MHPSS hand outs

Republic of the Philippines
Department of Health
CENTRAL VISAYAS CENTER for HEALTH DEVELOPMENT
BASIC FACILITATOR’S
TRAINING COURSE
ON MENTAL HEALTH &
PSYCHOSOCIAL SUPPORT
DURING CRISES,
EMERGENCIES &
DISASTERS
A Reference Manual/ Hand-outs
Copyright 2021
MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT
I. DISASTERS AND MHPSS
PHILIPPINE DISASTERS
- Philippines is located along typhoon belt
- Light structured houses in the provinces
- Average of 22 typhoons occur in a year(7)
- 352 volcanoes, 22 of which are active, 27 are potentially active
- Low lying areas; houses on river banks
- Denuded forest; illegal logging
- Poor waste management
- Philippines topped the list of countries with the most number of people killed by
natural disasters in 2012
- Philippines placed second in the world data in terms of the number of people affected
by natural disasters
- Worst sea accident: M/V Dona Paz (December 1987)
- Central Luzon Killer Quake, 7.7 magnitude (July 16, 1990)
- Worst flashflood: Ormoc City (November 5, 1991)
- Worst typhoon: Code Name Ike (September 1984)
- Century’s 2nd Largest Volcanic Eruption: Mt. Pinatubo Eruption (June 1991)
- Worst Festival Tragedy: Bocaue Pagoda Tragedy (July 2, 1993)
- Worst Terrorist Attack: Armed Conflict/ Ipil Massacre (April 1995)
- Ozone Disco Fire: March 18, 1996
- Worst Air Tragedy: Air Philippines Boeing 737-200 Flight 541 (April 19, 2000)
- Payatas Trashslide/Garvalanche (July 12, 2000)
- Terrorist attack: LRT Bombings – Rizal Day (2000)
- Bohol Mass Poisoning (2005)
- Worst Landslide: Guinsaogon Landslide (February 2006)
- Maguindanao Massacre (November 2009)
Disaster
- An emergency in which local administrative authorities CANNOT COPE with the
impact or the scale of the hazard, and therefore the event is managed from outside
the affected communities.
- An event, natural or man-made, sudden or progressive, which impacts with such
severity that the affected community has to respond by taking exceptional measure
Types of Disaster:
1. Natural Disaster
Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 1|P age
2. Human-induced Disaster
a. Technological
b. Complex Emergencies
Phases of Disaster:
1. Threat Phase
2. Impact Phase
3. Heroism Phase
4. Honeymoon Phase
5. Disillusionment Phase
6. Reorganization/ Recovery Phase
Usual Length of
Phases of D.R Actions Emotions
Time in that Phase
WARNING OR THREAT Days before actual If warning is If no warning, may

PHASE incident/ or no given, some feel vulnerable,
warning at all people will make unsafe & fearful of
preparations/ future unpredicted
some may ignore tragedies
IMPACT PHASE Day 1 – 3 days Getting over the The greater the
- start of disaster destruction and its scope, destruction &
- Immediately effects/ depends personal losses
characterized by great on the extent associated w/ the
dysfunction, intense disaster, the greater
overwhelming emotions the PSYCHOSOCIAL
or shock EFFECTS
HEROIC STAGE Prior to Impact up Struggle to Fear, anxiety,

(Rescue Stage) to 1 week prevent loss of stunned
- People working together afterwards lives &
to save each other/ Property damage;
properties-concern for survival; activity
survival level; actual
productivity
HONEY MOON STAGE 2 weeks – 2 months Relief efforts lift Euphoria at being
(Remedy Phase) spirits of alive; grateful; grief;
- Victims bouyed & survivors; hope of disbelief
supported by promises of Quick recovery
help from GO’s, NGO’s run high; optimism
often shortlived
DISILLUSIONMENT Several months to Realities of Frustration;
PHASE over a year bureaucratic depression, self-
- Unexpected delays & paper works; doubt; loss/grief;
failure – frustration– recovery delays; isolation
from bureaucratic outside help
confusion leaves;
- Rebuilding their own Survivors realize
lives they have lots to
- Solving own individual do by themselves
problems & their lives may
never be the
same again
RECONSTRUCTION Several years Normal Satisfied with

