mental health aid program to tsunami affected countries mental health aid program to tsunami...

Mental Health Mental Health Aid Aid Program to Program to

Tsunami Affected Tsunami Affected CountriesCountries

Japanese Society of Japanese Society of Psychiatry and NeurologyPsychiatry and Neurology

Tsuyoshi AkiyamaTsuyoshi Akiyama

Inter-Inter-governmental governmental

ConferenceConference April 4, 5 April 4, 5 JakartaJakarta India, MalaysiaIndia, Malaysia ThailandThailand Sri Lanaka, Indonesia Sri Lanaka, Indonesia

Inter-Inter-governmental governmental

ConferenceConference America, Australia,America, Australia, Iran, Japan, TurkeyIran, Japan, Turkey

WHO, UNICEF WHO, UNICEF UNESCO, IOM UNESCO, IOM

India India

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

Malaysia Malaysia

Death: Death: 68 68 Affected: 7,827Affected: 7,827

Thailand Thailand

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

Sri Lanka Sri Lanka

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

IndonesiIndonesia a

Death: Death: 126,915 126,915 Missing: Missing: 93,063 93,063 Injured: 2,375Injured: 2,375 Displaced: Displaced: 795,385795,385

India India

Psychiatric Symptom 60-80% Psychiatric Symptom 60-80% Grave Psychiatric DisorderGrave Psychiatric Disorder

2,250 2,250 Training Training 110110 TraineeTrainee 4,387 4,387         SessionSession 35,00035,000

ThailanThailand d

Psychiatric SymptomPsychiatric Symptom 100100% % Grave Psychiatric DisorderGrave Psychiatric Disorder

2,3252,325 ClientClient 9,0159,015

IndoneIndonesia sia

Psychiatric SymptomPsychiatric Symptom 9090% %

Indonesia, Sri Indonesia, Sri Lanka Lanka

Lack of PsychiatristLack of Psychiatrist Lack of Primary Lack of Primary Mental Health SystemMental Health System Huge DisasterHuge Disaster Lack of AidLack of Aid

Number of Number of Psychiatrist Psychiatrist

20012001 Population 100,000Population 100,000 United States: 10United States: 10 Japan: 8Japan: 8 Indonesia: 0.21Indonesia: 0.21 Sri Lanka: 0.2Sri Lanka: 0.2

Lack of Primary Lack of Primary Mental Health Mental Health

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

Lack of Aid in Lack of Aid in Aceh Aceh

Conflict Conflict SafetySafety Language DifferenceLanguage Difference Malaysian-Indonesian Malaysian-Indonesian

Aid Aid ProgramProgram

Trauma: OnceTrauma: OnceStress: Stress: ContinuesContinues

Few Years Few Years SystematicSystematic

RecommendationRecommendation

Inter-ministry Inter-ministry CooperationCooperation

Inter-sectoral Inter-sectoral CoordinationCoordination

Public AwarenessPublic Awareness

Psychosocial Psychosocial SupportSupport

Mental Health Mental Health CareCare

Psychosocial Psychosocial AreasAreas

Formal Education Formal Education Non-formal Education Non-formal Education Social and Economic Social and Economic Cultural and Religious Cultural and Religious EnvironmentalEnvironmental

Formal Formal EducationEducation

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

Non-formal Non-formal EducationEducation

Community CenterCommunity Center Youth CenterYouth Center Drop-out – Reintegration Drop-out – Reintegration Life SkillLife Skill Vocational Training Vocational Training Peer to Peer Support Peer to Peer Support

Social and Social and Economic Economic

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

Social and Social and Economic Economic

ContinuedContinued CommemorativeCommemorative ActivitiesActivities Training of Support Training of Support Service Providers Service Providers Lost Documents Lost Documents Legal Support Legal Support

Cultural and Cultural and ReligiousReligious

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

Environmental Environmental ResettlementResettlement On Higher GroundOn Higher Ground ProtectionProtection Re-planting of Mangrove Re-planting of Mangrove Natural or Artificial Natural or Artificial Reefs Reefs

