40% • Moderate or severe psychological distress • 30-50% • This group would benefit from a range of social and basic psychological interventions that are considered helpful to reduce distress

3. THE BURDEN OF PSYCHOSOCIAL DISORDERS (cont) MENTAL DISORDER • Mild and moderate • 12-month prevalence rates (e.g., mild and moderate depression and anxiety disorders, including PTSD) are on average about 10% • Severe mental disorder. • The 2-3% rate may be expected to go-up (e.g. to roughly 3-4%)after exposure to severe trauma and loss

4. The effect • The psychiatric morbidity will affect the outcome of physical problem • It will affect the Social Capital which in turn will affect all the rehabilitation and recovery

5. Principles • No vertical (stand-alone) services • Integrated in health sector • Integrated in Non Health sector such as education. • Public Health Approach

6. Support for families and care givers • It is very important how the support is provided. While providing the support must be careful to • Self esteem • Persons view of what they need • Support tailored to the cultural, religious and social needs • Not to reinforce the guilt

7. Support for families and care givers • Viewing the situation from a public health perspective (i.e., a population perspective), rather than a clinician's perspective. • Collaboration with education sector educational Psychologists • Make community aware that psychological help is available and it works.

8. INTEGRATION OF MENTAL HEALTH • In General Health Services • In other sectors –most importantly education • In Child care services and reproductive health services as women and children are high risk groups.

9. Short TermsIdentifying existing psychiatric morbidity- PRE EARTH QUAKEObjectives Identify Higher Risk Multiple Losses Children DisabledPast Psychiatric History

10. ACTIONS • Raise awareness. THE MESSAGE “Psychological consequences are treatable” • Train health workers, relief workers. • Translate Instruments for identifying high risk. • Teams of Psychiatrists, psychologists, Social worker

11. At least two workers One Psychiatrists, One Psychologist/Social worker in each major area, Balak, Batgram, Batal, Haripur, Havelian (Camps)

12. RESOURCE IMPLICATION • Training for at least 30 mental health workers, 200-300 General health workers. • Translating at least 5 instruments. • Public health and media campaigns. • Provision of basic psychotropic, antiepileptics.

13. MEDIUM TO LONG TERM • Rehabilitation of psych facilities ATH. • Establishment of new psychiatric facilities in all the major centers. • Facilities for investigations such as EEG,CT Scan, MRI etc • Compulsory 1-2 weeks training in mental health for primary care physicians working in the area.

14. MEDIUM LONG TERM (Contd) • School mental health services, • Child psychiatry at ATH. • Educational psychologists at schools. • Provision of psychotropics and antiepileptics.

15. MEDIUM TO LONG TERM (Contd) • Screening and psychological support for all those who have paraplegia, amputation, brain damage. • Rehabilitation for the disabled. • Training for Psychiatric Nursing and Paramedics for providing Continuity of care • Training the social workers and psychologists for assessment for the children and foster parents for adoption.

16. Care for the relief workers. • Regular Support groups • Regular supervision • Increase competence by training • Preventing over-identification, over-ownership, over-involvement

17. Research and Training • Must for maintaining the preparedness in future and human resource development