24th Sept 2013
Mental Health in Post-Disaster/Crisis
: Systematic Approach
Outline
1. Worldwide Increase in Disasters
2. Disaster/Crisis Event in Thailand
3. Disaster/Crisis Mental Health
Surveillance System in Thailand
4. Disaster/Crisis Preparedness in
Community
Pitakpol Boonyamalik, M.D., Ph.D., M.B.A.
Worldwide Increase in Disasters
I. Worldwide Increase in Disaster
Over 18,000 mass disasters
in the world from 1900 to
present
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24th Sept 2013
Psychological Impacts of The 2011 Great
Flood Victims
II. Disaster/Crisis Event
in Thailand
Proportion of Victims,
with Mental Health Problems
Severe flooding started at the end of
July 2011, monsoon season in Thailand
and persisted in some areas until midJanuary 2012
Sixty-five of Thailand's 77 provinces
were declared flood disaster zones
815 deaths (with 3 missing)
Department of Mental Health together
with Office of Public Health for mental
health cared and enhanced community
resilience
A cohort of the victims in the 2006 floods/mudslides
in Uttaradit province, northern Thailand
Background
Stress, 6%
Depression,
7.75%
Source: Department of Mental Health
Flash floods and mudslides hit Uttaradit
province, northern Thailand, after a heavy
monsoon rains in May, 2006
Northern Thailand's worst floods in 60
years killed at least 30 people and left
nearly 100 missing
Department of Mental Health together
with Uttaradit Office of Public Health
launched a one-year continuing
psychological support for a group of
victims
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24th Sept 2013
Background (Cont.)
Incidence of Mental Health Problems among the
Cohort of Mudslide Victims (Post 3 months)
One village each in 3 affected
districts,
Lub Lae, Tah Pla, and Mueang
districts, were selected.
One village in a non-affected
district, Thong San Khun was
selected as the control.
All of the villagers (892 persons) in
selected villages were screened
for mental disorders at 3 months
after the incident.
The victims with mental health
problems were followed up 3
times every 3 months.
70
%
23.66
20
10
0
Tha Pla
Lub Lae
Mueang
Control
Incidence of PTSD among the Cohort of
Mudslide Victims
(Post 3 months vs. Post 12 months)
14
11.89
9.29
7.8
10
8
4
40
30
14
6
50
15.34
16
%
68.87
52.52
60
Incidence of Mental Disorders among
the Cohort of Mudslide Victims (Post 3 months)
12
70.69
80
TahPla
PTSD
7.46
0.46
0
LubLae
MDD
10.69
10
3.25
2
11.89
12
%
4.65
4.46
0
11.27
10.69
Suicide
2.45
0.981.22
0
8
4
Control
0
Mueang
Alcohol usedisorder
Others
6.61
6
2.98
1.91
0
0
2
1.01
All districts
1.86
TahPla
0.93
LubLae
Post 3months
0.98 0.49
Mueang
0
Control
Post 12months
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24th Sept 2013
Psychological relief efforts for the victims
of 2004 Indian Ocean Tsunami
Background
• 2004 South Indian Ocean Earthquake caused
one of deadliest Tsunami on December 27,
2005.
• Affected 6 southern provinces in Thailand:
Phuket, Phung Nga, Krabi, Ranong, and Satun.
• Causing 5,392 deaths, 3100 missing, and
8,457 injured.
Incidence of Mental Health Problems among 2004
Tsunami Victims in Phung Nga, Krabi, and Phuket
33.6
30.2
35
30
25.1
25.7
25
PTSD
18.9
20
15
Stress
9.5
10
15.1
Depress
Anxiety
4.7
5
0
Post 2 months
Post 9 months
Source: From Department of Mental Health conducted by
Using SF-36, HSCL-25, HTQ
Psychological care for the victims of the violent
events in the 4 southernmost provinces
Background
Southernmost area (Pattani, Yala,
Narathiwat, and some parts of Songkla) have
faced continuous violence problems since
2001.
Mental health services system is not well
established due to a scarcity of mental health
professionals in the affected area.
