Erasing emotional scars after disasters

By Shanika Sriyananda

Harshi was crying alone and looked frightened. She only spoke few words and wanted to be isolated from her family and friends. Once a bright student, she couldn’t concentrate on her studies and got poor grades for most of the subjects. 

She was disturbed in her sleep and mostly she would sit on the bed, staring at the ceiling with tears in her eyes. Her mother, Kanthi, tried her best to uncover what made her once-talkative daughter fall silent, but she failed. 

It was eight months after the deadly tsunami, which washed away the country’s coastal terrain with people and their properties that her parents noticed the behavioural change in the teenager who was in grade nine. Harshi’s family, who also lived in an area close to the sea in Panadura, survived miraculously but their belongings were washed away by the giant waves.

After languishing in a temporary camp for a few months, they returned home and gradually rebuilt their lives.

While her elder brother and younger sister didn’t show any difference, Harshi changed emotionally with each passing day.

Finally, she was referred to the Psychology Unit of the Colombo South Teaching Hospital, Kalubowila, where the hidden mental scar – losing her best friend – was identified and treated. 

Her sorrow was ignored by all including her mother Kanthi, elder brother, friends and even the Buddhist monk in the temple. Each person to whom she spoke about the death of her best friend, who had disappeared in the ocean, consoled her saying death was natural and common to all. As none validated and understood her feelings, she emotionally closed down, which led to depression. 

“She could have suffered a severe mental disorder or committed suicide if she hadn’t been brought in for psychological treatment immediately. However, most victims of disasters like floods, landslides and other calamities suffer silently and they carry forward their mental traumas which will badly affect their recovery process,” Base Hospital Kiribathgoda Clinical Psychiatrist Dr. N. Kumaranayake said.

Dangers of dismissing mental scars

Though Harshi’s name is fictitious, the incident of the mentally-disturbed girl mentioned here is true. Several researchers have found that if mental scars of small children, adolescents and adults who have faced deadly calamities go unnoticed and untreated, they become victims of several severe mental disorders later in life.

The Daily FT spoke to some psychologists who stressed the need of addressing emotional issues of the recent flood and landslide victims, especially children, to help them to recover fast to rebuild their lives and also State officials about their plans to address those psychological issues effectively. 

According to the latest reports of the Disaster Management Centre (DMC), around 717,622 people belonging to 184,265 families in 15 districts have been affected due to the flood and landslides. While 79 people have gone missing, 213 people have died in the disaster and over 139,000 children have been directly affected. The majority of them have lost their houses. 

In a disaster, when people who are not prepared are suddenly thrown into a nightmarish situation, it will have a huge psychological impact and affect them emotionally.

“In a disaster situation, victims will have ‘fight or flight’ reactions and during the first few days due to over-secretion of adrenaline they will have amazing levels of energy; sometimes some victims become brave in facing the situation and they will be very active. They will even lead rescue missions and help officials get information and distribute relief. But, after a few days, the severe emotion reactions will surface, making them weak and impacting them emotionally,” Dr. Kumaranayake explained.

He said that several researchers had found that addressing psychological traumas, which are hidden deep in the mind, are vital in one’s resilience and recovery process through a properly-formulated plan with effective coping strategies.

Psychological traumas in the aftermath of a disaster are the hidden causes for mental disturbances, including some of most severe mental disorders, which will hinder the ability of the victims to bounce back.

“These traumas will appear within a month of the disaster and some trained people need to talk to the victims to listen to them and calm down their stressful emotions,” Dr. Kumaranayake said, suggesting having a volunteer contingent, comprising people who are trained to handle emotional reactions in the first few days of the disaster.

Importance of psychological first aid

When people are caught in a disaster, apart from losing loved ones and property, they also lose control over their future, peace of mind and dignity. 

“Providing psychological first aid as recommended by the WHO during the first few days is vital in getting them back to normal emotions but need to avoid talking about traumatic experiences and losses, avoid treating for any psychological illnesses like depression, anxiety and PTSD and avoid diagnosed illnesses or conduct counselling sessions,” he said.

He said that was the reason that the DMC needed a trained volunteer force ready to deploy in disaster-hit areas to provide psychological first aid to affected people by listening to them with empathy to reduce their distress.

He said that the trained volunteers need not to be professionals like psychologists or counsellors.

Dr. Kumaranayake said that he was against keeping disaster victims in camps for months as it would affect their inner ability to bounce back in life.

