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National Disaster

Management Guidelines

Psycho-Social Support
and Mental Health Services
in Disasters
National Disaster Management Guidelines: Psycho-Social Support and Mental Health Services in
Disasters

A publication of:

National Disaster Management Authority


Government of India
NDMA Bhawan
A-1, Safdarjung Enclave
New Delhi - 110 029

ISBN: 978-93-80440-00-2

December (2009)

When citing this report, the following citation should be used:

National Disaster Management Guidelines: Psycho-Social Support and Mental Health Services in
Disasters, 2009. A publication of the National Disaster Management Authority, Government of
India. ISBN 978-93-80440-00-2, December 2009, New Delhi.

The National Guidelines are formulated under the Chairmanship of Lt. Gen. (Dr.) J.R. Bhardwaj,
PVSM, AVSM, VSM, PHS (Retd.), Hon'ble Member, NDMA, in consultation with various
stakeholders, regulators, service providers, and specialists in the concerned subject/field from
all across the country.
National Disaster
Management Guidelines

Psycho-Social Support
and Mental Health Services
in Disasters

National Disaster Management Authority


Government of India
Contents

Foreword ix
Acknowledgements xi
Abbreviations xiii
Executive Summary xvii

1 Introduction 1
1.1 Significance of Psycho-Social Support and Mental
Health Services (PSSMHS) in Disaster Management 1
1.2 Need for PSSMHS 3
1.3 Aims and Objectives of the Guidelines 4

2 Present Status and Context 5


2.1 Institutional and Policy Framework 5
2.1.1 National Policy 5
2.1.2 The National Mental Health Programme (NMHP) 5
2.1.3 National Rural Health Mission (2005) 6
2.1.4 Panchayati Raj Act (1992) 6
2.1.5 Other Government Initiatives 6
2.1.5.1 Disaster Management Act, (2005) 6
2.1.5.2 National Disaster Management Authority (NDMA) 7
2.1.5.3 National Crisis Management Committee (NCMC) 8
2.1.5.4 State and District Disaster Management Authority 8
2.2 Resources for PSSMHS 8
2.2.1 PSSMHS in Disaster Management 9
2.2.2 Provisions of Service 9
2.2.2.1 Service Providers 9
2.2.2.2 Nature of Services 11
2.2.2.3 Delivery and Impact of the Services 11
2.3 Capacity Development 12
2.3.1 Human Resource Development 12
2.3.2 Target Groups for Training 12
2.3.3 Nature and Impact of Training 12
2.3.4 Training Material 13
2.3.5 Recent Progress in Training and Capacity Development 13
2.4 Research 13
2.5 Convergence and Integration 14

v
CONTENTS

2.5.1 International, Public and Private Sector Initiatives 14


2.6 Genesis of National Disaster Mangement Guidelines: Psycho-
Social Support and Mental Health Services in Disasters 15

3 Salient Gaps 17
3.1 Operational Framework 17
3.1.1 Planning and Co-ordination 17
3.1.2 Service Requirements and Delivery 18
3.1.2.1 Assessment 18
3.1.2.2 Manpower 18
3.1.2.3 Service Delivery 18
3.1.2.4 Integration 18
3.1.2.5 Planning 19
3.1.2.6 Ethical Considerations 19
3.1.2.7 Monitoring and Evaluation 19
3.2 Capacity Development 19
3.2.1 Human Resource Development 19
3.3 Implementation and Co-ordination 20
3.4 Research and Development 21
3.5 Documentation 22
3.6 Finance 23

4 Guidelines for Disaster Preparedness in PSSMHS 24


4.1 Legislative Framework 24
4.1.1 Policy, Plans and Programmes 24
4.1.2 Institutional and Operational Framework 25
4.2 Planning and Preparedness 25
4.2.1 Review and Regular Updating 26
4.2.2 Planning at the National and State Levels 26
4.2.3 Resource Mapping 27
4.2.4 Preparedness for PSSMHS 28
4.3 Institutional Framework for PSSMHS 28
4.3.1 Institutional Framework at the National Level 28
4.3.2 Institutional Framework at the State and District Levels 30
4.4 Capacity Development 30
4.4.1 Human Resource 30
4.4.2 Education 31
4.4.3 Training 32
4.4.4 Research and Development 33
4.4.5 Documentation 35
4.4.6 Community Participation 35

vi
CONTENTS

4.4.7 Role of Community Level Workers 36


4.4.8 Infrastructure for PSSMHS 36
4.4.8.1 Hospital Preparedness 37
4.4.8.2 Network of Institutions 38
4.4.8.3 Public-Private Partnership 38
4.4.8.4 Technical and Scientific Institutions 39
4.4.8.5 Communication and Networking 40
4.5 International Co-operation 41
4.6 Special Care of Vulnerable Groups 41
4.6.1 Psycho-Social First Aid 42
4.6.2 Referral System 43
4.7 Media Management 43

5 Guidelines for PSSMHS in the Post-Disaster Phase 45


5.1 PSSMHS in the Response Phase 45
5.2 Psycho-Social First Aid 46
5.3 Integration with General Relief Work 47
5.3.1 PSSMHS in Relief Camps 47
5.4 Integration with the Health Plan 48
5.5 Referral System 49
5.6 Role of NGOs in PSSMHS 49
5.7 Integration of Community Practices with PSSMHS 50
5.8 PSSMHS during Recovery, Rehabilitation and
Reconstruction Phases 51
5.9 PSSMHS for Vulnerable Groups 53
5.10 PSSMHS for Care-Providers 53

6 Approach to Implementation of the Guidelines 55


6.1 Implementation of the Guidelines 56
6.1.1 Preparation of the Action Plan 56
6.2 Implementation and Co-ordination 57
6.2.1 National Level 57
6.2.2 Institutional Mechanisms and Co-ordination at the
State and District Levels 58
6.2.3 District Level to Community Level Preparedness Plan and
Appropriate Linkages with State Support Systems 59
6.3 Financial Resources for Implementation 59
6.4 Implementation Model 59
6.5 Monitoring and Evaluation of PSSMHS 62

vii
CONTENTS

7 Summary of Action Points 63

Annexures 71
Annexure-A a. Table 1.1 Common Psycho-Social and Mental Health
Consequences of Disaster 71
b. Table 1.2 Common emotional reactions and behavioural 72
responses after disasters
Annexure-B Indicators of PSSMHS after Disasters 73
Annexure-C Important Websites 77

Core Group for the Psycho-Social Support


and Mental Health Services in Disasters 78

Contact Us 84

viii
Vice Chairman
National Disaster Management Authority
Government of India

FOREWORD

Preparation of guidelines for various types of disasters constitutes an important part of the mandate
of the National Disaster Management Authority. Formulation of guidelines on Psycho-Social Support
and Mental Health Services is an important landmark in this direction.

Disasters leave a trail of agony which significantly impact the survivor's mental health. Psycho-
Social Support and Mental Health Services have an important role to play, to cope up with the challenges
in the recovery and restoration of the victims to the pre-disaster status. Unfortunately, this facet also
tends to be generally ignored while handling of any disasters. Consequently, the formulation of the
national guidelines on the entire gamut of Psycho-Social Support and Mental Health Services has been
one of our key thrust areas with a view to build our resilience to respond effectively in all types of
disasters.

The intent of these guidelines is to develop an integrated, holistic, coordinated and proactive
strategy for management of Psycho-Social Support and Mental Health Services in disasters through a
culture of prevention, mitigation and preparedness to generate a prompt and effective response in the
event of an emergency as part of comprehensive medical preparedness and response.

The document contains comprehensive guidelines for preparedness activities, strengthening of


the existing legislative, institutional and operational framework and support during the preparedness,
response and rehabilitation phase. It specifically lays down the approach for implementation of the
guidelines by the central ministries/departments, states, districts and other stakeholders, in a time bound
manner.

The national guidelines have been formulated by members of the Core Group and Steering
Group constituted for this purpose, involving the active participation and consultation of over 100
experts from central ministries/departments, state governments, scientific, academic and technical
institutions, government/private hospitals etc. I express my deep appreciations for their significant

ix
contribution in framing these guidelines. I also wish to express my sincere appreciation for Lt Gen (Dr.)
J.R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd) for his guidance and coordination of the entire
exercise.

New Delhi General NC Vij


24 December 2009 PVSM, UYSM, AVSM (Retd)

x
Member
National Disaster Management Authority
Government of India

ACKNOWLEDGEMENTS

Disasters have a devastating effect on the survivor's physical as well as mental health resulting in
social disability and affecting overall well being of the survivors. It was only during Tsunami PSSMHS
as part of disaster response received greater importance and required further institutionalisation. The
Government has initiated various programmes like National Mental Health Programme and District
Mental Health Programme as part of national health plan to reach out to every citizen of the country. In
order to strengthen PSSMHS in disasters it is imperative to integrate PSSMHS in to these programmes
to provide both short and longer psycho-social support and mental health care. These guidelines
would provide directions and impetus to proper planning for comprehensive psycho-social and mental
health care to the surviving.

The National Disaster Management Guidelines on Management of Psycho-Social Support and


Mental Health Services in disasters have been formulated by the untiring efforts of the core group
members and experts in the field. I would like to express my special thanks to all the members who
have proactively participated in this consultative process from time-to time. It is indeed the keen
participation by the Ministry of Health and Family Welfare, Ministry of Home Affairs, Armed Forces
Medical Services, Ministry of Defense, state and union territory health departments, academic and
research institutions and non-governmental organisations, that has been so helpful in designing the format
of this document and provided valuable technical inputs. I would like to place on record the significant
contribution made by Dr. Nimesh Desai, Dr. Nagaraja. Dr. K. Sekar, Dr. P. Ravindran, Brigadier
Saldana and other core group experts.

Teams from IHBAS and NIMHANS, Professor Nimesh and Professor Sekar have immensely
contributed in preparation of the guidelines. I would like to place on record that Prof Nimesh Desai
who has been coordinator of the core group has worked very hard in bringing number of experts
together at various forums for discussions and deliberations which have proved very useful in this
formulation of guidelines. Prof. K. Sekar brought in the interface between the field realities coupled

xi
with the capacity building expertise and the critical dimensions in the formulation of the guidelines.
Dr. Sujata Satpathy, Assistant Professor at National Institute of Disaster Management has untiringly
worked days after days in framing up and editing of PSSMHS.

I would like to thank Dr. Surinder Jaswal of Tata Institute of Social Sciences and Dr. Mohan
Agashe for their sustained help and support throughout the process of development of these guidelines.

I would also like to express my sincere thanks to the representatives of the other central ministries
and departments agencies and institutes including National Institute of Mental Health and Neuro sciences,
Armed Forces Medical College and Institute of Behavior and Allied Sciences, professionals from
other scientific and technical institutes, eminent mental health professionals from leading national
institutions like the Tata Institute of Social Sciences, National Institute of Disaster Management and
various INGOs and NGOs sector for their valuable inputs that helped us in enhancing the contents and
overall presentation of the Guidelines.

The efforts of Dr. Jayakumar C, Senior Specialist, PSSMHS in providing technical inputs,
editing, shaping and coordinating release of the guidelines and Dr. Raman Chawla in coordinating the
guidelines during the preparatory stages are highly appreciated. I would like to appreciate the support
rendered by Dr. Pankaj Kumar Singh and Dr. T.S Sachdeva. I would like to acknowledge the active
cooperation provided by Mr. A.B. Prasad, Secretary and the administrative staff of the NDMA. I
express my appreciation for the dedicated work of my secretarial staff including Mr. Deepak Sharma,
Mr. Munendra Kumar and Mr. Vinod during the convening of various workshops, meetings and
preparation of the Guidelines.

Finally, I would like to express my gratitude to General N.C. Vij, PVSM, UYSM, AVSM (Retd),
Hon'ble Vice Chairman, NDMA, and Hon'ble Members of the NDMA for their constructive criticism,
guidance and suggestions in formulating these Guidelines.

New Delhi Lt. Gen. (Dr.) J.R. Bhardwaj


24 December 2009 PVSM, AVSM, VSM, PHS (Retd)
MD DCP PhD FICP FAMS FRC Path (London)

xii
Abbreviations

AFMC Armed Forces Medical College


AICTE All India Council of Technical Education
ASSWI Association of Schools of Social Work in India
ATI Administrative Training Institute
CBDM Community-Based Disaster Management
CBO Community-Based Organization
CLW Community Level Worker
CME Continuous Medical Education
CMO Chief Medical Officer
CSR Corporate Social Responsibility
DDMA District Disaster Management Authority
DDMP District Disaster Management Plan
DFID Department For International Development
DIET District Institute of Education and Training
DM Disaster Management
DMHP District Mental Health Programme
DMT Disaster Management Team
ECHO European Commission’s Humanitarian Aid Office
GGSIPU Guru Gobind Singh Indraprastha University
GHPU General Hospital Psychiatric Unit
GIS Geographical Information System
GO Government Organization
GoI Government of India
IASC Inter-Agency Standing Committee
ICDS Integrated Child Development Scheme
ICMR Indian Council of Medical Research
IGNOU Indira Gandhi National Open University
IHBAS Institute of Human Behaviour and Allied Sciences
IMA Indian Medical Association
INGO International Non-Governmental Organization

xiii
ABBREVIATIONS

IPS Indian Psychiatry Society


LGBMH Lokopriya Gopinath Bordoloi Regional Institute of Mental Health
MCI Medical Council of India
MIMH Maharashtra Institute of Mental Health
MoD Ministry of Defence
MoH&FW Ministry of Health and Family Welfare
MoL(ESIC) Ministry of Labour (Employees' State Insurance Corporation)
MoR Ministry of Railways
MoSJ&E Ministry of Social Justice and Empowerment
MoW&CD Ministry of Women and Child Development
NAC National Accreditation Council
NBE National Board of Examinations
NCC National Co-ordination Committee
NCERT National Council for Educational Research and Training
NCMC National Crisis Management Committee
NDMA National Disaster Management Authority
NDRF National Disaster Response Force
NEC National Executive Committee
NGO Non-Government Organization
NHP National Health Policy
NIDM National Institute of Disaster Management
NIMHANS National Institute of Mental Health and Neuro-Sciences
NMHP National Mental Health Programme
NIRD National Institute of Rural Development
NRHM National Rural Health Mission
NYK Nehru Yuva Kendra
PSFA Psycho-Social First Aid
PHC Primary Health Centre
PPP Public-Private Partnership
PRI Panchayati Raj Institutions
PSS Psycho-Social Support
PSSMHS Psycho-Social Support and Mental Health Services
PTSD Post-Traumatic Stress Disorder
QRT Quick Reaction Team

xiv
ABBREVIATIONS

SDMA State Disaster Management Authority


SHIFW State Institute of Health and Family Welfare
SMHA State Mental Health Authority
SSW School of Social Work
TISS Tata Institute of Social Sciences
ToT Training of Trainers
UGC University Grants Commission
ULB Urban Local Body
UMHP Urban Mental Health Programme
UN United Nations
UNDP United Nations Development Programme
UNESCO United Nations Educational Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
UT Union Territory
WHO World Health Organization

xv
Executive Summary

Background psycho-social support to the disaster-affected


communities needs to be provided on a long-
India is vulnerable to natural and man-made term basis. Appropriate and timely interventions
disasters, prolonged conflicts and other complex will determine the victims' adjustment to various
situations that impede the country's overall changes in lifestyle, caused by the disaster. The
development. Disasters are quite devastating interventions have to be community-based and
and usually leave a trail of human agony including culturally sensitive, taking into account the
loss of human life, livestock, property, livelihood needs of vulnerable groups like women,
and physical injuries that have a significant impact children, the elderly, the disabled etc. Such
on the survivors’ quality of life. Along with relief, support can relieve the psychological distress
rehabilitation and care of physical health and of the affected people to a significant extent.
injuries, psycho-social and mental health issues The main aim of the PSSMHS Guidelines
are also important that need to be addressed on is to envisage that disaster-affected
priority. Apart from logistic and material help, the communities are able to rebuild their shattered
survivors will require psycho-social and mental life through combined community activity,
health interventions. provided that the diminished capacity and
Psycho-social support in the context of support systems are rebuilt at the earliest and
disasters refers to comprehensive interventions their coping capacity is increased through the
aimed at addressing a wide range of psycho- simple mechanism of minimal emotional
social problems arising in the aftermath of a support, combined with a spectrum of care.
disaster. Psycho-Social Support and Mental The objective of the PSSMHS Guidelines
Health Services (PSSMHS) should be considered is to prepare national guidelines as a part of ‘all
as a continuum of the interventions in disaster hazard’ health plan which shall concentrate on
situations. Psycho-social support will comprise response, relief and rehabilitation aspects of
of general interventions related to the larger different kinds of disasters. It shall also focus
issues of relief work needs, social relationships on implementation of PSSMHS activities
and harmony to promote or protect psycho- through capacity building, training, service
social well-being of the survivors. Mental health delivery, research, documentation, monitoring
services will comprise of interventions aimed and evaluation at the national, state, district and
at prevention or treatment of psychological community levels. The provision of PSSMHS
symptoms or disorders. These interventions shall be based on the general health
help individuals, families and groups to restore programmes and will be integrated with National
social cohesion and infrastructure along with Mental Health Programme (NMHP) as well as
maintaining their independence and dignity. with District Mental Health Programme (DMHP)
There is considerable experience and and it will be delivered through general health
evidence supporting the benefits of PSSMHS. care programme and district health plan.
The experiences from PSSMHS interventions
in Orissa super cyclone, Gujarat earthquake, Structure of the Guidelines
Tsunami and Kashmir earthquake, reveal that
PSSMHS need to be planned ahead of disasters The Guidelines are designed to acquaint
so as to be executed in a co-ordinated and the reader with the basics of managing Psycho-
integrated manner at the time of disasters. The Social Support and Mental Health Services.

xvii
EXECUTIVE SUMMARY

These Guidelines deal with the subject in a at all levels. Capacity development and upgradation
balanced and thorough manner and give the of infrastructure required for implementing
information required by organizations to PSSMHS are described along with hospital
formulate PSSMHS at various levels. It is also preparedness. The need for creating a network
envisaged that these Guidelines will be used of institutions is been stressed, which shall prepare
for the preparation of national, state and district adequate knowledge material and modules for
Psycho-Social Support and Mental Health training of various human resources at different
Services as a part of 'all hazard' Disaster levels. The need for activation of psycho-social
Management (DM) Health Plan. Standard support, enhancing manpower for psychiatry and
Operating Procedures (SOPs) shall be prepared psychology, psychiatric social work, psychiatric
for all the stakeholders. nursing, community level workers and other
volunteers is stressed. Proper documentation,
Chapter 1 – Introduces the subject and
international co-operation and the role of NGOs
provides the background to these Guidelines.
are delibrated. Appropriate attention to vulnerable
The psycho-social trauma and its long-term
groups and the necessity of creating proper
consequences are presented. The emotional
referral systems for disaster-affected people once
reactions and behavioural responses due to
stressed.
disasters are outlined in Annexure-A. It also
deliberates on the need, aims and objectives Chapter 5 – Deals with the mechanism
of the Guidelines. of response for the PSSMHS in the Response
phase at national, state and district levels, by
Chapter 2 – Describes the present
various ministries and departments and all the
status of mental health resources available in
other stakeholders including International Non-
India and the Indian experience of working in
Government Organizations (INGOs), Non-
various disasters. The chapter also deals with
Government Organizations (NGOs) and
the various government policies, programmes
communities. This chapter also describes the
and initiatives on Disaster Management (DM)
mechanism of including PSSMHS in the general
Health Plans. The chapter briefly describes the
relief work and health plans. It further deals with
evolution of PSSMHS in India and capacity
the integration of community practices in
development in terms of both human resources
PSSMHS in case of a disaster. The important
and infrastructure in the country during disaster
aspect of long-term PSSMHS services is to be
and non-disaster situations. The chapter also
included in the recovery, rehabilitation and
provides a clear picture about the role of
reconstruction phases of disaster. The
different ministries, department of health and
importance of providing special care to the
other stakeholders in the management of
vulnerable groups as well as to the care-givers
PSSMHS during disasters.
to enhance the quality of service delivery is
Chapter 3 – Reveals the salient gaps in stressed.
delivering PSSMHS. The noticeable gaps in
Chapter 6 – Rounds off the Guidelines
policies, strategies, planning, human resources
to provide a broad perspective on PSSMHS in
and other preparedness-related aspects are
disasters. Various components of a system
presented. The gaps and limitations are clearly
necessary to prepare for, and respond to,
noticeable at various levels for adequate
disasters once set out. The time-lines proposed
capacities, lack of skilled human resource,
for the implementation of various activities in the
service delivery, co-ordination, research and
Guidelines are both important and desirable.
development, proper documentation, adequate
Precise schedules for structural measures will,
finance and proper implementation.
however, be evolved in the PSSMHS in DM plans
Chapter 4 – Deliberates on legislation for that will follow at the central ministries/state level,
institutional and operational framework. It also duly taking into account the availability of financial,
describes proper planning and resource mapping technical and managerial resources. In case of

xviii
EXECUTIVE SUMMARY

compelling circumstances warranting a change, Management (DM) Plan and


consultation with the National Disaster Health/Hospital DM Plans.
Management Authority (NDMA) will be e. Inclusion of PSSMHS in the
undertaken well in advance, for adjustment on a Minimum Standard of Medical
case-to-case basis. Care in disasters.
These Guidelines provide a framework for f. Establishing linkages with all
action at all levels. The Ministry of Health and stakeholders identified to play an
Family Welfare (MoH&FW) shall prepare an important role in PSSMHS.
Action Plan to enable all sections of the g. Strengthening the government
government and administrative machinery at agencies and NGOs; devloping
various levels to prepare and respond Public Private Partnership (PPP)
effectively. and the partnership mechanism in
Milestones for implementation of capacity development, research
Guidelines are as follows : and service provision on mutually
agreed terms and conditions.
A) Phase-1 (0-3 years)
iii) Capacity Development
i) Regulatory Framework
a. Sensitising and training (basic and
a. Dovetailing of existing Acts, Rules advanced) on PSSMHS across
and Regulations with the DM Act, identified departments, sectors
(2005). and levels.
b. Ensuring implementation of b. Strengthening of the national,
PSSMHS in National Mental Health regional and nodal capacity
Programme (NMHP) and District building institutions and resource
Mental Health Programme (DMHP) centres at state and district levels.
c. Integration of the PSSMHS in c. Developing PSSMHS needs
DMHP and General Health assessment indicators and
Programme as part of hospital and templates.
district health plan. d. Strengthening of District
d. Enactment/amendment of any Counselling Centres under the
Act, Rule and Regulation, if Department of Social Welfare/
necessary, for better Women and Child Development.
implementation of PSSMHS e. Strengthening the resource base
across the country. and data management/
ii) Mitigation documentation in PSSMHS.
a. Formation of a National Sub- iv) Education and Training
Committee on PSSMHS. a. Inclusion of Disaster PSSMHS in
b. Developing/strengthening a Post-graduate Curriculum of
mechanism for quick and effective Psychiatry, Psychology, Social
referral system. Work, Disaster Management,
c. Training of National Disaster Emergency Medicine and Health
Response Force (NDRF), Quick Education.
Reaction Teams (QRTs) Disaster b. Inclusion of PSSMHS in Under-
Management Teams (DMTs) in all graduate medical studies.
basic psycho-social support skills. c. Integrating with all training
d. Integrating with Disaster programmes in the area of

xix
EXECUTIVE SUMMARY

Psychology, Social Work, Mental c. Formation of National PSSMHS


Health, Emergency Medical Resource Inventory to be part of
Response, Hospital National Health Resource
Administration, Nursing and Inventory.
Paramedics. d. Initiation of distance learning
v) Community-Based Disaster courses for sensitisation across
Management (CBDM) different categories of disaster
management stakeholders.
a. Inclusion in the CBDM Plan and
training of Panchayati Raj e. Development and standardisation
Institution (PRI) members. of uniform training packages for
various designated target groups.
b. Developing awareness material for
the community. iii) The following Phase 1 activity will
c. Evolving a mechanism for continue in this Phase as well:
community outreach education Integration of PSSMHS training in
programmes on PSSMHS. DMHP, district health and hospital
B) Phase-II (0-5 years) plans.
i) Capacity Building C) Phase-III (0-8 years)
a. Strengthening nodal institutions The long-term Action Plan will intensify the
and hospitals. areas identified in Phase-I along with the
b. Developing database important issues that have been raised in
management and evidence-based chapters 4 and 5. A detailed action plan, will be
research. prepared by the National Sub-Committee and
c. Evolving a mechanism for follow- submitted to the NDMA and MoH&FW. The
up response. long-term planning will include the following
d. Establishing a National important aspects:
Accreditation System for quality i) Evolving a mechanism to include
assurance. disaster-induced psychiatric disorders/
e. Continuation and updating of physical disability in the disaster
human resource development insurance and medical/health
activities. insurance.
ii) Preparedness ii) Intensive Post-graduate Diploma/Post-
a. Creation of a core group of master graduate courses in PSSMHS.
trainers at district level. iii) Networking of Institutions and their
b. Strengthening Public-Private activities.
Partnership in research and
development.

