1. Emergency Mental Health care Stressors: They are factors that effect the normal biological, psychological and social homeostasis of human being Stress: Biological and psychological reaction to stressors, it is usually expressed in 3 stages Alarm: hyperarousal, increase alertness, excessive production of adrenalin (in order to bring fight-flight response and activation of HPA axis). Resistance: attempts to cope with stress at the biological and psychological level (coping strategies and defense mechanisms) Exhaustion: break up of defenses and depletion of body resources to the level that the person can not maintain normal function. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

2. Mental Health and Psychosocial problems in emergencies Mental health problems caused by disasters include: 1.Pre-existing problems: traumatic events can cause exacerbations of pre-existed severe mental disorders (e.g. depression, psychosis, bipolar affective disorder, anxiety disorders, substance abuse ….) 2.Stress related problems: grief reaction, acute stress disorder, Somatization disorder, adjustment disorder and post traumatic stress disorder. 3.Humanitarian aid related problems: Anxiety, depression, burn out syndrome (psychological exhaustion)

3. Mental Health in emergencies General principles: 1.Preparation before the emergency: –Development of a system of co-ordination with specification of focal persons responsible within each relevant agency. –Design of detailed plans to prepare for an adequate social and mental health response. –Training of relevant personnel in indicated social and psychological interventions.

4. 2.Assessment: Careful planning and broad assessment of the local context (setting, culture, history and nature of the problems, and, community resources) 3.Collaboration: Intervention should involve collaboration with other governmental and non-governmental organizations.

5. 4.Integration of mental health in PHC 5. Training and supervision: should be done by mental health specialist

6. Acute emergency phase Psychological interventions in acute emergency phase: Do not force talking, do not force debriefing, do not force social support. Do not organize forms of single- session psychological debriefing that push persons to share their experiences beyond what they would naturally share. Organize outreach groups from volunteer /non volunteer community workers to provide “psychological first aid”

7. Disaster counseling skills Establish rapport: Active listening: Problem solving: Psychological first aid: –Attentive listening –Convey compassion –Identify current needs and concerns –Tailoring psychological interventions( need for immediate referral, need for additional services, need for follow up) –Information on coping: provide information about stress reactions and coping to reduce distress and promote adaptive functioning

8. Reconsolidation phase Continue relevant social interventions Organize outreach and psychoeducation: To educate the public on available choices of mental health care. Encourage the application of pre- existing positive ways of coping.

9. Psychological interventions during consolidation phase Educate other humanitarian aid workers (teachers, religious leaders, police...) in core psychological care skills such as, psychological first aid, emotional support, providing information, sympathetic reassurance and early recognition of mental health problems. Train and supervise PHC workers in basic mental health knowledge and skills: Ensure continuation of medications of psychiatric patients who may not have had access to medications during the acute phase of emergency.

10. Train and supervise community workers: psychological first aid, emotional support provision, grief counseling, stress management and problem solving counseling. Collaborate with traditional healers Facilitate creation of community based self help group. These groups focus on problem solving, brain storming for solutions or more effective ways of coping and generation of mutual emotional support.