World Disasters Report: Resilience: saving lives today, investing for tomorrow
Chapter 5: Inner resilience: mental health and psychosocial support
A good half of the art of living is resilience
Alain de Botton
Psychosocial repercussions can be long-lasting (Goenjian et al., 2011) as the long-term impacts of disasters can undermine well-being and threaten peace and human rights. Empirical evidence reports that mental disorders and psychosocial problems are significant public health concerns in humanitarian settings (Tol et al., 2011) with most of the affected population experiencing considerable distress, but only a minority experiencing symptoms or mental disorders that will impact on their daily functioning and may require access to specialized care (WHO, 2014; 2016).There are many definitions and understandings of resilience. IFRC’s definition of resilience is “the ability of individuals, communities, organizations or countries exposed to disasters and crises and underlying vulnerabilities to anticipate, reduce the impact of, cope with, and recover from the effects of shocks and stresses without compromising their long-term prospects” (IFRC, 2015).
Psychosocial support, individual and community resilience
Psychosocial support is an integral part of the IFRC’s emergency response and is broadly defined in the IFRC Psychosocial Framework of 2005–2007 as “a process of facilitating resilience within individuals, families and communities by respecting the independence, dignity and coping mechanisms of individuals and communities. Psychosocial support promotes the restoration of social cohesion and infrastructure.”
The individual psychological dimension includes emotional and thought processes, feelings and reactions. The social dimension includes relationships, family and community networks, social values and cultural practices.
Community resilience post-disaster concerns the adaptability of the environment in the face of threats so as to continue sustainable development (Kulig et al., 2013).
The well-being of a community is recognized as part of resilience (Gibbs et al., 2015). A common understanding of what defines psychosocial well-being and resilience may differ not only from country to country but also in different populations within the same country. Before planning a psychosocial response, it is necessary, therefore, to understand what concepts mean locally for the particular population. However, there appear to be some commonalities in well-being and resilience processes that should also be incorporated into psychosocial support intervention design.
Psychosocial support and humanitarian action
The aim of mental health and psychosocial support programming is to prevent mental disorders as well as promote and protect psychosocial well-being. A multi-layered, step-by-step approach is proposed, which includes practical and more specialized assistance so as to provide a spectrum of services, which is illustrated in the diagram below.
Source: IASC, 2008
A mental health and psychosocial support programme should address multi-level intervention and can include:
- basic aid delivered with a psychosocial support perspective (i.e., shelter, respecting family and social bonds and safety considerations; food and water distribution, and first aid, delivered with cultural understanding and inclusivity)
- information (i.e., about what has happened, about the fate of loved ones, about normal reactions)
- social and emotional support (i.e., comfort, a listening ear, recognition of grief, compassion)
- practical help (i.e., legal and financial issues, household orientation)
- facilitation of community resources, networks, and connection
- mental health (i.e., adequate detection, referral avenues, and management)
- support to responders.
Psychosocial support integrated with disaster risk reduction
Psychosocial support interventions in disaster risk reduction can facilitate community networks, contribute to mapping strengths and vulnerabilities, and promote capacity-building of local populations (e.g., promotion of effective coping and community solidarity), including that of staff and volunteers needed for future response.
Preparing individuals and families psychologically to cope with crises increases their sense of agency and efficacy and may influence communities to invest more in mitigation and disaster preparation. Improving community connectedness can promote more inclusion of at-risk groups pre-crisis, and increase knowledge of local healing rituals and adaptive coping methods. Similarly, working on psychosocial guidelines in disaster risk reduction can foster the development of local or national-level psychosocial policies prior to emergencies and facilitate inclusion of psychosocial support in contingency planning.
Psychosocial support in disaster response
Psychosocial support guidelines mainly focus on the disaster response phase of the disaster cycle by setting out minimum standards and good practice in response (OPSIC, 2015). Psychosocial support can be integrated into food distribution, shelter, water/sanitation and protection responses (IASC, 2014). For example, psychosocial support workers can link with shelter response to increase efforts not to interfere with existing social networks and communities in shelter programme activities.
Psychosocial activities in disaster response can include psychological first aid, lay counselling, peer support, support groups, life-skill training, psycho-education, advocacy, recreational and creative activities. A common psychosocial support intervention after a disaster is psychological first aid. The aim is to assist persons to take care of themselves and regain their capacity to think clearly.
Psychosocial support in recovery and development programmes
In major disaster situations the consequences produce secondary stressors (e.g., reconstruction, relocations) that negatively impact on populations (Lock et al., 2012) resulting in psychosocial reactions sometimes lasting many years in the recovery process (Ghuman et al., 2014). In one-off acute events, distress tends to lessen when danger has passed compared to when individuals experience prolonged situations such as conflict, where symptoms may persist for several years (ODI, 2015). Support for resilience and recovery is therefore an ongoing, long-term need (Hobfoll et al., 2011). Long-term psychosocial support programmes can address evolving needs to support communities and individuals, as demonstrated in New Zealand in 2010–2012 in the immediate response by New Zealand Red Cross (NZRC) to around 13,000 aftershocks following two major earthquakes that affected the Canterbury area during that time.