xx
1 Introduction

India due to its unique geo-climatic signs and symptoms or mental disorders among
conditions has been experiencing natural disaster-affected persons and persons with
disasters like earthquakes, tsunamis, cyclones, pre-existing mental health problems. In addition,
floods, droughts and landslides. The country is psycho-social support interventions are aimed
equally vulnerable to man-made disasters like at mental health and psychological well-being,
chemical, biological, radiological and nuclear promotion and prevention of psychological and
emergencies. Disasters, whether natural or psychiatric symptoms among disaster-affected
man-made, cause enormous devastation and community.
human suffering to the community. These
The Psycho-Social Support and Mental
disasters usually leave a trail of human agony,
Health Services shall be considered as a
including loss of human life and injuries,
continuum of the interventions as an important
Emotional trauma, loss of livestock, property
component of general health services in disaster
and livelihood, resulting in long-term psycho-
situations. Psycho-social support will comprise
social and mental health problems. Apart from
of the general interventions related to the larger
logistic and material help, the affected
issues of promoting or protecting psycho-social
community requires Psycho-Social Support and
well-being through relief work, meeting essential
Mental Health Services(PSSMHS).
needs, restoring social relationships, enhancing
Psycho-social support in the context of coping capacities and promoting harmony among
disasters refers to comprehensive interventions survivors. The mental health services will
aimed at addressing a wide range of psycho- comprise of interventions aimed at prevention
social and mental health problems arising in the or treatment of psychological and psychiatric
aftermath of disasters. These interventions help symptoms or disorders. The overall goal of the
individuals, families and groups to build human Psycho-Social Support and Mental Health
capacities, restore social cohesion and Services is restoration of well-being of the
infrastructure along with maintaining their disaster-affected community.
independence, dignity and cultural integrity.
Psycho-social support helps in reducing the level 1.1 Significance of Psycho-Social
of actual and perceived stress and in preventing Support and Mental Health
adverse psychological and social consequences Services (PSSMHS) in
amongst disaster-affected community.
Disaster Management
Mental health services in disaster
interventions are aimed at identification and There is adequate knowledge amongst
management of stress related psychological the professionals both at the national and

1
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

international levels regarding the psycho-social after disasters are Normal and pathological grief
and mental health consequences of disasters. (Bereavement), acute stress reaction,
It has been recognised that most of the depression, generalised anxiety disorder, Post-
disaster-affected persons experience stress Traumatic Stress Disorder (PTSD), alcohol and
and emotional reactions after a disaster as a drug abuse rather than the issues related to
'normal response to an abnormal situation'. psycho-social well-being. Besides clearly
While some of the survivors would be able to identifiable mental health and psycho-social
cope by themselves, a significant proportion of problems, various emotional/ psychological
them may not be able to do so effectively. In reactions and behavioural responses to the
the absence of appropriate and adequate disasters have been documented to highlight
support, these survivors experience emotional its spectrum Annexure A (1.2)
distress and decline in social functioning there
Emotional reactions such as guilt, fear,
by require psycho-social support and mental
shock, grief, Hyper-vigilance, numbness,
health services. The individual psycho-social
intrusive memories, and despair are universal
responses/reactions are directly related to the
responses in people experiencing unforeseen
type of trauma and severity of the disaster.
disastrous events beyond their coping capacity.
The greater the trauma, the more severe Emotional reactions reported by the people are
is the psychological distress and social disability. normal responses to an abnormal event. It is
The magnitude of psychological trauma and estimated that nearly 90% of survivors undergo
subsequent experiences due to disasters like these emotional reactions immediately after the
earthquakes and tsunamis may be severe for a disaster. However, it reduces to 30% over a
majority of the people. The magnitude of trauma period of time with psychological reactions to
in lesser gravity disasters may be less severe. stress, leading to a change in behaviour,
In contrast man-made disasters such as relationships and physical or psycho-social
communal riots, terrorism, chemical, biological, situations. Continuation of the situation leads
radiological and nuclear disasters cause more to an abnormal pattern and long-term mental
prolonged psychological distress than natural illness among the survivors, if not attended to.
disasters. In both cases, large-scale human Indian experience in Orissa super cyclone,
suffering and psycho-social consequences Gujarat earthquake, riots and tsunami has
require co-ordinated response from both demonstrated that appropriate psycho-social
government and non-government organizations intervention during the rescue, relief,
as will as from the community. The recovery rehabilitation and rebuilding period significantly
process is directly related to the severity of the decreases the distress and disability among
experience and is prolonged in the case of survivors, leading to an overall improvement in
higher magnitude disasters. the quality of life.
Traditionally, psycho-social and mental Experiences in recent major disasters in
health consequences of disasters as shown in India indicate that there is an increasing in
Annexure A (Table 1.1) have been understood awareness about the role of PSSMHS. There is
more in terms of mental illnesses/ disorders. a need to create psycho-social support to
The common mental health disorders reported develop protective barriers for the community

2
INTRODUCTION

to reduce the long-term effects of disasters. Therefore, it is essential that the various
These protective resources are themselves interventions shall also focus on the three
vulnerable to the impact of disasters and they important dimensions–Human Capacity, Social
decline or deteriorate in their capacities. In order Ecology and Cultural Capacity–as well as
to tap the community resources, three regional and cultural sensitivities of the area
important dimensions are identified: Human which may differ from region to region.
Capacity, Social Ecology and Cultural Capacity.
These dimensions are complementary in nature 1.2 Need for PSSMHS
for the total well-being of people and the
The importance of mental health and
community.
psycho-social interventions after disasters has
i) The first dimension Human Capacity been increasingly recognised. The World Health
is primarily constituted by the health (physical Organization (WHO) recommends that
and mental), knowledge and skills of an appropriate interventions are necessary to
individual. In these terms, improving physical prevent and manage the psycho-social and
and mental health, or education and training in mental health consequences of a disaster.
support of increased knowledge, enhances
The PSSMHS interventions are intricately
human capacity and psycho-social well-being.
related to general relief work and general health
ii) The second dimension is Social services after disasters. A well-planned and co-
Ecology. It includes social relations within ordinated general relief work adequately
families, peer groups, religious and cultural addressing the needs of the affected people
institutions, links with civic and political will have a positive impact on their mental health
authorities. It also includes changes in power and psycho-social needs. Timely and appropriate
relations between ethnic groups and shifts in management of injuries and general medical
gender relations etc. (all of these may be conditions will decrease the level of stress and
referred to as the 'social capital' of the the need for mental health interventions. The
community). It is a well established that quality and quantity of general relief work and
disasters and the effects on social dimensions health services provided during disasters have
are widely accepted as contributing factors to tremendous impact on the psycho-social well-
psycho-social well-being. There is strong being of the people. It is essential to effectively
empirical evidence linking mental health integrate PSSMHS with general relief work and
outcomes to the presence of effective social health services. This will ensure maximum
engagement, including wider cultural and utilisation of the limited resources available
pragmatic concerns. during disasters.
iii) The third dimension is Cultural Capital, The PSSMHS plan shall be prepared during
which essentially comprises of values, beliefs the pre-disaster phase which will be integrated,
and practices of the community. Disasters, co-ordinated and monitored by nodal agencies
irrespective of their nature, can threaten cultural at national, state and district levels. This shall
traditions and erode the values and beliefs due cater to immediate and long-term needs of the
to devastation and trauma. affected communities.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Appropriate and timely interventions will shattered lives through combined community
facilitate survivors' adjustment to various activity, provided that the diminished capacity
changes in lifestyle, caused by the disasters. and support systems are rebuilt at the earliest
These interventions will be community-based, and their coping capacity is enhanced through
culturally sensitive and will take into account the the simple mechanism of emotional support,
needs of vulnerable groups like women, combined with a spectrum of care-based
children, the elderly and the disabled etc. activities.

1.3 Aims and Objectives of the The major objectives of the Guidline are:
Guidelines i. To provide guidelines to various
Under Section 6 of the Disaster stakeholders on the preparedness,
Management Act, (2005), the National Disaster response, relief and rehabilitation
Management Authority (NDMA) is, inter alia, aspects of PSSMH services, in
mandated to issue Guidelines for preparing different kinds of disasters.
action plans for holistic and co-ordinated ii. To provide guidelines for the
management of all disasters. The Guidelines will implementation of PSSMHS activities
focus on all aspects of Psycho-Social Support such as resource mobilisation, capacity
and Mental Health Services (PSSMHS) with a building, training, service delivery,
emphasis on prevention, mitigation, research, documentation, monitoring
preparedness, response, relief and rehabilitation and evaluation at the national, state,
in disaster senario. district and community levels.
The Guidelines will form the basis for iii. To facilitate development of the
preparation of plans for the concerned central institutional framework and response
ministries and departments, state authorities mechanism for providing PSSMHS
and districts to evolve programmes and during disaster situations.
measures to be included in their Action Plans.
iv. To facilitate the standardisation of
It is basically meant for all the functionaries who
preparedness, response, relief and
are involved in general health-care related
rehabilitation measures in PSSMHS
interventions in all types of disasters. The
during disaster situations.
PSSMHS Guidelines envisage that disaster-
affected communities will be able to rebuild their

4
2 Present Status and Context

Psycho-social support and mental health 2.1.2 The National Mental Health
aspects of disasters in India in terms of service Programme (NMHP)
delivery, training and research activities carried The NMHP programme was initiated in
out during the last two decades reveal a 1982. The re-strategised NMHP’s District
progressive shift in the nature and scope of Mental Health Programme was developed as
services. This shift is well reflected in the an approach to deliver mental health-care
developments that have taken place during through the Primary Health Care system for all
major disasters like the Bhopal gas tragedy districts. DMHP has been implemented in nearly
(1984), Latur earthquake (1993), Orissa super 94 districts. Based on the mid-term review and
cyclone (1999), Gujarat earthquake (2001), two national consultative meetings, the existing
Tsunami (2004) and Kashmir earthquake (2005). DMHP programme is being strengthened by
The developments in the area of service, training adding the adolescent mental health programme
and research have been taking place in a parallel that includes health promotion for high school
and complementary manner. The present status students, intervention for students with
of these developments is described in this emotional problems, counselling for out of
chapter. school children and college-based counselling
services for college students. Apart from
2.1 Institutional and Policy continuing the existing programmes, it is
envisaged that 500 more districts will be brought
Framework
under the DMHP activities in the 11th Five-Year
2.1.1 National Health Policy Plan. Urban Mental Health Programme is a new
addition to the NMHP. It has been envisaged to
The National Health Policy (NHP) was start UMHP in 50 centres by the end of five
formulated in 1983, and since then, there have years. Specific budget allocation has been made
been marked changes in the determinant for 500 rural and 50 urban districts in the
factors relating to the health sector. The country. As such, since the target/goal of the
changed circumstances made it imperative to NMHP during the 11th Five-Year Plan period is
review the old policy and to formulate a new extensive, it is proposed to achieve nearly
policy framework as the National health Policy complete coverage of all the districts in the
(2002), according to which an adequately robust country. The availability of mental health teams
disaster management plan has to be in place to in every district for a disaster situation shall be
effectively cope with situations arising from ensured. This can form one of the major starting
natural and man-made calamities'. points for the PSSMHS in disaster situations.

5
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

2.1.3 National Rural Health Mission (2005) empowering the community to function as a
well-knit family in case of any disaster. From the
The mandate of the National Rural Health
recent experiences, the capacity building of the
Mission (2005) is to provide total health
community at panchayat level demonstrated the
solutions to the grassroot level population,
usefulness of local capacities. It is envisaged
reaching different states, districts, taluks and
to include PRIs to build capacities at grassroot
villages. One of the main goals of the
level for PSSMHS interventions in every
programme is to buildup the capacity of the
community.
grassroot level workers and forge partnerships
among various actors to provide effective health- 2.1.5 Other Government Initiatives
care. The district health plan will be set up
2.1.5.1 The Disaster Management Act
through National Rural Health Mission (NRHM)
(2005)
so that health-care reaches every
part of the country. The resources and The Government of India initiatives,
infrastructure created through the programme subsequent to the Orissa super cyclone, in
shall be used for PSSMHS preparedness and terms of the High Power Committee
response to fill the existing gaps, especially in recommendations and the National Disaster
the area of skilled human resources. Management Plan (2000) had provided impetus
to disaster related activities. These policies
All the initiatives delivered through various
national policies and programmes shall converge became structuralised after the Tsunami when
into a comprehensive district disaster the National Disaster Management Authority
management plan in which the various initiatives (NDMA) was established in (2005) to enact the
get translated into deliverables for the disaster- institutional mechanism at national, state and
affected people throughout the country. district levels. Through this mechanism the State
Disaster Management Authorities (SDMA) will
2.1.4 Panchayati Raj Act (1992) strengthen the capacity building for both natural
The Constitutional Amendments of 1992 and man-made disasters so that relief,
(73 and 74) mandate the States to enact laws rehabilitation and reconstruction are quick and
for devolution of powers and responsibilities to efficient. In terms of the implementation
the Panchayati Raj Institutions and Urban Local mechanism, the District Collector/District
Bodies respectively for preparation of plans for Magistrate who is also the chairperson of the
economic development and social justice. This District Disaster Management Authority (DDMA)
relates to implementation of the twenty-nine assumes the leadership in terms of both
subjects listed in the eleventh schedule of the administrative control as well as regulatory
Constitution. mechanism for rescue, relief, and rehabilitation.
Panchyati Raj Institutions (PRIs) constitute He/she is responsible for the overall co-
the foundation for the implementation of most ordination, supervision and monitoring of various
of the Rural Development Programmes. They activities performed by the government and
empower the local communities, ensuring their non-government agencies. The long-term
participation and contribution in reconstruction rebuilding process largely rests upon the
of the village. PRIs play a catalytic role by collective efforts of government and non-

6
PRESENT STATUS AND CONTEXT

government agencies, including the affected or disaster as it may consider necessary; and (j)
community itself. lay down broad policies and guidelines for the
functioning of NIDM. NDMA is assisted by the
2.1.5.2 National Disaster Management
National Executive Committee (NEC), consisting
Authority
of Secretaries of 14 Ministries and Chief of the
The Disaster Management Act, (2005) was Integrated Defence Staff of Chiefs of the Staff
enacted to provide effective management of committee, ex-officio as provided under the DM
disasters. The Act seeks to institutionalise Act, (2005).
mechanisms at the national, state and district
NDMA is, inter alia, responsible for
levels to plan, prepare and ensure a quick and
coordination/mandating the government's
efficient response to natural calamities and man-
policies for disaster reduction/mitigation and
made disasters/accidents. The Act mandates
ensuring adequate preparedness at all levels.
the following: (a) formation of a national apex
Co-ordination of response to a disaster when it
body, the NDMA, with the Prime Minister of
strikes and post-disaster relief and rehabilitation
India as its Chairperson, (b) creation of SDMAs,
will be carried out by National Executive
and (c) co-ordination and monitoring of Disaster
Committee (NEC) on behalf of NDMA.
Management (DM) activities at district and local
levels through the creation of district and local NDMA has been supporting various
level DM authorities. initiatives of the central and state governments
to strengthen DM capacities. NDMA proposes
The NDMA is responsible to (a) lay down
to accelerate capacity building in disaster
policies on DM; (b) approve the National Plan;
reduction and recovery activities at the national
(c) approve plans prepared by the ministries or
level in some of the most vulnerable regions of
departments of the Government of India (Gol)
the country. The thematic focus is on awareness
in accordance with the National Plan; (d) lay
generation and education, training and capacity
down guidelines to be followed by state
development for mitigation, and better
authorities in drawing up the state plan; (e) lay
preparedness in terms of disaster risk
down guidelines to be followed by the different
management and recovery at community,
ministries or departments of Gol for the purpose
district and state levels.
of integrating mitigation effects of disasters in
their development plans and projects; (f) Ministry of Health and Family Welfare
coordinate the enforcement and (MoH&FW), the nodal ministry for medical
implementation of the policy and plans for DM; preparedness, is mandated to formulate and
(g) recommend provision of funds for the implement national health policies and
purpose of mitigation; (h) provide such support programmes in the country including mental
to other countries affected by major disasters health. All the other line ministries including
as may be determined by the central Ministry of Railways (MoR), Ministry of Defence
government; (i) take such other measures for (MoD), Ministry of Women and Child
the prevention of disasters, or the mitigation Development (MoWCD), Ministry of Labour -
or preparedness and capacity building for Employees State Insurance Corporation (MoL-
dealing with the threatening disaster situation ESIC) who have their own medical set-up will

7
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

also follow the policies and plans laid down by public sector undertakings have general hospital
the nodal ministry. psychiatric units. The District Mental Health
Programmes are there in 123 Districts under
2.1.5.3 National Crisis Management
the National Mental Health Programme of India,
Committee (NCMC)
but the manpower availability is limited. The
The NCMC, under the Cabinet Secretary, last survey of mental health resources was done
is mandated to co-ordinate and monitor in (2002) by ICMR. As per the survey, there were
response to crisis situations, which includes all 2219 Psychiatrists, 343 Clinical Psychologists
disasters. The NCMC consists of 14 union and 290 Psychiatric Social Workers in the
secretaries of the concerned ministries including country. A current estimate of these mental
the Chairman, Railway Board. NCMC provides health professionals would be 3500
effective co-ordination and implementation of Psychiatrists, 500 Clinical Psychologists, 400
response and relief measures in the wake of PSWs and 1000 Psychiatric Nurses in the
disasters. country. Further, out of many institutions
2.1.5.4 State and District Disaster providing training in mental health, only a few
Management Authorities have been consistently working in the area of
PSSMHS in disaster situations.
State and District Disaster Management
Human resources are the most valuable
Authorities, (SDMA & DDMA) shall also ensure
asset of a mental health service provision. In
incorporation of NMHPs at the state and district
resource-rich countries like USA, UK and
levels and integrate them into state and district
Australia the proportion of available manpower
disaster management plans and part of general
in mental health is far higher than in comparison
relief and general health response.
to a country like India as shown in the table
2.2 Resources for PSSMHS below. The paucity of manpower in making
provision of mental health care in the whole
The available resources for psycho-social country makes it much more difficult to provide
support and mental health services are currently psycho-social support and mental health
limited in the country. There are 43 state-run services in disaster situations. Hence, there is
mental hospitals in the country. All recognized a need to deprofessionalise the skills and create
medical colleges are required to have a multi-agency, multi-disciplinary, inter-sectoral,
psychiatric unit which qualifies as general private and NGO sectors to participate in
hospital psychiatric unit (GHPU). In addition, developing non-professionals in mental health
ESIC, Railways, Armed Forces and many other care at different levels with defined roles and
Table No. 1 – Status of Global Mental Health Manpower
Professionals per 100,000 WORLD USA UK AUSTRALIA INDIA
Population
Number of Psychiatrists 1.20 13.7 11 14 0.2
Number of Psychologists 0.60 31.1 9 5 0.03
Number of Social Workers 0.40 35.3 58 5 0.03
Number of Psychiatric Nurses 2.0 6.5 104 53 0.05
Ref. Mental Health Atlas, 2005

8
PRESENT STATUS AND CONTEXT

tasks, according to their educational workers came forward to address the short- and
background. These non-mental health long-term psycho-social effects of Tsunami for
professionals could be involved in provision of the affected community.
PSSMHS to promote mental health, prevent
The area of disaster mental health has
disorders and provide care for people with
evolved during the last two decades. From a
mental disorders.
mental disorder based approach after the
2.2.1 PSSMHS for Disaster Management Bhopal gas disaster, the approach has been
modified to mental health integrated with public
Earlier, PTSD was considered as a prime
health after the Latur earthquake and further
effect of the disasters and most of the
interventions were focused on these symptoms. broadened to psycho-social and mental health
Subsequent identification of long-term psycho- care in the Orissa super cyclone, Gujarat
social effects on the survivors in Bhopal earthquake, Tsunami and Kashmir earthquake.
disaster, Orissa super cyclone, Gujarat The purely clinic/hospital-based planning and
earthquake and Tsunami has revealed negative delivery of services has given way to
impact on the persons’ mental health, behaviour community-based services with active utilisation
and ability to function normally. This has of community resources. The nature of
reaffirmed that psycho-social factors will have manpower involved in service delivery has also
short and long-term effects on the community. undergone a significant change. Earlier, only
Thus, there is a need to expand and bring out psychiatrists were visible but now all mental
guidelines to provide holistic PSSMHS care to health professionals, including clinical
communities. Epidemiological surveys psychologists, psychiatric social workers, etc.,
conducted in populations not affected by to professionals, para-professionals and trained
disasters revealed that the proportion of people community level workers (CLWs) and volunteers
requiring mental health services is around 8- can be seen, as service providers.
10% of the population. After disasters, people It is important to note that available
requiring psycho-social support and mental resources like medical service providers in
health services are likely to increase by two to private sector, NGOs working with the
three times. community, Schools of Social Work,
PSSMHS in the post-disaster phase were Departments of Clinical Psychology, Nursing
given by mental health professionals, Colleges, Family Counselling Centres, Indian
institutions and the MoH&FW, albeit to a limited Medical Association, Indian Psychiatric Society,
extent, from the Bhopal gas tragedy onwards. Nursing Council of India and other professional
These were quite visible at the time of the bodies are not being used adequately though
Gujarat earthquake. However, clearer and they have the potential to make up the
greater recognition of the significance of deficiency in PSSMHS.
PSSMHS by the Government came at the time
2.2.2 Provision of Service
of the Tsunami. Ministry of Health and Family
Welfare, National Institute for Mental Health and 2.2.2.1 Service Providers
Neuro-Sciences (NIMHANS) and a large number i) Mental Health Professionals from the
of NGOs, INGOs and community-based social mental health institutions and

9
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

psychiatric departments in medical community. During Orissa super


colleges are engaged in providing cyclone and Gujarat earthquake,
specialised mental health services in CLWs, including volunteers from non-
the country. An evolving trend has affected areas and some survivors of
been seen wherein besides the disaster-affected community, were
psychiatrists, other mental health trained to provide PSSMHS.
professionals like clinical psychologists v) Some Government Institutions like
and psychologists and psychiatric NIMHANS, Institute of Human
social workers and social workers from behaviour and Allied Sciences (IHBAS)
other disciplines have also been and Maharashtra Institute of Mental
involved in providing services. Health (MIMH) etc., have been actively
ii) The centre and state governments involved in providing PSSMHS.
have been deploying a few mental vi) The involvement of the government
health professionals immediately after sector in the delivery of PSSMHS has
the disasters. These professionals been largely through MoH&FW.
have taken the initiative to provide Though it has been possible to
mental health services and psycho- integrate mental health services with
social care in different disasters general health service delivery after
ranging from emergencies like bomb disasters, up to some extent, the
blasts and train accidents to major overall PSSMHS activities have not
disasters like earthquakes and been well co-ordinated with other
cyclones. components of disaster response.
iii) Medical officers were trained to vii) A significant development during the
provide services for people with last decade has been the extensive
identifiable mental disorders after the involvement of International agencies,
Bhopal gas disaster. After the Gujarat especially UN agencies like Office for
earthquake and Tsunami, some health Coordination of Humanitarian Action
workers were also imparted brief (OCHA), World Health Organization
training in PSSMHS, who supported the (WHO), United Nations Childern’s Fund
community for psycho-social support (UNICEF), United Nations High
and health-care services. Commissioner for Refugees (UNHCR)
iv) The list of formalised service providers and United Nations Population Fund
was further enlarged where (UNFPA) in PSSMHS activities during
Community Level Workers (CLWs), disasters in Gujarat earthquake,
Social Welfare department workers, Tsunami and Kashmir earthquake.
Anganwadi workers, and community- viii) A number of national and international
based religious and spiritual level NGOs have also participated in
organizations significantly contributed providing disaster PSSMHS. The
in providing PSSMHS to the affected notable NGOs in the field are Action

