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Three Key Actions for Mental Health and Psychosocial Support in the Aftermath of May 2016 Floods, Sri Lanka
3 Key Actions Pic
Three Key Actions for Mental Health and Psychosocial Support in the Aftermath of May 2016 Floods, Sri Lanka

- by Ananda Galapatti

 This short document is a quick update to brief notes that I developed with Dr. T. Gadambanathan (Consultant Psychiatrist, Batticaloa Teaching Hospital) a few years ago in response to queries we received on how to respond to the mental health and psychosocial impacts on affected people when serious flooding in 2011 inundated large portions of the Batticaloa district.

As I write on the evening of May 18th, it is already clear that thousands of families have been badly affected by the past few days of flooding, and that many people are still left stranded in areas inundated by water. It also seems that the death toll is likely to rise above 100, as rescuers continue to search for people missing in areas affected by landslides. It is not yet clear what the severity or extent of psychological and social impacts of this current flood disaster will be, or how these will be distributed amongst the affected population. However, this does not mean that we cannot not begin to provide appropriate support.

Even whilst the urgent rescues continue and affected people are being provided with initial temporary shelter and relief, there are simple but important things that we can do to reduce distress and try to protect vulnerable people from longer-term negative psychological and mental health consequences. Later, when individuals and families return to their communities and homes from temporary shelters, and the relief effort transitions towards meeting the needs of restoring homes, resuscitating livelihoods and repairing infrastructure, there will be other ways in which we can promote recovery and wellbeing and also ensure that people in need of specialised services are able to access these.

The options for support outlined below are derived from the IASC Guidelines on MHPSS in Emergencies, which is the global standard for organising MHPSS responses to large scale crises. Drawing on these guidelines as well as experience in similar disasters in Sri Lanka, I would like to suggest an approach to assisting positive coping and recovery that is built around three key actions:

1. Providing practical, humane support during rescue and relief activities based on the principles of Psychological First Aid.

When people are in the midst of the chaos and danger of a disaster, as well as for hours, days, or even weeks afterwards, they may be distressed and in need of support. The approach of Psychological First Aid is designed to meet this need through practical, humane, adaptable actions that any non-specialist person can do to support people who are distressed or vulnerable after a crisis, to promote 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope. Provision of PFA does not depend on the arrival of counsellors or other mental health professionals, but can be provided by neighbours, relief workers or any other person who is at a crisis site. It is now a key recommended first line response in the immediate aftermath of a crisis, and the 2011 WHO manual on PFA has already been adapted and translated into Sinhala(2013) and Tamil (2013).

a) Provide rapid orientation (2–4 hours) on PFA for first responders, especially those associated with the Disaster Management Centres at district-level (including volunteers, community health staff, police and armed forces personnel mobilized for the disaster). There are a number of PFA trainers in Sri Lanka and there is also a useful guide to facilitating PFA training.

b) Promote public messages based on PFA principles via radio, television and internet so that members of affected communities, as well as other lay persons responding to the crisis, so that they will be able to drawn on these when they are providing assistance to friends, family, neighbours and others.

Courtesy: WHO (2011) Psychological first aid: Guide for field workers

2. Ensuring that mainstream relief and recovery programmes integrate special considerations into design and implementation so that these can promote and protect mental health and psychosocial wellbeing, whilst serving other needs.

The way that support is provided to meet the material and practical needs of individuals, families and communities affected by the floods can have positive or negative implications for their levels of distress and difficulty — both at individual and group levels. Eruptions of commotion or even anger around relief distribution often illustrates dramatically some of these impacts. Sensitive approaches can go a long way to addressing material needs that are causing worry to affected people, as well as avoid creating new problems.

a) Ensure access to and clarity of information about relief, possible compensation, available services and recovery processes. Ensure predictability, reliability and transparency in relation to these, as this will allow people to develop a feeling that they know what is going on — reducing distress, and allowing them to gain confidence in their own ability to understand and manage the situation.

b) Do No Harm — prevent relief and other forms of assistance from causing conflict, competition or disruption within affected communities; avoid creating unrealistic expectations; prevent creating long term dependencies.

c) Involve affected communities in prioritisation, planning and implementation of recovery programmes. Ensure that relief provision is based on up-to-date needs assessment, and responds to community or family priorities. Actively coordinate with others providing assistance to the same community. Reinforce the sense of control and competence of people in the community and within families, rather than helplessness.

d) In time, support the resumption of normal community structures and activities (ie. schools, religious practices, village committees, etc), and ensure minimal disruption of these by external programmes.