PHASE Functioning is progress, emotions
- Characterized by gradually re- appropriate to current
coordinated individual & established; events
community effort to emotional
rebuild & reestablish resources w/in the
normalcy family-exhausted
3 Types of Victims
1. Direct Victims – those who actually experienced the disaster: those who were hurt;
lost a family member/s; lost properties
2. Indirect Victims – those who have relatives who are direct victims and do not have
actual experience of the disaster
3. Hidden Victims – service providers/ humanitarian workers
Key Concepts of Disaster
1. Everyone who sees a disaster is affected by it.(anxiety provoking esp. people with
relatives/ loved ones who live in the area)
2. Target Population is primarily NORMAL (pertain to hysterical reactions; crying,
trembling etc.; considered normal under the circumstances)
3. How people have coped with CRISES in their past will be a GOOD INDICATOR
of how they will handle the disaster
4. People do not disintegrate in response to disaster. (help each other; bayanihan
system)
5. Disturbance is transitory. Splitting events can’t stop for a while and have recurrent
episodes. Emotional Reactions of survivors is brought about by disaster rather than
poor coping skills.
6. Disaster relief procedures have been called the “SECOND DISASTER”.
7. Disaster stress reactions may be immediate or delayed. (anxiety delay or immediately
response to stress or event
8. Be innovative in offering help. (regret disaster assistance, busy, pride,, feel control of
the event, named crazy)
9. Avoid mental health labels. (stigmatized and would create more trauma) (crisis
worker, councilor)
10. People respond to active interest and concern. (Defusing, ventilation of feelings,
lessening trauma, which has cathartic effect)
11. Informed early intervention can speed recovery and prevent serious or long
term problems (cisd- coordination and voluntary)
12. The FAMILY is the FIRST line for individuals. (Stay together in one place, main
support sys., locate missing members)
13. Support systems are crucial to recovery. (The more support the faster & better the
recovery is)
14. Fit the program into the community in order to have it accepted
15. A disaster CAN BRING OUT THE BEST & THE WORST IN MAN.
MHPSS as a Program in the Over-All Disaster Response
1. Mitigation Phase
- MH Risk Assessment and Management
2. Preparedness Phase
- Policy development
- Plan development
- Program development
- Capability Building
- Technical Assistance
- Partnership building
- Promotion and Advocacy
- Logistics
3. Response Phase
- Health assessments
- Health services
- Nutrition
- Environmental health
- Mental health
- Public Health Services
- Hospital Services
- Hospital Networking
- Resource mobilization
4. Recovery Phase
- Financial/Logistical Support
- Mental health and psychosocial support
- Research
- Documentation of practices
MHPSS TWG in the Philippines (Members)
1. National Disaster Coordinating Council – Office of Civil Defense (NDCC-OCD)

2. Department of Health (DOH)
3. Department of Social Welfare and Development (DSWD)
4. Department of Education (DepEd)
5. Philippine Red Cross (PRC)
Amended Cluster Approach in the Philippines

- National Disaster Coordinating Council Memorandum 12 Series of 2008
CLUSTER GOVERNMENT LEAD

Department of Social Welfare and
Food and NFIs
Development (DSWD)
Camp/ IDP Management, Emergency Department of Social Welfare and
Shelter and Protection Development (DSWD)
Department of Social Welfare and
Permanent Shelter and Livelihood
Development (DSWD)
WASH, Health, Nutrition, and
Department of Health (DOH)
Psychosocial Services
Logistics and Emergency Office of Civil Defense/ NDCC Operations
Telecommunications Center
Education Department of Education
Agriculture Department of Agriculture
Early Recovery Office of Civil Defense
MHPSS Domains vs. Responsible Lead Agency
DOMAINS (IASC Guidelines on MHPSS) AGENCY

1. Coordination OCD
2. Assessment, Monitoring, Evaluation OCD
3. Protection and Human Rights Standards DSWD
4. Human Resources DOH
5. Community Mobilization and Support PNRC
6. Health Services DOH
7. Education Dep Ed
8. Dissemination of Information DSWD
9. Food Security and Nutrition DSWD/DOH
10. Shelter and Site Planning DSWD
11. Water and Sanitation DOH
AREAS FOR COORDINATION (given the situation when all these agencies have their
own Psychosocial/ MHPSS teams are present on the site
1. Provision of basic psychosocial services

- DSWD - food, clothing, shelter, camp management
- PRC - family tracing, community
- Dep Ed - school
- DOH – military, service providers, media
- OCD and other Agencies - search and rescue, management of the dead, financial
aid, etc.
2. Provision of Community and Family Support
- LGUs, NGOs, Academe, Religious Organizations
3. Provision of Focused, non-specialized services
- Mental health workers (social workers, psychologists, etc), NGOs
4. Provision of Specialized services
- Psychiatrists, Psychologists, other Mental health Professionals
- Mental health facilities
MHPSS - This composite term is used to describe any type of local or outside support that
aims to promote or protect psychosocial well-being and or prevent/ or treat mental disorder.
Mental Health - A state of well-being in which the individual realizes his or her own abilities,
can cope with the normal stresses of life, can work productively, and is able to make a
contribution to his or her community.
Psychological – relating to or Influencing the mind or emotions
Social - relating to, or occupied with matters affecting human welfare/ relationship
Psychosocial Issues
• Survival
• Loss
• Uncertainty
• Evacuation
• Services provided
• Displacement
• Resettlement
• Cultural differences
• Religious differences
• Social Factors
The GOAL in Disaster Management (Health Sector)

✓ To minimize the deteriorating effects of the disaster on the life and health of the
victims.
MHPSS Core Strategies

1. Program Development
2. Advocacy
3. Capacity Building
4. Response
5. Networking
Scope of Public Health vs. Public Mental Health
II. WELL-BEING, RESILIENCE AND COPING
The 7 Aspects of Well-Being
Resilience
- is the property of a material to absorb energy when it is deformed elastically and
then, upon unloading to have this energy recovered. In other words, it is the
maximum energy per unit volume that can be elastically stored. It is represented by
the area under the curve in the elastic region in the Stress-Strain diagram.
- Modulus of Resilience, Ur, can be calculated using the following formula:
where σ is yield stress, E is Young's modulus, and ε is strain.

- Ability to recover or regain readily our normal level of functioning or particular state.
Factors promoting resilience

✓ Belonging to a caring family
✓ Maintaining traditions and cultures
✓ Having a strong religious belief or political ideology
4 “I” of Resilience
✓ I HAVE
✓ I CAN
✓ I AM
✓ I WILL
Coping - is a way to protect, delay, avoid or manage stress.
How do people usually cope with stress?