Besides undertaking immediate response activities, NZRC extended psychosocial programmes throughout the recovery period, supporting community-led outreach to those impacted by the earthquakes but not needing clinical assistance. With a focus on long-term recovery, a smartphone app and website were developed to reach out to adolescents, based on tips gathered from the young people themselves or from others like them in other countries who had faced a similar situation. Physical community activities and linkages with sectors such as transport, wherein support to drivers and passengers in relocated communities was helpful, gave a long-term perspective to the programme (NZRC, undated).
Psychosocial support is also pertinent to extension from recovery to longer-term development programmes. Although there have been advances in consensus of good practice in psychosocial support throughout the disaster cycle, there continues to be a gap between good practice consensus and some activities in the field.
Opportunities and challenges
When effective, psychosocial interventions can provide genuine benefits to crises-affected populations. Psychosocial support programmes can be integrated into multiple situations and throughout all stages of the disaster response cycle (from relief and recovery through to mitigation and preparedness). Challenges remain, however. Work is needed to ensure that these interventions are incorporated into relevant sectors and to transition from response activities to all phases of disaster management. In some regions, increased collaboration with local entities, including integration of innovative local, culturally-framed resilience processes, is still necessary. However, with the growing interest in understanding quality in psychosocial interventions, the availability of guidelines, and recent monitoring and evaluation tools, empirical reports suggest that the number of inappropriate or harmful interventions will lessen.
Chapter 5 was written by Maureen Mooney PhD, Research Scholar, Massey University, New Zealand. Box 5.1 was written by Mark Harvey, CEO, Resurgence, London, UK; Box 5.2 by Alison Schafer, Technical Specialist Mental Health and Psychosocial Support, World Vision International, Victoria, Australia; Box 5.3 by Virginia Murray, Vice-chair, UNISDR Science and Technical Advisory Group, London, UK; and Box 5.4 by Naushan Muhaimin, Executive Director, Care Society, the Maldives. The case of the Green Jobs Initiative in Samoa was contributed by Samoa Red Cross Society.
Sources and further information
Gibbs L, Howell-Meurs S, Block K, Lusher D, Richardson J, MacDougall C, Waters E and Harms L (2015) Community wellbeing: applications for a disaster context. The Australian Journal of Emergency Management, 30(3).
Ghuman S J, Brackbill R M, Stellman S D, Farfel M R and Cone J E (2014) Unmet mental healthcare need 10–11 years after the 9/11 terrorist attacks: 2011–2012 results from the World Trade Center Health Registry. BMC Public Health, 14:491. Available online: http://doi.org/10.1186/1471-2458-14-491.
Goenjian A K, Roussos A, Steinberg A M, Sotiropoulou C, Walling D, Kakaki M and Karagianni S (2011) Longitudinal study of PTSD, depression, and quality of life among adolescents after the Parnitha earthquake. Journal of Affective Disorders, 133(3):509–515. Available online: http://doi.org/10.1016/j.jad.2011.04.053.
Hobfoll S E, Mancini A D, Hall B J, Canetti D and Bonanno G A (2011) The limits of resilience: distress following chronic political violence among Palestinians. Social Science & Medicine, 72(8):1400–1408.
Kulig J C, Edge D S, Townshend I, Lightfoot N and Reimer W (2013) Community resiliency: emerging theoretical insights. Journal of Community Psychology, 41(6):758–775. Available online: http://doi.org/10.1002/jcop.21569.
IASC (Inter-Agency Standing Committee) (2014) Review of the implementation of the IASC guidelines on mental health and psychosocial support in emergency settings: how are we doing? Available online: https://interagencystandingcommittee.org/system/files/1_iasc_guidelines_on_mhpss_review-2014-final_2_0.pdf.
Lock S, Rubin G J, Murray V, Rogers M B, Amlôt R and Williams R (2012) Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010–2011. PLoS Currents: Disasters. doi:10.1371/currents.dis.a9b76fed1b2dd5c5bfcfc13c87a2f24f.
NZRC (New Zealand Red Cross) (undated) Leading in disaster recovery: a companion through the chaos. New Zealand.
ODI (Overseas Development Institute) (2015) Psychological resilience, Working Paper No. 425. ODI, London, UK.
OPSIC (Operationalising Psychosocial Support in Crisis) (2015) The comprehensive guideline on mental health and psychosocial support (MHPSS) in disaster settings. Available online: http://opsic.eu/wp-content/uploads/2015/06/OPSIC-Comprehensive-guideline-FINAL-June-2015.pdf.
Tol W A, Barbui C, Galappatti A, Silove D, Betancourt T S, Souza R, Golaz A and Van Ommeren M (2011) Mental health and psychosocial support in humanitarian settings: linking practice and research. The Lancet, 378(9802):1581–1591. Available online: http://doi.org/10.1016/S0140-6736(11)61094-5.
WHO (World Health Organization) (2014) Mental health: a state of well-being. Available online: www.who.int/features/factfiles/mental_health/en/.
WHO (World Health Organization) (2016). Mental health: strengthening our response. Available online: www.who.int/mediacentre/factsheets/fs220/en/.