3. Linking people in need of more specialized or specific assistance with existing MHPSS services in their own district.

Whilst most people will not require specialised or targeted MHPSS interventions, there may be a few whose pre-existing vulnerabilities may have been worsened by what has happened to them during and after the flood. Being sensitive to the existence of people who may be in need of special assistance, and connecting them to existing services is a valuable action that can be taken by non-MHPSS service providers and volunteers. There may be some people who are so distressed or unwell that they are unable to take care of themselves or are a risk to themselves or others — in such cases, it is necessary to help them to access professional help.

a) Pay attention to pre-flood vulnerabilities (serious mental illness, disability, extreme poverty, complex family or social problems) that may prevent some individuals and families from making a successful recovery without additional assistance after the floods. Identify support needs and create sustainable responses to these problems, many of which may persist in the medium to long term.

b) Identify local resources for mental health and psychosocial support to whom difficult cases or complicated issues may be referred, or from whom assistance may be sought in responding to very vulnerable individuals or groups. There are now many relevant public sector service providers to whom persons in distress or difficulty may be referred. There are Medical Officers for Mental Health (MOMH) attached to MOH area and District level health service who are a good point of contact for support. Similarly, Counselling Officers can be accessed at many Divisional Secretariat and most District Secretariats. There are also a wide range of other personnel at DS Division and District level who have roles relevant to psychosocial support or mental health.

Courtesy TAF (in press): Mapping the Roles of Community-Level Government Service Providers Relevant to Mental Health & Psychosocial Support Services in Sri Lanka

In remote areas where these services do not yet exist or are not of adequate quality, the opportunity should be used to extend available services to meet MHPSS needs for the medium and long-term.

c) Specialised or targeted MHPSS interventions at a community-level should be based on systematic needs assessments, and should seek to integrate with the existing systems for care.

Useful Sources for Further Information:

Ananda Galappatti is a medical anthropologist and MHPSS practitioner. He is the Director of Strategy at The Good Practice Group, a Managing Board Member of MHPSS.net and also a member of the editorial board of the journal Intervention.

MHPSS in Guinea Conakry – A Literature Review
english ebola

MHPSS in Guinea Conakry – A Literature Review

The World Health Organization (WHO) requested a Mental Health and Psychosocial Support (MHPSS) literature review of countries impacted by the Ebola virus, including Sierra Leone, Liberia and Guinea. International Medical Corps expressed an interest in completing the review for Guinea and commissioned a rigorous review of the literature on pre-existing information relevant to mental health and psychosocial support (MHPSS) in Guinea, in the French and English languages. This report presents the findings using an integrated psychological and anthropological framework that is instrumental in understanding MHPSS needs, and how to devise culturally-appropriate MHPSS interventions in Ebola-affected areas.

The report outlines the key findings of the existing academic and grey literature related to Guinean mental health and psychosocial issues and services, with a specific emphasis on the recent Ebola humanitarian crisis. The review was conducted in June-July 2015 and identified relevant academic publications using academic search engines and databases (Google scholar, Medline, Pubmed, PSYCHinfo, APA psycNET, and Anthrosource). The search was extended through manual searches on Google in French and English, and in the journals: Social Science and Medicine; Culture, Medicine, and Psychiatry, Transcultural Psychiatry; and Medical Anthropology. Researchers with relevant expert knowledge were also consulted. The overall search identified academic sources, but also relevant reports, policy documents and internet resources.

The report introduces general background information regarding the population of Guinea, its religions, history, politics, economics and health. It subsequently summarizes information on mental health and psychosocial issues including prevalence, local nosologies, help-seeking strategies, formal and informal resources of MHPSS sources of support. There is discussion of the ways in which causes and course of illness and misfortune are intertwined with plural cosmologies and with individuals’ relationships with the living, the dead, the spirit world, and nature itself. Finally, the humanitarian crisis of Ebola in Guinea is explored, alongside responses to it, and its social and psychological ramifications for the affected population.

The scholarly and grey literature available on MHPSS specifically in Guinea was limited and thinly spread over many documents. This presented a challenge when writing this report and we acknowledge that there may have been further relevant material to be found in sources that did not focus specifically on MHPSS, but which it was not possible to obtain within the time-scale of the review. Nonetheless, we hope the report can provide useful insights for policy-makers, donors, governments and service-providers.

To access review please visit http://mhpss.net/?get=268/Guinea-MHPSS-Literature-Review-2015-English1.pdf or download Guinea MHPSS Literature Review 2015 English here.


Guidance to provide MHPSS care for pregnant women and for families with microcephaly in the context of Zika virus
Psychosocial support for pregnant women and for families with microcephaly and other neurological complications in the context of Zika virus
Interim guidance for health-care providers


On 1 February 2016 WHO announced that a cluster of microcephaly and other neurologic disorders reported in Brazil is a Public Health Emergency of International Concern. Several countries have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome (GBS) (2) concurrent with Zika virus outbreak. A causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not scientifically proven.

This document describes guidance for a supportive response by healthcare providers (e.g. physicians, nurses), focusing primarily on women affected by Zika virus infection during pregnancy and their families, for their mental health and psychosocial needs.

Translations of this document in Spanish and Portuguese will also soon be available on mhpss.net. To access these and other resources related to  this crisis please go to  Zika – Microcephaly, Emergency Response, 2016.



3.1. Types of Resources

You can upload documents such as word files, PDF files, power point presentations and photos. Maximum file size is 5 MB. You can also view and download these resources, depending on the permission settings applied to them. For instance, some resources will be accessible only to members of a particular group. Once you have read them, take some time to rate or review them so that others can find them to be useful. You can also add one or more keywords to a resource to help others find it more easily. Read more about these options below.

3.2. Adding Resources

You can currently add documents (word, excel, powerpoints, PDF) and photos. Videos and images can be uploaded as well. Please abide by our community rules for posting videos. mhpss.net reserves the right to remove images and videos that violate these rules. Links to videos can be posted to groups or profile, and the video will then be accessible/viewable on the site.

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Step 1: Go to the group where you want to upload the resource. Click on the ‘Resources’ button on the sub-navigation bar underneath the group image.

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Step 2: Click on ‘Upload Resources’ tab below the sub navigation bar, follow the instructions and upload the document.

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Step 3: You can set the resource as recommended in the group by selecting ‘recommended resource’. You can also add your resource to other groups by selecting them from the list.

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Step 4: Select from the list of the keywords, those keywords which describe your resource in the best way. Other members can also add keywords to resources you have uploaded. Each resource can have up to 8 keywords.

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Step 5: Click ‘upload’

3.3. Creating An Editable Document

A google document can be edited by members who have shared access. Create a google document by following the steps below:

Step 1: Create a google account by following the steps on www.google.com. Click on the google drive icon from the apps menu after signing in to your account.

Inbox (1) - chathuri@mhpss








Step 2: Click on ‘Documents>Create New’ and select the type of document you would like to create.

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Step 3: Click on the ‘Share’ tab at the top right and add the email addresses of the people with whom you want to share the document. You can select whether they view and/or edit.

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Step 4: Copy-paste the link of the document with the relevant members either via a site message or via a status update on your profile or via the relevant group.

3.4. Editing Resources

Step 1: Go to the group to which the document has been uploaded to and click on ‘resources’ in the sub-navigation bar.

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Step 2: Select the document you want to edit and click on the ‘edit’ tab.

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Step 3: You can edit the document details (title, description, keywords etc) using the links provided. However, you can edit only the documents you have uploaded. You can edit any document in the group if you are the group admin.

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3.5. Searching for Resources

Step 1: Go to the Resources page and search for the resource you need. You can do this by entering the keyword(s)you are looking for or the title of the resource in the search box provided. The search will look in both the title and description.










Step 2: You can also order the results by ‘newest’ or ‘alphabetical’.

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Step 3: OR if you are on another page, type the name or any other key word into the google search box. Using the google search box on the site will result in a search of the entire site and therefore the results will include more than the resources. You can select which areas of the site to look in by clicking on the cog located next to the search box.


Google search



3.6. Viewing Resources

Step 1: On the Resources page, resources can be viewed, sorted either by ‘newest’ or ‘alphabetical’ order.

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Step 2: If you want to view documents that belong to a particular group, click on the relevant group from the list shown on the right hand side of the Resources page.

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Please note: Private Groups and Hidden Groups will only be displayed if you are a member.

Step 3: Resources can also be viewed via the ‘Groups’ pages. Go to the relevant group, click on ‘Resources’ on the sub-navigation bar below the group image.

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Step 4: Here, you can sort the documents either by ‘newest’, ‘alphabetical’ or ‘Most Popular’.

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3.7. Sharing Resources

Sharing Resource Between Groups

You can share resources you have uploaded to other groups to which you belong by clicking on those groups from the list provided, at the time of uploading or editing a resource. 

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Sharing resources via FB, Twitter, Outlook and more!

You can share the link to a resource by either clicking on any of the social media/application icons next to the resource descriptions, or clicking on the ‘share’ button below and selecting the appropriate application through which you want to share the resource.

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Activity streams mentioning resources can be shared subject to permissions, using the ‘share’ button as well.  However, it would be essential to be a member and log in, in order to access the resource.