10
PRESENT STATUS AND CONTEXT

Aid, Aga Khan Foundation, Save the However, only a small fraction of the
Children, CARE, Catholic Relief needy people could receive it in the
Services (CRS), CARITAS, Medicines absence of an institutionalised
Sans Frontiers (MSF), Oxfam, World approach and appropriate co-ordination
Vision, American Red Cross, mechanism. After Tsunami, these
International Federation of Red Cross interventions were provided in a more
& Red Creseant, Indian Red Cross widespread manner but there is a
Society and many other community need for a more systematic and
based NGOs in providing PSSMHS after structured delivery of services.
disasters. These organizations have
ii) Spiritual and faith based group
frequently worked in collaboration and
activities like prayers, singing bhajans,
partnership with institutuions like
discourses by religious leaders
NIMHANS and Tata Institute of Social
contribute to psycho-social well-being
Sciences (TISS) for technical support
and might play a significant role in
in providing PSSMHS.
preventive mental health care and
2.2.2.2 Nature of Services promote well-being. Other indigenous
practices and alternative medicinal
After the Bhopal gas tragedy, the focus
was on identification as well as treatment of systems have also been utilized and
those who suffered from clinically diagnosable they have gained a wide acceptance.
mental disorders and who visited the health 2.2.2.3 Delivery and Impact of the Services
clinics, started after the disaster. Identification
A paradigm shift came after the Orissa
and treatment of psychiatric disorders by mental
super cyclone, Gujarat earthquake and the
health professionals in the field, or identification
Tsunami and volunteers were trained at the
and referral of persons with psychiatric disorders
community level to impart PSSMHS with referral
continued as a major mental health service
support from mental health professionals.
activity. Since then, the nature of PSSHMS
provided after disasters have also undergone a i) PSSMHS interventions in the country
significant change during the last two decades. have been a stand-alone activity and
were integrated only partially with the
i) A number of non-disorder oriented
interventions were undertaken to general health services. Varieties of
restore the psycho-social and mental community-based mental health
health well-being in subsequent interventions have been developed and
disasters specially after Orissa super these were found useful after the
cyclone and Gujarat earthquake.This tsunami. These community-based
interventions were crisis intervention, models were developed, incorporating
emotional first aid, counselling for grief contextual realities and cultural
reaction, group therapy, play therapy practices of the community.
for children, facilitating community self- ii) A systematic evaluation of the impact
help groups by trained workers as well of mental health delivery models
as mental health professionals. provided in disaster situations in India

11
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

has been carried out only in a few PSSMHS are grossly inadequate to
instances, after the tsunami. cater to the needs of our country.
iii) PSSMHS services have not been able ii) After the Bhopal Gas Disaster, it was
to reach all the affected people. This evident that there was a dire need for
has been mainly due to lack of skilled training of non-mental health
human resources and co-ordination. professionals to deliver mental health
services to the disaster-affected
iv) There has been no systematic plan for
community. It was also established
PSSMHS disaster preparedness and all
that non-mental health professionals
the PSSMHS that have been carried out
could provide effective intervention if
so far, happened in an adhoc manner
trained properly which was
after the disaster. These interventions
demonstrated in various disasters like
usually lasted for only 3 to 6 months,
the Bhopal Gas Disaster, Latur
except in case of the tsunami where
earthquake, Orissa super cyclone,
these activities were planned for 2-3
Gujarat earthquake, and the Tsunami.
years.
iii) A dynamic shift was witnessed after
2.3 Capacity Development the Orissa super cyclone where the
volunteers and survivors were trained
Capacity building encompasses human,
to provide basic psycho-social support
scientific, technological, organisational, and
and mental health support with the
institutional resource capabilities. The primary
help of mental health professionals.
goal of capacity building is to enhance the ability
For rehabilitation of tsunami victims, it
of persons and institutions based on the needs
was widely adopted and practised by
perceived. Capacity building is a long-term,
many organizations, both government
continuing process, in which all stakeholders
and non-government.
participate to enhance their skills and knowledge
to achieve the desired objectives. 2.3.2 Target Groups for Training
2.3.1 Human Resource Development The list of target groups for training has
grown tremendously from professionals to non-
Human resource development is the
professionals like medical officers, NGO
process of equipping individuals with the
workers, social work students, health workers,
understanding, skills and access to information,
community level workers, teachers, Civil
knowledge and training that enables them to
Defence personnel, Nehru Yuva Kendra (NYK)
perform effectively.
volunteers, Anganwadi workers, community
i) Human resource development in the leaders and various other relief providers.
area of PSSMHS has undergone a
2.3.3 Nature and Impact of Training
dynamic shift from the Bhopal disaster
to the recent tsunami. But the growing Post-disaster capacity building training
inadequacy of the available human was provided mainly by the mental health
resources is evident and resources in professionals, usually from outside the disaster-

12
PRESENT STATUS AND CONTEXT

affected areas with or without collaboration of development activities, which is evident during
local mental health professionals. These disasters in the country. These advances
initiatives were technically and financially indicate a major shift in the approach to PSSMHS
supported by various international organizations by emphasising the need to carry out these
like WHO, UNICEF, Action Aid and Care India. activities in the preparedness phase rather than
The training was imparted, based on the needs initiating them in the post-disaster phase. There
of the disaster-affected community and the have been significant developments such as the
trainees/participants. The most widely followed inclusion of disaster management in the
approach was the top-down approach for master curriculum at the school level. Some universities
trainers, trainers and volunteers. The training (e.g., GGSIPU, IGNOU etc.) have included the
included non-pharmacological interventions as subject in their curriculum both at under
well as pharmacological interventions and graduate and post-graduate levels. A few
referral. Standardization of training methods by Schools of Social Work like TISS and Indian Red
using indicators for evaluation has been done Cross have started full-fledged courses.
and the same has been imparted in large-scale
training programmes, subsequent to the 2.4 Research
tsunami disaster.
i) Indian Mental Health and Social
2.3.4 Training Material Science researchers have been keenly
Training manuals for different categories involved in carrying out research on the
of care-providers like medical officers, mental health aspects of disasters for
community level workers and the community more than two decades. The nature
were developed both for general and disaster of issues addressed in various
specific situations by organizations like research studies have undergone a
NIMHANS and WHO. These manuals were significant change. These range from
developed, keeping in mind prevailing local a pure epidemiological head-counting
culture and customs and are available in regional of mentally ill, through normative
languages to benefit the community. approach to know about the overall
human experiences and behaviour in
The material on the care of care- providers
disaster situations to intervention-
is available to help care-providers and their
based research.
organizations to take care of their emotional
needs. Information, education and ii) Institutions like WHO and ICMR have
communication material was also developed to a credible record of supporting
disseminate information and create awareness research studies for disasters like the
among the disaster-affected communities and Bhopal gas tragedy, Latur and Gujarat
the general population. earthquakes, and Tsunami. Institutions
like NIMHANS, IHBAS, MIMH and
2.3.5 Recent Progress in Training and many medical college psychiatry
Capacity Development departments have been involved in
Steady progress has been noticed in the these research projects as well as
last two decades in training and capacity other research studies.

13
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

iii) Research studies have focused on conducted workshops and


various aspects of response and conferences to share their
rehabilitative measures. Some studies experiences, which advocated the
have established the gross inadequacy need for PSSMHS in a disaster
of trained manpower and availability of situation. The experience from
services for the disaster- affected previous disasters shows that often
community. A few long-term research the mental health professionals and
studies have also established mental agencies, carrying out research for
health morbidity and outcome. psycho-social and mental health
aspects of disasters, also delivered
iv) Conclusions can be drawn from the
services either as a part of ethical
few short and long-term research
obligation or independent of that.
studies conducted by various
These research works have shown no
institutions which reveal the following:
uniform pattern and are generally
1) Definite need of providing PSSMHS
sporadic in nature. There is a wide gap
to the disaster-affected community as
in co-ordination among different
emergency psycho-social first aid and
agencies and a lot of duplication of
long-term recovery and rehabilitation
services is seen.
support. 2) Common mental health
disorders reported in the post-disaster ii) Inter-convergence of mental health
studies are depression, anxiety, services with general relief work and
somatoform disorder, and alcohol and general health services did occur to
substance abuse. 3) Post-Traumatic some extent, as a result of training of
Stress Disorder has not been found to medical officers, health workers and
be the most common disorder as CLWs in providing PSSMHS.
reported by many western countries. Significantly, inter-sectoral convergence
4) There is a significant gap between between government, NGOs and
need and service provision. international agencies occurred to a
limited extent. However, no inter-
2.5 Convergence and Integration sectoral convergence with non-health
sectors in planning or actual delivery of
i) Integration of PSSMHS with relief and services has occurred.
rehabilitation support involving
different departments of Government 2.5.1 International, Public and Private
and NGO sector, combined with Sector Initiatives
various training and research activities, Functionally, the PSSMHS has broadened
is essential for optimum utilisation of from a counselling and medical approach to a
the limited resources. Yet very limited more comprehensive and integrated approach,
work has been done for this crucial incorporating social and economic dimensions.
aspect. In this direction, professionals, These developments have enlisted more
administrators and other key players organizations to take up PSSMHS to empower
involved in the PSSMHS of disasters, the community and to deliver these

14
PRESENT STATUS AND CONTEXT

interventions. A number of international, public and Social Welfare of various state governments
and private institutions have played a significant are responsible for providing psycho-social care
role in the area of community preparedness. to the affected communities in conjunction with
the nodal agency NIMHANS. Further, the efforts
The UN agencies (such as WHO, UNFPA,
of the international NGOs also helped to
UNICEF, UNESCO and the UNDP) contributed
converge the efforts of the government and
to the standardization of approaches and
the non-government organizations in the area
processes, supporting the Government
of PSSMHS.
agencies in training, material development,
stocktaking and policy formulation. It is Donor agencies such as WHO, UNICEF,
important to mention here the Inter-Agency USAID, ECHO, DFID and other bilateral donor
Standing Committee (IASC) Guidelines on agencies play an important role by supporting
Mental Health and Psycho-Social Support in these efforts, thus helping the overall evolution
Emergency Settings, (2007), was developed to of PSSMHS in India.
provide a range of essential guidelines in this
area. The objectives of these guidelines are to 2.6 Genesis of National Disaster
enable the humanitarian actors to plan, establish Management Guidelines :
and co-ordinate a set of minimum multi-sectoral Psycho-Social Support and
responses to protect and improve people's Mental Health Services in
mental health and psycho-social well-being in
Disasters
the midst of an emergency.
Various International and National NGOs One of the important roles of NDMA is to
have contributed significantly to the evolution issue guidelines to ministries/departments and
states to evolve their DM Plan for holistic and
of the PSSMHS to its current level. The NGOs
co-ordinated management of disasters as
have carefully analysed and understood the
identified in the DM Act, (2005). In the year
vulnerability caused by emotional trauma after
(2006), a core group was formed to draft
disasters and discovered the socio-economic
National Guidelines on Medical Preparedness
dimensions of the emotional trauma. These
and Mass Casuality Management and on the
organizations have provided psycho-social first
recommendations of the mental health experts
aid, developed educational and informational
from the core group to expand the importance
materials and done capacity building at the
of PSSMHS to a larger framework to formulate
community level and provided psycho-social
guidelines on PSSMHS. In this direction, a
support to the affected people. Further, they
National meeting of experts in Psycho-Social
contributed by identifying specific needs of the
Support and Mental Health Services was
affected community, documenting their
convened by NDMA at its headquarters in New
experiences and creating a dedicated work
Delhi in January (2007) as part of a nine -step
force to work in disasters.
participatory and consultative process to
The government being the main deliberate the present status of PSSMHS and
responder, played a pivotal role in all the evolve the National Disaster Management
disasters. The Ministries of Health, Education, Guidelines : Psycho-Social Support and Mental

15
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Health Services in disasters. Stakeholders from A Core Group of Experts comprising major
various ministries/departments of GoI (Health, stakeholders as well as state representatives
Home Affairs, Defence) R&D organizations/ was constituted under the chairmanship of Lt.
Institutes [NIMHANS, TISS, AFMC and IHBAS]. Gen. (Dr.) J. R. Bhardwaj, PVSM, AVSM, VSM,
Professional institutions and professionals, PHS (Retd.), Member, NDMA to assist in
NGOs and experts, in the field of Psycho-Social preparing the Guidelines. Several meetings of
Support and Mental Health in disasters the Core Group were held to review the draft
participated in the deliberations. The present versions of the Guidelines in consultation with
status of the management of PSSMHS during concerned ministries, nodal and technical
the disasters in the country was discussed and institutions and other stakeholders to evolve a
important gaps were identified. The meeting consensus on the various issues regarding the
also identified priority areas for prevention, Guidelines. Then the draft document was sent
mitigation and preparedness for Psycho-Social to experts who are actively working in the field
Support and Mental Health Services in disasters of PSSMHS across the country for feedback and
and provided an outline of comprehensive comments. The comments obtained were
guidelines to be formulated as a guide for the discussed by the Core Group and necessary
preparation of action plans by ministries/ amendments were made.
departments/states. A future course of action
was set.

16
3 Salient Gaps

The chapter provides a description of the to address the following points in planning and
situational analysis in the areas of service co-ordination.
delivery, capacity development and research in i) There has been limited planning with
relation to PSSMHS in disaster situations in the
regard to immediate response in the
country. The past experience of PSSMHS,
area of physical and material response
notably after the Bhopal gas Disaster in (1984),
for the survivors of disasters. There
the (1993) Latur earthquake, the Orissa super
has been complete lack of planning for
cyclone of (1999), Gujarat earthquake of (2001),
preparedness and capacity
Tsunami in (2004), and the Kashmir earthquake
development for PSSMHS.
of (2005) has repeatedly brought out the
psycho-social needs of the survivors, ii) PSSMHS has been planned as a stand-
notwithstanding the progress made in various alone vertical programme in most of
aspects of disaster PSSMHS. A closer look into the disasters. There is a need to plan
these activities reveals that there have been and adopt an integrated and inter-
certain noticeable gaps both in terms of macro sectoral approach to address
issues of policy, strategies and planning as well immediate and long-term needs in the
as micro issues of preparedness, field logistics, field of PSSMHS.
co-ordination and implementation. This section
iii) Mental health professionals have
identifies the important gaps and scope for
usually been issued instructions to
improvement in the legal, institutional and
accompany the medical teams
operational framework to institute
dispatched to the disaster-affected
preparedness and put forth a robust response.
areas. It would be better if they were
The experience shows that the overall actively and appropriately involved in
approach in PSSMHS has been medical rather the planning process of PSSMHS.
than bio-psycho-social. The activities have
iv) PSSMHS is largely considered as a
mostly been short-term and natural disaster
oriented. These perceivable gaps, if addressed, "time-bound" activity, whereas the real
will further strengthen the preparedness and need of reconciliation goes along with
response for PSSMHS. long-term rehabilitation itself. PSSMHS
needs to be planned not as a "time-
3.1 Operational Framework bound" activity but rather as a "time-
line" activity for a period of 3-5 years
3.1.1 Planning and Co-ordination and sometimes even more than that.
Planning and co-ordination has been a vital v) Inter-agency co-ordination has been
aspect of PSSMHS intervention. It is necessary found lacking between those who are

17
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

involved in providing PSSMHS and the the enhanced requirements for PSSMHS during
general relief providing agencies. disaster situations.
There is inadequate co-ordination even There is lack of standardized tools in the
among PSSMHS providers thus form of manuals and indicators for a systematic
resulting in duplication of services or approach which are required by care-providers
uneven distribution of services. for PSSMHS.
3.1.2 Service Requirements and Delivery Most of the PSSMHS activity models that
3.1.2.1 Assessment were extended earlier were focused on
immediate interventions. They did not have
Based on the Geographical Information
sustainability to ensure availability of such
System (GIS) mapping of the area it is essential to
programmes for long-term relief and
carry out a comprehensive risk and vulnerability
rehabilitation programmes.
assessment as a part of preparedness activity. This
will ensure proper implementation of PSSMHS Existing PSSMHS programmes are based
programme at the time of disaster. on the concepts developed by donor agencies
without the participation of, and deliberations
Overwhelming response during the initial
with, the community as well as NGOs working
period of disaster, i.e., by providing too much
in the area. These programmes also get the
relief followed by its quick weaning, needs to
priorities and time lines as per the priorities laid
be replaced by appropriately designed phase-
down by the donor agencies, quite often
wise response. There is a necessity to
disregarding priorities and needs of the
streamline the proportionate services based on
community.
need assessment.
3.1.2.4 Integration
3.1.2.2 Manpower
The PSSMHS services have been mainly
There is an acute shortage of skilled
provided by organizations from out of disaster-
service providers both in psycho-social support
affected area. They have inadequate knowledge
and mental health care services. Even
of the cultural beliefs and practices and the
professionals lack adequate training for PSSMHS
community priorities of the affected population,
during disasters.
resulting in half-hearted acceptance and impact
3.1.2.3 Service Delivery of such services. These organizations often do
not collaborate with local authorities, thus
The mental health services in the country
affecting adversely the long-term sustainability
have been mainly concentrated in the
of the interventions.
psychiatric units of tertiary hospitals and the
psychiatric hospitals of different states, or in There is an urgent need for integration
large cities. The District Mental Health of government and non-government and other
Programme (DMHP) has so far been private care-providers engaged in activities
implemented in only one-sixth of the districts related to PSSMHS. A workable permanent
in the country. At present, the mental health Public-Private Partnership (PPP) model is
services in the country are inadequate to meet presently lacking.

18
SALIENT GAPS

There is a strong need to integrate and care-providers. Necessary ethical guidelines are
co-ordinate the various kinds of PSSMHS also not available for PSSMHS.
provided by different agencies. It will avoid
3.1.2.7 Monitoring and Evaluation
duplication of services and ensure appropriate
delivery of services. There is no institutional mechanism for
monitoring and evaluating the progress and
3.1.2.5 Planning
impact of services at different levels and phases
The service provision in PSSMHS is not of disaster management.
‘all hazard’ focused. It should include all types
Necessary mechanism and protocols are
of disasters, including populations affected by
required to assess the quality of the
conflict situations and internally migrated/
programmes, which should ultimately lead to
displaced communities and disasters of low
accreditation of programmes by nodal
intensity.
Institutions.
The services provided have primarily
It is essential to develop measures and
followed a medical model whereas there is a
outcome inputs for different programmes run
strong need to devise a bio-psycho-social-model
by various stakeholders. Standardized indicators
of care. The shift from medical model to psycho-
are required to be developed for such
socio-medical model, begun with Orissa super
programmes to make these prgrammes
cyclone, Gujarat earthquake, Tsunami and
effective. Sample indicators are given in
Kashmir earthquake, is required to be
Annexure B.
strengthened.
Specific intervention models for 3.2 Capacity Development
vulnerable groups, alcohol and substance
Capacity building means creating
dependents have been devised but have not
compatible infrastructure and enhancing
been applied to a desirable extent during
knowledge, skills and abilities of people to
disasters.
empower them. It would enable them to
The mental health services have seldom respond promptly and efficiently in pre, during
utilized the local best practices and indigenous and post-disaster phases. The following are
systems of care, resulting in vertical system of some of the significant limitations identified in
care with limited resources. It is essential to the aspect of capacity building in PSSMHS.
adopt and integrate well tested and recognised
3.2.1 Human Resource Development
methods of intervention for PSSMHS.
Trained manpower to provide PSSMHS is
3.1.2.6 Ethical Considerations
inadequate in our country and the issue has not
During disasters, it has been observed been addressed in a proper and systematic
that the ethical norms necessary to maintain manner for disaster situations. For the
the dignity of the individual and the community management of PSSMHS, there has been
are usually compromised. It is because of inadequate capacity for major disasters like the
inadequate resources, pressure to respond Orissa super cyclone, Gujarat earthquake,
within short periods and lack of training of the Tsunami and Kashmir earthquake, both in the

19
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

government and NGO sectors. It has been vii) Some basic components of PSSMHS
observed that there is: for disaster, need to be included in the
education curriculum of the health
i) Lack of database of trained manpower
sector at undergraduate level and
and infrastructure, limits the service
psychology and social work at master’s
providers in mobilising existing
level.
resources in the affected areas. There
is underutilisation or non-utilisation of viii) There is an urgent need for more
available trained manpower in disaster mental health specialists for providing
situations. PSSMHS. Newer strategies are
required to be adopted to train more
ii) Most of human resource development
mental health specialists like clinical
at community level has been focusing
psychologists, psychiatric social
only on short-term interventions. Such
workers, and psychiatrists who shall
an approach is not ideal for proper
train community level workers.
PSSMHS.
ix) Documented literature is available for
iii) Earlier, human resource development
awareness and training for various
was mainly focused on training of
types of disasters. But most of the
health workers and medical doctors.
documents do not mention anything
Recently, the focus has been
about psycho-social needs and mental
broadened to other departments of
health care during disasters.
education, welfare, community level
workers and local volunteers. It was 3.3 Implementation and
done only during the response phase
Co-ordination
of Orissa super cyclone, Gujarat
earthquake, Tsunami and Kashmir The following are the key lacunae,
earthquake–and not extended to identified in co-ordination and implementation
preparedness. of PSSMHS. There is complete absence of co-
iv) There is a lack of inventory on the ordination amongst various stakeholders who
are responsible for PSSMHS during disasters.
availability of skilled and trained
A predetermined co-ordination mechanism is
personnel at district or state levels.
essential for proper implementation of PSSMHS.
v) There is inadequate networking and
i) PSSMHS has always been provided in
institutional framework for training and
isolation by various agencies with little
capacity development for PSSMHS in
inter-agency co-ordination. There is
the country.
also lack of local and regional level co-
vi) There has been no mention of ordination for PSSMHS. The present
PSSMHS for disaster management in approaches for intervention are either
the District Mental Health Programme. medical or psychological, or
This will need a revisit to DMHP by the sociological in nature which lack in an
nodal ministry (MoH&FW). integrated bio-psycho-social approach.

20
SALIENT GAPS

ii) The PSSMHS services are poorly co- areas of basic and applied research and
ordinated and integrated with general development that need to be considered are:
relief work and only partially integrated
i) There is no identified body which
with general health work. screens and passes proposals based on
iii) Mostly, there were no well-defined/ local or scientific 'need', nor which acts
designated agencies for as a `gate-keeper' for the vulnerable
implementation of PSSMHS activities, communities facing the disaster. The
except in the Tsunami and Kashmir institutional research boards/ethics
earthquake. Thus, the accountability committees may not be able to capture
could not be decided for PSSMHS in all the aspects of research proposals in
most of the disasters. There has been relation to the ethical implications to the
complete lack of established local situation after a disaster.
institutional mechanism for planning ii) Ethical guidelines for conducting
and implementation of PSSMHS research are non existent or in
activities. adequate. It is because of donor driven
iv) The potential of the District Mental research are publication driven
Health Programme for providing research. Hence the need of the
PSSMHS, needs to be reviewed survivours are not properly taken care
carefully. This is attributable to lack of of. This deprives the professinals or
proper evaluation of effectiveness and the host communities of the relevant
impact of the programme in delivery knowledge to plan the rehabilition.
of basic mental health services. In view iii) Documentation to disseminate either
of the integration of district mental scientific findings to the research
health programmes with primary community and professionals or the
health centre, it is essential to review host communities to plan their own
and strengthen the functioning of PHC. rehabilitation is at times delayed by
It is because of its additional years together, losing much of its
responsibilities of providing PSSMHS, relevance and application.
so that PSSMHS programmes can be
iv) Trans-cultural issues related to disaster
properly implemented.
mental health such as occurrence and
manifestation of PTSD, community
3.4 Research and Development
responses to disasters, individual and
Research and development are the most group resilience to the psychological
important tools of PSSMHS intervention. The consequences of the disasters have
systematic tracking of every level of not been researched.
intervention and scientific analysis of v) There is no research on non-exposed
effectiveness of service delivery and outcomes cohort studies. Research using
will provide avenues to identify the controlled experimental design is also
shortcomings and improve service delivery. The lacking.

