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Mental Health In

Disaster Management

dr. Rinvil Renaldi, M.Kes, Sp.KJ(K)


Psikiater Anak dan Remaja
Departement Psikiatri FKUH
• Saat ini kita hidup dalam era yang mudah
mengalami krisis. Setiap tahunnya, jutaan orang
dihadapkan pada kejadian traumatik yang tidak
dapat diatasi oleh mereka sendiri.

• Roberts (2005) orang cenderung mencari


pelayanan kesehatan mental dalam bentuk unit-
unit pelayanan kesehatan primer di komunitas.
Emergency and Disaster Hazard Mapping, Indonesia (Emergency
Supermarket) (Win-Nath, 2006)

NAD W. Kalimantan C. Kalimantan S. Kalimantan E. Kalimantan Gorontalo N. Sulawesi


2,3,4,5,6,7,13 1,3,8,4,6,10,9,5,11, 6.10,8,9,3,11,7, 3,10,5,13,14 3,10, 8,9,5,14 3,14 1,3,8,2,4,11,13,14
,14 13,14 14
N. Sumatra C. Sulawesi
3,4,7,14 2,3,6,9,7,13,14

W Sumatra S. Sulawesi
1,2, 3,4,6,7,13,14
3,4,8,11,14
Bangka Belitung S.E Sulawesi
3,14 3,6,14
S. Sumatra
3,4,14 N.Maluku
2,4,6,7,9,13,14
Riau
3,5,7,8,14 Papua
2,3,4,6,7,9,11,13,
Kep Riau
14
14
3
Lampung Maluku
2,3,14 2,3,6,7,9,11,13,14
Bengkulu
2,4,14 NTT
1,3,6,9,11,2,13,4,5,
Jambi
14
3,14
Jakarta W, Java C. Java Jogyakarta E. java Bali NTB
Banten
3,4,6,7,9, 14 2,3,4,5,6,7,11 1,2,3,4,5,9,11 1,11,14 1,2, 3,5,6,7,9 2,3,4,6,7,9,14 3,6,2,9,4,5,11,7,1
2,3,5,12,14 ,14 ,12,14 ,11,12,13,14, 4

Type of Emergency and Disaster


1. Volcano 5. Hurricane 9. Disease outbreak 13. Tsunami
2. Earthquake 6. Conflict 10. storm 14. Transportation
3. Flood 7. Terrorism 11. Drought Accident
4. Landslide 8. Environment Pollution 12. Industrial Accident
Homeostasis/keseimbangan adalah keadaan alami
yang dicari oleh semua orang, dan kadangkala
trauma membuat keadaan ketidakseimbangan
Definisi Bencana ??
Definisi Bencana

Bencana adalah peristiwa atau rangkaian peristiwa


yang mengancam dan mengganggu kehidupan dan
penghidupan masyarakat yang disebabkan, baik oleh
faktor alam dan/atau non-alam maupun faktor manusia
sehingga mengakibatkan timbulnya korban jiwa
manusia, kerusakan lingkungan, kerugian harta benda,
dan dampak psikologis (UU 24/2007)
Contoh Bencana ??
Jenis Bencana (UU 24/2007)

• Adalah bencana yang diakibatkan oleh peristiwa atau


serangkaian peristiwa yang disebabkan oleh alam antara lain
berupa ; gempa bumi, tsunami, gunung meletus, banjir,
kekeringan, angin topan dan tanah longsor

• Adalah bencana yang diakibatkan oleh peristiwa atau serangkaian


peristiwa yang antara lain berupa ; gagal teknologi, gagal
modernisasi, epidemi dan wabah penyakit

• Adalah bencana yang diakibatkan oleh peris-tiwa atau


serangkaian peristiwa yang diakibatkan oleh manusia yang
meliputi konflik sosial antar kelompok atau antarkomunitas
masyarakat dan teror
Jenis-jenis Bencana*
(Berdasar Penyebab)
 Bencana Alam (Natural Disaster)
 Skala Meluas
 Familiaritas dan pengalaman akan membantu persiapan
 Umumnya tidak dapat dihindari

 Bencana Ulah Manusia (Man-made Disaster)


 Tidak dapat diprediksi, tidak dapat dikontrol
 Mendadak
 Kesengajaan vs Kecelakaan

*Menurut Pemerintah Queensland (2007)


Akibat Bencana ??
Bencana dapat menyebabkan
kehilangan yang beragam,
misalnya kehilangan
orang yang dicintai (misalnya
orangtua atau saudara) dan
hilangnya fungsi
anggota tubuh.

