What You Can Do Right Now to Support Wellbeing (Guidelines on Psychosocial Support for Helpers and Friends)

People in areas affected by tsunamis may be experiencing many different emotional and physical responses at this time. Some of these responses include confusion, fear, hopelessness, sleeplessness, crying, difficulty in eating, headaches, body aches, anxiety, and anger. They may be feeling helpless; some may be in a state of shock; others may be aggressive, mistrustful, feeling betrayed, despairing, feeling relieved or guilty that they are alive, sad that many others have died, and ashamed of how they might have reacted or behaved during the critical incidents. There may be some experiencing a sense of outrage, shaken religious faith, loss of confidence in themselves or others, or sense of having betrayed or been betrayed by others they trusted.

These are all normal reactions to extremely dangerous or stressful situations, or where people have felt helpless or overwhelmed. They do not mean that these people are traumatised, mentally disturbed or mentally ill. The majority of people will experience these reactions only for a short period of time; others may experience them for longer.

You may be able to support people get through these normal reactions and reduce further distress while meeting their basic and other practical needs by following the suggestions below.

DOs
* Do listen to people who share their stories, if necessary again and again.
* Do be friendly, compassionate and caring, even if people are angry or demanding.
* Do give practical help or assistance to people as and when required.
* Do help people to contact others either through post or making telephone calls on their behalf.
* Do engage people in meeting their own needs.
* Do find out where the government and non-government services are located and direct people to the appropriate services available in the area.
* Do understand the emotions of people who have suffered losses, and take them seriously. There is no right or wrong way for people to feel, given the horrific situation.
* Do give reliable information about what tsunamis are and how they occur. This will help people understand the situation.
* Do protect people from further harm, as they may be vulnerable to assault and abuse by those who are taking advantage of the chaotic situation.

DON’Ts
* Don’t force people to share their stories with you, especially very personal details. If they don’t want to talk much, do not disturb them.
* Don’t tell people what you think they should be feeling, thinking or doing.
* Don’t make promises about what you will do for them, if you are not sure about this.
* Don’t give simple reassurances to people, saying ‘everything will be ok’, or ‘at least you have survived’ or ‘others have suffered more than you’.
* Don’t tell people why you think they have suffered, especially giving reasons about their personal behaviours or beliefs.
* Don’t tell people what you think they should have or could have done, whilst in the critical situation, especially to save loved ones.
* Don’t criticise existing services and activities being carried out in these areas, especially in front of people who are in need of these services. Support the service providers to make the services better.
* Don’t separate surviving family members and relatives from one another, if possible, especially children.
* Don’t label people as traumatised.

Prepared by Psychosocial Support Programme and National Council for Mental Health, Sahanaya in collaboration with Dr. Jagath Bandara and Dr. Mahesh Rajasuriya from the College of Psychiatrists, Colombo. Please send in your comments and feedback to pspcp@eol.lk or sahanaya@panlanka.net.
01st January 2005

Psychosocial Care and Protection of Tsunami affected Children: Inter-Agency Guiding Principles (IRC, SCUK, UNICEF, UNHCR)

Introduction

Exposure to natural disasters has a devastating impact on the psychological and social well-being of children, adolescents and adults. It is now widely accepted that early psychosocial interventions that help to mitigate the effect of trauma, alleviating psychological distress, and strengthen resiliency must be an integral part of humanitarian assistance. In the case of children and adolescents, psychosocial interventions also aim to maintain or re-establish their normal development process. The broad framework for planning and implementing psychosocial programs is provided by a) the relevant Articles of the Convention on the Rights of the Child, and b) UNHCR Guidelines on Protection and Care of Refugee Children.

What do we mean by “psychosocial”?

For the purpose of this statement, “psychosocial” refers to the dynamic relationship that exists between psychological and social effects, each continually inter-acting with and influencing the other.

“Psychological effects” are those which affect different levels of functioning including cognitive (perceptions and memory as a basis for thoughts and learning), affective (emotions), and behavioural. “Social effects” pertain to altered relationships, family and community networks, and economic status.

The following principles based on a body of evidence should guide psychosocial programming

* Nearly all children and adolescents who have experienced catastrophic situations will initially display symptoms of psychological distress, including intrusive flashbacks of the stress event, nightmares, withdrawal, inability to concentrate, and others.

* Most children and adolescents will regain normal functioning once basic survival needs are met, safety and security have returned and developmental opportunities are restored, within the social, family and community context.

* Some children will require more specialized interventions to address their suffering and help restore their flow of development. Immediately after traumatic events, activities and opportunities which allow children to talk about or otherwise express painful experiences and feelings, such as physical and artistic expression, are most beneficial if facilitated by people the children know and trust, and have continued contact with.

* However, “trauma counselling”, should never be the point of departure for psychosocial programming, because structured, normalizing, empowering activities within a safe environment will help the majority of the children recover over time.

* Trauma counseling should never be provided unless an appropriate and sustained follow-up mechanism is guaranteed. Defense mechanisms exist for a reason and breaking them down before the child is ready and in a safe physical and emotional environment leaves him/her open and vulnerable to a re-traumatisation. There are serious risks associated with trauma counseling carried out by nonprofessionals.