21
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

vi) Studies on the possible correlation The following are the major deficiencies
between severity of disaster and its in the area :
psychological consequences are
i) Absence of proper format for
inadequate.
documentation.
vii) Though the resilience of people in
ii) Lack of adequate knowledge among
developing countries is emphasised,
first responders in documentation.
very little research has been initiated
to try to understand the factors iii) Complete lack of knowledge about the
underlying the concept. management of information.

viii) Research on protective and risk factors iv) Absence of reassuring entry of skilled
for diverse groups and regions is manpower.
lacking. v) Documentation has at best been need
ix) Culturally relevant concepts such as driven, such as conducting `needs
'Collective trauma', or the particular assessment' or case studies to
meanings of cultural groups to various negotiate with the state bureaucracy
responses are not understood as they or national and international donors.
are not studied in depth. Reports and other forms of
documentation are mainly for
x) There are comparatively few scholars
accessing resources.
researching the subject at the doctoral
or post-doctoral level. It highlights the vi) During disasters, there are no uniform,
need for conceptual exploration in this structured guidlines for
field with sound and rigorous methods documentations. There are no clear-
and from the public health perspective. cut ethical guidelines laid down for
providing PSSMHS.
xi) There are no studies available that
indicate the differences between the vii) There are no generic manuals on
psycho-social and mental health natural and man-made disasters that
impacts caused by natural and man- could be adapted to specific disasters.
made disasters. viii) There is no accepted and documented
xii) There is no gender and vulnerable framework within which PSSMHS can
population specific tools or studies be planned and implemented. There
about the psycho-social impacts. is also not enough documentation on
indicators of the outcome of PSSMHS.
3.5 Documentation Disaster situations need to be looked
at in a continuum, as actions taken
It is very important to document each and during various phases have an impact
every event during a disaster, integrating details on each other. Therefore, there is a
about the number and the quality of services need for a common framework within
provided during disasters. which different actors can plan their

22
SALIENT GAPS

PSSMHS so that programmes and well as gaps in planning and


outcomes are comparable. A implementation of the programmes.
framework also makes it possible to
generate measurable and comparable 3.6 Finance
indicators of outcome.
Disaster management has earmarked
ix) The increasing influence/impact of the funds for emergency response which the state
media in reporting and recording can operate, namely the Calamity Relief Fund
disasters has not been researched to (CRF) and National Calamity Contingency Fund
study its growing impact on resource (NCCF). However, the disasters for which CRF
mobilisation and giving visibility to and NCCF can be utilized are defined. PSSMHS
issues of PSSMHS. must be brought under purview of CRF/NCCF.
Also under the provision of DM Act, (2005),
x) Much of the documentation in
adequate funds need to be earmarked for
disasters and mental health is in the
provision of PSSMHS in disaster situations.
form of reports to meet the
requirements of contributors or state The National Disaster Response Fund will
institutions. There is inadequate be created and adequate funds earmarked for
scientific documentation of the local the management of PSSMHS in disasters from
experiences at the national or global this fund.
level. Though professionals from fields Adequate financing for disaster
such as psychiatry, social work, prevention, preparedness, rehabilitation and
psychology, sociology etc., have been management in PSSMHS at national, state and
published in reviewed publications this district levels has not been addressed properly.
has been sporadic and based on The authorities concerned need adequate
individual or institutional needs. There earmarked funds to strengthen PSSMHS. These
has been no mandatory reflective issues are required to be addressed on priority
publication of the Indian experiences basis so that the funds are made available for
which highlights the progress as long-term planning and preparedness.

23
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

4 Guidelines for Disaster


Preparedness in PSSMHS

Disaster management involves a planned 4.1 Legislative Framework


and systematic approach towards understanding
The policies, programmes and action plans
and solving problems in the wake of a disaster.
need to be supported by appropriate legal
Natural or man-made disasters can be
instruments, wherever necessary, for effective
prevented or mitigated by proper planning and
management of PSSMHS in disasters. It is
preparedness. The guidelines address all
important to develop a robust, though flexible,
aspects of PSSMHS, including prevention,
legal framework for achieving the above
mitigation, preparedness, response, relief, objectives. The existing Acts, Rules and
rehabilitation and recovery. All important Regulations at various levels will be reviewed
stakeholders including MoH&FW, other line and amended by the nodal ministry/state
ministries and departments along with the governments/local authorities. The proposed
mental health professionals and community draft legislation should also enable the
shall prepare themselves to achieve this government to access equipment/ training
objective. All concerned central ministries and available in the private sector. New Acts or
departments of health in the states will prepare Regulations, if needed, will be enacted and Rules
for the management of PSSMHS intervention laid down to strengthen the management of
based on the guidelines and will constitute the PSSMHS in disasters at the centre, state and
national resource for the management of district levels.
PSSMHS. The nodal ministry shall also lay down 4.1.1 Policy, Plans and Programmes
clear policies and plans including appropriate The Ministry of Health and Family Welfare
institutional and operational framework that (MoH&FW) is the nodal ministry which will evolve
addresses all aspects of PSSMHS. The plans and programmes for prevention,
preparedness and response plan is to be preparedness and mitigation and response to
prepared at the centre, state and district levels PSSMHS in disasters. The plans and policies
with the role and responsibilities of various will be a part of the National Mental Health
stakeholders clearly defined. Disaster plans will Programme.
be prepared by the nodal central ministry, state i) The primary responsibility of managing
and district authorities on the basis of the PSSMHS in disasters vests with the
guidelines issued by the national and state state governments as health is a state
authorities. subject. The central government will

24
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

support the states in terms of guidance, iii) In the districts, DDMAs will provide the
technical expertise, and with human and requisite management structure for
material logistics. All the states will district DM, factoring in the
develop their own plans and guidelines requirements for managing PSSMHS
for managing PSSMHS in disasters, in in disasters. At the district level,
accordance with the national guidelines. requisite PSSMHS management
structure will be integrated into
ii) PSSMHS interventions will be planned
medical preparedness as part of district
and integrated in NMHP and DMHP.
health plan. Ministries, departments
4.1.2 Institutional and Operational and district authorities will encourage
Framework participation of private institutions,
PSSMHS is a part of the general health NGOs and community level social
programme but it is a specialised component workers in providing PSSMHS.
of health during disasters and it needs to iv) The strategic approach for
integrate with plans prepared by nodal management of PSSMHS in disasters
ministries, state health departments and district would include responsible participation
authorities. The plans for PSSMHS will be of the government, private sector,
prepared, based on the national guidelines, NGOs and civil society.
national policies and NMHP. This will be v) Implementation of PSSMHS services
integrated with health plans at all levels. delivery can be ensured only through
MoH&FW will be the nodal ministry at the centre. well prepared plans based on the
Other line ministries shall have health plans guidelines. The plan will provide
based on national guidelines and will be adequate infrastructure and human
networked with plans prepared by MoH&FW. resources, training, public awareness
and public participation which are
The existing nodal institute like NIMHANS
important components of
need to be declared as centres of excellence
preparedness.
and create regional institutes to cater to the
different regions of the country.
4.2 Planning and Preparedness
i) The existing medical college hospitals
and universities and schools of social Planning is the first step in disaster
preparedness and it includes planning for
work will be made centres of PSSMHS
different phases of disaster. Psycho-social
in disasters. This would require
support and mental health services for disaster
upgradation in terms of infrastructure
prone and vulnerable areas shall be planned
and human resource development.
much ahead of any disaster. Planning shall not
ii) The institutions which are providing be done in isolation to create a stand-alone
technical expertise for PSSMHS during vertical programme for psycho-social support
disasters require capacity development and mental health. It shall be a component of
in the areas of teaching, training and overall planning for disaster management with
research. an aim of providing psycho-social support and

25
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

mental health services integrated with health- PSSMHS should be reviewed periodically. The
care and general relief work. Planning should review meetings of the working group shall take
emphasise appropriate inter-sectoral as well as place at district and state levels. It will also be
intra-sectoral collaboration and horizontal as well reviewed by the National Co-ordination
as vertical co-ordination among various agencies Committee on PSSMHS at the national level. A
involved in disaster management. checklist on disaster preparedness should be
developed and used for review of preparedness
i) The district shall be the primary unit
status.
for planning. The planning at state,
regional and national level is closely 4.2.2 Planning at the National and State
related to district plans. The national levels
and state level planning at macro level
Planning of PSSMHS services shall include
should include all the requirements of
national, state and district levels so as to
district level planning.
complement and facilitate each other. The broad
ii) The aim of planning and preparedness areas of actions for preparedness for PSSMHS
on disaster PSSMHS shall be at the national and state levels shall include the
targeted at short and long-term quality following:
support and services to the affected
communities in the post-disaster phase. i) MoH&FW shall constitute the National
Co-ordination Committee on PSSMHS
iii) Functionaries of DMHP and its
to co-ordinate, implement, monitor and
infrastructure shall be incorporated in the
evaluate programmes based on
institutional framework for disaster
national, mental health programme and
management for planning and delivering
plans prepared by the nodal ministry.
mental health services component.
This plan will integrate with general
Proposed expansion of NMHP to cover
health plans for disasters up to district
most of the districts during 11th plan may
level.
provide adequate opportunity for such
linkages. Planning of NMHP including its ii) At present NIMHANS is the only nodal
programme components, training institute which offers expertise in
materials, programmes and research shall capacity development, training human
be appropriately modified. resources and research. Hence, it
Consequently, mental health aspect of needs to be nominated as a centre for
disaster management to make such excellence. A number of other regional
linkages successful shall be included in institutions shall also be nominated as
it. nodal centeres to meet the enhanced
4.2.1 Review and Regular Updating requirement of training and capacity
development.
The planned preparedness programme
needs systematic monitoring. The execution of iii) The MoH&FW shall coordinate with
planning for preparedness has to be monitored other line ministries and departments
and the preparedness status regarding who have similar roles in PSSMHS so

26
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

that the programmes are implemented oriented uniform model for


uniformly. implementation across the country.
iv) Efforts of MoH&FW shall be viii) Structured and standardized capacity
strengthened by other ministries who building programme for different
will play a vital role in co-ordination, training modules of PSSMHS shall be
training and implementation of developed.
PSSMHS. This would include ministries ix) To ensure quality of service in the area
of Labour, Women and Child Welfare, of PSSMHS, an accreditation system
Human Resource Development and for agencies working in this field shall
Social Welfare. be developed.
v) State authorities shall ensure inclusion x) To ensure quality control and issues
of PSSMHS as an integral part of related to ethics and human rights
disaster planning for preparedness and during disaster management,
response, relief and rehabilitation. The appropriate qualitative indicators,
district plans shall include PSSMHS as monitoring and evaluation procedures
part of general health care and relief shall be developed.
work in the disasters.
xi) All the response plans shall adequately
vi) To ensure disaster preparedness for adhere to the concerns, related to
PSSMHS at the district level, a nodal PSSMHS so that all vulnerable groups
officer from DMHP will be appointed are adequately attended, on priority
He/She shall work closely with the Chief basis.
Medical Officer as well as to co-ordinate
4.2.3 Resource Mapping
and monitor PSSMHS. A standard
intervention model shall be duly All the stakeholders involved in the
prepared incorporating national and PSSMHS will require adequate trained personnel
international best practices. This shall for proper implementation of the programme.
achieve uniformity in PSSMHS across the The inventory of such persons shall be
country. The districts shall plan adequate maintained by MoH&FW at centre, state health
funds for implementation of PSSMHS. departments and district health department and
will focus on the following:
vii) The present scenario depicts a
complete lack of uniform intervention i) Resource mapping needs to be carried
modules of PSSMHS in disasters. The out both at macro and micro level to
modules of PSSMHS in complex ascertain the existing infrastructure,
emergencies/situations need to study material and manpower resources in
both national and international terms of their availability and adequacy
experiences and collaborate/tie up with to provide PSSMHS.
national and international bodies/ ii) The potential stakeholders in PSSMHS
agencies. The module shall incorporate at the national, state and district and
best practices to develop a culturally community resources will be

27
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

systematically mapped to facilitate the programmes (like NMHP/DMHP, NRHM) as well


total care and long-term care to the as non-health development programmes like
disaster-affected. Rural Employees Scheme, Community
iii) Data of PSSMHS resources including Development Programme, NSS/NYK
government, non-government and civil programmes.
society organizations will be Functionaries of DMHP its infrastructure
continuously updated to create a should be incorporated in the institutional
national pool of resources to help the framework for disaster management for
ministries and departments at the planning and delivering mental health services
centre and states respectively. component. The proposed expansion of NMHP
iv) Potential care-providers within the to cover most of the districts during 11th plan
community shall be identified, trained may provide adequate opportunity for such
and included in the network of linkages. The planning of NMHP including its
potential resources for PSSMHS in programme components, training materials,
disaster management. programmes and research should be
v) The mental health service infrastructure appropriately modified to include mental health
such as hospitals, health centres, social aspect of disaster management to make such
welfare centres where psycho-social or linkages successful
mental health services are provided in The proper linkages between PSSMHS
the district shall be mapped and and developmental programmes will reduce the
networked to provide PSSMHS.
expenditure on PSSMHS preparedness. It will
4.2.4 Preparedness for PSSMHS also improve the quality and impact of
developmental programme. The linkage is also
There is an urgent need for preparedness
in the field of psycho-social and mental health likely to add a humane aspect to the
care in the management of effects of disasters. developmental programmes
The need for institutionalising PSSMHS is
integral to preparedness, nested within the DM.
4.3 Institutional Framework for
The PSSMHS preparedness seeks to anticipate PSSMHS
emergencies/disasters and respond to them in
4.3.1 Institutional Framework at the
an effective manner to provide holistic service
National Level
delivery both on short- and long-term basis.
In order to respond effectively in disasters, The MoH&FW would continue to be the
a well-planned, integrated and co-ordinated effort nodal ministry for managing PSSMHS in
shall be made for PSSMHS preparedness. It shall disasters. The institutional framework for
be based on the existing best practices—national PSSMHS will be part of the overall health
as well as international–and incorporating intervention in disaster preparedness. An
lessons learnt from past experiences. institutional framework operating at the state
The preparedness activities for PSSMHS and district levels needs to be established by
can be formally linked with various health the state governments.

28
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

The following are inportant aspects; preparedness phase as part of


institutional framework. It will result in
i) This institutional framework shall be a
a with clearly defined chain of
part of the larger overall institutional
command and accountability at
framework for disaster management
administrative and technical levels.
horizontally at district level and
vertically at state and national level as vi) The preparedness for PSSMHS shall
per the Disaster Management Act, simultaneously occur from district to
(2005). state to national level. The institutional
framework for implementation at the
ii) The PSSMHS shall be an integral part
micro level, needs to be identified and
of the state and District Disaster
formalised in accordance with the local
Management Plan (DDMP). The
administrative and government
preparedness is done as per the action
agencies like the Block Development
plans. It shall be the joint responsibility
Office and the local Panchayati Raj
of the nodal officer for PSSMHS as well
institutions that keep an account of
as chairpersons of SDMA and DDMA
available resources and services.
to ensure the integration with the
overall state disaster management plan vii) The strengths and the potential of the
and DDMP. local communities shall be channelised
appropriately by the local administrative
iii) The mechanism for co-ordination
agencies. Therefore, service-providers
among agencies with varied
and functionaries at three levels, a)
backgrounds, goals, visions,
village/local communities, b) block/
objectives, expertise and resources
taluka c) district level will be identified
should be evolved through mutual
in health sector, non-health
consultations and discussions. This government sectors like welfare,
shall facilitate successful education, women and child
implementation of PSSMHS activities development etc., NGO sector,
in a disaster situation. corporate sector and local community
iv) A small working group comprising the organizations to include them as a part
nodal officer and other designated focal of institutional framework. They will be
points from other line departments, given appropriate basic training. Many
NGOs and selected community leaders of them will receive advanced training
shall be formed at state and district in providing PSSMHS during disaster
levels. This will help in effective situations by the nodal institutions as
planning, execution, monitoring and arranged by district authorities.
evaluation of the PSSMHS activities. viii) The health institutions are the key
v) The roles and responsibilities of various modem of mental health service
functionaries and service providers delivery specifically in linkage and
during disaster situations shall be collaboration with the local unit/team of
broadly delineated during the NMHP of the Government of India.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

The broad ranging component of universities and the state level NGOs
psycho-social support requiries working in the welfare sector.
involvement of health agencies. It goes
iii) SDMAs shall co-ordinate and ensure
well beyond the health or the welfare
the participation of the department of
sectors and needs multi-sector
social welfare, along with the
participation/co-ordination for smooth
departments of social work in the state
PSSMHS delivery.
universities and other state level NGOs
4.3.2 Institutional Framework at the State for PSSMHS.
and District levels
4.4 Capacity Development
The framework for PSSMHS at the state
level may be most beneficially evolved and Capacity development in the psycho-social
operationalised keeping in mind the linkages support and mental health is a priority area.
with (a) the larger relief, recovery and There is an acute shortage of skilled human
rehabilitation activities being carried out by resources both in government and non-
district administration and (b) the state level government organizations for management of
general medical services and mental health PSSMHS. It requires all-round development of
programmes. Essentially, the PSSMHS activities human resource infrastructure, at all levels of
while being operationally linked with the state the organizations related to PSSMHS in the
level activities of the National Mental Health community. Special attention be given to the
Programme must also be planned and carried development of trained manpower, their
out in the context of specific activities being availability during disasters, knowledge
carried out by the SDMA to be meaningful. networking and scientific upgradation at all
i) All some important fectors States and levels. The capacity building also will provide a
Union Territories already have a state platform to link the psycho-social needs of the
level nodal officer and NMHP unit beneficiaries to effective programming. The
located at State Mental Health training shall include CLWs from the community.
Institute. The activities of NMHP unit 4.4.1 Human Resource
are specified and facilitated by
Human resource development is one of
department of health through the
the most challenging areas of PSSMHS due to
Principal Secretary Health who also
paucity of professionals and trained manpower.
chairs the state mental health
The requirements of survivors are so wide that
authority.
it requires immediate and dynamic attention to
ii) PSSMHS activities shall be integrated take PSSMHS to every one. The need for
with the NMHP. In addition for the development of human resource is one of the
PSSMHS component, it will be paramount areas of planning the PSSMHS
necessary to co-ordinate with the State intervention in disasters. Compared to normal
Department of Social Welfare as well situations, disasters need a rapid deployment
as schools of social work/departments of trained manpower to cater to the needs of
of social work in the state level survivors.

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GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

A few vital factors are; Education on PSSMHS may be included


i) In disasters, the need for human at the graduate and post-graduate levels in
resources is a continuous various courses in humanities and other
phenomenon where it requires professional courses. The syllabi at various
different skills at different points of levels will focus on the following areas:
time due to changing psycho-social i) At the school level, the curriculum shall
needs. The human resources in the include 'do’s' and 'don'ts', and basic
country are inadequate for such an knowledge of PSSMHS without
enormous population. Hence, the overloading the students.
need for creating both professional
ii) At the degree level the curriculum shall
and non-professional resources,
cover adverse psycho-social effects of
keeping in mind the long-term
various types of disasters and basic
implication of the psycho-social issues
knowledge of various interventions
arising out of disasters, is imperative.
and support services.
ii) The planning for human resource
iii) All professional degrees at under-
development on PSSMHS shall be
graduate and post-graduate levels shall
carried out in accordance with the
include adequate knowledge on
available human resources vis-à-vis
PSSMHS, both for preparedness and
human resource needs in the country.
response, during various types of
This planing is for implementation of
disasters.
PSSMHS based on hazard, vulnerability
and risk assessment of the districts in iv) Regulatory authorities like National
the country. However, awareness and Council of Educational Research and
sensitisation programmes for PSSMHS Training (NCERT), School Boards,
shall form an integral part of the ‘all University Grant Commission (UGC)
hazard’ district management plans. and professional bodies like All India
Council of Technical Education (AICTE)
4.4.2 Education
and Medical Council of India (MCI) shall
The need for imparting formal education ensure that the following are included
to the students has become inevitable in the syllabi as follows:
considering the increasing incidents of
a. Education programmes for non-
disasters. PSSMHS is a crucial component of
professionals, Continued
education for professionals. Basic education on
Medical Education (CME) for
psycho-social support is essential and must be
existing stakeholders.
included in the syllabi of courses run by various
regulatory bodies. Mainstreaming the disaster b. Adding or modifying a special
management knowledge in the education paper on PSSMHS, in the post-
system will facilitate prevention and mitigation graduate or other higher
of adverse psycho-social effects of disaster. courses.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

c. Part-time courses, distance duration standardized courses


education online courses for designed for the management of
higher level managers. PSSMHS during disasters.

d. Any other similar plan/activity. iii) A graded training system for Training
of Trainers (TOT) for a standard module
4.4.3 Training
on PSSMHS shall be adopted during
The need for capacity building at various the preparedness phase. The training
levels is an essential part of PSSMHS, since the of state level master trainers will be
country needs a large number of community conducted at designated national and
based resources to deal with disaster situations. regional institutes. Training of district
Adequately trained manpower shall be prepared level trainers shall be held at
through education, training, academic/ Administrative Training Institutes
professional forums, and community practices. (ATIs), District Institutes of Education
The nodal ministry MoH&FW at the centre, state and Technology (DIETs), State Institutes
and district disaster management authorities, of Health and Family Welfare (SIHFW),
centre for excellence, as well as other nodal universities and other places.
institutions will implement PSSMHS. The following iv) Similarly, the length of the training
system of training can be imparted to prepare the programme shall vary from 3 to 15
community-based resources on PSSMHS: days, depending on whether it is the
i) Standardized training will be imparted basic or the advanced course. Duration
to the mental health professionals like of training will largely depend on the
psychiatrists, psychologists, psychiatric type of the target group and the type
social workers. Training will also be of training i.e., basic/ advanced course,
given to paramedics, community level TOT, sensitisation and orientation.
workers and NGOs on PSSMHS from v) Refresher courses shall be conducted
time to time. from time to time for those who are
ii) In view of the acute shortage of already trained and are required to
psychiatrists, it is necessary to train participate in PSSMHS. These
refresher courses shall focus on latest
medical officers who can identify the
trends and the prevailing best
psychological signs and symptoms and
practices in the field of PSSMHS.
mental health problems of the affected
people going to primary health centres vi) The designated institutes for PSSMHS
to enable prevention and treatment will develop uniform training modules
measures at an early stage. The and standard intervention practices to
Continuous Medical Education (CME) be implemented all over the country.
programme for these professionals will These PSSMHS training modules shall
help them to deal with persons with be practiced and tested during various
psychological effects. These medical mock drills and simulation exercise to
officers shall be trained on short test their efficacy.

