Mental Health Aid Program to Tsunami Affected Countries

1
Mental Health Aid Program to Tsunami Affected
Countries

• Japanese Society of Psychiatry and Neurology
• Tsuyoshi Akiyama

2
Inter-governmental Conference

• April 4, 5
• Jakarta
• India, Malaysia
• Thailand
• Sri Lanaka, Indonesia

3
Inter-governmental Conference

• America, Australia,
• Iran, Japan, Turkey
• WHO, UNICEF
• UNESCO, IOM

4
India

• Death 10,697
• Missing 5,811
• Affected 2,880,468

5
Malaysia

• Death 68
• Affected 7,827

6
Thailand

• Death 5,309
• Missing 3,810
• Injured 10,000

7
Sri Lanka

• Death 2,846
• Missing 1,027
• Injured 2,375
• Affected 250,000
• Displaced 70,000

8
Indonesia

• Death 126,915
• Missing 93,063
• Injured 2,375
• Displaced 795,385

9
India

• Psychiatric Symptom 60-80
• Grave Psychiatric Disorder
• 2,250
• Training 110
• Trainee 4,387    
• Session 35,000

10
Thailand

• Psychiatric Symptom 100
• Grave Psychiatric Disorder
• 2,325
• Client 9,015

11
Indonesia

• Psychiatric Symptom 90

12
Indonesia, Sri Lanka

• Lack of Psychiatrist
• Lack of Primary
• Mental Health System
• Huge Disaster
• Lack of Aid

13
Number of Psychiatrist 2001

• Population 100,000
• United States 10
• Japan 8
• Indonesia 0.21
• Sri Lanka 0.2

14
Lack of Primary Mental Health System

• District No Psychiatrist
• Coordination with General
• Primary Health Care (-)
• Local Policy (-)
• Lack of Psychiatric Care

15
Lack of Aid in Aceh

• Conflict
• Safety
• Language Difference
• Malaysian-Indonesian

16
Aid ProgramTrauma OnceStress
ContinuesFew Years Systematic
17
Recommendation Inter-ministry
CooperationInter-sectoral CoordinationPublic
Awareness
18
Psychosocial SupportMental Health Care
19
Psychosocial Areas

• Formal Education
• Non-formal Education
• Social and Economic
• Cultural and Religious
• Environmental

20
Formal Education

• Group Activities
• Children Parents
• Teacher Support / Training
• Curriculum on the Issues
• Student Guidance Center

21
Non-formal Education

• Community Center
• Youth Center
• Drop-out Reintegration
• Life Skill
• Vocational Training
• Peer to Peer Support

22
Social and Economic

• Media Campaign
• Community Participation
• Income Generating
• Program
• Culturally Appropriate
• Support Services

23
Social and Economic Continued

• Commemorative
• Activities
• Training of Support
• Service Providers
• Lost Documents
• Legal Support

24
Cultural and Religious

• Training
• Religious Leaders
• Community Leaders
• Traditional, Religious
• Healing
• Community Activities

25
Environmental

• Resettlement
• On Higher Ground
• Protection
• Re-planting of Mangrove
• Natural or Artificial
• Reefs

26
How to Strengthen Mental Health Care

• Access to Basic Care
• All People
• All Kinds of Problems
• General Mild Severe

27
Important Issues

• Anti Stigma
• Inter-ministry Cooperation
• Integration with General
• Health Care System
• Protection to Workers
• Information System

28
MIX OF SERVICES
high
low
Frequency of need
Cost
low
high
Need
WHO Dr. Van Ommeren, modified by Akiyama, 2005
Adapted from WHO (2003)
29
Specialty Sector

• MEMBER
• Psychiatrist
• Psychologist
• Psychiatric Nurse
• Clinical Social Worker

30
Specialty Sector

• ROLE
• Inpatient/Outpatient
• Treatment
• Outreach
• Community Treatment

31
Specialty Sector

• RECOMMENDATION
• Acute Treatment Ward
• Community Mental
• Health Team
• Training to PHC

32
Primary Health Sector

• MEMBER
• General Physician
• Nurse
• Midwife
• Assistants

33
Primary Health Sector

• ESSENTIEL ROLE
• Early Detection
• Referral
• Basic Mental Health Care
• Case Follow-up

34
Primary Health Sector

• ADDITIONAL ROLE
• Counseling
• Psychosocial Education
• Prevention
• Inter-sectoral Linkage

35
Primary Health Sector

• RECOMMENDATION
• Referral System
• Family Folder Method
• Training
• Supervision

36
Community Sector

• MEMBER
• Counselors
• Teachers
• Self-help Group
• NGO Workers
• Community Leaders

37
Community Sector

• ROLE
• Early Detection
• Referral
• Basic Support
• Prevention
• Health Promotion

38
Community Sector

• RECOMMENDATION
• Guideline Development
• Training
• Supervision
• Prevention
• Linkage

39
Self and Family Sector

• MEMBER
• Self
• Family
• Relative
• Friend

40
Self and Family Sector

• ROLE
• Basic Knowledge
• Disaster
• Mental Health
• Networking

41
Self and Family Sector

• RECOMMENDATION
• Information
• Education / Basic Training
• Peer Support Activity
• Self-help Group

42
Japanese Society Aid Program

• Fund Initial Phase
• Training
• Primary System
• Trauma Care Center

43
Fund in Initial Phase

• Malaysian Psychiatric
• Association
• Japanese Business
• Federation

44
Training

• Key Persons
• Disaster Preparation
• WHO Model
• Specific Program

45
Specific Program

• According to the Interests
• Cognitive Therapy
• Industrial Mental Health
• Psychiatric Nursing

46
Primary Mental Health System

• 8 Districts in Aceh
• Coordination by WHO
• 1, 2 Districts by Japan?

47
Trauma Care Center

• Center of Excellence
• Coordination Center
• Selected Sites

48
Collaboration with World Bank

• Training Community Sector
• Primary Mental Health System?
• Trauma Care Center?