1. Avoidance
2. Approach
3. Positive Coping
4. Negative Coping
✓ LOOB (inner reality) – consists of positive and negative changes in thoughts and
feelings which result from the adverse or extreme life events.
✓ KAPWA (external reality) – consists of adaptive or maladaptive changes in our

relationships with the family, at work and with the environment.
✓ KAGINHAWAAN (peace of mind) – refers to our state of inner peace which may be
sustained by faith in a “Higher Power” or ability to give positive meaning to the
adverse event.
✓ KAKAYAHAN (empowerment) – comes from our ability to recognize and use our
own resources as well as the availability of external support.
Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 10 | P a g e

III. TRAUMA AND RECOVERY
“The disaster experience shatters our assumption that our world is safe, thus, making us feel
that we have lost control over our life and destiny.”
Identifying Individuals who are High Risk or Likely to Develop Severe Psychological
Reactions after a Disaster
1. Those who were trapped inside fallen buildings, entombed for hours or caught in a
near-death situation during the disaster
2. Those that lost a limb or suffered any serious physical injury as a result of the disaster
3. Those who lost one or more members of the family because of the disaster
4. Those who watched a friend; a relative or a person die as a result of the disaster
5. Those who lost their homes; their properties or livelihood because of the disaster
6. Those who do not show the usual reactions to disaster
7. Those whose reactions are exaggerated or distorted (ex. Excessive fear of rain)
8. Those who were forced to flee, leave their homes or transfer to another place as
result of the disaster
9. Those whose reactions last for more than 4-6 weeks
10. Those that had previous psychiatric problems/crisis before the disaster
STRESS & TRAUMA
Traumatic Stress Reactions
✓ Shock ✓ Irritability
✓ Appetite loss ✓ Survivor’s guilt
✓ Fatigue ✓ Fear of going crazy
✓ Nausea ✓ Feeling lost
✓ Sleep disturbance ✓ Impaired judgment
✓ Headaches ✓ Flashbacks
✓ Breathing problems ✓ Homicidal and/or suicidal
✓ Anxiety thoughts
Some Symptoms that may lead to PTSD
✓ Nightmares ✓ Sadness
✓ Sleep disturbance ✓ Depression
✓ Nervousness ✓ Anger
✓ Confusion ✓ Physical symptoms may include
✓ Anxiety rapid heartbeat, night sweats,
✓ Irritability headaches, and dizziness.
✓ Inability to concentrate

✓ Job performance may also suffer ✓ Sexual function may be affected
as well as other aspects of the as well as one's ability to interact
individual's life. with family and friends
- Most REACTIONS last only a few days but they can also last for weeks or even months
and years.
- In some people symptoms appear immediately.
- In others, symptoms may be delayed or they may not react at all.
Trauma recovery restructuring is directed towards letting the survivors know & feel:
1. They are NOT ALONE

2. It is NOT THEIR FAULT
3. That their symptoms are part of a NATURAL REACTION to an ABNORMAL SITUATION
Stages of Trauma Recovery
1. REESTABLISHMENT OF SAFETY
- attention to physical safety & health needs
- development of plan for future protection
- enhancement of sense of competence & self-esteem
2. TELLING & RETELLING
3. FINDING COMMONALITY & RECONNECTION

- (past to future)
4. ORGANIZING FOR COMMUNITY ACTION

IV. GRIEF AND GRIEF PROCESSING
Grief - subjective feelings, precipitated by the deaths/loss of loved one
Mourning
- refers to the process by which grief is resolved
- may refer to societal expression of post bereavement behavior and practices
Bereavement
- Literally- to be deprived of someone by death
- refers to a state of mourning
Determinants of Grief
1. WHO THE PERSON WAS?

2. The Nature of the Attachment
✓ Strength of attachment
✓ Security of the attachment
✓ Ambivalence in the relationship
3. Mode of Death – N.A.S.H.
4. Historical antecedents
5. Personal Variables
6. Social Variables
The Four Tasks of Mourning
1. To experience the pain of grief

2. To accept the reality of the loss.
3. To adjust in an environment in which the deceased is missing
4. To withdraw emotional energy and reinvest it in another relationship
Normal Grief Responses

- Because grief can be so painful and seem overwhelming, it frightens us. Many people worry
if they are grieving in the “right” way, and wonder if the feelings they have are normal
Most people who suffer a loss, experience one or more of the following:
1. Tightness in the throat or heaviness in the chest.

2. Empty feeling in their stomach / lose their appetite.
3. Feel guilty at times, and angry at others.
4. Restless /difficult to concentrate.
5. Feel as though the loss isn’t real, that it didn’t actually happen.