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GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

vii) A district wise resources list of all with higher mental health needs. They
skilled and trained manpower, all will also liaison with other agencies for
government and non-government different types of interventions and
organizations working in the field of provide holistic PSSMHS care.
PSSMHS shall be prepared. It shall be
xii) Civil defence is a vital resource in our
shared with all the organizations and
country which can contribute
government functionaries.
immensely in preparing the CLWs for
viii) Regular training programmes in the psycho-social first aid during the
form of CMEs, workshops and disasters.
symposiums shall be held for regular
xiii) The capacity development for First
updating and knowledge enhance-
Responders shall be ensured to
ment. The do’s and dont's of psycho-
provide Psycho-social Support to the
social aspects for natural and man-
community during the disasters.
made disasters need to be formulated
at the state and district level and xiv) Personnel of NDRF are engaged in
incorporated in the education capacity development during various
programmes of schools, colleges and preparedness activities. The training to
professional educational curriculum. NDRF first responders will be imparted
for providing both for sensitizing the
ix) Higher training of mental health
community about the psycho-social
professionals could adopt various
effects of the disasters and also
models developed by different
provide Psycho-social First Aid.
scientific organizations to manage the
psycho-social trauma caused due to 4.4.4 Research and Development
ripple effects produced by the The scientific and systematic study of
disasters as secondary disasters, disaster population and intervention needs to
including mob hysteria. be an integrated part of PSSMHS. The disaster
x) The content of training must be work is very strenuous and involves numerous
designed to suit the particular culture tasks to be performed at various levels. It is
and ethnic needs of the community. very important to record the implementation,
This will be organised in a systematic how the intervention progresses and the
manner. The training will consist of brief process involved, in a scientific manner so as
orientation followed by ongoing support to identify the best practices and gaps for fine-
and supervision. tuning of the service delivery.

xi) The training of CLWs will play an Investment in research and the wider
important role in rehabilitation by dissemination of findings are important for
involving them in identification and extending knowledge about the magnitude and
referral of the probable mentally ill causes of psycho-social and mental health
persons from the disaster-affected problems. They are also important for exploring
community and follow–up of people possibilities of prevention and improved

33
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

service delivery. It is vital to use effective are living in conflict situations like
research methods and techniques to enhance insurgency and militancy.
the quality of the PSSMHS. New research
v) Research shall focus on the specific
initiatives using evidence-based research
needs of vulnerable groups.
studies needs to be planned and conducted in
the disaster areas. The research also needs vi) Research must also be instituted to
to identify the risks and protective factors explore, identify and define the
among the population during and after psychological assessment of persons
disasters. Case control studies will be helpful who indulge in unlawful and terrorist
to determine the extent of psychological activities.
effects. vii) Epidemiological studies on the
The important aspects of Research are incidence and prevalence of mental
as follows : disorders and psycho-social effects
can be conducted on the affected
i) Basic research must focus on specific
community as well as general
needs of a community based on
population to ascertain the differences.
prevailing culture and religion to
determine specific reactions, response viii) The research must be conducted on
patterns and coping mechanism of the both short-and long-term basis keeping
community. in mind the cultural and ethical
guidelines of the research. There is an
ii) The research shall also focus on
urgent need to develop newer
existing interventional methodologies
comprehensive interventional methods
to assess their effectiveness after
that should be able to address the
determining proper indicators and
short and long-term effects of
standards. Proper research always
disasters.
includes the study of the control group.
ix) Studies shall also be carried out on
iii) There is a need to carry out research
existing international best practices in
on existing cultural best practices and
PSSMHS so that relevant best practices
those derived from alternative
are incorporated in the plans.
medicine and spiritual beliefs. Novel
intervention modules and strategies x) Specific research studies must be
must be developed where older undertaken to understand the
intervention methods are found to be vulnerability factors which are specific
ineffective. to different groups. This needs to be
studied scientifically to facilitate
iv) Research shall also be carried out for
effective intervention and holistic
determining best services intervention
recovery of the vulnerable.
modules for people who are regularly
affected by recurring disasters like xi) Research findings related to PSSMHS
floods, cyclone and drought. Attention should be widely disseminated in
shall also be paid to the people who appropriate forums for various user

34
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

groups ranging from mental health ii) Only authentic data provided by the
professionals to policy-makers and to district authorities shall be
the general public. incorporated in case reports.
xii) Research needs to be carried out on iii) The data collected shall be shared with
baseline mental health of prospective all stakeholders at all levels. Such data
care-providers and on the psycho- will be made available to the public.
social and mental health needs of the
iv) PSSMHS must also capture salient
care-providers during disaster
points, lessons learnt and best
situations.
practices of intervention.
xiii) Adaptation and validation of research
v) Proper documentation shall provide a
and survey instruments commonly
monitoring and evaluation tool to
used in disaster research, based on
determine the quality of work in
the potential research topics in the
PSSMHS.
field of PSSMHS shall be carried out
by the national and regional nodal vi) Detailed documentation needs to be
agencies. This shall be in collaboration shared periodically at the district, state
with the ICMR, academic institutions and national level for cross-learning,
and experts in research on PSSMHS feedback and future planning.
related issues. vii) All research and documentation on
4.4.5 Documentation PSSMHS will be part of the resource
centres at all levels for easy access
One of the crucial aspects of PSSMHS is
and effective use.
documentation, where it captures the process
of intervention from beginning to end. Proper 4.4.6 Community Participation
and scientific documentation provides a Community is the first responder in the
comprehensive picture about the process of event of any disaster and plays an important
PSSMHS intervention. The following are few role in response and rehabilitation and provision
important aspects of documentation: of PSSMHS to the survivors of disaster. A large
i) The centre of excellence and nodal number of community level workers (CLWs)
agency as well as /DDMAs/SDMAs shall participate as important team members for
put a systematic methodology to providing psycho-social support to the
elaborate the details of disasters, community. To standardize and streamline
preparedness, response, mitigation, community participation in PSSMHS the
quality and quantity of response following things are important.
provided to the community. This would i) Training the community, especially
help in learning lessons for future CLWs, will enhance the reach of
programmes. DDMAs and SDMAs may PSSMHS to the community and there
take the help from nodal institutions to is a need to sustain them in all the
make the standardized protocol for phases of disaster and for all hazards.
documentation in disasters. These community level workers must

35
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

be utilized in all phases of disasters community problems, likely to become


especially in preparedness phases to an appropriate context for community
create awareness and information response in a disaster situation.
dissemination among the community.
4.4.7 Role of Community Level Workers
The integration of PSSMHS intervention
with other modes of intervention will The community plays an important role
help holistic well-being and during disaster preparedness and response.
improvement of the quality of life. Community level workers help the
ii) Other members of community like Civil community in the following ways:
Defence personnel, Panchayati Raj i) Helping survivors understand the
functionaries, local non-government changes that they experience in their
and community-based organizations body and mind.
and civil society will be involved in
ii) Helping the survivors to understand
preparedness, mitigation, response
the changes one undergoes due to
and rehabilitation.
traumatic experiences and losses.
iii) Community members understand the
iii) Decreasing physical and emotional
local culture and customs better than
reactions by using basic principles of
the outsiders. Therefore, it is essential
emotional support by establishing a
to associate them in strengthening
good rapport.
awareness, and resilience of the
society. They can be involved in iv) To strengthen and improve the quality
activities like street plays, dramas, of response by the response teams.
posters, distribution of reading v) To define the immediate impact of the
material, school exhibitions and disasters and provide immediate
interaction with media and publicity. psycho-social support to the affected
iv) Standardized training and intervention community, especially when there may
modules shall be prepared by the nodal be lot of panic, fear and apprehension.
institutions for training community vi) To understand and identify local
level workers so that services provided hazards, vulnerability and risks of
by them are uniform throughout the different communities.
country.
vii) To rehabilitate and help in recovery by
v) For promoting group work in the training them for follow-up and referral
community, there is a need to inculcate programmes, designed for psycho-social
the belief that a majority of the support interventions for various types
problems in the community are of disasters.
common, needing collective response.
This will result in better community
4.4.8 Infrastructure for PSSMHS
relationship and harmony for collective The presently available infrastructure for
response to non-disaster related management of PSSMHS like mental hospitals,

36
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

clinics and professional institutions is not (DIET) and NGOs at the district level shall be
adequate and therefore there is a need to utilized for preparedness.
expand this infrastructure to all the regions of
4.4.8.1 Hospital Preparedness
the country. The PSSMHS capacity building shall
start with the upgradation of existing physical Hospital preparedness is an important
infrastructure and creation of additional part of disaster management where PSSMHS
infrastructure at the centre, state and district forms an integral part of it. It enhances the
levels. The responsibility of activities will be with hospitals' capacity to respond in the event of
the nodal ministry at the centre and the states. disasters, both in the government and private
Some significant points regarding the sector.
infrastructure are: The following are the major factors of
i) A well-equipped infrastructure will PSSMHS in hospital preparedness:
provide a good environment for i) The hospital disaster management
management of PSSMHS both in plan shall include PSSMHS as one of
preparedness and response. These the specific components.
facilities need to be designed and built
ii) Networking with other institutions for
with state-of-the-art infrastructure,
preparedness and sharing knowledge.
keeping in mind the enhanced
requirements of PSSMHS. iii) Psychiatric ward of the hospital shall
ii) Existing infrastructure will be upgraded be upgraded to meet enhanced
to suit the various needs of capacity requirements during disaster, based
building for pre and post-disaster on vulnerability and risk assessment.
situations. This infrastructure will be iv) Adequate relevant medical equipment
developed in every district based on and other investigative tools shall be
hazard, vulnerability and risk. The made available in upgraded wards.
capacity development will not be
v) In addition, these wards shall also be
limited to government sectors alone
equipped with required equipment to
but also be encouraged in the private
handle acute emergencies to take
and corporate sector.
care of vital functions of the patients.
iii) A few more zonal centres shall be
created or upgraded to meet the vi) Adequate and specialised medical
enhanced need during the disaster stores required for management of
within medical colleges. Wherever patients with psychological and mental
such institutions are not available, the disorders.
departments of psychiatry in the vii) Adequate networking/telemedicine
medical colleges can be upgraded. facilities with other hospitals, medical
The existing infrastructure under the colleges, zonal and national institutes
District Mental Health Programme (DMHP), to share and pool resources to meet
District Institute for Education and Training the challenges of larger disasters.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

4.4.8.2 Network of Institutions iv) The existing general hospital


The existing number of nodal institutions psychiatric departments and medical
engaged in capacity development in the field college units will be strengthened and
for the management of PSSMHS are few in networked with the DMHP
number. A network of such institutions at zonal programme. Special focus will be given
teaching hospital level will be established to to the already existing units.
cover the entire country for the capacity v) SDMAs and departments of health will
development of the human resources. identify medical colleges in various
A few things to be kept in view: states that would be designated and
assigned the responsibility of
i) Existing institutions shall be upgraded
formulating short courses of 3-6
and will be given responsibility to
months duration to train medical
standardize training modules for both
officers and other professionals. This
professional and non-professional
would help in combating the existing
responders. The existing structures
deficiency of psychiatrists,
and health programmers under
psychologists and psychiatric social
national health policy need to be
workers as part of the NMHP.
utilized and the programmes such as
National Rural Health Mission (NRHM) vi) Identified local universities and national
will be used for this purpose. bodies with the responsibility of
imparting education/skill training on
ii) Institutes like NIMHANS which is a
PSSMHS shall be co-ordinated to
nodal institute of MoH&FW shall be
support infrastructural inadequacies of
developed as a centre of excellence
the training providing organization
and other regional nodal centres like
institutions in the district/state.
IHBAS, MIMH, LGBMH, TISS etc. for
formulating and designing vii) The NIDM and ATI's, NIRD will train and
standardized intervention modules for build capacitates for administrative
all professionals engaged in the area officials and community
of PSSMHS, they will also be representatives. The training will be
authorised to monitor and evaluate the focusing on providing psycho-social
PSSMHS. first aid and psycho-social support.

iii) The center of excellence NIMHANS viii) The district hospitals and medical
and other regional mental health college psychiatric departments will be
institutes like IHBAS, MIMH, LGBMH nominated as referral centres.
etc. shall develop appropriate tools and A new network of institutions and
materials and standard intervention organizations needs to be developed for cross
models to tie up with the regional and learning, developing new ideas and exchange
local centres. of ideas.

38
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

4.4.8.3 Public-Private Partnership v) Health plan of the district may enrol all
private institutes and their professional
The private sector has substantial capacity
capacities and infrastructure during the
and infrastructure and plays a vital role in the
preparedness, response and
management of disasters. Many community-
mitigation phases of disasters.
based programmes were collaborated on public-
private partnership and they have successfully vi) A well-coordinated preparedness
demonstrated the effectiveness of reaching the involving the government, panchayati
needy population. raj institutions, private and corporate
sector shall be adopted for planning,
The following recommendations may bring
co-ordinating and implementing
effective results in the field of PSSMHS through
programmes. This will enable
public-private participation.
community participation and enhance
i) Collaborations between the their ownership in PSSMHS
government and the private preparedness.
organizations based on mutually
4.4.8.4 Technical and Scientific Institutions
agreeable goals and objective of the
PSSMHS intervention. Centre and state authorities will identify
ii) Private sector facilities are required to and designate technical institutions that have
be included in district-level plans. DM resources and expertise in disaster mental
plans with collaborative strategies shall health. For example, NIMHANS will be
be evolved at the district level for the designated as a centre of excellence because
utilisation of manpower and of its long-time association with the various
infrastructure. disaster mental health interventions and its
expertise in the field of PSSMHS. In addition,
iii) Private medical health facilities, IHBAS, MIMH, LGBMH, TISS and other regional
paramedical staff, NGOs and community- level nodal institutions will be identified and
based organizations must be made part designated.
of the resources. Community-based
social workers can assist in psycho-social Some relevant points about these
institutions are :
need assessment, psycho-social first aid
and psycho-social support to the i) These institutions will function as key
affected population under the responders in the PSSMHS,
supervision of PSSMHS professionals. conducting need assessment based
on the hazard, risk and vulnerability of
iv) NGOs are valuable resources since
the affected community, developing
many of them have skilled manpower
standardized and structured need
and training centres that can be utilized
assessment tools to capture the
for imparting education/skill training at
psycho-social effects after disaster.
community level, thereby maximising
the capacities and minimising capital ii) These institutions with their manpower
expenditure. and scientific resources would conduct

39
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

research to ascertain the impact of both human and physical infrastructure. The ill-
disasters, coping, resilience, particular effects of the disaster abruptly bring cessation
behaviour patterns, quality of life and in communication and results in confusion and
well being of the survivors. chaos among the population. It is vital to
develop good communication and networking
iii) These institutions will develop
among the various stakeholders in order to
appropriate intervention modules to
provide PSSMHS.
suit general as well as region-wise
requirements. Various aspects of this vital component
are :
iv) The mitigation strategies will be based
on the mission of reaching out to all i) Disaster PSSMHS communication
communities. The mitigation needs to be established at the centre,
strategies include testing, evaluation, state and district levels. There will be
and upgradation of services. Based on control centres at respective places to
the mitigation, the short and long-term control and co-ordinate the
goals of intervention and creating communication between various
infrastructure will be undertaken. responders and stakeholders.

v) There is a need to adequately train the ii) At the district level, all the hospitals
required manpower according to and PHCs will be connected with a
population and local needs. The network. There is need to have intra-
intervention needs developed shall be hospital horizontal type network
based on the other intervention to linkages to facilitate swift
integrate PSSMHS with other methods communication.
of intervention to provide a holistic iii) Communication about the affected
intervention. community’s PSSMHS needs to be
disseminated through the print and
vi) These institutions will develop models
electronic media. Creating awareness
based on preventive strategy
about PSSMHS through the media will
essentially focused to prevent the
enhance the information and
vulnerability of the population and
knowledge level among the
mitigate the post-disaster effects. The
communities to alleviate their trauma
strategy will include public health
arising out of any disaster.
preparedness, long-term plans based
on the coping and resilience factors of iv) The media also helps to destigmatise
the population and community the psycho-social effects. This helps
resources. in educating the community about the
psycho-social effects and prepares the
4.4.8.5 Communication and Networking community to face rumours, panic and
impending disasters.
Communication is a vital component of
PSSMHS intervention. Disaster poses severe v) The NGOs with their local knowledge
disruption in the community because of loss of of people and terrain make them

40
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

appropriate to disseminate information its effectiveness in facilitating recovery


about psycho-social effects of the of the affected population.
disasters. These organizations play an Incorporation of international best
important role in sensitising and practices into PSSMHS will enhance
educating the community, on PSSMHS the understanding of the intervention.
preparedness. Such agencies shall also iii) The group of organizations working in
be networked to provide PSSMHS. PSSMHS will conduct workshops,
vi) International organizations such as seminars and conferences for direct
WHO provide information, interaction, exchange of ideas and
communication and alerts on health policy enhancement, periodically.
related issues, and technical experts iv) The forum will also promote the official
in disasters. Their expertise needs to interaction of state actors to evolve
be fully utilized. new policies and programmes in the
changing dynamics of psycho-social
vii) India Disaster Resources Network
needs in the wake of present situation.
functioning under the Ministry of
Home Affairs will be upgraded with v) The management of psycho-social
PSSMHS related issues. support requires the pooling of health
resources, logistics, trained human
4.5 International Co-operation resources and other essentials at the
international level. The management of
There are many international agencies
psycho-social support requires a
currently working in the country, including the
collaborative and integrated approach
UN agencies, that carry out a number of
wherein the affected countries will
interventions like training and capacity building,
make a combined effort to mitigate the
participating in response for disaster
impact.
management including PSSMHS.
vi) International mental health institutions,
International co-operation is a necessary organizations that are involved in
element in the management of PSSMHS. PSSMHS intervention, will collaborate
Various activities that will be undertaken to in the field of PSSMHS research and
enhance harmony in the functioning of PSSMHS material development to bring in more
service are as follows: cross-learning. Adaptation of
i) Establishment of an adequate international best practices in PSSMHS
mechanism to enhance the level of intervention can bring more quality
interaction between the various state services at the local level.
and non-state actors who are required Effective management of PSSMHS in
to work in tandem during such events. disasters depends upon the level of co-
ii) PSSMHS has been one of the main ordination between various stakeholders and
interventions in disasters in developed their preparedness. Such a process is highly
countries where it has demonstrated complex at the international level and requires

41
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

the initiation and co-ordination of pre- i) Based on the GIS mapping, it is


determined plans in immediate response after essential to define the vulnerable
disaster. groups and categories so that these
group can be provided with immediate
4.6 Special Care of Vulnerable relief and be attended to first.
Groups
ii) Basic needs and minimum requirement
Disasters do not affect uniformly and their of food, water and sanitation, medical
effect differs from person to person and region cover shall be provided to vulnerable
to region. Even under normal circumstances, groups on priority basis.
vulnerable groups due to their physical, iii) The preparedness plan shall focus on
emotional and social limitations do not get the vulnerable group and may require
adequate help and support and are prone to special relief items like wheel-chairs,
both physical and psychological difficulties. medical gadgets, dignity kits for
Vulnerability is the degree to which a population, women and life saving drugs.
individual or organization is unable to anticipate,
iv) Provision of special care will be made
cope with, resist and recover from the impacts
for children, especially who have lost
of disasters. These groups of survivors are more
their parents and siblings. Special care
prone to adverse psycho-social and mental will be provided to pregnant women,
health consequences of disasters due to a women who have lost their spouse
number of reasons like age, gender, ethnicity, and family members, aged persons
disability, poor health and mental illness. Due and those with physical and mental
to these factors they are at the higher risk which disability.
varies from region to region.
v) Relief and compensation shall be
The vulnerable group consists of children, provided to these groups on priority
women, refugees, internally displaced basis as they are usually left out
population, the aged, mentally ill, the disabled, because of their physical disabilities
people with special needs. They are at increased and incapacity to access help.
risk of developing mental health difficulties. vi) Specially trained professionals and
These groups need special attention and extra workers along with the health-care
care during disasters. Therefore, it is essential workers who provide psycho-social
to prepare specific intervention manuals for support and mental health services to
vulnerable groups. disaster survivors will be deployed.
It is essential to identify these vulnerable vii) Special attention will also be paid to
groups on the basis of pre-defined parameters the public health issues like personal
and update them at regular intervals. The hygiene and sanitation, disposal of
following factors shall be kept in mind while human refuse and excreta as well as
preparing PSSMHS for vulnerable groups in to the means of transportation and
different phases of disasters. evacuation.

42
GUIDELINES FOR DISASTER PREPAREDNESS IN PSSMHS

4.6.1 Psycho-Social First Aid 4.6.2 Referral System

Immediately after the disaster there is a The psycho-social support and mental
need to provide Psycho-social First Aid (PSFA) health services are long-term interventions not
only limited to community level as a primary care
to the affected population to cope with the
but also extends to secondary and tertiary care
psycho-social trauma of exposure to the
facilities. The referral system helps to identify
disaster. PSFA helps the affected population to
and treat the affected people who require a
deal with reactions related to loss and grief
higher level of psychological and mental health
providing crisis intervention.
care by trained professionals.
i) PSFA means providing immediate The following methods shall be evolved
psycho-social intervention helping the in referral system:
affected population to deal with
i) The DMHP will co-ordinate and monitor
immediate reactions and panic related the referral services in the state and
to loss of life and property. district level. The nodal officer of the
ii) PSFA is the first basic intervention of DMHP will identify the appropriate
hospitals and professionals for referral
PSSMHS and can be given quickly by
services.
both professionals and non-
professionals. It promotes safety and ii) The identified and designated referral
protection of the survivors to hasten centres and the professionals will be
psychological recovery. networked at the state and district
levels. A database of the same will be
iii) PSFA needs to form the first line regularly updated.
response to any disasters and there
iii) The non-professionals and community
must be adequately trained
level workers will be adequately trained
professionals and non-professionals to
to do referral and follow-up of the
provide PSFA in an event of disasters. population.
iv) PSFA training and skills can be iv) Periodic reviews shall be carried out on
given to hospital emergency the status of referred people and the
paramedics, ambulance crew, various interventions provided.
community level workers, students and
other first responders in the disasters
4.7 Media Management
to enhance the reach of the PSSMHS. Media, both electronic and print, plays a
vital role in disseminating information and
v) The SDMA and the DDMA will co- education to the public. Like most first
ordinate with the State Mental Health responders who provide information to the
Authorities (SMHA) and District Mental public, government and non-government
Health Programme authorities to organizations rely on the media for information,
provide traning and services. and media reports often shape public opinion.

43
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Responsible media not only provides the iii) Dissemination of knowledge,


statistics of the disasters but also the extent of information on positive coping
the loss, vulnerability, risks and hazards of the methods through printed material or
affected area. There is a great potential to tap through visual media has the potential
the media resource for PSSMHS preparedness. to reach vast majority of the affected
population. The aim of such
Some important aspects of media
information is to increase the capacity
management are :
of individuals, families and
i) The PRO at the district level will be communities to understand the
totally responsible for providing common ways to cope with difficult
authentic reports. He will collect situations.
reports from designated nodal officers
iv) Do’s and don'ts of PSSMHS for the
of the PSSMHS plan and will distribute
media will be prepared.
it to the media for the general public.
v) The media should play a responsible
ii) Media’s role in educating and sharing
role by reporting authentically without
information about the psychological
sensationalising the issue, thus
effects of the disasters and how to
preventing panic among the public.
take care of oneself in times of stress
will be useful.

44
5 Guidelines for PSSMHS in the
Post-Disaster Phase

Psycho-social response after the disaster responsibility of the Ministry of Health and
is one of the principal areas of health Family Welfare (MoF&W) at the centre. Other
management in disaster intervention. The line ministries like Ministry of Defence (MoD),
PSSMHS response starts immediately after the Ministry of Railways (MoR), Ministry of Labour
disaster and covers the rescue, relief, Employees State Insurance Corporation (MOL,
rehabilitation and reconstruction phases. It ESIC), MoW&CD shall also prepare their
emphasises both short-and long-term needs of response plans based on these guidelines. The
the affected community. Well-coordinated and efforts from the ministries shall be used to
planned preparedness ensures effective complement the main efforts of the nodal
PSSMHS response and service delivery. ministry in a major disaster. The response plans
for the PSSMHS shall be prepared, based on
5.1 PSSMHS in the Response the National Guidelines, National Health Policy
Phase and National Mental Health Programme (NMHP).
These plans will be integrated with health plans
Effective and rapid PSSMHS response
at all levels.
helps to reduce the stress and trauma of the
affected community and facilitates speedy The following checklist could be followed
recovery by bringing them back to their pre- for the activation of response plan:
disaster level. The response will be based on
i) Emergency meeting of health sub-
the timely ‘all hazard’ PSSMHS need assessment
committee with the nodal mental health
focusing all the areas both at the macro and
officer as member under the
micro levels to respond and manage the psycho-
chairperson DDMA and representatives
social issues after the disaster. PSSMHS will be
from social welfare, department of
part of the health response plan and will be co-
education and women and child welfare.
ordinated by the central, state and district
authorities, all the stakeholders including NGOs, ii) A rapid needs assessment based on
specialised institutions, civil society the data available from the nodal
organizations and the community. agency and it shall include those from
INGOs/NGOs.
The psycho-social support after the
disasters must follow an integrated approach. iii) Availability of trained manpower for
The PSSMHS response plan is the main PSSMHS.

