Psychological and Mental Health Support Program

The division and labeling of time frames in the disaster sequence is useful for defining the responses of survivors and the programs that are organized to assist them. Generally, the stages are identified as “threat”/”impact,” “short-term,” and “long-term.”
Post-traumatic responses follow a sequence similar to the emotions, thoughts, and behaviors documented in the process of loss and bereavement. Although reaction sequences are not of definite duration, there is an evolutionary process that has been identified and documented. This psychosocial adjustment process begins with feelings of disbelief, confusion, difficulty concentrating, and the use of denial as the main defense. Anxiety and fear are followed by varying degrees of depression and eventually sadness. Secondary events can influence these processes toward a healthy resolution or produce disease syndromes. Variables such as severity of impact, geographic extent of destruction, and speed of assistance are examples of modifiers that have been shown to rank reactions to trauma.

After the impact, the situation will pass tragically and catastrophically, as individuals in the affected areas will immediately go out and cooperate in rescue efforts and secure shelter and safety for citizens. Through these efforts, they will organize themselves to handle the priority of burying the dead, tending to the injured, identifying vulnerable members of the community, and beginning to apply their knowledge of emergency first aid while waiting for resources from outside.
After the early days, when issues of survival, shelter, food and water are dealt with, mental health issues emerge as needing attention and generally persist beyond recovery from physical trauma. The following list presents a summary of the main activities that must be organized and operated to deliver a mental health program aimed at mitigating the consequences of the disaster for the population at risk.

These activities are organized in shelters, congregate groups and homes in devastated communities, as well as in simultaneous online sessions. Specialists aim to provide emotional support during the acute period following a disaster. Communication helps survivors express and understand stress from the disaster, difficulty sleeping and thinking clearly, grief reactions, and helps individuals return to a state of balance and function. The information is presented to show that their reactions and behavior are normal and expected due to the abnormal situation in which they suddenly find themselves.
In the aftermath of the earthquake that hit Syria and Turkey in 2023, which killed many, international agencies organized efforts to develop a relief and catering assistance program and forgot about psychological support and mental health.
The emerging knowledge learned in disasters over the years has helped professionals to modify and reformulate intervention modalities to focus on “personal condition formation” as a unit of interest in post-disaster psychotherapy. This post-disaster intervention is now well known. Post-disaster crisis counseling is defined as “a mental health intervention technique useful in post-disaster events that seeks to restore individuals’ ability to deal with the stressful situation in which they find themselves”. It has three goals:
a) Restore the capacity of individuals.
b) Rearrange and organize their new world.
(c) Assisting victims in dealing with an emergency bureaucratic relief programme.
The methodology for achieving these goals varies according to the “school of thought” the professional uses. Reality conditions require a short, flexible, creative and adaptive approach compared to the usual structured and methodical clinical approach. This is an area where continued efforts to adapt clinical skills and modified approaches will be fostered as professionals learn from one disaster to the next. The distinction between variables such as age, gender, and cultural backgrounds points to the fact that both responses and successful interventions differ in children, adults, and older adults of different cultures, traditions, and religions.

Helping families
When death occurs after the impact of a disaster, families need preventive mental health services, as they are at risk. The degree of loss, which includes loved ones, possessions, community, employment, and an unfamiliar environment, may overwhelm their ability to cope.
Providing assistance in the morgue, near public cemeteries (where victims may be buried due to fear of epidemics) is an appropriate job for psychiatric and mental health workers. Cooperation with spiritual and religious representatives is very important. This is particularly effective when the body cannot be found/rescued and the burial plan cannot be submitted as happens in airline accidents or multi-building fires.

Help survivors in shelters and online
The intervention procedures are linked to the assessment of the shelter survivors’ condition. When this situation lasts more than a few weeks, survivors can generate frustration in the form of violence, anger, and depression.
The mental health worker in the shelter will have to ascertain how the condition of the survivors affects their ability to solve problems and deal with the challenges of the crowded environment found in countries with limited resources.
The sorting method should be developed to distribute the resources. The proportion of needs and the number of assistants will guide this procedure. The goals of intervention for shelter survivors include helping them achieve physical comfort and increasing the ability to organize their living area, as well as providing problem-solving support with surrounding survivors. To implement the intervention concretely, the trained professional will first form himself as a member of the risk-assisted team within the shelter or through its online sessions. This allows the freedom to approach the survivors and initiate interaction to provide support and guidance regarding the thoughts and emotions expressed by each survivor. The mental health aide will organize all his/her notes and statements, sharing information with the survivor about what happened to him/her, in an initial diagnosis, to ascertain the level of crisis and coping shown by the survivor. Using crisis techniques, the intervention begins to craft, including emotional support and empathy, and acceptance of feelings of denial and distortion. During the first stages after the impact of the event, the survivor’s cognitive system will lose sight of reality in order to filter out the traumatic thoughts. While receiving support, he will at the same time need personal guidance, help with plans and provide direction and information. Over time, the mental health worker may follow the survivor out of the shelter to temporary housing or have a team member continue to help. During this period, a number of problems develop that the survivors, traumatized, find it difficult to resolve.
Collaboration, education, and consultation with emergency medical personnel who deal with injured or burnt survivors will aid in recovery toward a healthy outcome. It is important to check whether the population is suffering not only from the impact of the disaster, but also with the myriad of health and mental problems that preceded the disaster. The need to triage the survivor’s mental health condition will facilitate the triage work and assist in making a referral decision if long-term professional services are needed.

The short term stage
The program’s goals for consultation, education, and assistance change during the weeks and months following a disaster. The acute phase is over and now a new phase appears after the disaster, which can last for months, with various problems facing the survivors. Mental health disaster workers can be trained to identify novel problems, which include all ranges of depression, anxiety, and PTSD.
A variety of treatment approaches have been developed in the past few years by specialized professors in the Faculty of Education and Social Sciences at International Suleiman University, combining psychotherapeutic techniques and medication. Many survivors of traumatic experiences suffer not only from stress-related syndromes but also from depression, alcohol or drug abuse, or personality disorders. If the catastrophe is the death of a close family member, untangling the grieving process from the traumatic circumstances of the loss becomes an important part of the assessment.
Therapy generally addresses two components present in most survivors: traumatic memories and the physiological response of the organism that was compromised. Both will continue for periods of time after the end of the event. Among the psychotherapeutic options, cognitive, exposure and behavioral methods are used by professionals. They aim to recreate the painful memories, fantasies, fears and grief resulting from the trauma in a safe environment. The survivor repeats the memorized events over and over and slowly but regularly loses their ability to cause anxiety and pain.
Pharmacotherapy treats many physiological disorders. Antidepressants will reduce anxiety, sleep disturbances, startle reactions, and difficulty returning to work. Large trials of SSRIs are being conducted in order to evaluate their effectiveness in reducing the above symptoms. In addition, group therapy, family therapy, and pediatric therapy add to the options available after a disaster strikes.
Further deterioration in survivor capacity during this phase can be mitigated if preventive measures are taken. One important program that has emerged is the school program for children, parents, teachers and administrators. Due to the fact that these individuals congregate in institutions to help educate children, the opportunity to train them to impart psychological support skills seems very effective if they are educated about preventive mental health approaches. As heads of household in developing countries, women are an important group who need assistance in their jobs as caregivers and to help them obtain resources to rebuild their lives.

Another group that needs guidance are the survivors who have lost their homes and are frustrated with the country’s long reconstruction strategy. These diagnosable conditions are more common in this group and professionals should be referred to specialists. This condition is more common in Syria and Turkey now that the earthquake has destroyed entire cities.
Severe acute stress reactions, post-traumatic stress disorder, depression and anxiety syndromes that increase in severity during this stage can be ignored, misdiagnosed or poorly treated if professionals are not trained in catastrophic mental health problems.

The support services program needs to be extended to traumatized individuals for longer periods of time than would generally be expected. Where psychosocial support providers recognize that a percentage of at-risk individuals are unable to support themselves for a variety of reasons, their services can include assistance in finding shelter, employment, and health resources. This part of the program is difficult to implement in some countries due to lack of resources.

Burn-out syndrome for caregivers
The mental and psychological health of rescue professionals after a disaster is an important component of emergency operations.
Their job can expose them to the most awful sights and smells. Despite their willingness, in their daily work as policemen, firefighters, ambulance drivers, etc., to communicate traumatic experiences, when this is multiplied by the 100 or 1000 corpses that need to be disposed of, the effect is severe. No one is prepared or immune from this devastating influence. Besides, we need to consider fatigue and extreme dedication to the task with a reluctance to relieve us of duty, even on a short respite. This was evident in the angry reaction of the rescuers who clashed with the police when they were told to stop working in the earthquake zone in Syria and Turkey. The essential components of an intervention consist of debriefing, identifying critical incidents, and helping to put the situation into perspective. The graduated procedures are as follows:

1- An introduction to the objectives, format, schedule, and confidentiality of the debriefing.
2- Asking group members to express their experiences.
3- Share responses and feedback.
4- Explain and understand feedback.
5- Determine methods of confrontation using cognitive and educational methods.
6- Close the meeting and provide further assistance if needed.

Take advantage of professional experts
In some areas, there is a need to develop a range of professional and semi-professional response teams to assist survivors. Professional and semi-professional workers can successfully combine efforts to provide a disaster recovery response grounded in crisis theory and intervention techniques. Professionals resorted to variations and experimentation with a variety of human resources depending on availability. Certain circumstances emerge as necessary to achieve the goals of successful utilization of paraprofessionals. These include:

1- Individuals who have some counseling experience.
2 – Individuals with communication skills and sensitivity to the ethnic, social and religious characteristics of the victim.
3- Training sessions and close supervision throughout the intervention programme.

Cross-cultural issues in disaster assistance
Some of the participation of political institutions in disaster response is global and in many cases broad. The level of government involvement varies greatly between different societies. Disaster response at Soliman International University is primarily a responsibility when local resources are severely diminished due to direct impact. Disaster response is primarily a national responsibility for government involvement in vulnerable areas. Government organizations in Middle Eastern regions are not given psychological support as a priority in those cases.

Opportunities for media outreach and the dissemination of mental health information emerge after a disaster. The human story in the disaster is compelling and media professionals are seeking interviews with psychiatrists at a brisk pace. In the midst of a crisis in society, the impact of these messages is having a powerful impact. There are two specific areas that present the goals to be achieved through educational methods. One area deals with our knowledge of how populations are psychologically affected by trauma and the sequence of stress response to disaster. The other area is providing knowledge about how the mental health system is responding and what professionals have to provide in post-disaster situations. Each of these areas has: a) methods; b) Content. c) a structure for the dissemination of knowledge.