MARKING KEY FOR GNC NOVEMBER 2019 MENTAL HEALTH AND

PSYCHIATRY EXAMINATION

1. A 11. C 21. A 31. C 41. A 51. C 61. A

2. A 12. A 22. A 32. C 42. A 52. E 62. E
3. B 13. A 23. C 33. B 43. B 53. H 63. F
4. B 14. C 24. C 34. B 44. D 54. G 64. G
5. D 15. B 25. C 35. D 45. B 55. A 65. B
6. A 16. D 26. C 36. C 46. A 56. C 66. C
7. B 17. D 27. C 37. C 47. B 57. E 67. D
8. B 18. C 28. B 38. D 48. A 58. A 68. F
9. C 19. B 29. B 39. A 49. D 59. G 69. A
10. C 20. B 30. D 40. A 50. B 60. F 70. E

71. ADDICTION 86. ANXIETY

72. ANOREXIA NERVOSA 87. LEARNING
73.DISSOCIATIVE IDENTITY DISORDER 88. AVOIDANT PERSONALITY DISORDER
74. DISABILITY 89. DEJAVU
75.THOUGHT BLOCK 90. HEALTH IMPROVEMENT
76.FACTITIOUS 91. CATATONIC STUPOR
77. REGRESSION 92. FLIGHT OF IDEAS
78. DEPRESSION 93. PERSONALITY DISORDER
79. SOMNAMBULISM 94. CONFUBULATION
80. PARAPHRENIA 95. BEHAVIOUR MODIFICATION
81. DEPENDANCE 96. MENTAL RETARDATION/ INTELLECTUAL DEFICIT
82. SUICIDAL IDEATION 97. PSYCHIATRY
83. FATIQUE 98. INVOLUNTARY ADMISSION
84. NARCISSISTIC PERSONALITY 99. MENTAL STATE EXAMINATION
85. LOOSENING OF ASSOCIATION 100. CHILD NEGLECT

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QUESTION ONE (1)
a) Define mental illness. 5%
1. Mental illness is psychological or behavioural manifestation and/or impairment in
functioning due to social, psychological, genetic, physical/chemical or biological
disturbance.
2. A mental illness or psychiatric disorder is a behavioral or mental pattern that causes
significant distress or impairment of personal functioning.
3. Mental illnesses are health conditions involving changes in emotion, thinking or behavior
(or a combination of these). Usually associated with distress and/or problems functioning in
social, work or family activities.
b) Outline Five (5) predisposing factors or aetiology or causes of mental illness (25%)
1. Genetics (heredity)

Many mental disorders tend to run in families, suggesting that people who have a family member
with a mental disorder are more likely to develop a mental disorder. Mental disorders do occur in
people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People
who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease may
also develop mental disorder more often than the general population.

2. Different Brain Chemistry and Structure

Some mental disorders have been linked to an abnormal balance of special chemicals in the brain
called neurotransmitters like dopamine and glutamate, and possibly others. Chemical abnormalities
are known to play a role in some mental disorders like schizophrenia. Neurotransmitters help nerve
cells in the brain communicate with each other. If these chemicals are out of balance or are not
working properly, messages may not make it through the brain correctly, leading
to symptoms of mental disorder.

3. Brain Defects or Injury

Defects in or injury to certain areas of the brain has also been linked to some mental disorders.
4. Prenatal Damage Some evidence suggests that a disruption of early fatal brain
development or trauma that occurs at the time of birth -- for example, loss of oxygen to the
brain may be a factor in the development of certain conditions, such as autism.
5. Alcohol and substance abuse. Long-term alcohol and substance abuse, in particular, has
been linked to anxiety, depression, and paranoia.
6. Psychological Factors. Psychological factors have been identified and linked to mental
disorders and the notable ones include:

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  Severe psychological trauma suffered as a child, such as emotional, physical, or sexual
abuse.
 An important early loss, such as the loss of a parent.
 Neglect.
 Poor ability to relate to others.
Environmental Factors. Certain stressors within the environment can trigger a mental
disorder in a susceptible person. These stressors may include:

7. Death or divorce.
8. A dysfunctional family life.
9. Living in poverty.
10. Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness.
11. Changing jobs or schools....
12. Social or cultural expectations (For example, a society that associates beauty with thinness
can be a factor in the development of eating disorders.)
13. Life events, stresses and relationships. Maltreatment in childhood and in adulthood,
including abuse, physical, emotional abuse, domestic violence and bullying, has been linked
to the development of mental disorder, through a complex interaction of societal, family,
psychological and biological factors.
14. Poor nutrition and exposure to pollutants, such as lead may play a role in the development
of mental disorders.
15. Poor general health has been found among individuals with severe mental disorders thought
to be due to direct factors including diet, substance use, effects of medication and social
economic disadvantages.
16. Parenting skills, parental depression, divorce have been known to play a role in the
aetiology of mental disorders.
17. Early social privation or lack of ongoing harmonious secure committed relationships has
been implicated both in childhood (including institutional care) and also through life span
relationships. This is very evident during adolescence.

c) DISCUSS ANY FIVE SIGNS AND SYMPTOMS OF MENTAL ILLNESS (30%)

1. Derealisation: Feelings of unrealness involving the outer environment.
2. Depersonalization: Feelings of unrealness, such as if one is “outside” of the body and
observing his own activities.
3. Suicidal and homicidal ideation: Suicidal and homicidal ideation requires further
elaboration with comments about intent and planning (including means to carry out
plan).
4. Anhedonia: loss of interest in previously pleasurable activities

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 5. Amnesia: Amnesia is a partial or total loss of memory.
6. Apathy: Can be defined as an absence or suppression of emotion, feeling, concern or
passion. Further, apathy is an indifference to things generally found to be exciting or
moving.
7. Neologisms: Invention of new words by the patient.
8. Clanging association: Speech based on sound, such as rhyming and punning rather than
logical connections.
9. Perseveration: Repetition of phrases or words in the flow of speech.
10. Ideas of reference: Interpreting unrelated events as having direct reference to the
patient, such as believing that the television is talking specifically to them.
11. Tangentiality: Thought that wanders from the original point.
12. Circumstantiality: Unnecessary digression, which eventually reaches the point.
13. Echolalia: Echoing (repeating) of words and phrases.
14. Flight of ideas: Accelerated thoughts that jump from idea to idea, typical of mania.
15. Loosening of associations: Illogical shifting between unrelated topics.
16. Pressured speech: Rapid speech, which is typical of patients with manic disorder.
17. Poverty of speech: Minimal responses, such as answering just “yes or no.”
18. Thought Blocking: Sudden cessation of speech, often in the middle of a statement.
19. Delusion: False belief not true to fact ordinarily accepted by other members of the
person’s culture.
20. Hallucinations: Sensory perceptions that occur in the absence of an actual external
stimulus. They may be auditory, visual, olfactory, gustatory or tactile.

d) As a nurse working in the mental health unit, what measures would you put in place
to try and reduce stigma against the mentally ill patients? (40%)
Student should at least come up with at least 10 points
What can we do to reduce and prevent mental health related stigma?
There are number of steps we can take to reduce and overcome mental health related stigma.

1. We need to develop anti stigma programs with substantive elements targeting all
types of stigma paying attention to the following:

 Myths about the causes of mental disorders.

 Causes of mental disorders.
 Ensuring that our communities have a deep understanding of what mental
illness is.

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  Creating recognition and understanding of mental disorder stigma including
what it is ; how it is harmful to ourselves, our families and our communities
and the role each person has to play in reducing it.