45
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

iv) Assessment of additional trained psycho-social care to the survivors of


manpower requirement. disasters.
v) Immediate initiation of emergency iii) Psycho-social first aid is provided in the
psycho-social first aid and evacuation initial one to six weeks period. The
of acute mentally ill persons. psycho-social first aid shall be provided
by trained CLWs and the relief and
vi) Support to vulnerable groups within
rescue workers who are provided
the affected community.
training for psycho-social first aid,
vii) Adequate arrangement for PSSMHS along with providing general relief
for recovery and rehabilitation. services.
viii) Constitute a co-ordination committee iv) The psycho-social first aid could be
that will co-ordinate and ensure provided through mass catharsis,
implementation of district mental undertaking rituals as per local
health response plan. This co- practices and culture, organising
ordination committee will also monitor regular meetings of the survivors and
the quality of services provided, helping them ventilate their feelings
availability of adequate manpower and and providing play material to children.
relief material based on the technical
Components of psycho-social first aid
advice received from regional
include:
institutions.
i) The basic human response of
5.2 Psycho-social First Aid comforting and consoling a distressed
person.
During the initial stages of the response,
the immediate support for the affected ii) Protecting the person from further
population is provided in the form of psycho- threat or distress as far as possible.
social first aid. iii) Furnishing immediate care for physical
A few salient points about the PSFA are : necessities including shelter.

i) The psycho-social first aid could be iv) Providing goal orientation and support
viewed as a process which prevents or specific reality based tasks.
further deterioration of the coping v) Facilitating reunion with loved ones
capacities of the survivors, thereby from whom the survivor has been
enhancing the chances for rapid separated.
normalisation process.
vi) Facilitating the sharing of experiences.
ii) In the absence of psycho-social first
vii) Linking the survivor to systems of
aid, the normalisation to the affected
support or sources of help that will be
community will be delayed and the
ongoing.
process of normalisation prolonged.
Hence, psycho-social first aid has a viii) Facilitating the beginning of some
great significance in provision of sense of control over the situation.

46
GUIDELINES FOR PSSMHS IN THE POST-DISASTER PHASE

ix) Identifying needs for further psycho- v) The previous experiences of providing
social first aid. culturally appropriate interventions like
MAMATA GRUHA during super
5.3 Integration with General Relief cyclone in Orissa in 1999 could be
Work explored keeping the cultural and
community sensitivity in mind. This will
Effective psycho-social support and help in developing culturally acceptable
mental health intervention requires an inter- care for the affected community.
sectoral co-ordination with the various
stakeholders. The general relief measures 5.3.1 PSSMHS in Relief Camps
begin, once the evacuation of survivors is over Relief camps are setup in large numbers
by the concerned authorities. The PSSMHS in the wake of disasters with survivors being
measures shall start with implementation of the shifted to the camps. These survivors because
health response plan. of their dislocation and displacement from
Following are the key aspects of homes, separated from families in terms of
integration of PSSMHS with the general relief gender, socio-religious cultural practices of the
work : family, results in higher amount of psychological
distress. Their functionality is reduced due to
i) It is essential to integrate emergency
unEmployees resulting and disruption in daily
psycho-social first aid as a part of health
routine. Further there are basic needs of food,
response plan and shall be instituted as
shelter and personal safety that will be at stake,
part of immediate response and relief.
especially for vulnerable groups viz., women,
ii) PSSMHS response team for Psycho- widows, adolescent girls, the aged, the injured,
social first aid will work and integrate children–orphaned and semi-orphaned.
with other first responders.
PSSMHS needs to be provided on priority
iii) While giving psycho-social first aid, basis to these vulnerable groups through group
cultural sensitivity is kept in mind and mass activities. Experience suggests that
throughout the response. The first involvement of NGOs and CBOs through health,
responders who have been sensitised education activities and by engagement of
to local cultural, traditional and ethical traditional forms of building support systems.
differences shall be utilized. Some of This shall facilitate them to grieve on their losses
the well recognised local practices may through mass catharsis, following up rituals,
be included in the first aid with the help externalisation of interest of the various groups,
of village head or local elected in building space for recreation and spiritual
representative. activities. Further normalisation of children in
iv) Community Level Workers who have their routine activities through child care activity
been sensitised and trained to provide centre within the camps will be an important
care to vulnerable groups shall be camp intervention. Persons with pre-disaster
identified and involved in the response mental illness and the disabled will be identified
and relief. by the camp medical teams and provided

47
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

available essential medication and, the post- compensation, paralegal, health-care,


disaster mentally ill can be identified and psycho-social care, education, and self-
referred and followed up through secondary help within the communities through
and tertiary service sector. the governmental departments of
health, welfare and education. Non-
5.4 Integration with the Health governmental agencies would also be
Plan encouraged to extend such psycho-
social care through community level
The integration of psycho-social support workers working with them. This
and mental health services in the general health- phase would be carried out till the year
care is an effective way of reaching care to the after the disaster.
affected people. The PSSMHS focuses on
iv) The anniversary of disaster event
integration of services with the general health-
would be carried out to externalize the
care to facilitate early identification,
emotions still prevalent among the
management, referral and follow-up of PSSMHS
survivors. Specific activities be carried
along with the medical problems so that they
out as a part of the same by the GOs
can be dealt together in an integrated manner.
and NGOs during the anniversary
In the process of integrating PSSMHS in event.
general health-care, the important aspects are:
v) The continuation of PSSMHS after a
i) The integration of PSSMHS shall start year would concentrate predominantly
at the primary health care level centres on creating a caring community by
at block and the specialised services institutionalizing the psycho-social
at district level. The community health support activities. They would include
teams will be working together with moving the survivors to permanent
the local health workers and will provide shelters as well as developing support
linkages with DMHP for referral and systems within the community.
specialised psychosocial care.
vi) The PHC workers shall provide psycho-
ii) Creating referral system for the social first aid to those who require
identified cases and which can be PSFA even after 4-6 weeks and need
referred to the nearest specialised of intensive counselling or with mental
hospital/medical college. However, health disorders requiring referral.
facilitating the follow up of the Minimal mental health care by PHC
treatment shall rest with the health medical officers must be re-activated.
department. District health authorities shall ensure
iii) Immediately after the rescue and relief the availability of treatment for the
phase with the coverage of PSFA the referred cases.
PSSMHS would enter the stage of vii) After a year or so, the physical care
psycho-social care by providing needed needs are likely to reduce further,
spectrum of care including the while PSSMHS needs till continue up

48
GUIDELINES FOR PSSMHS IN THE POST-DISASTER PHASE

to a period of 3-5 years (in case of shall accompany the patient to the
special situations, the need may referral centre.
continue till 10 years). PHC workers
iv) Linking the referral to the health
shall devote more time in providing
facilities in the field and organizations
PSSMHS to the survivors on long-term
working in traditional healing methods,
basis. District authorities shall ensure
alternative medicines and Indian
that PHC workers shall deliver PSSMHS
systems of medicines shall also be
on long-term basis to the survivors.
encouraged.

5.5 Referral System 5.6 Role of NGOs in PSSMHS


Large number of survivors only require Non-Government Organizations often play
psycho-social first aid while a fair number of an important role in psycho-social support and
them require long-term and special care. mental health services for survivors of a disaster
Therefore, a referral mechanism will be worked in rebuilding the eroded social support systems.
out for their long-term treatment and follow– There is a need to create a caring community
up. The core aim of the referral is not only to with the existing resources. Such resources can
lessen the workload but to facilitate and sustain be found among the Non- Government
long-term PSSMHS. Organizations (NGOs) and Community-Based
i) Referral is a specialised service which Organizations (CBOs).
is required when the psycho-social These organizations can provide an
disorders cannot be managed or integrated PSSMHS along with their other
resolved at the disaster site or at the rehabilitation and developmental activities for
PHC. The trained PHC team, health the survivors of the disaster and their
teams, community level workers and communities. These organizations and their
volunteers, who provide basic psycho- workers often provide effective care because
social support after the disaster, can they have better knowledge of the community,
identify the persons with psycho-social language, and customs. Survivors also readily
difficulties and mental health identify with them and form therapeutic
problems, and refer them for relationships. It is important to ensure that
professional support. these non-professional workers are
ii) Mechanism of referral shall be evolved appropriately trained, their capacities being built
for referring those already identified, with support and supervision to ensure better
affected person to zonal mental health standards of care to the survivors. These
clinic or hospital or to specialised organizations need to be regulated in terms of
mental health centres, depending their PSSMHS practices and the services they
upon the type and level of illness. provide.

iii) Proper documentation with the Currently, a large number of such NGOs
summary of illness and details of the are working in various States of the country.
treatment imparted at the disaster site Action Aid India, CARE India, SEWA, Oxfam,

49
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Lutheran World Services India, Swayam Sevak mental health impact on the
Prayog, Plan International, Medecins Sans community. Most of these practices
Frontieres, Everychild India, Terres de Hommes, have an inbuilt psycho-social coping
Mennonite Central Committee, Malteser aspect within themselves, which shall
International, Aga Khan Foundation are some be taken into consideration while
of the NGOs that are working in the area of providing PSSMHS.
PSSMHS. There are large numbers of other iii) Indian society has a very rich strength
State level or local NGOs and CBOs who have of family bonding. The strength of
integrated PSSMHS as part of their other family bonding is aptly described as
rehabilitation and rebuilding work with disaster root organization (family bonding) in
affected communities. comparison to roof organization
(nuclear family) prevailing in the
5.7 Integration of Community developed countries. This strength
Practices with PSSMHS factors need to be taken into
consideration while providing support
Community practices play a crucial role in
to the survivors as it plays an important
the process of normalisation in post-disaster
role in the support systems for the
period. The bereavement process of healing
members of the family during disasters
depends on many factors because of local
and other adverse circumstances. This
cultural, religious practices and beliefs. Well-
family bonding is very strong in the
tested and good community practices shall be
rural areas but this gradually
encouraged and integrated with PSSMHS.
decreasing in the urban areas.
Community practices strengthen the Therefore those affected in the urban
psycho-social support in many ways as given areas will require additional support
below : from the community and NGOs.
i) Integration of community practices iv) The traditional cultural practices in the
with psycho-social support shall help community including family rituals and
in developing faith in the service practices shall be encouraged and
providers and will result in better facilitated. The group activities like
development of linkages between community kitchen, community group
community and service providers services, mass prayers, spiritual
irrespective of caste, creed and discussions shall also be encouraged
religion. This builds mutual faith and in consultation with the community.
enhances better and effective rapport
v) CLWs and other PSSMHS personnel
between the service providers and
shall participate in these activities as
survivors.
much as possible to express their
ii) Certain community practices like mass oneness with the community, which in
prayers in gatherings at religious turn will enhance the acceptability of
places and singing spiritual songs have PSSMHS by CLWs and other service
significant preventive and promotive providers.

50
GUIDELINES FOR PSSMHS IN THE POST-DISASTER PHASE

vi) CLWs and other care providers should stretch for a few years depending upon the
not discourage/stop people/families magnitude of the disaster and its effects on
who wish to carry out faith related the community.
activities along with the PSSMHS
Therefore, PSSMHS efforts shall not be
interventions.
limited to psycho-social first aid only but will
vii) Well-tested community practices need extend for a longer period during the recovery
to be encouraged to be part of the and rehabilitation to cater for long-term efforts
PSSMHS. However, if certain of psycho-social trauma. Such efforts will aim
community practices are clearly at enhancing individual and community
harmful to the mental health and capability for a better development at personal
psycho-social well-being or violate and community levels to bring back normalcy in
human rights of the survivors e.g., the affected community to a maximum level as
gender discrimination, communal well as to provide intensive support to the high
discrimination, not giving medicines to risk groups.
diagnosed mentally ill, restricting
The following PSSMHS activities are to be
personal freedom, such practices shall
carried out during this phase:
be reported immediately to superiors
in the PSSMHS chain of command for i) The rehabilitation and reconstruction
appropriate tactful non-confrontational interventions need to be flexible and
intervention. based on affected community and
community assessment needs.
viii) The CLWs and elected community
Periodic assessment of mental health
representatives will monitor such
and psycho-social needs shall be
practices and inform the district
carried out to define physical, social
authorities (nodal officer) to take
and economic factors and factors
appropriate action.
which perpetuate mental health
disorders. Based on the assessment,
5.8 PSSMHS during Recovery,
special attention and care will be given
Rehabilitation and to more vulnerable and high risk
Reconstruction Phases groups in the community.

A successful PSSMHS effort during a ii) The effective service delivery of


disaster, goes through multiple steps and PSSMHS during this phase shall require
stages for a considerable period of time and proper inter-sectoral co-ordination and
involves multiple stakeholders. The holistic networking among the government,
recovery of survivors shall require a non-government organizations and civil
considerable period of time during which a society. The concerned authorities at
number of important actions and involvement the state and the district levels shall
of multiple stakeholders shall be required co-ordinate with the organizations
for PSSMHS. The recovery, rehabilitation working on livelihood generating
and reconstruction phases in disaster could activities, and vocational training to

51
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

ensure the integration of PSSMHS planning interventions for the survivors


with general recovery and health. and their families.
iii) For long-term follow-up, the district viii) Special attention shall be given to the
authorities shall ensure a development effect of the life events subsequent
of Standard Operating Procedures to disaster and life style changes that
(SOP) so that a proper rapport is may occur subsequent to disasters.
established between care- providers Increased uses of alcohol, substance
and survivors in the community. abuse, family violence are some of the
issues that shall be addressed by
iv) The PSSMHS support services shall be
PSSMHS during this phase.
strengthened to the extent that
appropriate outreach services can also ix) The rights of the children among
be provided to those who are suffering survivors as well as the international
from mental Illness. It would be convention stipulations for this
necessary to activate the services to vulnerable group shall be taken into
adopt self-care methods at the consideration. Child Trafficking and
individual, family and community violence against children need to be
levels. tackled.

v) The main premises of PSSMHS are to x) Caring for the orphan children and
strengthen the co-ordination and to semi-orphan children needs to be
streamline the efforts of institutions given priority and the emotional and
providing PSSMHS. Appropriate behavioural issues arising among the
outreach services should be planned children need to be addressed by the
and implemented to identify those in PSSMHS professionals available at the
need of mental health services. A district level.
structured need assessment is to be xi) The cultural sensitivity is crucial
done on individual, family and work component of PSSMHS intervention,
aspects of the care-givers to provide while providing intervention, the
a holistic care. organizations as well as the care giver
need to be sensitized towards the
vi) All the activities related to PSSMHS
individual, family and community
both by government and non-
cultural sensitivity.
government organizations need to
focus on the larger development of the xii) Ensuring care to the care-givers must
community to improve the quality of be part of the intervention plan. The
life (QoL) after disasters. help and support must start from day
one of the intervention and must be
vii) Stress due to life events subsequent
continued throughout rescue, relief,
to the disaster needs to be taken into
and rehabilitation and recovery phases.
consideration during the recovery
phase. The PSSMHS teams need to be xiii) Monitoring and Evaluation of PSSMHS
sensitive on these dimensions while are essential to track the progress of

52
GUIDELINES FOR PSSMHS IN THE POST-DISASTER PHASE

the intervention. The district and special emphasis will be given to


authorities will work out a well- the referral and follow-up.
structured mechanism in collaboration
iv) The rehabilitation of these groups will
with the national and zonal nodal
be taken up on priority basis through
agencies for technical inputs for
various organizations for facilitating
developing well structured measures.
their early recovery.
The developed mechanism shall be
rehearsed during the mock drills and v) Mass uprooting of orphan children or
simulation exercises. widowed women outside the state be
prevented as it would add further
xiv) Human rights needs of the disaster
psychological impact to these
survivors shall be adequately taken
survivors.
care of during the recovery and
rehabilitation phases of disaster at 5.10 PSSMHS for Care-
macro level. A code of conduct to
Providers
preserve human rights while providing
intervention shall be formulated as part The care-providers generally perform
of response plans by government and multiple functions beginning with rescuing the
non-government organizations. survivors from their life-threatening situation to
Cultural sensitivity being a crucial distribution of various relief materials,
component of PSSMHS intervention, transporting the survivors to safe destinations,
the organization with care-givers shall managing safe living spaces, delivering psycho-
be sensitised towards individual, family social first aid and providing support in the hour
and communities accordingly. of crises at the place of family. This work usually
stretches for a longer period and continued
5.9 PSSMHS for Vulnerable exposure to the survivors and their difficulties
Groups will multiply the care-givers, stress.

The vulnerable groups in disasters are at The following aspects shall be


higher risk for psycho-social and mental health incorporated in disaster response for the care-
consequences due to a number of reasons and providers at all levels.
PSSMHS to them shall focus on the following: i) Providing the care-givers with proper
i) Special attention shall be given to the Personal Protective Equipment (PPE)
vulnerable groups on priority basis. and other basic needs.

ii) Trained teams will look after the special ii) Providing continuous stress
needs of the vulnerable groups and management training and skill- updates.
provision of Psycho-social First Aid and iii) Severely affected care-givers will be
Psycho-social Support subsequently. spared from the work responsibilities
iii) The intervention shall focus on the and will be referred for a higher level
long-term treatment and interventions of care.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

iv) A proper training and preparation for vi) Team leaders of first responders and
the assignment where the care-givers crisis group shall monitor and keep a
are educated in all hazard disaster vigil on their emotional and physical
work. stress. Those showing physical or
clinical signs of psycho-social trauma,
v) The first responders will be provided
illness or fatigue shall be immediately
adequate rest by placing alternative
evacuated to nearest mental health
teams after scheduled time.
centre/hospital.

54
6 Approach to Implementation
of the Guidelines

The National Guidelines on psycho-social will be encouraged to integrate with the existing
support and mental health services are an health plan at the community level, for further
essential part of the health plan as an integrated revamping the system. In order to optimise the
national ‘all hazard’ disaster management use of resources while ensuring effectiveness
approach. It is ensured that all aspects of and promptness, the response to PSSMHS will
preparedness are covered for a quick and be highly structured and co-ordinated at every
efficient PSSMHS response, including measures level. The following factors are considered
pertaining to post-disaster phases of disaster critical for ensuring a flawless and harmonious
management. The objective is to develop functioning of all concerned stakeholders during
capacities of the community that is rightly and the management of PSSMHS:
adequately informed, resilient, trained and
i) Institutionalisation of programmes and
capable to face the psycho-social consequences
activities at the ministry/department
of a disaster. Therefore, it will be the endeavour
level.
of the central and state governments and local
authorities to ensure its implementation in an ii) Identification of various stakeholders/
efficient, co-ordinated and focused manner. All responsibilities, a clear chain of
relevant institutions are also clearly identified command and work relationships.
for providing technical support in each phase iii) Rationalisation and augmentation of the
of disaster management. This can be achieved existing mental health programmes,
by forging a multi-sectoral partnership as resources and infrastructure.
envisaged by the institutional mechanism, set
iv) Matching infrastructure, capacity
up through the Disaster Management Act,
development and response
(2005) viz. the NDMA, SDMAs and DDMAs.
mechanisms for overall preparedness.
The primary responsibility of
v) Improved inter-ministry and inter-
preparedness and response shall continue to
agency communication, co-ordination
remain with the state and district authorities.
and networking at all levels.
Further capacity enhancement and
reinforcement of the system, whenever MoH&FW, as the nodal ministry, will over
required, will be provided by the central and see implementation of the Guidelines at the
state governments. Initiatives like community national level. The other stakeholders in
participation and Public-Private Partnership (PPP) PSSMHS management are Ministry of Defence

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

(MoD), Ministry of Railways (MoR), Ministry of a detailed action plan (involving programmes and
Labour, Employees State Insurance Corporation activities) as part of ‘all hazard’ medical
(MoL, ESIC), and Ministry of Women and Child preparedness Disaster Management plans by
Development (MoW&CD) departments of MoH&FW that will promote coherence among
health of the states/UTs; mental health technical different PSSMHS practices and strengthen the
institutions, academic institutions in social work, community level capacities at various levels.
psychology, professional bodies, corporate Line ministries such as MoD, MoR, MoL, ESIC
sector, NGOs and the general community. MoW&CD shall also develop preparedness plans
Implementation of the Guidelines will begin based on the Guidelines as part of the 'all hazard'
with the formulation of a PSSMHS disaster Disaster Management (DM) plans and the action
preparedness plan as part of an 'all hazard' medical plan. In view of the expected role of these
preparedness DM plan in all districts, states/ UTs important line ministries in management of
and central ministries. The enabling phase will be PSSMHS in the event of national calamities, they
used to build necessary capacity, taking into should also cater for developing additional
consideration the existing elements such as capacities, besides meeting their own
techno-legal regimes, stakeholder initiatives, requirements, in their preparedness plan.
emergency plans and gaps. The existing DM plans The plan will be simple, realistic, functional,
at various levels will be further revamped/ flexible, concise, holistic and comprehensive,
strengthened in central ministries/ departments, encompassing networking of psychological and
states/UTs and all levels that address the strategic, social components. The plan would lay special
operational and administrative aspects through an emphasis on the most vulnerable groups to
institutional, legal and operational framework. enable and empower them to respond to and
These Guidelines have set modest goals recover from, the effects of disasters.
and objectives of PSSMHS in disaster The National Plan needs to include:
preparedness to be achieved by mustering all
stakeholders through an inclusive and i) Measures to be taken for minimisation
participative approach. All concerned ministries or reduction of psycho-social effects
of Government of India, the state governments, of disasters (leading to zero tolerance),
UT administrations and district authorities will or mitigation of their effects (leading
allocate appropriate financial and other to avoidable morbidity and mortality).
resources, including dedicated manpower and ii) Measures to be taken for integration
targeted capacity development, for successful of mitigation procedures in the
implementation of the Guidelines. development plans.

6.1 Implementation of the iii) Measures to be taken for preparedness


and capacity development to effectively
Guidelines
respond to any threatening mass
6.1.1 Preparation of the Action Plan casualty situation.