6. Sense the loved one’s presence,
7. Wander aimlessly and forget, and don’t finish things they started
8. Have difficulty sleeping, and dream of their loved one frequently.
9. Experience an intense preoccupation with the life of the deceased.
10. Assume mannerism or traits of their loved one.
11. Feel guilty or angry over things that happened or didn’t happen in the relationship with
the deceased.
12. Feel intensely angry at the loved one for leaving them.
13. Feel as though they need to take care of other people
14. Need to tell and retell, and remembers things about the loved one and the experience of
their death.
15. Feel their mood changes over the slightest things.
16. Cry at unexpected times.
Manifestations of Grief
1. Affect or Feelings
- Sadness - Relief
- Anger - Emancipation
- Anxiety - Numbness
- Loneliness - Guilt and Self-Reproach
- Helplessness - Yearning/pinning (pangs of grief
- Shock
2. Cognition or Thoughts
- Disbelief - Dry mouth

- Confusion - Tightness in the throat
- Preoccupation - Lack of energy
- Hallucinations - Oversensitivity to noise
- Indecisiveness - Breathlessness
- Sense of Presence - Tightness in the chest
- Physical Sensation: - Weakness in the muscle
- Depersonalization
3. Behavior
- Sleep / Appetite Disturbance - Restless/agitation

- Absent minded behavior - Avoiding reminders of the
- Social withdrawal deceased
- Sighing / Crying - Treasuring objects that belong to
- Searching and calling out the deceased
- Taking on mannerism (Attitude) - Visiting places or carrying
of the deceased objects that remind the survivor
of the deceased
5 STAGES OF 5 STAGES OF 4 PHASES OF

GRIEVING (DABDA) BEREAVEMENT BEREAVEMENT
(Elizabeth Kubler-Ross) (C.M. Parker) (John Bowlby)
1. Shock & Denial 1. Alarm 1. Numbness of Protest

2. Anger 2. Numbness 2. Yearning and Searching
3. Bargaining 3. Pinning or Searching 3. Disorganization & Despair
4. Depression 4. Depression 4. Reorganization
5. Acceptance 5. Recovery & Reorganization
Two General Forms of “Abnormal” Grief
1. Variants of the critical grief process – (When it is pathological/complicated)

- Timing - delayed or prolonged
- Intensity - increased or diminished
- Symptoms - diminished or prolonged
2. Grief reactions w/ disorders which replace the grief reaction:

- Affective disorder: depression or mania
- Psychosis
- Alcoholism/substance
- Other problems/disorders: hypochondriac, neurotic disorder, etc.
Goals of Grief Counseling

- the overall goal is to help the survivor complete any unfinished business with the
deceased and to be able to say final goodbye.
More Specific Goals that Correspond to the 4 Tasks of Mourning:
1. To increase the reality of the loss.

2. To help the counselee deal with both expressed and latent effect.
3. To help the counselee overcome various impediments to read adjustments after the loss.
4. To encourage the counselee to make healthy emotional withdrawal from the deceased
and to feel comfortable reinvesting the emotion in another relation

Counseling Principles:
1. Help the survivor actualize the loss.

2. Help the survivor identify and express feelings.
3. Assist living without the deceased.
4. Facilitate emotional withdrawal from the deceased.
5. Provide time to grieve
6. Interpret “normal” behavior.
7. Allow individual differences.
8. Provide continuing support.
9. Examine defenses and coping style.
10. Identify pathology and refer.
Goals of Grief Therapy

- To identify and resolve the conflicts of separation which preclude the completion of the
task of mourning in persons whose grief is “abnormal”
Procedures for Grief Therapy
✓ Rule out physical disease

✓ Set up the contract and establish an alliance
✓ Revive memories of the deceased
✓ Assess which 4 grief tasks are not completed
✓ Deal with affect or lack of affect stimulate by memories
✓ Explore and defuse linking objects
✓ Acknowledge the finality of the loss
✓ Deal with the fantasy of ending grieving
✓ Help the patient say a final goodbye
Hindrance to Adequate Grieving
1. Relational Factors
- Ambivalent (most common)
- Narcissistic (deceased represents extension of the survivor)
- Dependent (loss results in an overwhelming (desperate) helplessness which
precludes a balanced self-image)
2. Circumstances Surrounding the Loss

- Uncertainty of loss, multiple losses, NASH, legal issues, etc.
3. Historical Factors
- Complicate grief in the past, early parental loss, depressive illness

4. Personal Factors
- People who are unable to tolerate extremes of emotional distress and withdraw
against such strong feelings.
5. Social Factors
- Socially unspeakable loss – suicide
- Loss is socially negated – abortion
- Absence of social supports network, social isolation, etc.
Clues to Unresolved/ Complicated Grief Reaction
1. Inability to speak of the deceased without experiencing intense and press grief.
2. Minor event trigger off an intense grief reaction.
3. Themes of loss come up in a clinical interview.
4. Unwillingness to move material possessions of the deceased.
5. Development of physical symptoms like those the deceased experienced before death/
a compulsion to imitate the dead person.
6. Radical change in lifestyle following a death.
7. Long history of sub clinical depression.
8. Self-destructive impulses.
9. A phobia about illness or about death.
10. Unaccountable sadness.
When is Mourning Finished?
✓ When the TASKs OF MOURNING are accomplished

✓ When the person is able to think of the deceased without pain
✓ When one is able to think of the deceased without physical manifestation
✓ When a person can reinvest his or her emotions back into life and into the living
CHILDREN AND GRIEF
“We routinely shelter children from death and dying. Thinking we are protecting them from
harm, but it is clear that we do them disservice by depriving them of the experience…”
- Elizabeth Kubler- Ross
Effects when grief is not worked through
1. Long term despair / depression /melancholia

2. Impairment of the capacity to love again
3. Various irrational attitude towards death and destruction
4. Senseless violence and vandalism

