The Indian Red Cross Society

Disaster Mental Health and Psychosocial Support Program

Joseph O. Prewitt Diaz1, PhD

Vimala Ramalingam2, MD

The purpose of this paper is to set forth the policy for the development
of the Disaster Mental Health and Psychosocial Care within the Indian Red
Cross Society at four target States and the National Headquarters.

Introduction

The Indian Red Cross Society (IRCS) is conscious of the exceptional

emotional needs of survivors from disasters. As a result of the Gujarat
Earthquake in 2001, the IRCS requested the American Red Cross to provide
technical assistance in the development of a community based program that
will provide immediate assistance to survivors for disaster and first
responders, and provide assistance after a disaster in the form of disaster
preparedness in schools and villages in selected States.

A review of existing disaster mental health and psychosocial care

programs outside of India (Pan American Health Organization, 2002;
Seynaeve, 2001; New South Wales Institute of Psychiatry, July 2000). The
existing programs throughout the World today are predicated on the stages of
the Continuum of disaster. A lot of emphasis is placed on the development of
community based programs, that use community resources and that encourage
the integration of community networks.

A review of existing literature in India (Suri, 2000; Mukherjess, 2002;

Kishore Kumar, and others, 2000; Bharat and others, 2000; Sen Dave and
others 2002; and Sekar and others 2002) present and in-depth discussion on
the need for psychosocial care after disasters such as the Orissa super cyclone,
the Gujarat riots, and the Bhopal gas leaks. Narayana (2003) has compiled all
the studies documenting the psychological response given by Institutions in
1
Dr. Prewitt Diaz is the Head of Programs- India for the American Red Cross. He is the recipient of the APA
International Humanitarian Award.
2
Dr. Ramalingam is the former Secretary General of the Indian Red Cross Society and is currently the
Honorary Secretary of the Tamil Nadu State Branch.
India. It is the agreement of these studies that during the immediate response
there are great needs in the population and that many Government and Non-
Government Organizations provide support to the surviving population. There
is concurrence that psychological support is a long-term proposition that
should be addressed by Government Organization in the case of individual
needs and non-Government organizations in terms on community level work.
The Indian Red Cross Society provided assistance in the form of satisfying the
basic needs to the survivors in Camps of the Gujarat earthquakes at a request
of the Government of India. The results suggest that the immediate assistance
was helpful to the survivors.

A planning meeting was held on October 28-29, 2002. Representative

from target States and partner organizations meet to attempt to develop
guidelines for a community based program. A SWOT analysis looked at
strengths, weaknesses, challenges and opportunities of the IRCS as it related
to a Disaster Mental Health program. The greatest strengths in the IRCS is its
representation in all States and its volunteer force of 11 million members. A
second strength is the capacity to deliver community based programs. The
greatest weaknesses were the lack of trained personnel in Disaster Mental
Health at the National, State and local Branch level, lack of appropriate
materials for preparedness activities in schools and villages, and lack of
integration of psychological first aid with the existent community first aid
programs already in existence within the IRCS.

During the meeting we learned that the Ministry of Health is

responsible for providing Health services to the population including mental
health services. A challenge for the Ministry which became evident during the
Gujarat earthquake was that (1) there was no real Health Post to serve all the
villages affected by a disaster and that (2) those villages that have Health Post
they were staffed by personnel who would conduct primary health activities
and then refer to the Hospital. (3) A National Health Response Plan during a
disaster does not include community based mental health.

The partner organizations such as the National Institute for Mental

Health (NIMHANS), OXFAM India, ACTION AID India, and CARE, have
developed community based mental health programs in affected communities
in Orissa and Gujarat. Recent studies (Murthy, and others, 2003; ) report that
psychosocial care is an important part of the long-term rehabilitation of the
survivors. They found in their studies that (1) proactive community
interventions are important, (2) community level helpers are an important link
to provide service, (3) care should be provided to the total community, (4)
practical assistance is as important as emotional support, and (5) psychosocial
care should be a long term proposition.

The planning meeting suggested that there is currently no integrated

plan in India to provide disaster mental health or psychosocial care to
survivors of disasters. The opportunity for the Indian Red Cross Society is to
develop a community based disaster mental health and psychosocial care
program that complements the services offered by the Ministry of Health and
that has a theory base and a span of services that follow the continuum of
disasters. The IRCS DMH/PC will be part of the Disaster Management effort
within the realm of disaster preparedness and response.