Bencana biasanya menimbulkan


kerusakan yang bervariasi, seperti
hancurnya lingkungan dan hilangnya
sistem dukungan sosial bagi anak,
misalnya sekolah, tempat bermain, dsb.

Anak dapat kehilangan anggota keluarga, pindah dan berhenti


sekolah. Keluarga juga akan kehilangan kehidupannya
Bencana

Kepribadian,
Kemampuan
menyelesaikan masalah,
Krisis pada individu Resilience dan daya
adaptasi, sistem
dukungan dan durasi saat
mengalami stress.
Beberapa reaksi emosi yang mungkin terjadi
saat bencana

• Ketakutan,sedih,mara
h perasaan bersalah,
juga rasa lega,
kebahagiaan saat
berkumpul kembali
dengan keluarga, iri
hati terhadap mereka
yang lebih beruntung,
dan lain-lain.
MACAM2 RX PSIKOLOGI setelah BENCANA

PD ANAK2
• Grief
• Cemas perpisahan
• Perilaku yg regressive pd anak
• Cemas antisipatorik
• Ggn tidur
• School phobia
* tempat yg tdk biasa
* cemas meninggalkan OT
PD ORANG DEWASA
• Cemas & depresi
• Psikosomatik
• Cpt tersinggung, marah
• Perasaan terayun / melayang
• Curiga, irritable
• Apathy
• Nafsu makan terganggu
• Ggn tidur
• Kinerja menurun
- - ·- -
---

Tahukah anda?
 Sekitar 10-20% korban bencana akan mengalami
gangguan mental bermakna seperti:
 GSPT/PTSD, Gangguan Depresi, Gangguan Panik, dan
berbagai gangguan anxietas terkait trauma
- - ·- -
Gejala Depresi1 ---

Sedih/murung Kehilangan Tidak bertenaga,


setiap waktu minat mudah lelah

Rasa tidak berguna/ Konsentrasi/


rasa bersalah perhatian

Depresi berkurang

Pandangan
masa Gangguan
depan yang pola makan
suram dan
pesimistis
Harga diri Gagasan/perbua
dan tan
kepercayaan Gangguan Tidur membahayakan
diri berkurang diri/
bunuh
1. PPDGJ – III , 1993/ICD-10 8
diri
- - ·- -
---

Gejala cemas
1. Gangguan Motorik
2. Gangguan Otonom
3. Kewasapadaaan meningkat dan konsentrasi
berkurang
- - ·- -
---

Gejala Psikotik
 Afektif
 Pikiran
 Persepsi
 Perilaku
- - ·- -
---

Gangguan stres Akut – F 43.0


 Setelah trauma, kondisi mental penderita tampak
berf luktuasi dan ini jelas terkait dengan peristiwa
tersebut
 Gejala akan mereda dalam waktu beberapa hari
sampai 4 minggu
 Gejala tersebut bukan merupakan eksaserbasi
gangguan mental sebelumnya.
- - ·- -
---

Gangguan Stres Akut – F 43.0


 Gejala :
- Kebingungan
- Agitasi atau sangat reaktif
- Menarik diri
- Gejala anxietas; misalnya berkeringat, berdebar, muka
merah
- Disorientasi‘
- Depresi
- Amnesia
Gangguan Stres Pasca Trauma –
F 43.1
 Ini adalah respon anxietas yang berkepanjangan
terhadap peristiwa traumatik
 Gejala-gejala paling tidak harus dialami selama 1 bulan
Gangguan Stres Pasca Trauma –
F 43.1
 Gejala tersebut adalah :
- bayangan, mimpi atau kilas balik peristiwa traumatik
- Menghindari hal-hal yang mengingatkan akan peristiwa
itu
- Amnesia terhadao aspek penting peristiwa tersebut
-
Timbul anxietas hebat dan kesiagaan berlebihan jika
terpapar pada hal-hal yang mengingatkan akan peristiwa
- itu
- Mood yang depresif atau iritabel
- Menarik diri
- Sulit berkonsentrasi
- Mudah tertegun
Mimpi buruk atau tidur terganggu
Anak-anak
Perempuan
Lanjut Usia
- - ·- -
---

