Enhancing psychological support
Loss of lives and livelihoods is not the only suffering caused by natural disasters. Stress-related mental health problems are known to be widespread. These psychological traumas are not as evident as the physical destruction of homes and communities; however, recovery from them often takes far longer.
The International Federation of Red Cross and Red Crescent Societies, responding to a number of technological disasters, acknowledged the need to offer psychological assistance in addition to traditional relief activities. With no formal training and little preparation in this area, officials initiated efforts to develop response methods to this hidden emergency. In 1993, he International Federation and the Danish Red Cross established the Federation Reference Centre for Psychosocial Support as part of this effort. Today, psychological support is systematically being integrated into relief operations alongside programmes for shelter, health and food.
Additionally, the Federation's Strategy 2010 identifies health and care as one of its four core business areas. Emotional support provided by volunteers to vulnerable people in the community is specifically highlighted as a crucial programme area.
Psychological support is increasingly becoming an accepted element in relief, care, support and first aid throughout the world. However, it differs from material support in that the recovery process is much longer and less visible. Only a reliable and long-term commitment will ensure that the psychosocial aspects of relief work are professionally implemented and make a crucial difference to the victims and volunteers affected by disasters.
A child's world
"We can really see an improvement. When they started they were drawing with black. Now they have really opened up," explains Mladin Telebak. Telebak is a teacher and participant in a programme to help war- traumatized children in Banja Luka, Bosnia Herzegovina. The programme, supported by the Danish Red Cross, aims to assist children recover from the painful experience of the conflict in the former Yugoslavia. Telebak describes the impact the psychosocial support has had on the children "At first the children did not want to talk. Now they are forming very strong friendships and are sharing their experiences from the war."
Areas of action: building on comparative advantages
Stress-related emotions can overwhelm people's capacity to surmount significant personal grief and begin rebuilding their lives. If ignored, these psychological symptoms can progress into more severe disorders. Psychological support can help prevent this from occurring. Through the use and distribution of simple psychological tools in training workshops and seminars, volunteers are empowered to assist people overcome their traumas.
Federation programmes are targeted at three groups, who suffer from a variety of psychological reactions and need support following a crisis:
- a) the victims and other people affected by the event,
- b) National Societies' volunteers and staff engaged in disaster response,
- c) expatriate delegates.
Victims and other people affected by the disaster receive assistance to move through a normal sequence of psychological reactions in response to the grief and loss. National Societies' volunteers and staff are trained and supported to help them cope with the situation and to ensure that their own psychological needs are recognised and met. The expatriate delegates on assignment for the Federation are frequently exposed to various types of pressures. To prevent negative long-term effects, psychological assistance is provided to help them manage this stress.
a) Victims and other people affected by the event
Victims of a disaster need to regain an acceptable physical quality of life as well as heal emotional scars. This requires attention to both traditional relief and to the psychological reactions. The Federation is committed to assisting the individual as an entity.
The key components of psychological assistance for victims are ongoing interaction and presence with the aim of bolstering feelings of security and hope. This support endeavours to help the affected person strengthen his or her personal coping capacities and reinforce support from family members and friends. The goal is to empower communities to be responsible for their own caring and healing.
Psychological support programmes are increasingly part of relief operations. Recently two major programmes were launched in Kosovo and Turkey. Both programmes run parallel to traditional relief efforts, with the objective to help people heal from the psychological traumas, and to empower and assist them in meeting other basic needs. The crucial component of both programmes is the presence of psychosocial centres established in the most affected communities.
Children are among the most vulnerable victims of violent events, primarily because they are dependent on others for both their safety and the healthy development of their minds and bodies. The Children Affected by Armed Conflict (CABAC) programme is currently being implemented in the Balkans and Africa. This programme is built on an existing and recognized institution - the school - and is implemented through a respected profession - the teacher. Group-based and creative activities allow the children to express their emotions and concerns.
Other psychological support programmes aim at HIV/AIDS caregivers. Red Cross and Red Crescent volunteers are assisting people with HIV through home-based care programmes. They focus on providing emotional support to families and victims, encouraging and teaching family members to care for ill relatives at home, and preventive measures to avoid infection. The stresses on those caring for people with HIV/AIDS are enormous. HIV/AIDS programmes cannot afford to focus on victims alone. Caring for carers - many of whom are HIV positive - is a necessity, not a luxury. This programme will be expanded, giving further attention to teaching HIV/AIDS carers to deal with stress and how to prevent burnout.
Sabrie Zequiri, 38, lives in a small village in Kosovo with her seven children. Her husband disappeared during the conflict between the NATO-led forces and the Yugoslav army in 2000. The family held on to the hope that he was in prison in Serbia and would come home one day. The uncertainty made it very difficult for them to accept his loss and begin the grieving process. To cope Sabre and her children developed an unhealthy dependency on each other, isolating themselves from the rest of the community. An outreach mobile team of Red Cross and Red Crescent paraprofessionals sought to provide counselling to help them overcome the trauma. Today, the children are attending school and participating in other activities outside the family circle.
b) National Societies' volunteers and staff engaged in disaster response
Psychological support deals with basic human feelings and needs - shock, loss, bereavement, and powerlessness. These feelings are common to everyone, but coping mechanisms vary with different cultures. Local staff and volunteers provide Red Cross and Red Crescent psychological support thereby overcoming any cultural barriers. Furthermore, education and training utilises local resources and professionals to ensure that implementation is culturally sensitive.
Trained volunteers provide active listening, information and referral, and help beneficiaries meet their basic needs. Support groups are established to help solve common problems, allow for emotional ventilation, improve communication skills, develop social networks, and build trust, empathy, and understanding.
Psychological support programmes have an important long-term goal of strengthening a country's preparedness to respond to stress-related problems should another disaster occur. This ensures a major developmental and capacity-building component is integrated into the programme thereby strengthening its sustainability within the local branch or chapter.
Emphasis is put on creating strong support systems around the volunteers. Mental health professionals organize their work and provide regular supervision. Volunteers are also vulnerable, as they themselves are often part of the collective crisis. Supervision is the most effective tool to avoid or deal with traumas and burnout among volunteers.
c) Expatriate delegates
Relief work is stressful and may lead to limited operational capacity at a time when the skills of delegates are most needed. Taking care of staff, therefore, is a priority. Delegates are briefed about typical reactions and symptoms of stress and trauma and trained on basic stress management skills. This service is furthermore available during and after missions. Psychological debriefing allows the delegate to express him or herself, gain feedback on stress and other factors affecting his psychological well-being and ease the re-entry process.
Helping yourself by helping others
David Mukasa is a counsellor for the HIV/AIDS Network in Uganda. David, who is also HIV positive, gave a moving testimony at the 5th Pan African Red Cross and Red Crescent Conference on living with the virus. His story began in 1989 when he first became ill and learned of his diagnosis. His mother cared for him at home during that time and his health improved. After testing positive a second time, he decided to change his life. He took a part-time job and became involved in HIV/AIDS counselling and education. "If you're involved in HIV/AIDS prevention and share your experiences, it's like therapy and your quality of life improves, though you are always conscious of your mortality," he explains.
The Federation continues to strengthen its collaboration with UN agencies and other institutions that have expertise in this area, including WHO, UNICEF, UNHCR, NGO's, mental health professional associations and research institutions.