TO THE TSUNAMI DISASTER:
effective global response to the Tsunami Disaster needs to be well
thought out and coordinated. While the media is reporting the need
for immediate mental health interventions, a rush to help may not
be the most appropriate action to take in the immediate aftermath
of this disaster. At this stage, it is too early to begin a "mental
health" response. People are in shock, grieving and in the
first stages of recovery. These are normal responses to traumatic
experiences. Not trauma in itself. The needs right now are still
the basics of food, water, medical care and shelter. Even at a later
stage, it will not be appropriate for scores of mental health professionals
from other countries to descend on these areas to provide care.
There are language and cultural issues to be considered, as well
as the experience and credentials of those volunteering in a trauma
response. Finally, these efforts are often organized hastily and
provide short-term interventions that can be inappropriate and leave
people without support for their long-term needs. This was clearly
one of the lessons from past global disasters.
Our immediate recommendation is to encourage people to give donations
now, and over the long haul, to appropriate international and UN
aid organizations, particularly those that will be involved with
supporting national and local mental health efforts on the ground.
Efforts, conducted by those with appropriate expertise, should be
focused on doing short and long-term needs assessment in each of
the affected areas, and further actions should be coordinated through
local, established mental health organizations. We would encourage
people to advocate to governments, health ministries and other intervening
agencies to ensure that local, long-term mental health interventions
are included and funded as a part of all emergency response plans.
The media should also be encouraged and educated to provide sensitive,
and informed coverage of events from an appropriate psychosocial
perspective. Probably the most effective assistance from the global
community will be supporting psychosocial training initiatives focused
on a family and community based orientation for trauma-affected
We are aware that despite the above recommendations, numerous
groups are planning to send teams of people to various locations
to do needs assessment and provide counseling. It would be best
if these efforts could be coordinated rather than separate and
potentially disruptive, competitive interventions, and should
be managed through official organizations that are already on
Finally, we should be focusing attention on the psychological
needs of the aid workers, journalists and all others involved
in the post-disaster relief efforts. We should be ensuring that
the aid organizations and news services have systems and resources
in place to support these workers. The burnout and emotional toll
is already evident in reports coming out of these affected areas.
We are monitoring the ongoing mental health responses being developed
by WHO and UNICEF, two of the main international bodies already
working in the Tsunami countries. WHO Department of Mental Health
and Substance Abuse (MHS) has sent people to various locations
to do rapid assessments of mental health needs, make plans for
mental health assistance, provide advice and guidance on mental
health programmes to Ministries of Health or to the WHO country
office, and to provide assistance in coordination of various agencies
offering mental health or psychosocial services. For the long-term
support projects, WHO will soon be organizing coordination meetings
to plan immediate, mid-term and long-term mental health responses
to this disaster.
Here are basic recommendations from WHO:
mental health concerns should complement humanitarian
work in the first days of the aftermath and not unduly burden
It may not be helpful to have large numbers of people
arrive on site in the Tsunami impacted areas. There will be a
need for specialists to address specific concerns, but the impacted
countries are in the best position to determine who is needed
at which times.
Coordination of the detailed aid response should
occur at the country level. To ensure a coordinated effort, people
should first contact the country-offices of WHO, UNICEF, and the
country's Red Cross/Red Crescent Society.
Basic social and mental health interventions should
be implemented before more specialized interventions are considered.
The Sphere standard for social and mental health, which was developed
for these kinds of situations, should provide guidance on what
the minimum response should be in middle and low-income countries.
The Sphere Handbook, the most influential book in international
humanitarian aid is available on line at: www.sphereproject.org/handbook
In the acute relief phase, it is advisable to conduct
few social/medical actions so there will be little interference
with responses to vital needs such as food, shelter and control
of communicable diseases.
Specific mental health activities should be initiated
during week three/four, once life-saving operations are already
Please continue to check this site for updated information.
ITSP is available for media interviews, technical assistance,
expert advice and information.
Guidelines for International Training in Mental Health and Psychosocial
Interventions for Trauma Exposed Populations in Clinical and Community
Mental Health in Emergencies: Mental
and Social Aspects of Health Populations Exposed to Extreme Stressors
For Information, Contact:
Jack Saul, Ph.D., Director
International Trauma Studies Program
New York University
155 Avenue of the Americas 4th Floor
New York, New York 10013
Tel. 212.691.6499 Fax 212.807.1809