Anak-anak
 Usia perkembangan
 Rentan menjadi korban KDRT
 Tidak berperan dalam mengambil keputusan
- - ·- -
---

Perempuan
 Peran Subordinat
 Peran Multifungsi
 Rentan menjadi KDRT
- - ·- -
---

Lanjut Usia
 Deteriorasi kemampuan fisik/mental
 Sulit beradaptasi dengan situasi baru
 Kehilangan peran
 Rentan Pengabaian keluaga
Apa yang dapat kita
lakukan ??
Menjadi pendengar, mencoba mengerti bukan
menghakimi
Memberikan edukasi, koseling,
psikoterapi dan psikofarmaka
Memberikan psikofarmaka untuk
memperbaiki gejala
- - ·- -
---

Prinsip Penanganan
 Kenalli faktor risiko
 Deteksi Dini
 Pendampingan
 Bila mengganggu fungsi peran perlu penangan
profesional
Tugas kita adalah membantu mereka menemukan cara
terbaik bagi dirinya
What comes to mind when you
hear…
“Psychological First Aid”
Prinsip Dasar PFA
• Berikan bantuan sesegera mungkin langsung pada orang yang
memerlukan dukungan
• Sediakan informasi akurat dan logis tentang situasi yang ada
• Bersikap jujur, jangan pernah menjanjikan sesuatu yang tak bisa
• kita penuhi
• Sediakan dukungan emosional bagi orang yang memerlukan
dukungan
• Fokus pada kemampuan yang dimiliki orang yang memerlukan
dukungan untuk pulih
• Berikan perhatian yang non diskriminatif untuk semua.
Perhatian yang non diskriminatif adalah perhatian dengan tanpa
membeda-bedakan latar belakang dari orang yang memerlukan
dukungan
What PFA Is?
• Supportive and practical assistance to fellow human
beings who recently suffered exposure to serious
stressors, and involves
– Non-intrusive, practical care and support
– Assessing needs and concerns
– Helping people to address basic needs (food, water)
– Listening, but not pressuring people to talk
– Comforting people and helping them to feel calm
– Helping people connect to information, services and social
supports
– Protecting people from further harm
PFA Action Principles

Prepare
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Look Listen Link
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PFA Action Principles
Prepare •Learn about the crisis event.
•Learn about available services and supports.
•Learn about safety and security concerns.

Look •Observe for safety.


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•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions.

Listen •Make contact with people who may need support.


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•Ask about people’s needs and concerns.
•Listen to people and help them feel calm.

Link •Help people address basic needs and access services.


•Help people cope with problems.
•Give information.
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•Connect people with loved ones and social support.


Wherever possible, before you enter a crisis
site, try to learn about…
The Crisis What happened?
Event Where?
When?
How many and who are affected?

Available Who is providing for basic needs (emergency


Services medical care, food, shelter)?
When & where can people access services?
Who is helping, including community members?

Safety & Is the crisis over or ongoing (aftershocks, fighting)?


Security What dangers may be in the environment?
Are there places to avoid due to insecurity or
because it is not permitted to be there?
Look •Observe for safety.
•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions.

Safety •What dangers can you observe? If you’re not certain about
•Can you be there without harm to safety…DO NOT GO! Seek
yourself or others? help from others.
Communicate from a safe
distance.