Principles of the Indian Red Cross Society Disaster Mental

Health and Psychosocial Care Strategy

The IRCS looked at the best practices in Disaster Mental Health and
Psychosocial Care after a disaster or complex emergencies. The International
Federation of the Red Cross and the Red Crescent (IFRC) has developed
guidelines for psychological support (Abdallah, and Burnham 2001; IFRC
Working Group 2001. These guidelines have been elaborated in consultation
with the International Working Group for Psychological Support, which met
in Geneva, 5-8 April 2001. The working group identified principles to be valid
for preparedness as well as during the disaster.

The current Policy for Psychological Support (2003) states that (1)it is
the responsibility of the National Societies to include psychological
perspective in every area of intervention, (2) design psychological support as a
component in other programs like disaster preparedness, disaster response,
first aid, health, social welfare, youth and organizational development, (3)
provide psychological support as a long-term and reliable commitment to
ensure that the psychological aspects of relief work are professionally
implemented and make a crucial difference to the population, volunteers and
staff affected by the disaster. The IFRC (2003) Policy refers to the design of
psychological support according to basic principles.

The basic principles defined by the IFRC and adopted by the Indian
Red Cross Society are:
1. A community-based approach as opposed to a clinical and/or individual
approach. The majority of reactions following a disaster, for example, distress
and suffering, are not psychiatric illnesses (and do not therefore require
professional treatment), but are reactions that can be prevented from
developing into something more severe if services such as information,
psychological education and support groups are provided. Working with
people on an individual basis should be the exception, as this only responds to
the needs of a few, and might lead to stigmatization. To tackle problems in
isolation is expensive and is not sustainable.

Any organized activity should relate to everyday realities and priorities that
have been identified by the communities. It is important to make use of
institutionalized social infrastructure already in existence. Target
beneficiaries of PSP should be considered active survivors rather than passive
victims.

2. Using community volunteer technicians and specialists is an important

response of the Indian Red Cross Society. With training and support from
mental health professionals, community volunteers can work in an
independent, efficient and effective manner. These community volunteers
have the access to, and the confidence of, the beneficiaries. And, equally
importantly, they benefit from the necessary cultural sensitivity to provide
adequate assistance to the affected population.

3. The program will be technically appropriate and sensitive to the

cultural and linguistic diversity of India. Programmes should be designed
and implemented through a continuous community dialogue. The goal is to
reintegrate individuals and families within the community, and identify and
restore natural networks and coping mechanisms. Be aware of the degree of
heterogeneity of the community. Communicate with local partners and
beneficiaries to create mutual respect for linguistic diversity and cultural
beliefs and the expertise of the staff and local professional resources.

4. Identifying and strengthening problem-solving resources in the

community. The IRCS recognizes the importance of the communities have
the capacity to help themselves through their own support networks and
coping mechanisms that existed prior to the disaster. One of the important
tasks pre-disaster is to find out about the communities’ previous and existing
coping mechanisms and strategies, and support or build on these. In some
situations, support structures may have disintegrated as a consequence of the
disaster, and an alternative structure has to be introduced. This new structure
should be adapted to the community’s pre-disaster traditions. Facilitate access
to communication with family and relatives and to family reunion, because
these are very effective methods in promoting psychological well-being, and
in reassuring people, especially children. Focus on people’s positive efforts to
deal with and come to terms with their experiences, but without minimizing
their concerns.

The Indian Red Cross Society DMH/PC Program

Based on the principles and best practices proposed in the literature, the
experience of our partner organization in India and the identified community
needs, the Indian Red Cross Society has planned and has begun to implement
a Disaster Mental Health and Psychosocial Care program. The goal of this
program is “Alleviate stress and psychological suffering resulting from
disasters”. The program will:

1. Increase the capacity of the IRCS to manage disaster mental health and
psychosocial care programs,

2. Expand the capacity of trained community health volunteers to offer

psychological first aid,

3. Enhance the capacity of schools and villages to reduce stress after a

crisis or a disaster, and

4. Develop skilled volunteers at the National levels to provide Disaster

Mental health and psychosocial care consultation and psychological
support to disaster responders.

The program is expected to train Crisis Intervention Specialist at a State

level, Crisis Intervention technicians at the local Branch level, and teachers
and community facilitators at the school and village level. A group of skilled
Crisis Intervention professionals will be trained at the National level to
complement the Disaster Management Center in the event of National level
disasters.

The program will be developed in four target States (Andra Pradesh,

Bihar, Gujarat, and Orissa). Three hundred selected schools and villages will
develop disaster response plans with a focus on stress mitigation during and
after disasters. The target population for each program year is 400,000.