“It should be a temporary measure. When you keep them for a longer period of time, they will become dependents as they get relief free. They should be moved to relatives’ houses or to their own houses, if their houses are safe to live, to rebuild their lives,” he explained.

Protecting children

Meanwhile Dr. Kumaranayake stressed on the need of moving children from disturbing sites and environs soon as any delay would result in them being re-traumatised.

He advised parents and authorities to make camp environs child-friendly to avoid exposing children to discussions about the disaster, recalling the past and how their relatives and neighbours died in the disaster, accompanying them to funerals or mass graveyards, taking them to their disaster-hit environs and allowing them to watch television news or programs on the disaster. 

“We especially need to protect children from media interviews as they will develop flashbacks of the traumatic incidents of the disaster when recalling what they had seen and experienced,” he stressed.

After a month or two of the disaster, people, including children, will develop acute stress symptoms – headaches, a sense of hopelessness, poor sleep, anger, irritability, feel isolation, have a poor appetite, memory loss and crying spells.

“Most of the victims have resilience to overcome the distress naturally but some will develop mental disorders, which need to be handled by professionals,” Dr. Kumaranayake said.

Giving play activities, he said, is the best for children in camps to release their stress and if a child looks frightened, is sweating, avoids talking, is always clinging to his parents and not moving with others, the child needs psychological help.

If an adolescent shows irritability, anger, lack of sleep and stubbornness, he also needs help to overcome mental agony due to the disaster.

“Most important concerns in helping such children are listening to them without forcing them to speak, not to control their behaviour, validate their feelings but avoid questioning them about the things they have lost and how it happened. Show that you understand them, give them hope that they can be happy soon but don’t give false promises which you can’t fulfil,” he said.

He requested Government officials to help children to commence their education soon to divert their concentration to studies from the disaster. 

However, Dr. Kumaranayake asserted that the Government should take the responsibility for mismanaging the post-disaster situation as it lacked a proper comprehensive mechanism to handle the situation although there was a separate ministry and the DMC.

“The massive community support channelled to disaster-hit areas is highly commendable. People didn’t wait until the Government relief mechanism was activated but all those who would afford to offer help came forward,” he said, adding that the DMC also lacked a proper mechanism to channel all relief aid provided by the people and various organisations to the needy victims.

Collaborative approach is key

Sri Lanka Foundation Institute Lecturer and Psychologist Pubudu Senaratne suggested that the Government should have a collaborative approach with the support of the NGOs to provide an effective psychological intervention process for the victims – the young and the adults – in disaster-hit areas.

She said that most of the victims of recent landslides and floods were suffering from trauma, which would surface after a month or two.

Senaratne noted that psychological interventions needed to be done once their other basic needs – shelter, health and livelihood restoration – were met. 

“Some volunteers providing psychological first aid who went to relief camps in Eheliyagoda, which is badly affected by landslides, had found am eight-year-old boy who had seen his both parents disappear under a huge landslide. He was in a severe shock and couldn’t speak. Children and adults become numb due to severe shock and they need to be identified immediately through a proper screening process to direct them for treatment as they are in a traumatic condition,” she said.

She cautioned that if they had not been properly identified and treated, they would develop PTSD later and they would have different behaviour, which would make them violent, aggressive and harmful.

According to Senaratne, the children who have lost their loved ones in the disasters need to be especially looked after to restore their emotional condition.

She suggested the Government should get the support of professionals in the mental health sector – the psychologists and counsellors – to have a long-term well designed process to address the mental health needs of the disaster victims.

“This process needs to be a continuous process, where the Grama Sevaka identifies the affected family members who need psychological treatment and directs them to State institutions which work with professionals in the psychology field, continuously monitoring and evaluating their mental situation until they recover,” she said.

According to her, this should be a holistic approach with the help of all stakeholders to address the psycho-social needs of the affected people.

Senaratne said that psychological treatment being given on a few occasions would not help the victims recover as the trauma would only heal through long-term psychological intervention. 

She said that after the first few days of a disaster, most victims would come out with their stories but after a few days they would withdraw from communicating with others as it would re-traumatise them. 

Nilanga Abeysinghe, Senior Lecturer of Psychology, South Asian Institute of Technology and Medicine (SAITM) has also highlighted the need of looking into the psychological needs of the victims in the aftermath of a disaster.

“Survivors in a disaster do better over the long-term if they feel safe, connected to their families and others and have access to social, physical and emotional support. They regain a sense of control by being able to help themselves. But some very distressed people affected in a disaster need psychological first aid immediately after the disaster or a few days or weeks after the disaster,” he explained.

