1. PSYCHOSOCIAL CARE SERVICES PROVISION FOR THE EARTHQUAKE AFFECTED AREAS Dr. Saeed Farooq Head Department Of Psychiatry And Director Research PGMI Lady Reading Hospital, Peshawar

2. THE BURDEN OF PSYCHOSOCIAL DISORDERS • PSYCHOLOGICAL DISTRESS • Mild psychological distressperhaps • 20-40% • Moderate or severe psychological distress • 30-50% • This group would benefit from a range of social and basic psychological interventions that are considered helpful to reduce distress

3. THE BURDEN OF PSYCHOSOCIAL DISORDERS (cont) MENTAL DISORDER • Mild and moderate • 12-month prevalence rates (e.g., mild and moderate depression and anxiety disorders, including PTSD) are on average about 10% • Severe mental disorder. • The 2-3% rate may be expected to go-up (e.g. to roughly 3-4%)after exposure to severe trauma and loss

4. The effect • The psychiatric morbidity will affect the outcome of physical problem • It will affect the Social Capital which in turn will affect all the rehabilitation and recovery

5. Principles • No vertical (stand-alone) services • Integrated in health sector • Integrated in Non Health sector such as education. • Public Health Approach

6. Support for families and care givers • It is very important how the support is provided. While providing the support must be careful to • Self esteem • Persons view of what they need • Support tailored to the cultural, religious and social needs • Not to reinforce the guilt

7. Support for families and care givers • Viewing the situation from a public health perspective (i.e., a population perspective), rather than a clinician's perspective. • Collaboration with education sector educational Psychologists • Make community aware that psychological help is available and it works.

8. INTEGRATION OF MENTAL HEALTH • In General Health Services • In other sectors –most importantly education • In Child care services and reproductive health services as women and children are high risk groups.

9. Short TermsIdentifying existing psychiatric morbidity- PRE EARTH QUAKEObjectives Identify Higher Risk Multiple Losses Children DisabledPast Psychiatric History

10. ACTIONS • Raise awareness. THE MESSAGE “Psychological consequences are treatable” • Train health workers, relief workers. • Translate Instruments for identifying high risk. • Teams of Psychiatrists, psychologists, Social worker

11. At least two workers One Psychiatrists, One Psychologist/Social worker in each major area, Balak, Batgram, Batal, Haripur, Havelian (Camps)

12. RESOURCE IMPLICATION • Training for at least 30 mental health workers, 200-300 General health workers. • Translating at least 5 instruments. • Public health and media campaigns. • Provision of basic psychotropic, antiepileptics.

13. MEDIUM TO LONG TERM • Rehabilitation of psych facilities ATH. • Establishment of new psychiatric facilities in all the major centers. • Facilities for investigations such as EEG,CT Scan, MRI etc • Compulsory 1-2 weeks training in mental health for primary care physicians working in the area.

14. MEDIUM LONG TERM (Contd) • School mental health services, • Child psychiatry at ATH. • Educational psychologists at schools. • Provision of psychotropics and antiepileptics.

15. MEDIUM TO LONG TERM (Contd) • Screening and psychological support for all those who have paraplegia, amputation, brain damage. • Rehabilitation for the disabled. • Training for Psychiatric Nursing and Paramedics for providing Continuity of care • Training the social workers and psychologists for assessment for the children and foster parents for adoption.

16. Care for the relief workers. • Regular Support groups • Regular supervision • Increase competence by training • Preventing over-identification, over-ownership, over-involvement

17. Research and Training • Must for maintaining the preparedness in future and human resource development