2. We need to translate the existing mental health policies and develop institutional and
care practice plans and activities to improve mental health and reduce the burden of
mental disorders.
3. We need to support the new legislation which intends to guarantee human rights,
ensure mental health integration into general health care like what has been stipulate
in the Mental Health Act No. 6 of 2019.
4. We need to advocate for inclusion in our health care settings - mental health agenda
in all clinical activities (budgeting, drug supply and programming).
5. Ensure the availability and access of essential medicines for people living with mental
disorders by including psychotropic drugs in the general health care essential drug kit.
Since medicines are often not available in health-care facilities, patients and families
need to be helped to access them.
6. Talk openly about mental health. “Mental illness touches so many lives and yet it’s
kept as a great secret for the people who are suffering from mental illness.
7. Educate yourself about mental health. “Challenge people respectfully when they are
perpetrating stereotypes and misconceptions. Speak up and educate them.”
8. Be conscious of your language. Don’t use mental illnesses as adjectives. “Saying
someone is “retarded” or use words like crazy, psycho, lunatic, etc.
9. Encourage equality in how people perceive physical illness & mental illness. “We
should explain mental illness as similar to any other illness. When someone acts
differently or “strange” during diabetic shock we don’t blame them for moral
failings.”
10. Show empathy & compassion for those living with a mental health
condition. Listening is one of the most important ways one can show empathy.
Listening without judgment or preconceived notions about mental illness and being
open to what the person is sharing will go a long way.
11. Stop the criminalization of those who live with mental illness. The criminalization of
mental illness has wide ranging and devastating consequences. For example:
Individuals with psychiatric diseases like schizophrenia and bipolar disorder are 10
times more likely to be in a jail or prison than a hospital bed.
12. Push back against the way people who live with mental illness are portrayed in the
media. “Research suggests most media portrayals of mental illness are stereotypical,
negative or flat-out wrong.”

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 13. See the person, not the illness. Strive to listen and understand rather than judge.
Focus on the individual instead of the illness.
14. Advocate for mental health reform. “It’s empowering people whenever and
wherever you can. It’s also writing legislators. It’s also talking in front of a board of
commissioners to advocate for continued mental health funding… It’s doing the right
thing and treating others justly.”
15. Don’t label people who have a mental illness. Don’t say, “He’s bipolar” or
“She’s schizophrenic.” People are people, not diagnoses. Instead, say, “He has
a bipolar disorder” or “She has schizophrenia.” And say “has a mental illness” instead
of “is mentally ill.” This is known as “person-first” language, and it’s far more
respectful, for it recognizes that the illness doesn’t define the person.
16. Don’t be afraid of people with mental illness. Yes, they may sometimes display
unusual behaviors when their illness is more severe, but people with mental illness
aren’t more likely to be violent than the general population. In fact, they are more
likely to be victims of violence. Don’t fall prey to other inaccurate stereotypes from
movies, such as that of the disturbed killer or the weird co-worker.
17. Don’t use disrespectful terms for people with mental illness. In a research study
with British 14-year-olds, teens came up with over 250 terms to describe mental
illness, and the majority was negative. These terms are far too common in our
everyday conversations. Also, be careful about casually using “diagnostic” terms to
describe everyday behavior, like “That’s my OCD," or, "She’s so borderline.” Given
that 1 in 4 adults experience a mental illness, you quite likely may be offending
someone and not be aware of it.
18. Don’t be insensitive or blame people with mental illness. It would be silly to tell
someone to just “buckle down” and “get over” cancer. The same applies to mental
illness. Also, don’t assume that someone is okay just because they look or act okay or
sometimes smile or laugh. Depression, anxiety, and other mental illnesses can often
be hidden, but the person can still be in considerable internal distress. Provide
support and reassurance when you know someone is having difficulty managing their
illness.
19. Be a role model. Stigma is often fueled by lack of awareness and inaccurate
information. Model these stigma-reducing strategies through your own comments
and behavior and politely teach them to your friends, family, co-workers and others in
your sphere of influence. Spread the word that treatment works and recovery is
possible. Changing attitudes takes time, but repetition is the key, so keep getting the
word out to bring about a positive shift in how we treat others.