Children’s Reaction to Death
1. Children usually take longer than adults in going through the phases of grief. (Adult – 1
year/ child – many years)
2. A child over six years of age is deeply affected by the death of anyone close to him
3. Children under six years cannot accept the finality of death. They expect the loved one to
return.
4. Children often express their feelings about death in indirect, delayed and disguised ways.
5. Between 6-9 y.o. - permanency of death is generally accepted, but the inevitability of
death for the child and his/her loved ones is likely to be too difficult for him to face.
6. Children may not move out of the first phase of reaction to death. They continue to protest
the anger & separation and refuse to face the finality of the loss.
Advise to Caregivers/Parents
1. Avoid telling fairy tales and half truth

2. Allow children to vent his emotions
3. Suffering and death should not be linked with sin and punishments
4. Do not close the door to doubts , questioning and difference of opinions
5. Do not teach the child as if you have the final answer that he must accept
6. From age seven funerals may be attended by a child if he/she chooses
7. Help the child to unburden his/her feelings through remembrance and release
8. Avoid focusing on morbid details
9. Help the child not only by the tone of your voice but by the non verbal response & the
warmth of your body

V. FACILITATION AND COMMUNICATION SKILLS
Facilitation - The process of assisting (never forcing) the person in their capability to learn,
express & sustain the eagerness to do so
Communication
- The transfer of information from one person to another.
- It is a way of reaching others by transmitting ideas, facts, thoughts, feelings, and
values.
Communication Values
✓ Cultural regard
✓ Empathy
✓ Respect
✓ Genuineness
✓ Positive regard
✓ Non-judgmental
✓ Empowering
✓ Practical
✓ Confidentiality
✓ Ethical conduct
Types of Facilitating Skills
✓ Listening
✓ Sensitivity
✓ Trust
✓ Attending
✓ Observing
✓ Questioning
Attending
- Presenting yourself physically in a manner that shows you are paying attention to the
group
- Purposes:
✓ Increasing trust and Confidence
✓ Build rapport
✓ Connect with learners
✓ Encourage involvement
✓ Communicate that you value them as individuals and are interested in their
learning

5 Elements of Physical Attending
✓ S – sit squarely
✓ O – Open posture
✓ L – Lean forward
✓ E – eye contact
✓ R - relax
Observing
- Watching for cues to gain feedback on how intervention is being received by learners
- Purposes:
✓ Respond to learners’ needs
✓ Provide accurate and timely feedback
Guidelines in Observing
1. Note learner’s facial expressions, body position and movements

2. Observe interaction patterns
3. Formulate inference on person’s feelings/ reactions
4. Take appropriate action based on inference
Listening
- Obtaining verbal information and verifying that you understand the information
- Purposes:
✓ Understand learners’ perspective
✓ Demonstrate that you understand “where participant is coming from”
✓ Gain feedback (whether what you heard was accurate)
Some Listening Guidelines
1. Stop talking
2. Focus on the person
3. Suspend judgment initially
4. Ask questions to clear up confusion
5. Paraphrase (repeat in your own words) what you heard
6. Listen to what is not said
7. Hold your tempers
✓ Sometimes, despite our best attempts at Active listening, people become agitated.
This is their REACTION TO AN EXTREMELY ABNORMAL SITUATION, and has nothing
to do with you
✓ The most important thing to remember when working with someone who is agitated is that
YOU MUST LOOK & ACT CALM even if you are not.

Asking Questions
1. Clear and concise

2. Cover single issue
3. Reasonable
4. Challenging
5. Relevant
6. Non-threatening
Guidelines in Improving Facilitation Skills
1. Face the learners

2. Maintain appropriate eye contact
3. Move towards the learners
4. Avoid distracting behaviors
5. Nod affirmatively.
6. Be aware of internal & external distractions
7. Practice paraphrasing (to help clarify or ensure you hear what the learner is trying to say)
8. Practice restating.
9. Use open-ended questions
10. Ask clear concise questions covering single issue.
11. Ask challenging questions which provoke thoughts
12. Use positive reinforcement for correct answers.
13. Acknowledge effort of the respondent in answering questions.
14. Start questions with ”Ano” or “Paano”
15. Use encouraging hand gestures.
16. Lean forward when you listen or speak.
17. Use natural facial expressions (interested)
18. Be honest and sincere.

VI. THE INTER-AGENCY STANDING COMMITTEE (IASC) GUIDELINES ON
MENTAL HEALTH & PSYCHOSOCIAL SUPPORT IN EMERGENCY SETTINGS
The Inter-Agency Standing Committee (IASC)

- a unique inter-agency forum for coordination, policy development and decision-making
involving the key UN and non-UN humanitarian partners.
- was established in June 1992 in response to United Nations General Assembly
Resolution 46/182 on the strengthening of humanitarian assistance.
- General Assembly Resolution 48/57 affirmed its role as the primary mechanism for
inter-agency coordination of humanitarian assistance.
Agencies involved in the Task Force
✓ American Red Cross

