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
Lampung
3 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,marah
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
 - - ·-
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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

Konsentrasi/
Rasa tidak berguna/
perhatian
rasa bersalah

Depresi berkurang

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

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

People with •Is anyone critically injured
obvious urgent •Does anyone need rescue?
basic needs •Obvious needs (torn clothing…)?
•Who may need help to access
services or to be protected?
•Who else is available to help?
Know your role. Try to
obtain help for people who
need special assistance.
Refer critically injured
people for care.

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

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