* Dramatic consequences for a child’s life pathway can have more damaging consequences for the individual’s well-being than the traumatic event itself (an example would be a child’s loss of parents having to grow up as an orphan, or destruction of school system leaving children without education).

* The psychosocial well-being of adults, particularly parents and caregivers has a direct impact on that of children, and should thus be addressed through concurrent parent-focused psychosocial interventions.

* Children – and adults’ – participation in decisions which affect their lives has a positive effect on their mental health, empowers them and helps them to regain control over their own lives.

* Grounding all psychosocial interventions in the culture, unless it is not in the best interests of the child, is both ethical and more likely to produce a sustained recovery.


Psychosocial interventions based on the above principles:
* Reconnect children with family members, friends and neighbors
* Foster social connections and interactions
* Normalize daily life
* Promote a sense of competence and restore a person’s control over one’s life
* Allow for expressions of grief within a trusted environment, when the child is ready and follow-up is guaranteed


* Listen to children and adults before acting. Ensure that interventions are based on consultation with the affected communities, reflect what they need and take into consideration the age and stage of development of the children involved.

* Understand and respect the culture and religion of the affected population; give material and other support so that grieving and mourning practices and rites can take place.

* Help children, family members, friends and neighbours find out what happened to those who are missing, and find each other, and let them know that efforts are underway.

* Set up “child-friendly” spaces as soon as possible and activities that normalize the lives of children, give them a sense of safety, structure and predictability through drawing, puppet-making and playing, drama and songs, story-telling, sports, non-formal education, etc. These activities also allow for the release of any stored distress.

* Restore normal schooling as soon as possible.

* Encourage children to ask as many questions as they want, and be ready to answer them truthfully.

* Focus and build on interventions that strengthen the population’s resiliency and resources, and current and traditional ways of coping when they are in the best interests of the child.

* Involve youth in organizing activities for younger children: undertakings that give an affected person a sense of accomplishment has a healing effect.

* Involve children, their families and communities in the psychosocial recovery process, discussing with them their perceptions, and how they see their needs.

* Set up support group discussions, as much as possible accompanied by involvement in concrete and meaningful activities that give a sense of accomplishment and control over one’s life: recreational and non-formal education for children, common interest activities for young people, sewing, gardening, building, leading children’s activities etc.

* Promote and support interventions which preserve and reinforce the cohesion of the family, and discourage any which risks separating children from their families.

* Promote activities and opportunities to allow children to express their experiences and feelings so that they may make meaning from and integrate them into their lives, as much as possible within a familiar environment and only if:
- The child is ready for this expression – eliciting emotional material too early can cause more distress and potential harm to the child.
- We can ensure further, on-going comfort and help.

* Identify referral services for the small number of children and adults who will need professional, medical assistance (some of these people may have had pre-existing psychiatric illnesses).

* Assess the need and provide support to adults caring for children for example provision of crèches or child focused activities (e.g. child friendly spaces) which allow adults some time to recover and re-energise them so that they can provide the support children need.

* Provide training to those caring/responsible for children so that they are comfortable dealing with children’s natural distress and recognise children who may need more specialised support.

These principles represent the views of the following agencies: the International Rescue Committee (IRC), Save the Children UK (SCUK), the United Nations Children’s Fund (UNICEF) and the United Nations High Commissioner for Refugees (UNHCR).

Organizations wishing to work on behalf of children are strongly encouraged to endorse these principles.

PSYCHOSOCIAL RESOURCES

Please follow the links below to access resource documents that may be of use in planning psychosocial interventions in the aftermath of the tsunami disaster in Sri Lanka.

General Psychosocial Documents
Psychosocial Working Group_Conceptual_Framework.pdf
Psychosocial Working Group_Framework_for_Practitioners.pdf
Mental Health in Emergencies WHO Document.pdf
What is a Psychosocial Intervention: Mapping the field in Sri Lanka.pdf

Separated Children Documents
Ananda Galappatt Presentation on Children and Residential Care at Dialogue, Colombo 2003.pdf
David Tolfree Community Based Care for Separated Children at Dialogue, Colombo 2003.pdf David Tolfree Notes for Sri Lanka Pre-Conference at Dialogue, Colombo 2003.pdf

Information on the December 26 Tsunami
(It has been identified that some children in areas affected by the tsunami have no information on 'why the sea came over the land'. This lack of information means that many children continue to feel unsafe whilst living in coastal areas. The following documents are offered as tools with which to initiate discussions with children - to share information and address their fears.
Why_Did_The_Sea_Come_Over_The_Land_ENGLISH Why_Did_The_Sea_Come_Over_The_Land_TAMIL Why_Did_The_Sea_Come_Over_The_Land_SINHALA Information_on_Tsunami_(Complex English)
Thanks to SB Chatterjee for technical support in getting these documents linked. Thanks also to organisations and individuals whose documents I have borrowed for use in this post. AG