This program has been designed to complement the services provided by

the Ministry of Health and the partner organizations during and after disasters
at the State level in four selected States.

Summary and Conclusion

The Indian Red Cross Society has been increasingly concerned in

providing a total repertoire of services as part of its disaster preparedness and
response. In addition there is an intention to look at ways to complement
existing services by Government and other Non-Government Organizations in
providing long-term psychological support to the survivors of emergencies or
disasters. A review of the literature was performed of document existent in
India and outside of India. The findings suggested that disaster mental health
and psychosocial care programs assist the survivors in a more rapid emotional
recovery after a disaster.

The International Federation of Red Cross and Red Crescent has set forth
a Policy Paper which mandates the inclusion of Psychological Support in
disaster preparedness, disaster response, first aid, health and organizational
development. The IRCS as part of the movement has adopted the
Psychological support policy and has requested the American Red Cross
technical assistance in the development of a comprehensive DMH/PC
program to be initially implemented in four States (Andra Pradesh, Bihar,
Gujarat, and Orissa).

This paper sets forth basic principles in the development of DMH/PC

programs through the IRCS in India. These services will compliment existing
programs sponsored by governmental and non-governmental organizations.
The program will be community based; volunteer based, includes community
planning and participation, targets the survivors, and is based on contextual
assessment and analysis.

The IRCS DMH/PC program focuses on staff development, service

delivery by volunteers in community and schools, development of technically
appropriate and culturally and linguistically applicable materials, and capacity
building at all levels. This program is initially developed for a two year
period and will serve approximately 400,000 per year in the target States.
Bibliography

Abdallah, S. and Burnham (Eds.) (2001). Emergency mental health care –

(Chapter 12). In Public health guide for emergencies. Baltimore, MD: John
Hopkins School of Public Health and the International Federation of Red
Cross and Red Crescent Societies.

Bharat, S., Chandrashekar, C.R., Kishore Kumar, K.V., Chowdhury, P.,

Parthasarathy, R., Girimaji, S., Sekar, K., and Srinivasa Murthy, R. (2000).
Psychosocial care for individuals, Information: Manual 1. Bangalore, India:
Books for Change.

International Federation of the Red Cross and Red Crescent (IFRC). (2001).
Guidelines for the implementation of a psychosocial support program in
emergencies. Geneva, Switzerland: IFRC.

International Federation of the Red Cross and Red Crescent (IFRC) (2003).
Psychological support policy. Geneva, Switzerland: IFRC.

Kishore Kumar, K.V., Chandrashekar, C.R., Chowdhury, P., Parthasarathy,

R., Girimaji, S., Sekar, K. and Srinivasa Murthy (2000). Psychosocial care for
community level helpers. Information Manual 2. Bangalore, India: Books for
Change.

Mukherjee, S. (2002). Bhopal gas tragedy: The worst industrial disaster in

human history. Abhiramapuram, Chennai, India: Tulika Publishers.

Murthy, R.S., Kar, N., Sekar, K., Swain, S., Mishra, V., and Daniel, U. (2003).
Psychosocial care for survivors of Orissa super cyclone. Bhubaneshwar,
Orissa, India: ACTION AID India.
Narayana, R.L. (2003). INDIA: Environmental and organizational
assessment: Disaster mental health and psychosocial care. New Delhi, India:
American Red Cross.

NSW Institute of Psychiatry (2000). Disaster mental health response

handbook. New South Wales, Sydney, Australia: State Health Publication
(No. CMH-00145).

Pan American Health Organization (2002). Protección de la salud mental en

situaciones de desastres y emergencias, (Manuales y guías sobre desastres No.
1). Washington D.C.: PAHO/WHO Publications.

Saynaeve, G.J.R. (Ed.). Psychosocial support in situations of mass emergency.

A European policy paper concerning different aspects of psychosocial support
for people involved in major accidents and disasters. Brussels, Belgium:
Ministry of Public Health.

Sekar, K., Sen Dave, A., Bhadra, S. Rajashekar, G.P., Inshore Kumar, K.V.
and Strivings Murthy, R. (2002). Riots: Psychosocial care by community level
helpers and survivors. Bangalore, India: Books for Change.

Sen Dave, A., Sekar, K., Bhadra, S., Rajashekar, G.P., Kishore Kumar, K.V.
and Srinivasa Murthy. (2002). Riots: Psychosocial care for individuals.
Bangalore, India: Books for Change.

Suri, S. (2000). Orissa disaster: Agony of the living. New Delhi, India: Asian
Disaster Mitigation Institute. Authors Press.