✓ Christian Children’s Fund (CCF)
✓ Int’l Catholic Migration Committee (ICMC)
✓ Intl Medical Corps (IMC)
✓ Intl Rescue Committee (IRC)
✓ Mercy Corps
✓ Save the Children (USA/UK)
✓ Intl Network for Education in Emergencies
✓ Intl Council of Voluntary Agencies
✓ Action Aid Intl
✓ CARE Austria
✓ HealthNet
✓ Medicos del mundo
✓ Medicins Sans Frontieres Holland
✓ OxFam
✓ Refugees Education Trust
✓ Intl Federation of Red Cross & red Crescent Societies (IFRC)
✓ Intl Organization of Migration
✓ Office for the Coordination of Humanitarian Affairs (OCHA)
✓ UNICEF
✓ United Nations High Commissioner for Refugees (UNCHR)
✓ United Nations Population Fund
✓ World Food Programme
✓ World Health Organization
✓ Others: NGO’s Academe, Interest groups
The IASC issues these guidelines to:

Enable humanitarian actors to plan, establish and coordinate a set of minimum
multi-sectoral responses to protect & improve people’s mental health and
psychosocial well-being in the midst of an emergency

Mental Health & Psychosocial Support
- This composite term is used to describe any type of local or outside support that aims
to promote or protect psychosocial well-being and or prevent/ or treat mental disorder
- The focus of the guidelines is on implementing minimum responses which are
essential, high priority responses that should be implemented ASAP in an emergency
Problems
Nature of Problems - predominantly
1. Social
• Pre-existing (pre-emergency) social problems
- E.g. extreme poverty;
- domestic violence,
- criminality,
- belonging to a group that is discriminated against or marginalised;
- political oppression
• Emergency-induced social problems
- E.g. family separation;
- Unemployment,
- disruption of social networks;
- destruction of community structures, trust and resources;
- increased substance abuse, gambling, gender-based violence;
• Humanitarian aid-induced social problems

- E.g. Undermining of community structures or traditional support mechanisms.
2. Psychological
• Pre-existing (pre-emergency) problems
- E.g. mental disorder;
- alcohol/drug abuse,
- gender-based violence,
- child abuse,
- Criminal violence,
- Social/ cultural deprivation or isolation
• Emergency-induced problems
- E.g. grief,
- trauma related distress;
- depression and anxiety disorders,
- post-traumatic stress disorder (PTSD);
• Humanitarian aid-related problems
- E.g. anxiety due to a lack of information and coordination,
- insufficiency of relief provisions,
- poor survivor-caregiver dynamics due to caregiver burn-out, or compassion fatigue,
etc.
✓ Inter-relationships between social, mental and physical aspects of health are commonly
ignored in the rush to organize and provide health care.
✓ Community settings offer the first point of contact for helping people with mental health
and psychosocial problems.
✓ General health care providers frequently encounter survivors’ emotional issues in treating
diseases and injuries.
Size of the problem: Summary Table of Generic WHO (2009) Projections
BEFORE DISASTER: AFTER DISASTER:

12-month prevalence b 12-month prevalence
(median across (median across
countries) countries)
c
Severe disorder 2-3% 3-4%
(e.g., psychosis, severe
depression, severely disabling
form of anxiety disorder)
Mild or moderate mental disorder 10% 15-20% d
(e.g., mild and moderate forms of
depression and anxiety disorders,
including mild and moderate PTSD)

“normal” distress / other No estimate Large percentage
psychological reactions (no
disorder)
✓ In most situations natural recovery over time will occur for many – but not all – *survivors
may develop mild and moderate disorders.
✓ Some forms of psychosocial support (i.e. psychological first aid / PFA) for people in acute
psychological distress do not require advanced knowledge and can easily be taught to
workers who have no previous training in mental health.
✓ Intervention must focus on protection and the re-establishment of basic pre-existing care.
✓ Basic care and dignity includes appropriate clothing, feeding, shelter, sanitation, physical
care and basic treatment (including medication and psychosocial support).
✓ In many emergencies, hunger and food insecurity cause severe stress and damage the
psychosocial well-being of the affected population.
✓ In emergencies, access to clean water for feeding infants, drinking, cooking, personal
hygiene, sanitation is often disrupted thus is a major concern of victims for survival and
therefore a source of significant distress
✓ The organization of sites and shelters can have a significant impact on wellbeing--
overcrowding and the lack of privacy.
✓ Conflicts among displaced people or between displaced people and host communities
over scarce resources.
✓ Populations affected by emergencies frequently experience enormous suffering.
✓ Humanitarian actors are increasingly active to protect and improve people’s mental
health and psychosocial well-being during and after emergencies.

MATRIX OF INTERVENTIONS
1. Emergency Preparedness –
2. Minimum Response - to be conducted even in the midst of an emergency, but also as a
part of a comprehensive response
3. Comprehensive Response – potential additional response for stabilized phase and early
reconstruction.
The Guidelines: Purpose

Minimum response is only the starting point for more comprehensive supports
Guidelines have been written for low- and middle-income countries
Common Functions across Domains
1. Coordination
2. Assessment , Monitoring & Evaluation
3. Protection & Human rights Standards
4. Human Resources
5. Community Mobilization & support
6. Health Services
7. Education
8. Dissemination of Information
9. Food Security & Nutrition
10. Shelter & site planning
11. Water & Sanitation
The Guidelines consist of very detailed and specific, well-explained ACTION SHEETS &
KEY ACTIONS
IASC Core Principles:
HUMAN RIGHTS & EQUITY – humanitarian actors should promote the human rights of all
affected persons & protect individuals & groups. / promote EQUITY & NON- DISCRIMINATION/
Maximize fairness in the availability & accessibility of MHPSS supports
PARTICIPATION – Maximize participation of local affected populations in the humanitarian

response, for them to retain or resume control over decisions affecting their lives, & build local
ownership to achieve programme quality, equity & sustainability.
DO NO HARM – MHPSS has the potential to cause harm as it deals w/ sensitive issues. Reduce
risks:

✓ Participate in coordination groups to learn from others & minimize duplication &
gaps in response
✓ Design interventions on basis of sufficient information
✓ Commit to evaluation, openness to scrutiny & external review
✓ Develop culture sensitivity & competence in the area which they intervene/work
✓ Stay updated on the evidence-base re: effective practices
✓ Develop an understanding of universal human rights, power relations between
outsiders & emergency-affected people & the value of participatory approaches
BUILDING ON AVAILABLE RESOURCES & CAPACITIES – All affected groups have assets/
resources that support MHPS well-being. (building local, government & civil society, capacities
– key principle) At each level of the pyramid, key tasks are to identify, mobilize & strengthen the
skills & capacities of individuals, families, communities & societies.
INTEGRATED SUPPORT SYSTEMS – activities & programming should be integrated/ tend to

reach more people, more sustainable.
MULTI-LAYERED SUPPORTS – meet the needs of different groups. All layers are important &
should ideally be implemented concurrently.

Level 1: Social and Psychological Considerations in Basic Services and Security
✓ Document impact of lack of services and security on MHPS wellbeing and use this for
advocacy
✓ Advocate for the protection of children from violence, abuse and exploitation, the
promotion of family unity, re-establishing safe and supportive education
✓ Advocate for delivery of humanitarian assistance in a manner that promotes well-being
✓ Work to promote ways of delivering aid that promote self-reliance and dignity
✓ Facilitate community involvement in decision-making and assistance
✓ Disseminate essential information to affected populations on situation and emergency
response
Level 2: Community and Family Supports
✓ Support play, art, recreational and sporting activities

✓ Provide structured groups activities for expression and the development of life skills
and coping mechanisms
✓ Support children and youth friendly spaces/environments
✓ Promote meaningful opportunities to participate in rebuilding society
✓ Provide information on positive coping mechanisms
✓ Activities that facilitate the inclusion of isolated individuals (orphans, widows, widowers,
elderly people, people with severe mental disorders or disabilities or those without their
families) into social networks;

Strengthening the family:
– Provide culturally appropriate guidance on how parents and family members
can help children
– Support parents and families to cope with their own difficulties
– Support and facilitate the establishment of parent groups/committees
– Early childhood stimulation (with nutrition)
– Informal family visits for caregivers in need of extra support
– Support family access to basic services
Strengthening community supports:

– Helping caregivers and educators to better cope and to support children
– Strengthen community based supports for adult caregivers
– Strengthen child-to-child or youth support
– Resumption of cultural and spiritual activities, including appropriate grieving
rituals
– Strengthening social networks
– Teacher training on psychosocial care and support
– Group discussions on how the community may help at-risk groups identified in
the assessment as needing protection and support
Level 3: Focused Supports
✓ For people who are: (not for the general population)

– struggling to cope within their existing care network
– Not progressing in terms of their development
– Unable to function as well as their peers
– In need of activities that address their psychosocial needs more directly
✓ Focused psychosocial support activities require trained and experienced staff
✓ Activities may include:
– Case management
– Family visits
– Support groups
– Structured play activities
– Psychosocial hotlines
– Non-clinical family or individual counseling (e.g. school counseling)
Level 4: Specialized Services
✓ Traditional specialized healing (e.g. cleansing and purification rituals)

✓ Clinical social work or psychological treatment
✓ Psychotherapy
✓ Drug or alcohol treatment

✓ Specialized mental health care

VII. PSYCHOLOGICAL FIRST AID
Psychological First Aid: Guide for Field Workers
• WHO publication (http://www.who.int/mental_health/emergencies/en/)

• Collaborative effort:
– World Health Organization
– War Trauma Foundation
– World Vision International
• Endorsed by 24 UN/NGO international agencies
• Available in numerous languages
Crisis events you have encountered
• Large events affecting many people

– Natural disasters, plane crash, war/conflict
• Events affecting individuals
– Car accident, robbery, home fire
✓ What physical, social and psychological reactions did people have?
✓ What was done to help and support people?
Psychological First Aid

– is simply a “first-aid” response aimed to *stabilize, *reduce symptoms and
*return the survivor to functional capacity in the aftermath of a critical incident.
It refers to any effort that reduces the victims’ feeling of helplessness and
promotes their sense of control
– According to Sphere (2011) and IASC (2007), Psychological First Aid (PFA)
describes a humane, supportive response to a fellow human being who is
suffering and who may need support.
– Humane, supportive and practical assistance to fellow human beings who
recently suffered exposure to serious stressors.
▪ It involves:
✓ Non-intrusive, practical care and support
✓ Assessing needs and concerns
✓ Helping people to address basic needs (food, water)
✓ Listening, but not pressuring people to talk
✓ Comforting people and helping them to feel calm
✓ Helping people connect to information, services and social supports
✓ Protecting people from further harm

What PFA is NOT?
• It is NOT something only professionals can do.

• It is NOT professional counseling.
• It is NOT “psychological debriefing.”
– No detailed discussion of the distressing event
• It is NOT asking people to analyze what happened or put time and events in order.
• Although PFA involves being available to listen to people’s stories, it is NOT
pressuring people to tell you their feelings or reactions to an event.
Responses to Crisis Events
• People may have very different reactions to an event.