He said that victims with serious life-threatening injuries, those who can’t care for themselves or their children, those who may hurt themselves or others, especially need advanced psychological support to recover. 

Education Ministry steps in

Meanwhile,   Ministry of Education Additional Secretary (Schools) Ashoka Hewage said that following the directions of Minister Akila Kariyawasam, the Ministry had already taken steps to look into the psychological issues among school children in disaster-hit areas.

He said the Ministry had sent instructions to all schools to release teacher-counsellors to work in affected areas to provide psychological first aid and also to conduct counselling sessions for the affected school children. 

“Two hundred teacher-counsellors will help divisional education officers in disaster-hit areas to conduct psychological assessments and provide counselling for the school children affected by floods and landslides,” he said.

Meanwhile, scouts and girl guides from 50 national schools will also be sent to affected schools to talk to children and perform some musical events and play activities next week.

According to Hewage, over 60,000 school children have been affected in the recent floods and landslides.

“These students from national schools will carry the message that they had faced similar agony last year due to floods in Colombo but now they have come to make their friends happy and say that they are not alone,” he said.

DMC Deputy Director Pradeep Kodippili said that psychological first aid comes under the Ministry of Health and the DMC facilitates and coordinates with the psychologists and counsellors to address the mental health issues of the displaced people.

“Since the Ministry handles providing psychological first aid for disaster victims, we have no separate team at the DMC,” he said. 

UNICEF and Plan International support

UNICEF Country Representative Dr. Paula Bulancea said: “The flood emergency is putting a huge strain on thousands of children and families. Many have lost their homes, personal possessions and loved ones. In times like these, it is important that we enable children to recover from the trauma they have experienced, ensuring they can return to normality as soon as possible.”

UNICEF has established 200 temporary child-friendly protective spaces in camps and 100 children’s clubs and networks in affected areas to address child protection issues.

Targeting 10,000 children below 18 years, UNICEF with the help of the NGOs has started supporting children who have already returned their homes in their education. 

UNICEF had also started training 300 Government officers and camp managers on child-friendly camp management, child safeguarding and provision of required supplies while helping the children in disaster-hit areas to get their lost legal documents – birth certificates and identity cards. 

Plan International Sri Lanka Acting Country Director Sian Platt said that children who have suffered through this disaster would require immediate and continuous psycho-social support.

“We want to continue our response efforts to support communities impacted by the floods, and it is absolutely critical that we address and prioritise the needs of children. We will work with schools through a holistic back-to-school approach that ensures children are ready to go to school and schools are ready to receive them,” she said, adding that enabling children to get back into their school lives was one big step that would help them return to normalcy. 

She said the back-to-school program of Plan International was aimed at empowering the children to be more resilient and to overcome their traumatic experiences.

“This will help the children to learn new skills and values, and to improve their coping strategies. We work in partnership with the relevant line ministries and local departments and the local partner organisations.”

Meanwhile, Plan International said it would extend its support to the children from the most affected schools in the Ratnapura District to attend schools, providing them psycho-social support, school restoration and the necessary teaching and learning material.

Apart from facilitating the affected children to return to their schools, Plan International will also support to restore water and sanitation facilities in schools damaged by floods and landslides to ensure the school premises are safe and hygienic for children. 

Plan International in the coming weeks will start working with teachers, child protection and probation officers and psycho-social experts to promote the natural recovery of the students, by supporting them to feel safe and connected with their parents and peers while continuing with their normal lives. 

Samutthana support

Samutthana Senior Technical Officer and Counselling Psychologist Nivendra Uduman said that the volunteers who had visited some relief camps in landslide-hit Eheliyagoda had successfully addressed the emotional distress of the displaced villagers, especially the children. 

Samutthana, which is providing training and support for organisations and individuals responding to trauma in Sri Lanka, will train counsellors and mid-wives in the affected areas to handle psychological first aid soon.

“This is the first time Samutthana had trained a group of volunteers on psychological first aid to talk to people affected by a disaster. It has proved very effective. There were over 300 children in those camps and they had several play activities to get rid of their emotional stress,” Uduman said, adding that the group of volunteers would continue to visit the affected areas in the coming weeks.

A week after flood waters receded, huge slabs of earth have stop rolling down and providing relief for victims will come to an end soon. But the mental scars in some of the disaster survivors will surface, hindering their ability to bounce back. As a country which is now more prone to natural disasters and man-made disasters, it is still questionable as to whether we have a proper collaborative plan to provide psychological first aid in a disaster situation and monitor mental issues and trauma of disaster victims.