Shortage of psychiatrists in the southern
border province (Pattani, Yala, Narathiwat).
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24th Sept 2013
Number of Violent Victims
with Mental Health Problems
Number of Violent Victims (%),
Classified by Province (1,048 cases)
Songkla, 4,
0.38%
Pattani, 328,
31.3%
No Risk , 966 cases
Depress,
2 Cases
Narathiwat,
469, 44.75%
PTSD,
3 cases
Yala, 247,
23.57%
Risk , 82 cases
Source : Violent-Related Mental Health Surveillance (VMS) Report
The suicide rate of Thai people after
the Asian financial crisis/ Tom Yam Kung Crisis
in 1997
Source : Violent-Related Mental Health Surveillance (VMS) Report
The suicide rate in Thailand (Cases per 100,000 population)
(1997-2012)
1st round of economic crisis
Background
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The crisis began in July 1997, and raised fears of a
worldwide economic meltdown due to financial contagion.
Thailand's booming economy came to a halt amid massive
layoffs in finance, real estate, and construction that resulted
in huge numbers of workers returning to
their villages in the countryside and
600,000 foreign workers being sent back
to their home countries.
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6
The economic Recovery
8.12
6.92
8.59 8.40
7.74 7.84
7.13
2nd round of economic crisis
6.87
5.34
5.77 5.97 5.98 5.97 5.90 6.03 6.20
4
2
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
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Phases of Disaster
III. Disaster/Crisis Mental
Health Surveillance System
in Thailand
Warning
Impact
Heroic
Disillusionment Reconstruction
Sources: Johns Hopkins Center for Health Preparedness and Response
Pitakpol Boonyamalik, MD, PhD
Phases of Psychosocial Support for
Disaster
Phase 1: Pre-disaster (Preparation)
Phase 2: Crisis and Emergency (< 2 weeks)
• Phase 2.1: Crisis (< 72 hours)
• Phase 2.2: Emergency (72 hours – 2 weeks)
Phase 3: Post-disaster (2 weeks – 3 months)
Phase 4: Rehabilitation (> 3 months)
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Phase 1: Pre-disaster (Preparation)
Policy formulation and planning process
Set up responsible organizations
Personnel training
Other resource preparation
guideline manuals to drills/tabletop exercises
National level
Mental health professionals in
psychiatric hospitals
Health professionals in community
and provincial hospitals
Source: Department of Mental Health of Thailand
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24th Sept 2013
Phase 2 : Crisis and Emergency (< 2 weeks)
Phase 2.1: Crisis (< 72 hours)
• Focusing on physical and social supports
• Assessment of situation and preparation
Phase 2.2: Emergency (72 hours – 2 weeks)
• Psychological first aid
• Risk assessment and high-risk group surveillance
Phase 3: Post-disaster(2 weeks–3 months)
Screening for mental health problems
• PISCES-18 for adults
• Symptoms checklist for children (precaution with the
appropriate timing)
Diagnosis and treatments for mental disorders
• M.I.N.I
• Crisis intervention for the persons with severe
psychological reactions
Surveillance for mental disorders
• Depression , suicide, PTSD and alcohol use disorders
Continued physical and social supports
Phase 4: Rehabilitation (> 3 months)
Screening for mental health problems
• PISCES-18, Depression/ suicide screening, and
PTSD screening for adults
• SDQ for children
Diagnosis and treatments for mental disorders
• M.I.N.I
Continued surveillance for mental disorders
• Depression , suicide, PTSD and alcohol use
disorders
Psychosocial rehabilitation
• Occupation
IV. Disaster/Crisis
Preparedness in Community
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24th Sept 2013
Capacity Building for Mental Health
System in Community
Mental Health Crisis Assessment and Treatment
Team (MCATT)
GRI. Together with IMH and Others
Partnerships with the Support of Temasek
Established in every district and personal training
Training 200 community based workers in 4
regions of Thailand
(Northern, Northeastern, Central and Southern)
Training 40 Master Trainers
In partnership with IMH to develop curriculum for
community based workers
Building Community Resilience
VIDEO
Thank you
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