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 20. We need to know that some words and acts could be poison and others could heal.
For poisonous words, we do not have to speak them. For acts that create a distance,
we do not need to do them
Words Can Be Poison or perpetuate stigma Words Can Heal or prevents stigma
Stigma discourages people from getting Here are six steps you can follow to help
help At any given time, one in four adults end the stigma of mental illnesses:
and one in five children experience a mental
health problem. 1. Learn More. Many organizations sponsor
Early and appropriate services can be the nationwide programs about mental
best way to prevent an illness from getting health and mental illness.
worse. Many people don’t seek such services 2. Insist on accountable media.
because they don’t want to be labelled as Sometimes the media portray people
mentally ill” or “crazy.” who have mental illnesses inaccurately,
Stigma keeps people from getting and this makes stereotypes harder to
examined and treatment. Some health change.
workers are reluctant to treat people who 3. Obey the mental health law. The mental
have mental illnesses. health law prohibits discrimination
against people with mental illness in all
Stigma leads to fear, mistrust, and
areas of public health and general health
violence. Even though the vast majority of
care.
people who have mental illnesses are no
4. Recognize and appreciate the
more violent than anyone else the average
contributions to society made by people
television viewer who watches Nigerian
who have mental illnesses. People who
Movies sees three people with mental
have mental illnesses are major
illnesses each week – and most of them are
contributors to Zambian life - from the
portrayed as violent. Such inaccurate
arts to the sciences, from medicine to
portrayals people to fear those who have
entertainment to professional sports.
mental illnesses.
5. Treat people with the dignity and
Stigma results in prejudice and respect we all deserve. People who have
discrimination. Many families try to prevent mental illnesses may include your
people who have mental illnesses from living friends, your neighbors, and your family.
with them 6. Think about the person – the contents
Stigma results in inadequate insurance behind the label. Avoid labeling people
cover Our heath system does not cover by their diagnosis. Instead of saying,
mental health services to the same degree “She’s a schizophrenic,” say, “She has an
as other illnesses. When mental illnesses are illness.”Never use the term “mentally ill.”
covered, coverage may be inadequate.

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“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” Bill Clinton.

QUESTION 2
a) i. Define defilement? 5%
Defilement is having sexual intercourse with a person (this includes both boys and girls) under
the age of 18 years. It doesn’t matter whether the person has given consent or not. The major
determinant in defilement is age.
ii. Outline 5 (five) Factors that could contribute to defilement cases in the
community. 20%
1. Indecent dressing and inappropriate behaviour. E.g. small girls patronizing clubs and
taverns and drinking alcohol while implicitly dressed could be the main reasons why you
find even big men are being tempted to have carnal knowledge with small girls.
2. Sex boosters or Libido enhancers: Traditional medicines and concoctions sold by
traditional healers to men, especially to have their private parts enlarged and libido
enhancers.
3. Sexual perversity. This is a situation where those that are involved have no control over
their sexual desires and therefore, take advantage of young children left in their care.
4. Lack of adequate institutional day care centres for children and the prohibitive fees tend to
create a situation where children, especially those with working mothers are left in the care
of relatives or others who tend to abuse them.
5. Psychiatric disorders: Some perpetrators are known to be “paedophiles” which is sexual
perversion in which children are the preferred sexual objects for reasons they may not even
comprehend.
6. Beliefs that having sex with a minor can cure HIV/AIDS. Witchdoctors were wrongfully
advising HIV and AIDS patients to sleep with minors in order to be cured, the prevalence of
HIV and AIDS, there are superstitions and beliefs that sex with a child cures HIV and AIDS,
boosts business potential, increases chances of promotions at places of work, or enhances
other powers such as witchcraft. This is usually done on advice of witchdoctors and
traditional healers.
7. Lack of parental care. It is argued that the inability of most parents to provide adequately
for their children due to poverty forces girls into sexual relations with taxi-drivers, bus
drivers and others so that they raise some money to afford them to eat something or go to
school. Parental support is thus, lacking in many households today where it is found that
parents spend less time with their families. Some parents leave home early, leaving their
children asleep and come back very late when the children have already gone to bed. It is
true that lack of parental care and poverty can actually motivate some children to engage