Implementation of the Guidelines at the iv) Role and responsibility of the nodal
national level will begin with the preparation of ministry, different ministries or

56
APPROACH TO IMPLEMENTATION OF THE GUIDELINES

departments of the Gol, institutions, PSSMHS plan as a part of ‘all hazard’ medical
community and NGOs in respect of the preparedness plans and dovetail it with the
measures specified in clauses i), ii), and national plan and keep the National Authority
iii) above. and SDMA informed. The state departments/
authorities concerned will implement and review
The action plan will spell out detailed work
the execution of the DM plans at the district
areas, activities and agencies responsible, and
and local levels along the above lines.
indicate targets and time-frames for
implementation and be continually reviewed and
6.2 Implementation and Co-
updated. The identified tasks, to the extent
possible, will be standardized to have SOPs and
ordination
resource inventory, etc. The action plan should 6.2.1 National Level
have an in-built mechanism to co-ordinate with
Planning, execution, monitoring and
other ministries and NEC. The plan will also
evaluation are four facets of the comprehensive
specify indicators of progress to enable their
implementation of the Guidelines. If desired, the
monitoring and review within the ministry and
nodal ministry can co-opt an expert nominated
by the National Authority. The plan would be
by the National Authority during the planning
sent to NDMA through NEC for approval.
stage so that the desired results are achieved
The ministries/agencies concerned, in through the action plan. The consultative
turn, will: approach increases ownership of the
i) Issue guidance on the implementation stakeholders in the solution process by bringing
of the plans to all stakeholders. clarity to various preparedness activities.
Detailed documentation of the monitoring
ii) Obtain periodic reports from the
mechanism to be employed for undertaking a
stakeholders on the progress of
transparent, objective and independent review
implementation of the DM plans.
of the National Disaster Management
iii) Evaluate the progress of Guidelines : Psycho-social Support and Mental
implementation of the plans against Health Services in Disasters, will be worked out.
the time-frames and take corrective A separate group of experts may be earmarked
action, wherever needed. for evaluation to get an objective, third-party
iv) Disseminate the status of progress feedback on the effectiveness of the activities
and issue further guidance on based upon the Guidelines.
implementation of the plans to The important issues while preparing the
stakeholders. action plan include:
v) Report the progress of implementation i) Adopting a single window approach for
of the plans to the nodal ministry. conducting and documenting the
MoH&FW will keep the National Authority activities outlined in the guidelines in
apprised of the progress on a regular basis. each of the stakeholder ministries,
Similarly, concerned state authorities/ departments, state governments,
departments will develop their state-level agencies and organizations.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

ii) Laying down the roles and the government hospitals and Mental Health
responsibilities of all stakeholders at Institute to assist the states in putting up the
the state and district levels to assist requisite infrastructure. A co-ordinated and
them in terms of the required synergistic partnership with non-government,
resources. private sector, corporate and community will
help in providing critical resources during
iii) Developing detailed documents on
response.
how to ensure implementation of each
of the activities envisaged in the 6.2.2 Institutional Mechanism and Co-
Guidelines to attain a synergy among ordination at the State and District
various activities and ensure co- Levels
ordination.
The respective state/UT/district
iv) Ascertaining PSSMHS measures, authorities will develop PSSMHS plans based
including capacity development to on the 'all hazard' medical preparedness DM
effectively respond to incidents of plans. The measures indicated at the national
psycho-social and mental health level may be adopted to ensure effective
disorders due to disasters. implementation by regular monitoring at the
state level by the concerned authorities. The
v) Incorporating measures for the
state will also allocate resources and provide
prevention of psycho-social and mental
necessary finances for efficient implementation
health disorders by integration of
of the plans. Since most activities under the
mitigation measures in the
Guidelines are community-centric and require
development plans.
the association of professional experts for
vi) Co-ordinating with line ministries such planning, implementation and monitoring, the
as MoD, MoR, MoW&CD and MoL SDMAs and DDMAs will formulate a suitable
(ESIC) networks for maintaining their mechanism for their active involvement at
resources and ensuring these are various levels.
available during major disasters.
The India Disaster Resource Network
vii) Ensuring professional expertise for the database will be strengthened by the states by
dissemination, monitoring and successful continual updating, enhancement and
and sustainable implementation of the integration with the respective DM plans. These
various plans at all levels. activities are to be undertaken in the project
mode with a specifically earmarked budget (both
viii) Ensuring that the skills and expertise
for plan and non-plan) for each activity.
of professionals are periodically
updated corresponding to global best 6.2.3 District Level to Community Level
practices according to the guidelines Preparedness Plan and Appropriate
on PSSMHS. Linkages with the State Support
Systems
The national plan would lay emphasis on
identified critical gaps in management of A number of weaknesses have been
PSSMHS programmes and would strengthen identified with regard to awareness generation,

58
APPROACH TO IMPLEMENTATION OF THE GUIDELINES

response time and actions like emergency Financial strategies will be worked out so that
psycho-social first aid. It also includes detection necessary finances are in place and the flow of
of psycho-social problems, identification of funds is organised on a priority basis for quick
vulnerable groups, providing care to the care- and effective support and service provision.
givers, referral systems and specialised facilities Important strategies include:
for the disabled, co-ordination among the
i) Specific allocations will be made by
PSSMHS providers and the need for long-term
Central ministries/departments and
interventions. This is specially observed in the
state governments in the annual plan
district DM plans and has been found to be a
for capacity development and training
weak link in emergency management. The
in PSSMHS.
central and state governments will evolve
mechanisms through mock exercises, ii) The developmental and social sector
awareness and training programmes, etc., with plans and agencies and private
a view to sensitise and prepare the officers stakeholders will have specific funds
concerned for initiating prompt and effective to carry out PSSMHS in post-disaster
PSSMHS response during such emergencies. situation and pre-disaster research and
capacity development
The PSSMHS nodal officer will be
appointed and Chief Medical Officer (CMO) of iii) Whenever necessary and feasible, the
the district will be in charge of overall response central ministries/departments,
and management of PSSMHS. He will be Panchayati Raj Institutions/Urban Local
responsible for preparing the district psycho- Bodies in the states may initiate
social and mental health plan as part of the discussions with the corporate sector
district plans based on the PSSMHS guidelines. to take up mitigation related activities
as a part of PPP and Corporate Social
Disaster resilience is the ability of the
Responsibility.
community to anticipate disasters and react
quickly and effectively when they strike. The iv) Whenever necessary, the International
process of building resilience will be made and National Funding agencies will be
through awareness generation, street shows involved, especially in case of longer
and other community and mock exercises in service provision, longitudinal research
which PSSMHS shall form an important studies, and major capacity building
component in the response. projects.
To conclude, the present system of
6.3 Financial Resources for PSSMHS is required to function in a more pro-
Implementation active and co-ordinated manner at all levels.

With the paradigm shift in the


6.4 Implementation Model
government's focus on mitigation activities,
adequate funds shall be allocated for capacity Planning, execution, monitoring and
development in addition to fund allocation for evaluation are four essential facets of
PSSMHS provisions in the post-disaster phase. comprehensive implementation of National

59
NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Guidelines on PSSMHS. The activities in each programmes and General


of these facets in disaster mitigation- Hospital Programmes as part of
preparedness and post-disaster phases at hospital and district health plan.
national, state and district levels are different
d. Enactment/amendment of any act,
and covered in detail in previous chapters.
rule and regulation, if necessary,
Irrespective of the scale and type of the for better implementation of
disaster, PSSMHS services shall ensure the PSSMHS across the country.
normal state of mind of all affected, which could
take a minimum of 2 years and maximum of five ii) Mitigation
years or more. While the post-disaster service a. Formation of a National Sub-
provision shall be converged with the short and Committee on PSSMHS.
long-term rehabilitation and rebuilding activities
at a micro level, at a macro level PSSMHS b. Developing/strengthening a
activities shall be integrated into the larger mechanism for quick and
developmental projects for the affected region effective referral system
so that the services are sustainable for the c. Training of NDRF/QRTs/DMTs
required duration of 2-5 years and their impact with all basic psycho-social
is sustained even after 5 years when the support skills
specific PSSMHS are withdrawn.
d. Integrating with DM mental
All identified activities under PSSMHS
health plans and Health/Hospital
action plan will be planned as listed below for
DM Plans
their implementation. The time-lines proposed
for the implementation of various activities in e. Inclusion of PSSMHS in the
the Guidelines are considered both desirable minimum standard of medical
and feasible, especially in cases where financial care in disasters.
and technical constraints are not limiting factors.
f. Establishing linkages with all
The detailed action plan will be submitted by
stakeholders identified to play
the National Sub-Committee later on, after
important role in PSSMHS.
publication of the Guidelines on PSSMHS.
A) Phase-1 (0-3 years) g. Strengthening the government
agencies and NGOs; devloping
i) Regulatory Framework
Public Private Partnership and
a. Dovetailing of existing Acts, the partnership mechanism in
Rules and Regulations with the capacity development, research
DM Act, (2005). and service provision on mutually
agreed terms and conditions.
b. Ensuring implementation of
PSSMHS in NMHP and DMHP. iii) Capacity development
c. Integration of the PSSMHS in a. Sensitising and training (Basic
disaster Mental Health and advanced) on PSSMHS

60
APPROACH TO IMPLEMENTATION OF THE GUIDELINES

across identified departments, a. Inclusion in the CBDM Plan and


sectors and levels. training of PRI team members.

b. Strengthening of the national, b. Developing awareness material


regional and nodal capacity for the community.
building institutions and c. Evolve a mechanism for
resource centres at state and community outreach education
district levels. programmes on PSSMHS.

c. Developing PSSMHS need B) Phase-II (0-5 years)


assessment indicators and i) Capacity Building
templates.
a. Strengthening nodal institutions/
d. Strengthening of District hospitals.
Counselling Centres under the
b. Developing database
Department of Social Welfare/
management and evidence-
Ministry of Women & Child
based research.
Development.
c. Evolving a mechanism for follow
e. Strengthening the resource
up response.
base and data management/
documentation in PSSMHS. d. Establishing a National
Accreditation System for quality
iv) Education and Training
assurance.
a. Inclusion of Disaster PSSMHS in
e. Continuation and updating of
Post-graduate Curriculum of
human resource development
Psychiatry, Psychology, Social
activities.
Work, Disaster Management,
Emergency Medicine and Health f. Developing community
Education. resilience.

b. Inclusion of PSSMHS in Medical ii) Preparedness


under graduate studies.
a. Creation of a core group of
c. Integrating with all training master trainers at district level.
programmes in the area of b. Strengthening public-private
Psychology, Social Work, Mental partnership in research and
Health, Emergency Medical development.
Response, Hospital Administration,
Nursing and Paramedics. c. Formation of National PSSMHS
Resource Inventory as part of
v) Community-Based Disaster National Health Resource
Management Inventory.

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d. Initiation of distance learning 6.5 Monitoring and Evaluation of


courses for sensitisation across PSSMHS
different categories of disaster
management stakeholders. In the absence of any structured
monitoring and evaluation procedures and
e. Development and
indicators for PSSMHS available in India, the Co-
standardisation of uniform
ordination Committee shall be responsible for
training packages for various
preparing criteria and methodology for the
designated target groups.
same.
f. Incorporation of PSSMHS in i) While the DDMA and the district
DMHP, district health and administration, along with respective
hospital plans. line departments, shall be the
implementing agencies, the regional
C) Phase-III (0-8 years)
nodal agencies would be the
The long-term action plan will intensify the monitoring agencies and the Co-
areas identified in phase-I, along with the ordination Committee shall be the
important issues that have been raised in evaluating body.
chapters 4 and 5. A detailed action plan will be
ii) While monitoring shall be done
prepared by the National Sub-Committee and
regularly at 3-month intervals,
submitted to the NDMA and Ministry of Health
evaluation of any specific programme
& Family Welfare. The long-term planning will
shall be done on yearly basis. Evaluation
also include the following important aspects of
and monitoring should be preferably
PSSMHS:
done on the specific format prescribed
i) Evolving a mechanism to include by the Co-ordination Committee.
disaster-induced psychiatric disorders/
iii) Depending on the yearly evaluation,
physical disability in the disaster
duration of PSSMHS shall be decided
insurance and medical/health
upon for determining the funding
insurance.
support. Monitoring and evaluation of
ii) Intensive PG Diploma/PG courses in programmes have to be done in
PSSMHS. relation to planned activities with pre-
iii) Streamlining of institutions and their defined indicators.
activities.

62
7 Summary of Action Points

The present chapter provides a summary of any disaster. The planning shall be a
of all the guidelines mentioned in Chapters 4 to component of overall planning for disaster
6 for the management of PSSMHS in disasters. management with the aim of providing PSSMHS
The important action points enumerated are as integrated with health- care and general relief
follows : work.
The planning should emphasize
1. Legislative Framework appropriate inter-sectoral as well as intra-
sectoral collaboration among various agencies,
The policies, programmes and action plans
involved in disaster management. The planned
need to be supported by appropriate legal
preparedness programme needs a systematic
instruments, wherever necessary, for effective
and periodic monitoring at district, state and
management of PSSMHS in disasters. The
national levels.
important means to develop a robust, though
The planning of PSSMHS services should
flexible, legal framework for achieving the above
include national, state and district levels to
objectives, the existing Acts, Rules, Regulations
complement and facilitate each other. The
at various levels will be reviewed and amended
Ministry of Health & Family Welfare (MoH&FW)
by the nodal ministry, state governments and
shall constitute a National Sub-Committee on
local authorities. PSSMHS to co-ordinate, implement, monitor and
Policies and Guidelines issued by NDMA evaluate the PSSMHS plan, based on national
will be the basis for developing PSSMHS in DM mental health policy. This plan will integrate with
Health Plans by various stakeholders and service general health plan for disasters right up to the
district level.
providers both in the government (nodal and
line ministries, state government and district In order to respond effectively in
administration) and private set-up at each level. disasters, a well to planned integrated and co-
The PSSMHS response to various disasters will ordinated effort shall be made for PSSMHS
be co-ordinated by NDMA/ NEC/NCMC, SDMAs preparedness, based on the existing national
and DDMAs. and international best practices and
incorporating lessons learnt from past
Para 4.1 - 4.1.2 experiences. The preparedness activities for
PSSMHS can be formally linked with various
2. Planning and Preparedness health programmes.
The PSSMHS for disaster-prone and The framework for PSSMHS at the state
vulnerable areas shall be planned much ahead level may be most beneficially evolved and

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

operationalized, keeping in mind the linkages 4. Education


with the larger relief, recovery and rehabilitation
activities being carried out by district Basic education on psycho-social support
administration and the state level general is essential and must be included in the
medical services and mental health syllabuses of courses run by various regulatory
programmes. bodies. Mainstreaming the disaster
Para 4.2 - 4.3.2 management knowledge in the education
system will facilitate in prevention and mitigation
3. Capacity Development of of adverse psycho-social effects of disaster.
Human Resource Education on PSSMHS may be included at the
graduate and post-graduate levels in various
The development of human resource will courses in humanities and other professional
be based on hazard, vulnerability, and risk courses.
assessment of the districts in the country to
Para 4.4.2
cater to ‘all hazard’ situations. The human
resource for providing PSSMHS will be planned
and developed at all levels with a well focused
5. Training
mechanism of developing infrastructure and
Regular training programmes in the form
creating both professional and non-professional
of CMEs, workshops and symposiums shall be
resources keeping in mind the long-term
carried out for regular updating and knowledge
implication of the psycho-social issues arising
enhancement. The training content of these
out of disasters that will be a priority. Centre
training programmes must be designed to suit
and state governments shall create adequate
capacity in a phased manner for human resource the particular culture and ethnic needs of the
development with the help of national community. Training of the community,
institutions like NIMHANS and other regional especially CLWs, has enhanced the reach of
nodal institutions like IHBAS, MIMH, LGBMH, PSSMHS to the communities and there is a need
TISS etc. in the states. to sustain it in all the phases of disaster. An ‘all
hazard’ approach shall be adopted while training
District-wise resource list of all skilled and
the CLWs. In addition to the CLWs, other
trained manpower available with all government
members of community like panchayati raj
and non-government organizations, who will be
working in the field of psycho-social support and functionaries, NGOs and other community-
mental health, shall be prepared and shared with based organizations like Civil Defence will be
all the organizations and government involved in training for PSSMHS. NIDM, ATIs and
functionaries. Uniform training modules will be other training institutions at the district levels
developed and standardized by central and will carry out such training programmes, in
nodal professional institutions and will be used addition to the programmes run by various
for training at each level by districts, states and professional institutions for medical and other
ministries. professionals.
Para 4.4 - 4.4.1 Para 4.4.3

64
SUMMARY OF ACTION POINTS

6. Research and Development 8. Community Participation And


Role Of Community Level
The scientific and systematic study of
Workers
disaster-affected community and intervention
needs to be incorporated as a part of PSSMHS. Community is the first responder in the
The research also needs to identify the risks event of any disaster and it plays an important
and protective factors among the population role in response and rehabilitation of the
during and after disasters. The research must community. A large number of community level
focus on the community needs and community workers (CLWs) participate as important team
best practices. The vulnerability and members for providing psycho-social support
to the community. These community level
epidemiological factors need to be studied in
workers must be utilized in all phases of
detail to ascertain the hazard, risk and
disasters especially in preparedness phases to
vulnerability of the community. The centre of
create awareness and information
excellence NIMHANS and other nodal and zonal
dissemination among the community. Promotion
professional institutions like IHBAS, MIMH,
of group work in the community to inculcate
LGBMH, TISS etc. will develop appropriate the belief that majority of the problems in the
methods. community are shared, rather than individual
Para 4.4.4 problems and hence need collective response.
These workers generally perform multiple
7. Documentation functions beginning with rescuing the survivors
from their life-threatening situation to
Systematic documentation procedure will distribution of various relief materials,
be evolved at all levels to capture every detail transporting the survivors to safe destinations,
of all the interventions and best practices. R&D managing safe living spaces, delivering psycho-
social first aid and providing psycho-social
will cater for evidence-based operational and
support in the hour of crises.
applied research. The research also needs to
identify the risks and protective factors among Para 4.4.6 - 4.4.7
the population during and after disasters. Case 9. Infrastructure for PSSMHS
control studies will be helpful to determine the
extent of psychological effects. Research Development of well-equipped
findings related to PSSMHS should be widely infrastructure will provide a good environment
disseminated in appropriate forums for various for psycho-social support and mental health
services (PSSMHS) both for preparedness and
user groups ranging from mental health
response. These facilities need to be designed
professionals to policy makers and to the
and built on state of the art infrastructure
general public.
keeping in mind the enhanced requirements of
Para 4.4.5 PSSMHS. Further upgradation of existing

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

hospital facilities, adequate networking with engaged in the area of PSSMHS. Existing mental
other hospitals, medical colleges, zonal and hospitals, general hospitals with psychiatric
national institutes to share and pool resources departments, medical college psychiatric units
to meet the challenges of larger disasters. The and mental health clinics shall be strengthened
responsibility of such activities will lie with the and networked with DMHP programme. SDMAs
nodal ministry at the centre and the state and departments of health shall identify and
departments. designate universities and medical colleges for
imparting education/skill training on PSSMHS.
Para 4.4.8
Para 4.4.8.2
10. Hospital Preparedness
12. Public-Private Partnership
Hospital preparedness is an important
part of disaster management where PSSMHS Private sector has substantial capacity and
forms an integral part of it. All the designated infrastructure and it plays a vital role in the
hospitals must enhance their capacity to management of disasters. Government and the
respond in an event of disaster, both in private organizations, based on mutually agreed
government and private corporate sectors. goals be encouraged to utilize their manpower
Hospital disaster management plan shall include and infrastructure for the purpose of PSSMHS.
the PSSMHS as one of the components. The Private medical health facilities, paramedical staff,
presently available psychiatric wards of hospitals non-government organizations and community-
shall be upgraded to meet the enhanced based organizations should be made part of the
requirements during disaster, based on total resource available in the area. The PPP also
vulnerability and risk assessment. A network will enhance the community participation in
shall be established amongst hospitals, medical provision of PSSMHS. Appropriate actions may
colleges, zonal and national institutes to share be taken in advance by the authorities at all levels
and pool resources to meet the challenges of to facilitate such collaboration with the private
larger disasters. State governments and sector. Attention is also drawn to Section 34 of
departments of health in the respective states Disaster Management Act (2005) where the
shall be responsible for the preparedness for district collector can act in the time of a major
PSSMHS in their states. disaster.
Para 4.4.8.1 Para 4.4.8.3

11. Networking of Institutions 13. Technical and Scientific


Proper networking of existing institutions Institutions
shall be established for capacity development
of human resources for proper management of Centre and state authorities will identify
PSSMHS for the entire country. NIMHANS as a and designate technical institutions who have
centre of excellence and other national center resources and expertise in disaster mental
like IHBAS will act as the national referral centre health. NIMHANS will be designated as a centre
for formulating and designing standardized of excellence, because of its long time
intervention models for all the professionals association with various mental health

66
SUMMARY OF ACTION POINTS

interventions and expertise in the field of The media also helps to destigmatize the
PSSMHS in the country. In addition IHBAS and psycho-social effects. This helps in education
other regional Institutions will be identified and of the community about the psycho-social
designated as nodal Institutions. These effects and prepares the community to face
institutions will function as key responders in rumours, panic and the impending disaster. The
the PSSMHS, conducting need assessment, NGOs play a very vital role at the community
developing standardized and structured need level in disaster intervention. Their knowledge
assessment tools, conducting scientific of local people and terrain makes them a handy
research on the affected community and tool to reach the information about the psycho-
developing specific intervention modules. social effects of disasters. These organizations
These institutions will develop appropriate play a very important role in sensitizing and
intervention modules to suit general as well as educating the community and preparing it for
region-wise requirements and importance will providing PSSMHS. Such agencies shall also be
be given to develop models based on a networked with International organizations such
preventive strategy, essentially focused on as WHO, a nodal agency for health in providing
preventing the vulnerability of the community information, communication and alerts on
and mitigate the post-disaster effects. The health-related issues and technical experts in
preventive strategy prepared by these disasters.
institutions will include both preparedness as Para 4.4.8.5
well as long-term interventions based on
community’s coping capacities and enhancing 15. International Co-operation
the resilience factor.
International co-operation is a necessary
Para 4.4.8.4 element in the management of PSSMHS.
International mental health institutions and
14. Communication and organizations, involved in PSSMHS interventions
Networking can be collaborated with, in the field of PSSMHS
research, material development, to bring in more
Communication is a vital component of
cross-learning. Adaptation of international best
PSSMHS. Emergency control rooms shall be
practices in PSSMHS intervention can bring
established at district, state and national levels
more quality services at the local level.
to co-ordinate between various responders and
Incorporation of the international best practices
stakeholders. Print and electronic media shall
into PSSMHS will enhance the understanding
also be linked for proper dissemination of
of the intervention. Encouraging the conducting
information related to the disaster and its
of workshops, seminars and conferences for
effects. Creating awareness about PSSMHS
direct interaction, exchange of ideas and policy
through the media will enhance the information
enhancement periodically at international level
and knowledge level among the communities
can bring more quality services at the local level.
to alleviate their trauma arising out of any
disaster. Para 4.5

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16. Special Care of Vulnerable line response that needs to be integrated with
the general response and it can be given by
Groups
any type of responders in disasters. The PSFA
Vulnerable groups like women, children, training and skills can be given to hospital
the aged and the less abled are more emergency para-medics, ambulance crew,
susceptible to stress and trauma. Generally their community level workers, students and other
special needs are not taken care of, adequately, first responders based on the modules
in the disaster situations due to a number of prepared by the nodal agencies. The SDMA and
reasons. The proper care of, and attention to, DDMA will co-ordinate with the SMHA and
these vulnerable groups, shall be given on DMHP authorities to provide the services.
priority basis. The PSSMHS assessment will Para 4.6.1
comprehensively study the hazard, risk and
vulnerability factors of the vulnerable groups to 18. Psycho-Social Support and
provide specific need based intervention to Mental Health Services in the
them. It is essential to identify these vulnerable
Post-Disaster Phase
groups based on the GIS mapping and it is
essential to define the vulnerable groups and The PSSMHS response plan is the main
categories so that these group can be provided responsibility of the Ministry of Health and
with immediate relief and be attended first. Family Welfare (MoH&FW) at the centre, other
Provisions for providing special care will be line ministries like Ministry of Defence (MoD),
made for children especially who have lost their Ministry of Railways (MoR), Ministry of Labour
parents and siblings. Special care will be (Employees State Insurance Corporation) shall
provided to pregnant women, women who have also prepare their response plans based on
lost their spouse and family members aged these Guidelines. The efforts from the
persons and those with physical and mental
ministries shall be used as complementary to
disability.
main efforts of the nodal ministry in a major
Specially trained professionals and disaster.
workers, along with the health-care workers,
Effective and rapid PSSMHS response
who provide PSSMHS to disaster survivors shall
helps to reduce the stress and trauma of the
be deployed.
affected community and facilitates speedy
Para 4.6 recovery by bringing them back to their pre-
disaster level. The response will be based on
17. Psycho-Social First Aid in the
the timely ‘all hazard’ PSSMHS need assessment
Disaster Preparedness Phase focusing on all the areas both at the macro and
The PSFA in the preparedness phase shall micro levels to respond and manage the psycho-
be given to both professionals and non- social issues after the disaster. The PSSMHS
professionals to promote safety and protection will be part of the health response plan and will
of the survivors to cope with the psycho-social be co-ordinated by the central, state and district
trauma of exposure to the disaster and to authorities, all the stakeholders including
promote psycho-social recovery. It is the first government, professional and academic