How to How to Strengthen Strengthen

Mental Health Mental Health Care Care

Access to Basic CareAccess to Basic Care All PeopleAll People All Kinds of ProblemsAll Kinds of Problems General Mild Severe General Mild Severe

Important Important IssuesIssues

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

4Self and family care

3Community care

2

Primary health care

Specialty mental health services

1

low

low

high

high

Need

CostFrequency of need

MIX OF SERVICES

Adapted from WHO (2003) WHO Dr. Van Ommeren, modified by Akiyama, 2005

Specialty Specialty Sector Sector

MEMBER MEMBER

PsychiatristPsychiatrist PsychologistPsychologist Psychiatric NursePsychiatric Nurse Clinical Social WorkerClinical Social Worker

Specialty Specialty Sector Sector

ROLEROLE

Inpatient/Outpatient Inpatient/Outpatient TreatmentTreatment OutreachOutreach Community TreatmentCommunity Treatment

Specialty Specialty Sector Sector

RECOMMENDATIONRECOMMENDATION

Acute Treatment WardAcute Treatment Ward Community Mental Community Mental Health TeamHealth Team Training to PHC Training to PHC

Primary Health Primary Health Sector Sector

MEMBER MEMBER

General Physician General Physician Nurse Nurse Midwife Midwife Assistants Assistants

Primary Health Primary Health Sector Sector

ESSENTIEL ROLE ESSENTIEL ROLE

Early Detection Early Detection Referral Referral Basic Mental Health Care Basic Mental Health Care Case Follow-up Case Follow-up

Primary Health Primary Health Sector Sector

ADDITIONAL ROLE ADDITIONAL ROLE

Counseling Counseling Psychosocial Education Psychosocial Education Prevention Prevention Inter-sectoral Linkage Inter-sectoral Linkage

Primary Health Primary Health Sector Sector

RECOMMENDATION RECOMMENDATION

Referral System Referral System Family Folder Method Family Folder Method Training Training Supervision Supervision

Community Community Sector Sector

MEMBER MEMBER

CounselorsCounselors TeachersTeachers Self-help GroupSelf-help Group NGO WorkersNGO Workers Community Leaders Community Leaders

Community Community Sector Sector

ROLE ROLE

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

Community Community Sector Sector

RECOMMENDATION RECOMMENDATION

Guideline Development Guideline Development Training Training Supervision Supervision Prevention Prevention Linkage Linkage

Self and Family Self and Family Sector Sector

MEMBER MEMBER

Self Self Family Family RelativeRelative FriendFriend

Self and Family Self and Family Sector Sector

ROLE ROLE

Basic KnowledgeBasic Knowledge DisasterDisaster Mental Health Mental Health Networking Networking

Self and Family Self and Family Sector Sector

RECOMMENDATION RECOMMENDATION

InformationInformation Education / Basic TrainingEducation / Basic Training Peer Support ActivityPeer Support Activity Self-help Group Self-help Group

Japanese Japanese Society Society

Aid ProgramAid Program Fund: Initial PhaseFund: Initial Phase TrainingTraining Primary SystemPrimary System Trauma Care CenterTrauma Care Center

FFund in Initial und in Initial PhasePhase

Malaysian PsychiatricMalaysian Psychiatric AssociationAssociation Japanese BusinessJapanese Business FederationFederation

Training Training

Key PersonsKey Persons

Disaster Preparation Disaster Preparation WHO Model WHO Model SSpecific Programpecific Program

Specific Specific Program Program

According to the InterestsAccording to the Interests

Cognitive Therapy Cognitive Therapy Industrial Mental Health Industrial Mental Health Psychiatric NursingPsychiatric Nursing

Primary Mental Primary Mental Health System Health System

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

Trauma Care Trauma Care Center Center

Center of Excellence Center of Excellence Coordination CenterCoordination Center Selected SitesSelected Sites

Collaboration Collaboration with World Bank with World Bank

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