People with •Is anyone critically injured Know your role. Try to
obvious •Does anyone need rescue? obtain help for people who
urgent basic •Obvious needs (torn clothing…)? need special assistance.
needs •Who may need help to access Refer critically injured
services or to be protected? people for care.
•Who else is available to help?
People with •How many & where are they? Consider who may benefit
serious •Is anyone extremely upset, immobile, from PFA and how best to
distress not responding to others or in shock? help.
People who Likely Need Special Attention
(to be safe…to access services)
• Children and adolescents QuickTime™ and a
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– Especially those separated from caregivers


• People with health conditions and
disabilities QuickTime™ and a
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– Chronic illness, elderly, pregnant or nursing


women, non-mobile, hearing/visual impairments
(deaf/blind)
• People at risk of discrimination or
violence
– Women, certain ethnic or religious groups,
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mental disabilities
Helping people in
distress

• Most people recover well over time, especially if


they can restore basic needs and receive support
(PFA).
• Those with severe or long-lasting distress may
require more support.
– Try to make sure they are not left alone.
– Try to keep them safe until the reaction passes or you
can find help from others.
Make •Approach respectfully
contact •Introduce yourself by name & organization
•Ask if you can provide help, find safe/quiet place
•Help person feel comfortable (water, blanket)
•Try to keep them safe

Ask about •Although some needs are obvious,


always ask
needs &
•Find out person’s priorities - what is most
concerns important to them.

Listen & •Stay close to the person


help •Do not pressure them to talk
•Listen in case they want to talk
people
•If very distressed, help them feel calm
feel calm & make sure they are not alone
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Listen with compassion by using your:

Eyes - giving the person your undivided attention


Ears - hearing carefully their concerns
Heart - with caring and showing respect
Help People
Feel Calm

• Keep your tone of voice soft and calm


• Maintain some eye contact
• Reassure them they are safe and that you are there
to help
• If someone feels “unreal”, help them make contact
with:
– Themselves (feel feet on the floor, tap hands on lap)
– Their surroundings (notice things around them)
– Their breath (focus on breath & breathe slowly)
Optional Slide
Good Communication Exercise

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Good Communication: TALK LESS,
LISTEN
MORE!
Things to Say and Do
• Try to find a quiet place to talk • Give information in a way the
and minimize outside person can understand - keep
distractions it simple.
• Stay near the person but keep • Acknowledge how they are
an appropriate distance feeling, and any losses or
depending on their age, gender important events they share
and culture with you, such as loss of home
• Let them know you hear them, or death of a loved one. “I’m
for example, nod your head and so sorry…”
say…”hmmmm.”
• Respect privacy. Keep the
• Be patient and calm person’s story confidential,
• Provide factual information IF especially when they disclose
you have it. Be honest about very private events.
what you know and what you
• Acknowledge the person’s
don’t know. “I don’t know but I
strengths and how they have
will try to find out about that for
you.” helped themselves.
Good Communication:
Things NOT to Say and Do
• Don’t pressure someone to tell • Don’t make up things you don’t
their story know.
• Don’t interrupt or rush • Don’t use too technical terms.
someone’s story • Don’t tell them someone’s else’s
• Don’t give your opinions of the story
person’s situation, just listen. • Don’t talk about your own
• Don’t touch the person if you’re troubles
not sure it is appropriate to do • Don’t give false promises or
so. false reassurances
• Don’t judge what they have or • Don’t feel you have to try to
haven’t done, or how they are solve all the person’s problems
feeling. Don’t say…”You for them
shouldn’t feel that way.” or “You • Don’t take away the person’s
should feel lucky you survived.” strength and sense of being
able to care for themselves
•Help people address basic needs and access services.
Link
•Help people cope with problems.
QuickTime™ and a

•Give information.
decompressor
are needed to see this pict ure.

•Connect people with loved ones and social support.

Help people to help themselves and


regain control of their situation.
Link -
basic needs

• What needs do they request?


• What services are available?
• Don’t overlook the needs of vulnerable or
marginalized people
• Follow-up if you promise to do so
Link - help people
cope with
problems
Distressed people may feel
overwhelmed with worries…
• Help them prioritize urgent needs (what to do first)
• Help them identify supports in their life
• Give practical suggestions how they can meet their needs
(i.e., registering for food aid)
• Help them remember how they coped in the past and
what helps them to feel better
Positive coping strategies (adjust
for culture)
Help people use their natural coping mechanisms to
regain a sense of control:
– Get enough rest
– Eat as regularly as possible and drink water
– Talk and spend time with family and friends
– Discuss problems with someone you trust
– Relax: walk, sing, pray, play with children
– Exercise
– Avoid alcohol or drugs, caffeine, nicotine
Terima Kasih

Rinvil Renaldi
rinvilrenaldi@gmail.com