• What factors influence how someone responds?
What Survivors Have Gone Through?
• Injured because of disaster

• At risk of losing life during disaster
• Loved ones missing or dead
• Assisted with rescue

• Lost home/property
• Has physical disability/ illness
• Experienced violence
• Financial concerns
Why PFA?
• People do better over the long-term if they…

– Feel safe, connected to others, calm & hopeful
– Have access to social, physical & emotional support
– Regain a sense of control by being able to help themselves
PFA: Who?
• Very distressed people who were recently exposed to a serious stressful event
• Can be provided to adults and children
• Not everyone who experiences a crisis event will need or want PFA
– Don’t force help on those who don’t want it, but make yourself available and
easily accessible to those who may want support.
Who needs more advanced support than PFA alone?
• People with serious life-threatening injuries

• People so upset they cannot care for themselves or their children
• People who may hurt themselves
• People who may hurt or endanger the lives of others
PFA: When?
• Upon first contact with very distressed people, usually immediately following an event,
or sometimes a few days or weeks after
PFA: Where?
• Wherever it is safe enough for you to be there

• Ideally with some privacy (as appropriate) to protect confidentiality and dignity of the
affected person
Contact
• Introduce self & role

• Ask permission to ask questions so you can help them

“Ako po si . Volunteer po ako mula sa . Maaari ba
akong magtanong para kumuha ng impormayson at matulungan naming kayo? “ or “
Meron lang po akong mga ilang katanungan o ilang impormasyon na kailangan para
mas matulungan naming kayo”
Safety & Comfort
• Check if they have eaten or if there is something they urgently need
***“Nakakain na po ba kayo? Meron po ba kayong kailangan bago tayo

magkwentuhan/mag-usap?” (be sure you have food to be offered if this is asked)
Information Gathering
• Identify severity and nature of experiences. But if survivors would rather not - don’t force
them!
“ Kung inyo pong mamarapatin Maari po kayong magkwento/magbahagi/ mag-share sa

akin kung ano ang ipinagdaanan ninyo dito sa bagyo?“
Stabilize
• Check for signs they are overwhelmed or disoriented
“Kamusta ang pakiramdam ninyo ngayon?
• But affirm normal signs of trauma
“Hindi kakaiba na ito ang inyong nararamdam. *(Huwag kayong mag-alala), kahit sino
ang nakaranas ng ganitong sitwasyon ay ganoon din ang mararamdaman”
• Acknowledge how they are feeling and any losses or important event they tell you about,
(loss of their home or death of a loved one) IF THEY WANT TO TALK ABOUT IT! DO
NOT FORCE!
“I’m so sorry. I understand how you feel now”
COMMON REACTIONS TO TRAUMATIC STRESS

Adults Children
Physical • Elevated heart rate • Headaches
• Elevated blood pressure • Stomachaches
• Elevated blood sugar • Nausea
• Stomach upset, nausea • Eating problems

• Gastrointestinal problems • Other physical reactions
(diarrhea, cramps)
• Sleep difficulties
• With extended stress,
suppression of immune
system functioning
Emotional • Fear and anxiety • Anxiety, fear,
• Sadness and depression vulnerability
• Anger and irritability • Fear of reoccurrence
• Feeling numb, withdrawn, • Fear of being left alone
or disconnected – Especially if separated
• Feeling a lack of from family during
involvement or enjoyment event
in favorite activities – May seem like an
• Feeling a sense of exaggerated reaction
emptiness or to adults
hopelessness about the • Loss of “Sense of Safety”
future • Depression
• Anger
• Guilt
Cognitive • Difficulty • Confusion and
concentrating disorientation
• Difficulty with • Difficulty concentrating
memory
• Intrusive
memories
• Recurring
dreams or nightmares
• Flashbacks
• Difficulty
communicating
• Difficulty
following complicated
instructions
Behavioral • Family • Childish” or
challenges (physical, regressive behavior
emotional abuse) – May not be deliberate
• Substance acting out
abuse • Bedtime
• Being problems
overprotective of family – Sleep onset insomnia
• Keeping – Midnight awakening
excessively busy – Fear of dark
• Isolating self – Fear of event
from others reoccurrence during
• Being very night
alert at times, startling
easily
• Problems

getting to sleep or staying
asleep
• Avoiding
places, activities, or
people that bring back
memories
Faith and Spirituality • Reliance upon faith
• Questioning values and beliefs
• Loss of meaning
• Directing anger toward God
• Cynicism
Risk Signs
• Looking glassy-eyed and vacant

• Unresponsive to verbal questions
• Extreme disorientation
• Uncontrollable crying, hyperventilation, rocking, or regressive behavior
• Uncontrollable physical reactions (trembling, shaking)
• Frantic searching behavior
• Feeling incapacitated by worry
• Thinking of harming oneself
• Feeling numb/disconnected
• Agitation/violent behavior
• Extreme fear or anxiety
Coping
• Obtain information on coping

“Ano pa angginawa o ginagawa ninyo para matulungan ang inyong sarili?
• Affirm positive
“Mabuti naman na….”
• Provide information if necessary

“Maari ninyong subukan….. “
Common Coping Strategies
1. Accepting (pinapasa-DIyos)
2. