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Psychological Harm Remains Long After the Rescue Teams Leave

In February I wrote the post below about the necessity of providing psychosocial support to communities prone to be hit by traumatic events. In late April an earthquake in Nepal and surrounding countries tragically surprised us all. It will take years to rebuild from this terrible disaster.

And of course we know more disasters and conflict will take place. There are numerous global locations known to be highly vulnerable to natural disasters and conflict. People there would get far better support for the money that will eventually be spent on disaster recovery if basic preparations for psychosocial services were put in place before disaster and conflict strikes.

Such programs need not require vast funding to have real impact and they do not depend on large external support. Identifying and training local teams in basic concepts of psychosocial service support and psychological first aid goes a long way towards ensuring that communities actually get the kind of support that makes a difference when disaster is at hand.

Such training starts from a basic reality that often seems to be forgotten: locals should conduct most of the psychosocial support work. Rescue teams come for a few weeks or months and make an important contribution to basic survival. But the psychological harm of trauma lingers for years, even decades, and the responses most useful in addressing it must be done on a long-term basis. This means that resources directed to quick, short-term psychosocial support strategies conducted by outsiders bring poor returns. Far higher benefits can be achieved by strategies that build local understanding of trauma and expand local capacities for resiliency.

Delivery of such a strategy after catastrophe is much more difficult, because the locals required to deliver it are themselves living in vast trauma, stress and disruption. So, intended or not, not to prepare for delivery of psychosocial support is essentially a choice for dependency on external actors delivering high-cost, low-yielding responses on the day when disaster eventually does arrive.

Until the modalities of delivery shift from reaction post-disaster to preparation, a concept like “building resiliency”, in most cases, remains only an attractive slogan. So here’s a simple test about resiliency: Are you investing in preparation for delivery of psychosocial support during disaster? If not, the odds are low that whatever programming is done after disaster, no matter how good the intent, will contribute anything to resiliency.

Which brings me to my February 2015 post: The UN Economic and Social Commission for Asia and the Pacific recently concluded, "The lessons from 2014 clearly show that building resilience remains a key priority in protecting lives and assets in the Asia and the Pacific”. Yes, but...

In the last year and half I have provided expressive psychosocial support trainings in the Philippines, S. Korea, China and Japan for people working in post-disaster settings. These experiences have greatly strengthened my belief that such training has an important role to play in community resilience and sustainable development programs.

But to achieve any impact requires more than passing out a leaflet of tips on resiliency or providing a half hour lecture on stress (even a full day is not enough). The needs are vast and complex, requiring a segmentation of response. The most immediate need after disasters is direct support for communities affected, for those suffering from primary trauma. Soon, however, the needs of another community become apparent as well: the networks of caregivers, who work in great jeopardy of secondary trauma.

Both direct community work and support for traumatized caregivers require several

layers of training:
 1) Both settings need short, introductory training that targets the largest number of people possible and provides then with basic understanding of trauma, how it impacts people, and techniques to mitigate it. 
2) Following introductory training, there is a need for continuing training for service providers in in-depth knowledge required by their work.
 3) Both settings require training of trainers to facilitate scaling up of ongoing training and go beyond one-off responses.

Key challenges must be considered. One is the modality of training. You can read an abstract here of my recent dissertation research and findings that challenge the effectiveness of lecture and passive learning as teaching methods with traumatized people, and demonstrate the impact of expressive training methods as compared to an oratorical approach.

Additionally, psychosocial programs must be culturally adapted to the context. Most existing psychosocial programs are monopolized by western definitions of stress and trauma and what to do about them. Honoring the resources existing within the local context is essential for such programs to be effective (see my recent blog on guidelines to conduct psychosocial support).

There is much work ahead to create the structures required to provide such training. The good news is that there are many signs that awareness is growing regarding the importance of building community resiliency before and after trauma. Now we need to take the next step and build from awareness to action.

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Click here for more on the UN report.

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