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 into child prostitution in order to make ends meet and thereby escalate incidences of child
defilement.
8. Inadequacy in housing could also cause a volatile situation that is likely to promote strange
behavioral patterns among members of a particular household. (Those mainly of extended
family setups) to live together in a house which does not have enough or adequate space.
For example, a family of eight or so members could be housed in a one bed roomed house.
The husband and wife who are the owners of the house could occupy the one bedroom, the
rest of the family share different corners, and may be the boys in one corner and the girls in
the other. This creates a vulnerable state. Sometimes, it has been taken for granted that a
youngster of 3 years or so can sleep with the elderly believing that nothing would happen to
the child since s/he is in the care of the elderly person.
9. Watching pornographic videos: Child defilement cases could also be escalated if watching
of pornographic videos in the home is allowed. With the coming of the internet,
pornography is more common than it used to be. These depict scenes of heterosexual, rape,
oral, anal and group sex, incest, bestiality and other loathsome out pouring of perversions.
Repeated use of pornography can interfere with the ability to enjoy and participate in
normal marital intimacy, a specialist in treating sex addiction, states that what starts as
casual viewing of pornography can eventually lead to deviant sexual acts.
10. Traditional and customary practices like initiation ceremonies and early marriages
perpetuate defilement of the girl-child. The lessons given during initiation ceremonies
include seductive scenes which the girl has to imitate and she can later put these lessons
into practice by engaging in sexual relationships.
11. Variation of culture to culture. In Zambia because of the popular belief that children are
‘safe’ HIV-free partners. Child sexual cleansing in a case where a widow or widower has sex
with a child to obtain cleansing and wade off the ghost of the deceased spouse from causing
trouble.
12. Quest for wealth: there is this belief that sex with children can bring about success in
business,
13. Girls are defiled and sexually exploited just because they are girls-selling produce on the
streets, walking to school in rural areas and working as house servants.
14. Customary marriages were the girls are married off at a tender age due to poverty or
certain traditional belief or lack of education

b) EXPLAIN FIVE (5) SIGNS AND SYMPTOMS THAT YOU COULD OBSERVE IN A CHILD THAT
HAS BEEN DEFILED. (15%)

Though children may not speak about abuse, they may nevertheless communicate that
something significant and disturbing has happened to them in a non-verbal manner.

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 1. Significant or sudden changes in mood or behavior may indicate a problem. Changes in
mood may include signs of depression: sadness, tearfulness, lethargy, anger, or mood
swings.
2. Children may also begin isolating themselves, withdrawing from family or friends,
spending all of their time outside the home, experimenting with alcohol or drugs when
this was not the case in the past, or start acting out at home or at school. Conversely,
promiscuity or sexually suggestive behavior when this was not characteristic of the child
in the past.
3. Sometimes victims of sexual abuse or assault will change their appearance and try to
become less attractive: wearing baggy, unattractive clothing, avoiding cosmetics, or
failing to style their hair. Or, youth may adopt a more seductive and sexualized manner
of dress.
4. Other behavioral changes which may indicate abuse include: significant changes in
sleeping patterns and habits, significant or sudden changes in appetite and eating
patterns, or significant weight gain or loss. A heightened sense of vigilance, vulnerability
and fearfulness, possibly combined with a new sensitivity to startle, and a desire to
withdraw socially may indicate the presence of post-traumatic stress disorder (PTSD).
5. When children have been sexually assaulted (raped) they may show medical signs of
their attack including sexually transmitted infection, urinary tract infection and other
hard-to-explain injuries.
6. Some abused youth will act out their inner pain by self-harming; often by cutting
themselves with a blade in an effort to distract from emotional pain. Such intentional
CUTTING is easy to confuse with a suicide attempt though it is almost never that.

c) AS A COMMUNITY MENTAL HEALTH NURSES WHAT COULD YOUR ROLE IN ADDRESSING

THE SITUATION IN THE COMMUNITY. 30%
The following roles have been identified for nurses working in community health services:-
I. Consultative role – Giving advice to other professionals in the community about the type
and level of nursing care required for given client groups who has been defiled or children
who have suffered defilement.
II. Clinical role – Providing direct nursing care to the patients in the community through home
visits to the parents who have their child defiled.
III. Therapeutic role – Employing psychotherapeutic and behavioral methods for management
of defiled patients.
IV. Assessor / Researcher – The nurse may assess the care given to clients and may also assess
the outcome of ongoing care programs in prevention of defilement cases.

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 V. Educator – Creating awareness in the community about mental health and mental illness
with special focus on vulnerable groups and how to prevent the vice of defilement in the
community.
VI. Trainer / facilitator – Training of other professional community leaders, school teachers
and other care giving professionals in the community in various prevention programs and
awareness in the community and what to do in case of child defilement.
VII. Manager/Administration – Manager of the resources, planning and co-ordination of
programs to do with prevention of defilements in the communities
VIII. Advocacy – Nurses speak out for the rights and interests of clients in the community by
raising awareness of clients’ needs in places of employment, school and markets. This they
do by sensitizing the public, NGOs, policy makers and service providers on the plight of
clients who have suffered defilement.
IX. Preventive roles: the uses primary, secondary and tertiary levels in identifying and
prevention of defilement cases in the community.
X. Law Enforcer: A nurse may be the health-care professional who must document these
activities as they are related to her by the patient or take photographs of injuries. In rape
cases, the nurse may be a member of the Sexual Abuse Response Team, or SART, who is
charged with collecting and preserving evidence. In many countries, nurses are mandated
reporters for domestic violence, child abuse and elder abuse.
XI. Maintenance of Ethics: Victims of abuse have been violated in physical, sexual or emotional
ways; nurses are expected to deliver care no matter how difficult or ugly the situation may
be. Nurses have an ethical expectation to be advocates for their patients, which includes
acting to protect them or support them in situations of abuse.
XII. Physical Care: sexually Abuse victims often require physical nursing care. In the emergency
room, this may include cleaning wounds or applying a dressing. If injuries are severe, the
patient may need surgery and nursing care during the convalescent period. The nurse might
provide medications for pain or help the patient learn to walk with crutches. In addition,
victims of abuse may need education for self-management if they have injuries that will
take some time to heal, such as broken bones.
XIII. Emotional Support: The empathetic nurse can help provide emotional support by listening
and allowing patients to express whatever they feel. Nurses offer an opportunity to talk
about feelings and may also be able to suggest a referral to a counsellor who is experienced
in dealing with abuse victims. The nurse may also be the first person to recognize symptoms
of depression or suicidal intent in an abuse victim.

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EXPLAIN THE MEASURES THAT GOVERNMENT COULD PUT TO PREVENT CHILD DEFILEMENT
30%
1. Establishment of stiffer punishments for the perpetuators of child defilement.
Government will continue working to ensure that the message gets to all the people and
that the law will continue to take its course in many issues of defilement. There is need to
reinforce current legislative laws to curb such vices across the country by providing tougher
punishments on culprits which would send a strong signal to would-be offenders.
2. There is need to ensure that funding for sensitisation programmes in communities is
increased to intensify on the programmes to do with child defilement.
3. Call upon all institutions, households and individuals to uphold the highest standards of
behaviours towards children both in their private and professional lives.
4. The Department of Child Welfare and Protection must have adequate facilities to house and
protect victims of this heinous form of violence against children.
5. The police must investigate and act on all child sexual abuse with the urgency it deserves.
6. The judiciary must expedite all sexual gender based violence cases involving children.

7. If it’s to do with fast healing from certain diseases then there is need to sensitise traditional
healers to start advising their clients to do away with the vice of child defilement adding
that if it also has to do with release from prison, there is equally need for more
sensitisation. A lot of parties are involved in dealing with cases of child abuse, from medical
specialists to youth care workers and criminal justice authorities. The government wants
them to work together in response to cases of (suspected) child abuse. This is referred to as
a multidisciplinary approach.
8. Stopping child defilement and minimizing the harm to the child
When it comes to child defilement, the main objective is to stop it from happening in the
first place. When abuse does occur, it needs to be identified at an early stage, so that it can
be stopped and the harm to the child can be minimised.

9. The ‘Signs of Safety’ method

Professionals can use the Signs of Safety method for families in which child defilement
occurs. Together, the social worker and the family draw up a safety plan for the child. The
government is financing a research programme entitled Effective working methods in the
youth sector to find out if this method works.

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10. Child protection
If a child’s development is in jeopardy and the parent or parents are not open to assistance,
then child protection services may need to get involved. The court may impose child
protection measures in order to stop child defilement.

11. Child abuse is a criminal offence

The court may impose treatment on the offender in order to prevent repeat of child
defilement. Government agencies are working with the police, the Public Prosecution
Service and other parties to improve the investigation and prosecution of offenders.

12. Support for victims of child abuse

The Youth Care Office provides support to victims of child abuse and their parents at their
request. Different therapies and interventions are available.
13. Legal Frameworks that Protect Children under the Zambian Statutes In Zambia, laws
related to children are disseminated among different statutes.
14. Enforcing the children’s rights. Some children’s basic rights, like the right to citizenship, the
protection from exploitation, the right to life of an unborn child, the right to personal liberty
of a minor, the right of young person’s not to be exploited, etc. are entrenched in the
Constitution (UN Human Rights Committee, 2007).
15. In addition to constitutional and statutory legislation, customary law also exist to regulate
matters concerning children.
16. The Victim Support Unit, the Child Justice Forum, the National Youth Policy and the
National Child Policy, and ministries: mainly the Ministry of Gender and Child Development,
the Ministry of Community Development, Mother and Child Health, the Ministry of Labour
and Social Security and the Ministry of Education
17. “The State shall protect the child from all forms of maltreatment by parents or others
responsible for child care and establish appropriate social programs for the prevention of
child abuse and treatment of victims,
18. “The State shall protect children from sexual exploitation, prostitution and involvement in
pornography and in particular take all appropriate national, bilateral and multilateral
measures to prevent: a] The inducement or coercion of a child to engage in any unlawful
sexual activity; b] The exploitative use of children in prostitution or other unlawful sexual
practices; c] The exploitative use of children in pornographic performances and material.
From the foregoing, one would assume that the Republic of Zambia has enough and
adequate laws to protect its children.
19. Parents and Caregivers: Must ensure the environment in and around the home is safe for
their children.

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20. Children: Must be given the confidence to report any form of abuse they experience to
parents, caregivers, police, their teachers or even their neighbors. They must be able to
report in the knowledge that they will be treated with dignity, sensitivity and confidence in
all cases.
21. Community members and local leaders:

 Continue raising awareness at household and community level about the importance
of protecting children from sexual abuse. There is need to emphasize that No child
(below 18 years) can provide consent to sexual activities.
 Ensure that all child abuse cases are reported to appropriate authorities including
any incidents where videos, photos or audio recordings of children being abused.
 Community Child Welfare Committees must review their child safeguarding and
protection policies to ensure children are safe.

QUESTION 3
DEFINE A CRISIS. 5%
 A crisis is a critical event or point of decision which, if not handled in an appropriate and
timely manner (or if not handled at all), may turn into a disaster or catastrophe.
 A crisis is any event that is going (or is expected) to lead to an unstable and dangerous
situation affecting an individual.
 A crisis is a difficult or dangerous situation that needs serious attention.
 A crisis is an emotionally significant event or radical change of status in a person's life
DESCRIBE THE FOUR PHASES OF A CRISIS 40%
THE FOUR STAGES OF A CRISIS
STAGE ONE
1. In Stage One, the client focuses on the incident. This is the “breaking news” stage.
“What happened?” is the key question. And the news travels very fast in Stage
One to Stage Two – it doesn’t take long for the story to jump the “fire line.” The client
makes preparations. Maps and tests the message, he educates and informs people
around him especially those he has built credibility and trust.
STAGE TWO
2. Stage Two is characterized by the focus on the response. The light moves quickly from
the incident itself (although new facts will continue to emerge) to the “drama.” How
could this have happened?. The focus is on be first, be right, be credible. The client
acknowledges that the problem is real. Client Empathize, client Informs, client
Explains, and Commits. This stage is key. This is the make it or break it stage, the
reputation forming stage, the stage where the rallying on social media sites, both
negative and positive, becomes a focal point.

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 STAGE THREE
3. Stage Three is the one best avoided, although inevitably we all want to go there – yes,
the Blame, Finger Pointing Stage. In this Finger Pointing Stage, everyone has an opinion
about you, Stage Three is all about blame with the key question focused on “why.” Your
crisis is beamed everywhere. This is the stage of maintenance. Help understand the
client understand the risk. Find other options to the crisis. Find out about the
background of the problem, Gain support, Listen to others
STAGE FOUR
4. The light begins to dim in Stage Four which is the fallout/resolution stage. The spotlight
now dims, but can easily be turned to full glare again if you slip up, or you can’t take it
back. Typically, this stage marks the end of the crisis; there is some resolution. A stage
to recovery during this stage client express relief and thanks, Rebuilds trust, Listens to
the feedback and Admit the short comings

OUTLINE THREE (3) TYPES OF CRISIS (30%)

