By Angela Leocata, Harvard College ‘18
Structural, sociopolitical, and cultural barriers challenge the global mental health response to disasters. These disasters, both natural and man-made, affect communities, and lead to individual and social suffering. According to panelists who presented at the workshop ‘Mental Health and Disaster Management,’ on April 17, there is a need for global actors to work with communities to create local solutions to post-disaster mental health initiatives. This panel highlighted the research being undertaken by SAI’s interfaculty research project.
Jennifer Leaning, François-Xavier Bagnoud Professor of the Practice of Health and Human Rights, Harvard T. H. Chan School of Public Health; Director, FXB Center for Health and Human Rights, contextualized the discussion by using the port-city of Karachi, Pakistan, as a case study to examine barriers to care in disaster settings. With a population of over 20 million, Karachi’s geographical, political, and urban characteristics make it particularly vulnerable to natural disasters. Bordered on its southwest by the Arabian Sea and to its north and west by the Indus River, Karachi is vulnerable to natural hazardous events like earthquakes, tsunamis, and floods.
The political context of Karachi makes the city specifically vulnerable to natural disasters, as a result of its growing refugee population and its weak infrastructure, which results in limits to capacity. In recognizing this vulnerability, improving response capacities is a focus of this research, with initiatives that include creating government-designated trauma hospitals, training emergency response staff, developing a deeper understanding of disaster planning needs, and supporting local mental health providers. Yet, inadequate infrastructure, including extensive but not well-coordinated ambulances, congestion, traffic accidents, poor emergency exit routes, and inadequate shelter, remains as barriers in improving natural disaster health care.
Grounding the discussion from Leaning’s commentary on the social, political, and structural barriers to care, Ruth Barron, Assistant Professor of Psychiatry, Harvard Medical School, discussed the interpersonal challenges to global mental health care and lessons learned from lived experiences of natural disasters. Mental health providers can support people in crisis by emphasizing that the event is abnormal; the individual is not abnormal. Barron discussed the social aspect of suffering by illustrating how disaster impacts not only individuals, but also communities.
In explaining how families, mental health providers, emergency responders, and other community members can be impacted by disaster, she concluded, “if someone has survived disaster, someone next to them is either injured or deceased.” Mental health professionals must make use a community-based approach. Cultural barriers, including the need to recognize how Western concepts may, or may not, fit into non-Western contexts is important when implementing care, as well as working with, and not for, local communities.
In response to these challenges, John Torous, Resident Physician in the Department of Psychiatry, Brigham and Women’s and Beth Israel Deaconess Medical Center, Harvard Medical School, discussed the potential of mobile intervention to aid in mental health response. With cell phones becoming increasingly prevalent in South Asia, mental health experts believe they might be beneficial during disasters. Used as a baseline monitor for pre-disaster contexts, mobile phones can be used to assess physical surroundings, detect community health services, and identify personal risk factors to pathological conditions.
Torous also emphasized the potential for mobile intervention post-disaster in monitoring mental health in communities, including assessments of PTSD, major depressive disorder, and anxiety, which Barron explained generally impacts 10-15% of people who experience disasters. While mobile technology has the potential to monitor the daily mental health experience, there is a need to further examine the role of mobile technology in disaster care, given the challenges of reliability of mobile devices post-disaster and cultural and structural barriers.
Following the panel, participants discussed the importance of listening to lived experiences of trauma and understanding narratives of illness. Psychiatrists, medical professionals, and emergency response providers offered on-the-ground accounts of trauma. The discussion was a powerful acknowledgement of the social nature of suffering, and the need for interventions that focus on community healing by developing a network of care.
Next steps for this research project: With support from the Aman Foundation, this SAI-supported research project will continue to conduct trainings at hospitals in Karachi, Pakistan for emergency rooms and hospital workers, with a special focus on how to treat mental trauma in disasters. Lessons from the Karachi trainings will help inform practices across South Asia and other emerging economies.