68
SUMMARY OF ACTION POINTS

institutions. The response plans for the problems so that they can be dealt together in
PSSMHS shall be prepared based, on the an integrated manner. The PSSMHS in disasters
National Guidelines, National Health Policy, envisages the long-term care and help to the
National Mental Health Programme (NMHP) and survivors and special emphasis on referral in all
District Mental Health Programme (DMHP). the phases of disaster. PSSMHS service providers
shall form an important constituent of relief and
Para 5.1 health teams. The first responders, providing
19. Psycho-Social First Aid in general relief and health- care will be trained to
provide psycho-social support till the skilled
Post Disaster Phase specialized PSSMHS teams take over to
comphrensively address the immediate and long-
The psycho-social first aid is a process
term care of the affected people.
which prevents further deterioration of the
coping capacities of the survivors, thereby Para 5.3 - 5.4
enhancing the chances of rapid normalization
process. In the absence of psycho-social first aid, 21. Referral; Integration with the
the process of normalization for the affected Community Practices
community will be delayed and prolonged. In the
Large numbers of survivors require only
response phase, PSFA will be provided by duly
psycho-social first aid whereas a fair number of
trained skilled first responders who form part of
them require long term and special care.
PSSMHS care team. Psycho-social first aid is
Therefore a referral mechanism will be worked
provided in the initial one-to-six week period.
out for them for long term treatment and follow-
Trained CLW's from the affected community shall
up. The core aim of the referral is not only to
be more successful in mitigating the effects of
lessen the workload but to facilitate and sustain
acute psycho-social distress. This will go a long
the long-term PSSMHS. Special attention shall
way in preventing major psychological and mental be given to vulnerable groups, particularly the
health problems. long-term treatment and interventions.Special
Para 5.2 emphasis will be laid on the referral and the
follow-up.
20. Integration with General Relief
Community practices play a crucial role in
Work and Health Plan the process of normalization in post-disaster
Effective psycho-social support and period. Integration of community practices into
mental health intervention requires an inter- psycho-social support will help in developing
sectoral co-ordination with the various faith in the service providers and will result into
stakeholders. The PSSMHS shall remain as an better development of linkages between
integral part of emergency health response plan. community and service providers, irrespective
of cast a creed and religion. This builds mutual
An integrative mechanism will be
faith and enhances better and effective rapport
developed with the focus on integrating PSSMHS
between the service providers and the
with the general health-care to facilitate early
survivors.
identification, management, referral and follow-
up of PSSMHS problems along with the medical Para 5.5 - 5.7

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22. Psycho-Social Support and of survivors. Generally, in disaster interventions


Mental Health Services during of the care-givers’ needs are given inadequate
priority and attention, it will have an adverse
Recovery, Rehabilitation and
effect on their well-being, which in turn, will
Reconstruction Phases affect the quality of service delivery. A proper
training and preparation for the assignment is
The recovery, rehabilitation and
essential when they are required to be prepared
reconstruction phases in disasters will require
for ‘all hazard’ disaster work. The care-givers
long-term PSSMHS to enhance individual and
should be provided proper training, adequate
community capability for a better development
Personal Protective Equipment (PPE) and other
at personal and community levels to bring back
basic needs. Severely affected care-givers will
normalcy in the affected community to a
be spared of the work responsibilities and will
maximum level as well as to provide intensive
be referred for higher level care. Provision of
support to the high risk groups. In this phase
stress management to the care-givers will be
care-givers must be part of the intervention
an integral part of the training.
plan. The help and support must start from day
one of the intervention and must be continued Para 5.10
throughout the rescue, relief, rehabilitation and
recovery phases. Special care and attention will 24. Development of ‘All Hazard’
be given to the vulnerable groups in both short Implementation Strategy
and long-term PSSMHS. The PSSMHS
interventions will also focus on the care of care- The strategy outlines the requirements
givers from the beginning of the intervention. for development of a PSSMHS action plan by
Appropriate referral and follow-up services will the nodal ministry, measures to implement and
be provided on priority basis to those care-givers co-ordinate various activities at the national
who need professional care. level, framework and co-ordination at the state
and district levels. Adequate strategy will be
Para 5.8
evolved to develop linkages and state support
systems. Necessary financial arrangements will
23. Care of Care-Givers
be made for implementation of all the plans
Taking care of care-givers is as important developed at district/state/national levels. An
as providing care to the survivors. The care- implementation model with broad time-frames
givers generally perform multiple functions as short, medium and long-term plans for 0-3,
beginning with the rescuing phase to the 0-5 and 0-8 years, respectively, are
rehabilitation and reconstruction phase by recommended.
providing a range of help to normalize the lives Para 6.1 - 6.4

70
Annexures

Annexure-A
(Refer to Chapter 1)

Table 1.1 Common Psycho-Social and Mental Health Consequences


of Disasters

(A) Psycho-social consequences


1. Exacerbation of pre-existing (pre-disaster) social problems (e.g. extreme
poverty, belonging to a group that is discriminated against or marginalised)
2. Disaster induced social problems (e.g. family separation; disruption of social
network; destruction of the community structure; resources and trust;
unEmployees, homelessness, increased gender-based violence)
3. Humanitarian aid induced social problems (e.g. undermining of the community
structure or traditional support mechanism).

(B) Mental health consequences


1. Exacerbation of pre-existing problems (e.g. severe mental disorder; alcohol
abuse)
2. Disaster induced problems (e.g. grief, non-pathological distress, depression
and anxiety disorders, like post-traumatic stress disorder (PTSD);
3. Humanitarian aid related problems (e.g. anxiety due to lack of information
about food distribution).
It should be noted that mental health and psycho-social problems in disasters
encompass far more than the experience of PTSD.

Reference : Inter-Agency Standing Committee Guidelines on Mental Health and Psycho-Social


Support in Emergency Settings, Geneva, (2007)

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Table 1.2 Common emotional reactions and behavioural responses


after disasters

1. Shock
2. Denial
3. Numbness
4. Fear
5. Anger
6. Crying
7. Apathy
8. Disorientation
9. Flashbacks and Nightmares
10. Anxiety
11. Worrying
12. Helplessness
13. Feeling Sad
14. Withdrawal
15. Frustration
16. Negativity
17. Inability to Think
18. Sleeplessness
19. Leaving the Place
20. Apprehensive about Future
21. Remembering / Praying to God
22. Participating in Rescue / Relief Work
23. Feeling of Brotherhood
24. Hostility
25. Impulsiveness
26. Violence
27. Alcohol and Drug Abuse

Reference: Sekar, K., Bhadra, S, Jayakumar, C., Aravind, R., Henry, Grace, Kishore Kumar, Psycho-
Social Care in Disaster Management : Facilitator's Manual for Training of Trainers in Natural Disasters.
TOT Information Manual - 1 (2007) NIMHANS, Bengaluru and Care India, New Delhi.

72
ANNEXURES

Annexure-B
(Refer to Chapter 3 )

Indicators of PSSMHS after Disasters


Objectives and Indicators for measuring the impact of PSSMHS:
Objective 1
Improved psycho-social well-being of the target group as measured by level of awareness of
personal and community issues regarding pro-social behaviour, cognitive/emotional functioning,
performance of daily tasks (livelihood), coping, self-esteem and self-efficacy.
Indicators:
1 Change in the proportion of target group, displaying culturally defined pro-social
behaviour.
2 Change in the proportion of target group, able to express fears or concerns and
seek care from others during stress.
3 Change in the proportion of target population who express a locally defined
"optimal" level [on a measurement scale, score X or higher] of a sense of control
in their daily functioning.
4 Change in the proportion of target population using positive coping strategies,
during times of stress–as defined by local cultural norms.

Notes on Methods for Measurement:


While various standardized quantitative measurement scales are available, most are not
yet validated cross-culturally or within contexts of crisis, emergency, or displacement.
However, they can be adapted and utilized, and it is best if such measures are developed
locally and validated with complementary qualitative data collection and analysis. Where
feasible, and where resources permit, it is best to work with local communities and different
beneficiary groups within communities in order to derive locally defined measures of
functioning, coping, pro-social behaviour, and other measures of psycho-social well-being.

Objective 2
Increased capacity of families/households, community organizations and service
providers to support community members to cope with stress/trauma.

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Indicators:
1 Change in the percentage of families/households, community organizations or
service providers, using positive coping strategies during times of stress.
2 Change in the proportion of opportunities for marginalised groups.
3 Change in the proportion of local service providers with capacity to support
target group to cope with stress/trauma in a specific way.
4 Change in proportion of citizens engaged in activities that support families and
households to cope with stress/trauma.
5 Change in proportion of community leaders and/or community groups with an
adequate [or desirable, or optimal] level of knowledge and understanding
regarding psycho-social needs and the elements of appropriate community
responses.
Notes on Methods for Measurement:
Capacity can be measured quantitatively, as in the indicators mentioned above, or through
qualitative measures. Individuals and the target groups may display a capacity to provide
support to others in ways that are measured through variety and depth of creative
responses. Such qualitative measures might be gathered through observation as well
as open-ended questions and discussions with individuals or groups.
Objective 3
Enhanced awareness among local authorities, NGOs, communities and community
leaders of protection principles and rights, risks and appropriate psycho-social
responses for children, families and at-risk groups, with a view to create a healthier
environment for social integration.
Indicators:
1 Change in the proportion of local authorities, NGOs, communities and community
leaders aware of protection principles, rights and risks faced by the target group
2 Change in the number of protection, rights and advocacy groups formally
registered and active in the community
3 Change in the per cent knowledge improvement in protection, rights and risk
issues among local authorities, NGOs, communities and community leaders
4 Change in the number of response mechanisms (i.e., community action plans,
interventions, information sharing) to address protection, rights and risk issues
initiated by local authorities, NGOs or community groups.

74
ANNEXURES

Notes on Methods for Measurement:


Change in the level of knowledge and the results of having acquired knowledge about
protection, rights, and risks can be measured quantitatively through questionnaires and
observation. If the budget and other resources allow, the important dimension of quality
of enhanced awareness should not be overlooked. Qualitative methods, such as open-
ended interviews and various mapping/visual/spatial exercises with local authorities,
community members, children, etc. can offer a fuller measure of achievement of this
objective. Methods might include: asking leaders in a relief camp to draw a diagram of the
protection risks women face while carrying on their daily tasks (e.g., gathering firewood,
collecting water, picking up food rations); or encouraging various community members to
make an outline using a pie-chart and then analyse the time youth typically spend in the
company of adults, peers, or in situations that might put them at increased risk. In the
process of carrying out such exercises, we can derive a qualitative measure of the depth
of understanding of protection issues.

Objective 4
Identification and reduction of threats to the protection and psycho-social well-being of
the target group

Indicators:
1 Change in the number of threats and risks to the psycho-social well-being of the
target group identified by the community (this indicator is also appropriate for
objective 3).
2 Change in the number of community identified response mechanism to address
threats to protection.
3 Change in the level of knowledge and attitudes regarding conflict resolution and
anger management in the target group.
4 Change in the level of knowledge and attitudes regarding sexual and gender-
based violence among youth in the target schools.
5 Change in the number of incidents/reports of gender-based violence.
6 Change in the number of reported incidents of problems caused by anger/
violence.
7 Change in the level of perceived safety or security.

Notes on Methods for Measurement:


The indicators suggested above are primarily quantitative, with the exception of perceived
level of safety or security. However, the development of quantitative questionnaires is

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

not as simple as asking a direct question; most of the quantitative measures mentioned
above must be derived from a set of indirect questions and observations. For example,
asking someone if they "feel safe" may not result in as valid a measure as a set of
questions or ranked responses to perceived danger or risk associated with specific
places, activities, times of the day, or in the presence of particular individuals. Various
mapping exercises may also prove useful in identifing indicators like: perceived levels of
safety and security among children and youth by giving them an opportunity to rank their
choice.

• Number of CLWs trained in Psycho-Social Support (PSS).


• Number of NGOs, GOs involved in Psycho-Social Support (PSS) activities.
• Number of families attended by CLWs.
• Type of PSS whether vertical or integrated and horizontal.
• Number of persons normalised during various phases of the disaster.
• Reduction in impact, distress, disability.
• Improvement in quality of life and quality of community life.
• Health seeking behaviour among the affected community.
• Incidence of alcohol, addictive substance use/abuse in the survivor community.
• Incidence of family violence, child neglect, wife battering, child trafficking.
• Number of suicides with relevance to disaster distress.
• Number of persons with mental illness pre and post-disaster, provided Mental
Health Services.
• District Mental Health Programme take-over of disaster mental health issues.

Some Additional Indicators:


• Number of vulnerable groups identified (women, children, etc.).
• Number of persons given interventions.
• Types of interventions.
• Types of referral services : Primary, Secondary and Tertiary.
• Number of persons Rehabilitated.
• Number of Self Help Groups (SHGs) formed.
• Number of Women provided with alternative activities.

76
ANNEXURES

Annexure-C

Important Websites

Ministry/Institute/Agency W ebsite

Armed Forces Medical Services www.indianarmy.gov.in/dgafms/index.htm

Indian Council of Medical Research www.icmr.nic.in

Institute of Human Behaviour & Allied Sciences www.ihbas.delhigovt.nic.in

Ministry of Defence www.mod.nic.in

Ministry of Health and Family Welfare www.mohfw.nic.in

Ministry of Home Affairs www.mha.nic.in

Ministry of Labour (Employees State Insurance) www.labour.nic.in

Ministry of Railways www.railnet.gov.in

Ministry of Women and Child Welfare www.wcd.nic.in

National Disaster Management Authority www.ndma.gov.in

National Institute of Disaster Management www.nidm.gov.in

National Institute of Mental Health and Neuro-Sciences www.nimhans.kar.nic.in

Tata Institute of Social Sciences www.tiss.edu

United Nations Children's Emergency Fund www.unicef.org

World Health Organization www.who.int

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Core Group for the Psycho-Social


Support and Mental Health
Services in Disasters

Lt. Gen. (Dr.) Janak Raj Bhardwaj Member, NDMA Chairman


PVSM AVSM VSM PHS (Retd.) New Delhi
MD DCP PhD FICP FAMS FRC Path. (London)

1 . Dr. Nimesh G. Desai Head, Department of Psychiatry Co-ordinator


and Medical Superintendent,
IHBAS, New Delhi
2 . Dr. D. Nagaraja Director and Vice Chancellor, Member
NIMHANS, Bengaluru
3 . Dr. K. Sekar Professor and Head, Member
Department of Psychiatric
Social Work, NIMHANS,
Bengaluru
4 . Dr. P. Ravindran Director, Emergency Medical Relief, Member
MoH&FW, New Delhi
5 . Dr. Cherian Varghese Cluster Focal Point Member
(Non-communicable Diseases
and Mental Health), WHO,
Country Office of India, New Delhi
6 . Brig (Dr.) Daniel Saldhana Professor of Psychiatry, Member
Armed Forces Medical College, Pune
7 . Dr. Surinder K.P. Jaswal Professor & Dean Member
School of Social Work
Tata Institute of Social Sciences,
Mumbai
8 . Dr. Sujata Satpathy Assistant Professor, Member
National Institute of Disaster
Management, New Delhi
9 . Dr. Dhanesh K. Gupta Additional Professor, Member
Department of Psychiatry, IHBAS,
New Delhi
1 0 . Dr. Jayakumar C. Senior Specialist, Member
Psycho-Social Support
and Mental Health Services,
NDMA, New Delhi

78
CONTRIBUTORS

Steering Committee

Dr. Raman Chawla Senior Research Officer


NDMA, New Delhi
Dr. Jahanara Gajendragad Assistant Professor
Department of Psychiatric Social Work, IHBAS, Delhi

Mrs. Vijaylakshmi Nagaraj Social Worker, Educationist and Author, Bengaluru

Significant Contributors

Acharya, Binoy, Director, Unnati, Ahmedabad, Gujarat


Agarwal, Dr. SP, Secretary General, Indian Red Cross Society, New Delhi
Agashe, Dr. Mohan, Advisor, Government of Maharashtra, Mental Health Policy &
Programme, Pune, Maharashtra
Amal Raj, PS, SJ Director, South Asia, Jesuit Refugee Services, Bengaluru
Chakraborty, Arup, West Bengal Voluntary Health Association (WBVHA), Programme
Manager, Andaman and Nicobar Island
Babu, Dr. Lucas, Director RIDO Sevagram, Dharmapuri, Tamil Nadu
Balagopal, N., Executive Chairman, CNRI, Kerala Educational Development Society,
Trivandrum
Battacharyya Devashish Dr., Chief Medical Officer, Disaster and Emergency Medicine,
Govt. of NCT of Delhi
Bansal, Maj. Gen. J.K., Co-ordinator CBRN, NDMA, New Delhi
Bhardwaj, Rohit Dr., Psychiatrist, 24 Tuglaq Crescent, New Delhi
Bhandari, R.K., Centre for Disaster Mitigation & Management, Vellore Institute of
Technology, Vellore, Tamil Nadu
Bharath, Dr. Srikala, Professor of Psychiatry, NIMHANS, Bengaluru
Bissell, Dr. Susan L., UNICEF India Country Office, New Delhi
Rao, Brig. D. V. (Retd.), Centre for Disaster Management
Chander Mohan, Dr. Professor and Head, Dept. of Psychiatry, Government Medical
College Hospital, Jammu
Chaudhry, Yogender, Executive Director, Nehru Yuva Kendra, Ministry of Youth Affairs &
Sports, New Delhi

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Chauhan, Dr. Ajay, Superintendent, Hospital for Mental Health, Ahmedabad


Dasan, Dr. Thulasi R., Project Director, G.B. Pant Hospital Complex, Port Blair
Dayal, Anjana, Co-operation Tracing Consultant, International Committee of Red Cross,
New Delhi
Deuri, Dr. S.K., Director, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health
(LGBMH), Tezpur, Assam
Devi, Dr. Gouri M., Medical Superintendent, Institute of Mental Health, Hyderabad
Dhanabalan Kennedy, Manager, Technical Services, EFFICOR, New Delhi
Dhongaonkar, Prof., Secretary General, Association of Indian Universities, New Delhi
Gandevia, Katy, Reader, Tata Institute of Social Sciences, Mumbai
Gautam, Dr., Shiv, Professor and Head, Psychiatric Centre, Jaipur, Rajasthan
Gautham, Dr. Dass, Director, ADEPT, Chennai
Gandi Sudhir J Dr., Deputy Director, Health Services, Govt. of Gujarat, Gandhi Nagar
Ghandhi, Dr. Anjali, Professor and Head, Department of Social Work, Jamia Millia Islamia,
New Delhi
Ghandi, Dr. Doss L.S., Professor and Chairman, Department of Social Work, Bengaluru
Goel, D.S., Col Dr., coldsgoel@hotmail.com
Gopalan, Prema, Director, Swayam Shikshan Prayog , Mumbai
Govinda, R., Professor and Vice Chancellor, National University for Educational Planning
and Administration, New Delhi
Hussain, Mazher, Director, Confederation of Voluntary Associations, Charminar, Hyderabad
Jaysingh, Dr. J.V., Professor and Head, Department of Social Work, Mizoram University,
Aizawl
Joseph, Bitty K., Project Manager, Peoples Council for Social Justice, Kochi
Joshi, Rajendra, Director SAATH, Ahmedabad, Gujarat
Kaur, Prof. Amarjeet, Director, Centre for Disaster Management Studies, Guru Gobind
Singh Indraprastha University, New Delhi
Rao, Dr. Kiran, Professor and Head, Department of Mental Health and Social Psychology,
NIMHANS, Bengaluru
Kazi S.A. Dr., Registrar, Karnataka State Women's University, Bijapur
Koshy, K., IPS, Director General, National Disaster Response Force & Civil Defence,
Ministry of Home Affairs, New Delhi
Kumar, Dr. Dileep T., President, Indian Nursing Council, New Delhi

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CONTRIBUTORS

Kumar, Dr. Kishore K.V., Senior Psychiatrist, Department of Psychiatry, NIMHANS,


Bengaluru
Kumar Raj Dr., Head Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of
Delhi, Delhi
Kumar S. Dr., Principal and Dean, M S Ramaiah Medical College, Bangalore
Lenin, Dr. R.K., Associate Professor, Department of Psychiatry, Lamphelpat, Imphal,
Manipur
Madhumita, Sneha Abhiyan, Action Aid, Bhubaneswar, Orissa
Malik Dr. S.C., Professor and Head, Department of Psychiatry, Lady Hardinge Medical
College, New Delhi
Mandal Manas K. Dr., Director Defence Institute of Psychological Research, Delhi
Manickam, Dr. SS., Professor and Head, Department of Clinical Psychology, JSS Medical
College, Mysore
Marian, Dr. Benita, Stella Maris College, Chennai
Mohanty, R. N., Director, CARE India Tsunami Response Action Project (CITRAP), Chennai
Muzaffar Ahmad, Dr., Director of Health Services, Government of Jammu and Kashmir,
Srinagar
Nagpal, Dr. Jitendra, AHSAAS Foundation,VIMHANS, New Delhi
Nambi, C., Director, Centre for Social Education and Development (CSED), Coimbatore
Newman, Paul, Jesuit Refugee Services, Indian Social Institute, Benson Town, Bengaluru
Padhmanabhan, G., United Nations Development Programme, New Delhi
Pandi, A. Dr., Professor and Head, Department of Social Work, Arinagar Anna Arts College,
Karaikal, Puducherry
Patro, Arup Kumar K., Project Officer, Andhra Pradesh Relief to Development Programme,
AKDN, New Delhi
Placid, G., Director, SAHAYI, Trivandrum, Kerala
Poddar, D.P., Executive Director, West Bengal Voluntary Health Association (WBVHA),
Kolkata
Prasad, Dr. Rajendra, Professor and Head, Department of Defence & Strategic Studies,
Gorakhpur University, Gorakhpur
Prewitt Diaz, Dr. Joseph, Head of the Programme, American Red Cross, India Operations
Centre, New Delhi
Prince, Fr. C. P., Vice Principal, Bharath Matha College, Ernakulam, Kerala
Prusty, N.M., Chief of Party, USAID - IRG India & Chairperson, Sphere India, New Delhi

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Rafi Ahmed Centre for Development, Ahmedabad, Gujarat


Reddemma, Dr. K., Professor and Head, Department of Psychiatric Nursing, NIMHANS,
Bengaluru
Reddy, Dr. Sunitha, Assistant Professor, Jawaharlal Nehru University, New Delhi
Reji, P.E., Programme Co-ordinator, TdH, India Programme, Southern Office, Bengaluru
Sachdeva T.S. Colonel (Dr.), Director Perspective Planning (NBC Medicine), Army
Headquarters, New Delhi
Saini, G.S., Director, National Civil Defence College, Nagpur
Sankar, C.V., IAS, Officer on Special duty (Relief & Rehabilitation), Ezhilagam, Chennai
Sekar, Dr. Rameela, Professor and Head, School of Social Work, Roshini Nilaya, Mangalore
Shah, Dr. Hamidullah, Professor and Head, Psychiatric Diseases Hospital, Srinagar
Shah, Dr. Nilesh, Professor and Head, Department of Psychiatry, LTM Medical College,
Mumbai
Shah Siddarth Ashvin, M. D. Medical Director, Green Leaf Integrative strategies,
Washington D.C.
Shetty, Dr. Harish, Social Psychiatrist, Mumbai
Siddiqui, M.H., Policy Research & Advocacy Co-ordinator, Action Aid, Afghanistan
Singh, Balaji C.B., Director, ERP, Care India, New Delhi
Singh, Surg Rear Admiral (Retd.) V.K., Consultant, NDMA, New Delhi
Singhal, Dr., National Institute of Rural Development, Rajendranagar, Hyderabad
Srilatha, Dr. Juvva, Reader, Tata Institute of Social Sciences, Deonar, Mumbai
Sriramappa, G., Country Director, Every Child, India Liaison Office, Bengaluru
Subramaniam, Dr. C.Rama, Professor & Head, Institute of Psychiatric Medicine
Government Rajaji Hospital, Madurai, Tamil Nadu
Swain, Dr. S.P., Consultant Psychiatrist, Mental Health Institute, SCB Medical College,
Cuttack
Uma, Dr. V., Professor and Head, Department of Social Work, SPMVV, Thirupathy, Andhra
Pradesh
Unnikrishnan, P., Action Aid, Bengaluru
Vankar, Dr., Professor and Head, Department of Psychiatry, Government Hospital,
Ahmedabad, Gujarat
Vikrant Mahajan, Chief Operating Officer, Sphere India, New Delhi

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NATIONAL DISASTER MANAGEMENT GUIDELINES: PSYCHO-SOCIAL SUPPORT AND MENTAL HEALTH SERVICES IN DISASTERS

Contact Us

For more information on these Guidelines for Psycho-Social Support and Mental
Health Services in Disasters

Please contact:

Lt. Gen. (Dr.) J.R. Bhardwaj


PVSM, AVSM, VSM, PHS (Retd.)
MD DCP PhD FICP FAMS FRC Path. (London)

Member,
National Disaster Management Authority,
NDMA Bhawan, A-1 Safdarjung Enclave,
New Delhi-110 029

Tel: +91 11 2670 1778


Fax: +91 11 2670 1804
Email: jrbhardwaj@ndma.gov.in; jrb2600@gmail.com
Web: www.ndma.gov.in

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