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ROLE OF PSYCHOLOGISTS IN DEALING WITH TRIPLE DISASTER SITUATION DURING COVID-19 PANDEMIC
DR. PRASANTA KUMAR ROY
Department of Clinical Psychology
Institute of Psychiatry, COE, Kolkata
Background:
Human society all over the world is facing an evolutionary crisis of survival of the fittest due to COVID-19 pandemic that has killed more than 3 lakhs of people in just 5 months. Lots of debates, allegations, discussions are going on regarding the origin, modality of infections, how to break the chain, treatment and appropriate strategies to deal with the pandemic. There are also debates about the waves of the disease, lethality, vaccine, role and impact of lockdown. Psychologists all over the world have become busy in helping people to cope with panic or anxiety and to manage the lockdown period without much psychological harm. Various strategies have been discussed and in India almost all the major mental health organizations are trying their best to contribute to the society. Probably, the mental health issues related to COVID-19 which are discussed by all sections of the society, ranging from children to geriatric population, community and media, have never taken place before. Many mental health professionals have also launched online research related to Covid-19 (Amulya, 2020).
Disaster, India and Mental Health Professionals:
Disaster has a long history in India and this country is one of the most vulnerable areas in the Asia-Pacific Region that can experience all sorts of disaster. With the beginning of the 21st century and in the last 20 years, India has witnessed many natural and man-made disasters with enormous repercussions in the community. Starting from the western part, i.e. the Gujarat earthquake in 2001, most of the disasters, be it in the southern region of India (Tamil Nadu, Karnataka, Kerala etc.), northern part (Kashmir & Uttarakhand etc.) or eastern part (Manipur, Odisha, Bihar, West Bengal etc.) have claimed lives of several thousands of people including children and disabled, destroyed thousands of houses, agriculture, livelihood and ruined the economy and community feeling. Most of these disasters have received good media attention and also international attention. Unfortunately, mental health professionals including psychologists were mostly silent (A good exception is Kerala psychologists in 2018) and there was hardly any well planned research to learn from those disasters. It is painful to think that India has hardly produced any disaster mental health professionals except a self-motivated few. Most of the professionals were concerned about post traumatic stress disorder (PTSD) though the reality was something different. Prevention of mental health crisis during disaster was not thought of at all. The approach was more of a “wait till the diagnosis” treatment approach. I witnessed the same in 2015 during the devastating flood of a beautiful hilly state. When some of us approached the head of a mental health department in a government set-up after 2 months of the flood, we were told that there was not a single registration with post-flood PTSD and they were willing to treat when ‘cases’ came for treatment. This is a common scenario all over this country as most of these professionals believe that the role of mental health professionals comes only during the post-disaster period after everything has been restored.
Now the question is, why is there so much involvement of mental health professionals during COVID-19? There might be four possibilities. One, they are under the threat of getting the infection and there is identification with the victim. Two, mental health professionals can visualize that there will be a huge mental health crisis and only prevention can minimize the burden. Three, there is a greater understanding of the community model of mental health and role of prevention in a disaster scenario. Finally the fourth is, availability of good mental health leadership in India. Whatever be the reason, there is no doubt that a revolution has happened in India in the field of mental health, specifically in relation to disaster mental health.
Complex Disaster- A unique experience:
With this backdrop, this paper is going to focus on complex disasters or multiple disasters as recently the states of West Bengal and Odisha witnessed extremely severe cyclonic storm “Amphan” (Pronounced as Um-phun) on 20th May 2020. The cyclone touched the coastal area of the famous Sunderbans with 185 km/hr speed and ransacked a major part of Southern West Bengal including Kolkata. Even after 10 days of the landfall, many areas are still under water, without electricity and people have no adequate drinking water, food and clothes. Thousands of houses have collapsed and the current estimated report is that more than sixteen lakhs trees were uprooted. Some parts received salt water rain too and environmentalists had expressed concern about the change of nature of the mangroves after Amphan.
The state of West Bengal has the burden of over 5,000 COVID-19 positive cases (as of June,1, 2020) and the lockdown is still in place. In such a situation the second disaster has made the condition more threatening even for a person with COVID-19. To approach this complex situation is a challenging task for the mental health professionals, especially disaster or emergency psychologists (Manickam, 2020). When we psychologists are encouraging the behavioural route to suppress the pandemic by improving the behaviour of proper hand washing, wearing mask and maintaining physical distance, the super-cyclone on the other hand demands the joining of hands of affected people through group activities, connecting them in the field to provide Psychological First Aid (PFA) in order to prepare a community based intervention and resiliency development programme (Anindya, Debora & Manickam, 2020). We are forced to use approaches that appear as contradictory or counter-productive. For example, due to prolonged lockdown people are deprived of medical facilities and while conducting a health-cum-mental health camp for the cyclone affected people, which is highly needed at this stage, there are two consequences. There are huge gatherings of people due to the lack of physical facilities that can increase the incidence of COVID-19 in the area, and the help/aid providers or organizers of those camps can be held responsible for spreading the virus in the community. Such a step can lead to the end of functioning of any Non Governmental Organization (NGO) or volunteers to help those who are in need in this crisis situation. Therefore the disaster mental health services in India that highly rely on volunteerism, are at high risk since they are likely to become ‘social and COVID-19 victims’ and the loss of volunteerism is going to be unimaginably high!. Does that mean that the psychologists have nothing much to do in this never experienced crisis situation where biological/ health and natural disasters occur simultaneously?
The Side-effect is Bigger:
There is another more threatening disaster for the earth and will definitely have an enormous impact on society. This has emerged as a ‘side effect’ of lockdown but the impact may be much higher than the pandemic. I would like to call this a ‘social or economic disaster due to loss of job or job-role or business’( Mishra & Sayeed, 2020). Some might argue that this is a man-made disaster. We psychologists need to develop appropriate strategies to prevent increased mental health morbidity, addiction, suicide, violence and anti-social behaviours that are likely to manifest. Are we in a state to address these triple disasters?
To me, this is an opportunity or a challenge for us to redefine our outlook as mental health professionals. If we start focusing on some of the strategies in such complex situations, we can achieve better psychological skills and better resilience. As we commonly say in disaster situations, “If you are part of the solution, you are no more part of the problem”, and this holds true for the psychologists too. I would discuss some of the issues that psychologists can give further thought to and then develop sustainable plans of action.
1. Assessing Risk:
I have witnessed many mental health professionals stating that disaster mental health services are not immediately needed at the onset of disaster. Many of them believe that their role is more meaningful only after a month or so after the occurrence of a natural or health disaster. They are not wrong, though the experienced and trained workers of disaster mental health may not agree with this notion (Manickam, 2005). The training on disease model, excessive dependency on psychopharmacological treatment or illness specific psychotherapy and lack of community based training or exposure might be responsible for this perception. Moreover, the administrative or government agencies are slow in realizing the importance of this tool for future disaster preparedness and immediate intervention of mental health professionals at the onset of disaster. Even these professionals are having a mainstream or primary role in need assessment and policy making for a particular disaster.
One of the important aspects is risk assessment, which means identification of those at higher risk of developing mental health consequences in a hazard prone area if they are exposed to any hazard or disaster. Hazard can be a future event (e.g. Sunderban area of West Bengal is cyclone prone but not the city of Kolkata as per history) or a recent event (e.g. COVID-19 outbreak or large scale unemployment). Impact of the hazard can be determined by its severity (e.g. 2001 Gujarat Earthquake), novelty (e.g. 2004 Tsunami, 2020 COVID-19) and lack of preparedness (e.g. 2013 Uttarakhand Flash flood). However, the psychological damage due to the hazard more importantly depends on the population vulnerability (i.e. who are at higher risk to face the consequences?) and the coping capacity of that community. Here the psychologists have a huge role in identifying the vulnerable populations (e.g. reinforced vs non-reinforced building, aid-dependent vs non-dependent, employed vs unemployed, migrated vs non-migrated, majority vs minority community etc.) and also in recognizing the existing coping skills (e.g. strong community bonding, better social and/or economic support, good leadership, presence of food/seed bank, number of initiative takers, belief in self-help etc.) or lack of coping mechanisms (e.g. lack of cultural identity, waiting for others to take lead, frequently complaining, poor emotional regulation etc.).
That means, we need to have a separate risk assessment for all the 3 disasters and to identify the commonalities in all the three disasters. If we can focus on the commonalities to begin with, there is a good scope to decrease the mental health burden in the future. Psychologists may take the help of various agencies including the local Anganwadi workers or local volunteers for assessment of this risk. Needs assessment through online and mobile apps is also possible with the help of local agencies.
2. Intervention Proper:
Once the vulnerability and coping assessments are completed, planning for appropriate grass-root intervention may not be difficult. In the current situation, psychologists may take the help of the media to propagate their message on how to identify who are at high risk for developing morbidity. Distribution of handouts or leaflets (preferably pictorial) with the help of local agencies may be extremely helpful. We can also prepare leaflets on how to build resilience for various sections of the community including children. We need to identify a good leader from the community who can be prepared to implement some of the resilience building strategies. A tele helpline also may be introduced not only for COVID-19, but for other disasters where people can get an opportunity to ventilate and appropriate PFA can be provided by a trained lay counsellor or a volunteer.
Many issues have been discussed about dealing with COVID-19 pandemic at various platforms. There is a need to prepare a psychological strategy or communication to bring about a change in the attitude of people to deal with the pandemic. Social and health psychologists together have a great role in formulating the attitude change communication. For example, they can discuss the role of reinforcing incompatible behaviors to minimize mouth-nose-eye touching. Role of placebo (e.g. By washing my hand appropriately I am respecting my health more) vs nocebo or unhelpful statement (e.g. I need to wash hands to avoid COVID-19 infection or I should not be reluctant about washing my hand) to modify behaviour also may be considered for preparation of effective communication. Psychologists may also prepare differential communication approaches for those who are high on ‘monitoring’ but less on ‘blunting’ and people who are less ‘monitoring’ but high ‘blunting’. This is necessary as both these extreme groups are more vulnerable to mental health crises or infection prone.
In the case of the third one, the socio-economic disaster, the media has to be educated to stop devaluing and empathize with the people who are forced to change their income profile to a less valued one. Here the dynamic ideas of ‘Social Role Valorization’(SRV) have to be implemented which is useful for making positive or desirable change in the lives of disadvantaged people because of their status in society (Wolfensberger, 1992). Labelling of the workers from low economic conditions as ‘migratory workers’ is perceived as a devalued term and we need to put an end to such derogatory use of the term. A basic principle of role-valorizing is that the good things any society can offer are easily accessible to people with valued social roles. Conversely, people with devalued or marginally valued social roles, have a harder time obtaining the good things of life. Therefore valued names or labelling or social roles or the positive status are the key to obtain the benefits inherent in any society or culture. Once we are able to implement this SRV, displaced people will have better social resilience or identity. Thus, there would be better acceptance of changing the job role. Non-acceptance of the new role can be highly stressful and can precipitate or aggravate emotional disturbances including depression or suicide. Helping them to mourn the previous role can be therapeutic too.
Conclusion:
As psychologists, we need to conduct more research studies related to disaster and disaster related situations that can be product based. The research findings can provide direction towards planning appropriate prevention and intervention. Moreover, research can work as historical documents and can be extremely beneficial to plan interventions for future disasters without investing much time in need assessment or in understanding the nature of the disaster. We also need to look for strategies for resilience building of the community with primary focus on the children and adolescents so that we will have psychologically healthy future citizens.
References:
Anindya, S. N., Debora, M. A., & Manickam, L. S. S. (2020). Refining psychological services and strategies in India in the wake of COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.8-22). Thiruvananthapuram: The Editor.
Amulya, D. S. L. (2020). An experiment with online group counseling during COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 182-197). Thiruvananthapuram: The Editor.
Manickam, L.S.S. (2005). A Report of the trauma counseling service provided at the IAF training station, Tambaram, Chennai, Tamil Nadu—December, 30-31, 2004
http://kspope.com/torvic/trauma.php
Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor.
Misra, A., & Sayeed, N. (2020). COVID-19 and migrant workers: Clinical psychologists’ viewpoints. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.43-55). Thiruvananthapuram: The Editor.
Wolfensberger, W. (1992). A brief introduction to Social Role Valorization as a high-order concept for structuring human services. Syracuse, NY: Training Institute for Human Service Planning, Leadership and Change Agentry.