Author: M.L.Somchai Chakrabhand, M.D., Director General, Department of Mental Health, Ministry of Public Health, Thailand
On 26 December 2004, the Tsunami severely affected the south-western area of Thailand: 5,395 individuals died, 2,991 were unaccounted for, and 8,457 were injured. People living in the disaster area were psychologically affected to varying degrees. A crisis mental health intervention plan was established by the Department of Mental Health (DMH).
Objective: To provide mental health support for survivors of the Tsunami.
Strategy: To establish a mental health care delivery system in collaboration with other organisations and community networks.
Phases of Intervention
Emergency Phase
During this phase, the aim was to provide emotional support. Mobile mental health teams were been sent out to evaluate the situation, to gather information, to work closely with local health personnel and to provide psychological first-aid, triage and acute mental health care.
The `Mental Heath for Thai Tsunami Centre’ was established in the Department of Mental Health and a front-line centre was established in the South to facilitate daily teleconferences for developing work plans and reporting data for policy and decision- making.
Post-Impact Phase (two weeks to three months after the Tsunami)
The aim in this phase was to provide mental health assessment and early intervention. Outreach services focused on `At Risk’ groups. The most severe cases were referred to psychiatric centres.
The Ministry of Public Health established a `Surveillance Centre’ in the South to coordinate service activities and develop health monitoring information systems including general health, disease control, physical and mental health care and identification of dead bodies.
Recovery Phase (three months after the Tsunami)
The aim in the Recovery phase was to reduce psychological morbidity and improve quality of life. The `Mental Health Recovery Centre’ was established in the most seriously affected area to collaborate with other organisations involved with mental health rehabilitation.
Impacts of the Tsunami
Collaborative research between the DMH and the US Centre for Disease Control and Prevention Collaboration to assess the mental health problems among adults in affected area, found an elevated rate of Post-traumatic Stress Disorder (PTSD), anxiety and depression two months after the Tsunami. At follow-up after nine months, the rates of these symptoms decreased.
The DMH developed a `National Guideline for Mental Health Intervention in Natural Disasters’ based on the lessons learnt from the response to the Tsunami.
Key Success Factors
1. A well-established chain of command
2. A well-developed existing health and mental health care delivery system with the village health volunteer network working in the community
3. A comprehensive data and information gathering system
4. Participation of partners - teachers, monks, etc.
Lessons Learnt
1. One commander in-charge to minimise staff confusion.
2. A lead coordinator should be identified to work with the different organisations involved to prevent secondary trauma from repeated interviews.
3. Mental health interventions should be appropriate for the each phase or time period.
4. Health personnel should be sensitive and aware of the beliefs, religion, and culture of the local people.
5. The Centre should report all urgent physical needs other than mental health to the organisations responsible for meeting these needs.
6. The mobile team should rotated every week and work less than twelve hours a day to prevent burnout
7. The Village Health Volunteers should be the main personnel to deliver psychosocial relief effort to the community.
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