THE 3 TYPES OF CRISIS
Crises can be divided into three categories:
1. Creeping Crises– this is crisis which is shadowed by a series of events that decision makers
don’t view as part of a pattern. For example
 Lack of a rumor-control system, resulting in damaging rumors.
 Inadequate preparation for partial or complete interruption.
 Inadequate steps to protect life and property in the event of emergencies.
 Inadequate two-way communication with all audiences, internal and external.
2. Slow-Burn Crises – this is a type of crisis were there is advance warning, before the
situation can cause any actual damage. For example through:-
 Internet activism
 Most lawsuits.
 Most discrimination complaints.
 Company reputation
 Lack of regulatory compliance – safety, immigration, environment, hiring, permits, etc.
 Major operational decisions that may distress any important audience, internal or external.
 Local/state/national governmental actions that negatively impact operations.
 Official/governmental investigations involving your healthcare organization and/or any of its
employees.
 Labor unrest.
 Sudden management changes – voluntary or involuntary.
 Marketing misrepresentation.

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3. Sudden Crises– this is a type of crisis were damage has already occurred and will get worse
the longer it takes to respond
 Patient death – Your healthcare organization perceived to be liable in some way.
 Patient condition worsened – Your healthcare organization perceived to be liable in some
way.
 Serious on-site accident.
 Insane/dangerous behavior by anyone at a location controlled by your healthcare
organization.
 Criminal activity at a company site and/or committed by company employees.
 Lawsuits with no advance notice or clue whatsoever.
 Natural disasters.
 Loss of workplace/business interruption (for any reason).
 Fires.
 Perceptions of significant impropriety that damage reputation and/or result in legal liability.

DISCUSS THE IMMEDIATE INTERVENTION TO HELP RESOLVE THE CRISIS 25%

Crisis intervention is an immediate and short-term psychological care aimed at assisting
individuals in a crisis situation in order to restore equilibrium to their bio-psycho-social
functioning and to minimize the potential of long-term psychological trauma.
Crisis situations can be in the form of natural disasters, severe physical injury, sudden death of
a loved one, and specific emotional crises as a result of drastic transitions such as divorce,
children leaving home, and pregnancy, family and school violence or may be a sudden
unexpected medical results.
 The priority of crisis intervention is counselling to hasten the process of and achieve
stabilization. Crisis interventions must be applied at the spur of the moment and in a variety
of settings, as trauma can arise instantaneously.

 Prompt intervention – Since victims are initially at high risk for maladaptive coping or
immobilization. Providing intervention as quickly as possible is imperative.
 Stabilization - Resource mobilization should be immediately enacted in order to provide
victims with the tools they need to return to some sort of order and normalcy, in addition
to enable independent functioning.
 Facilitate comprehension – processing the situation or trauma is necessary in order for the
sufferer to understand what the traumatic event was all about. This is done in order to help
the victim gain a better understanding of what has occurred and allowing him or her to
express feelings about the experience.

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 Problem-solving – The counselor should assist the victim(s) in resolving the issue within the
context of their situation and feelings. This is necessary for developing self-efficacy and self-
reliance.
 Return to normalcy – counselor must help the victim get back to being able to function
independently by actively facilitating problem solving, assisting him/her in developing
appropriate strategies for addressing those concerns, and in helping putting those
strategies into action. This is done in hopes of enabling the victim to become self-reliant.
Ways to cope with crisis
 Relaxation Training
Relaxation training is a technique that helps with stress management. Relaxation training
decreases the amount of stress endured in a crisis. Types of Relaxation Training consist of
but are not limited to: Deep breathing, Meditation, Music and art therapy.
 Grounding Techniques.
Grounding is a practice that can help you deal with distressing feelings and refocus your on
what’s happening in the present moment. Grounding consists of both mental and physical
techniques to soothe stress. Before and after a grounding exercise, rate your distress as a
number between 1 and 10. Making note of how much stress decreased after a grounding
exercise can help you get a better idea of whether a particular technique works for you.
 Physical techniques: uses your five senses or tangible objects to help get through distress.
For Example, Take a short walk: focus on your steps, count them. Notice the rhythm of your
steps and how it feels to put your foot on the ground and lift it again.
 Mental techniques: uses mental distractions to redirect your thoughts away from
distressing feelings and back to reality For Example: Describe your favourite task. Think of
an activity you can do very well. Go through the process step-by-step, as if you’re giving
someone else instructions on how to do it.

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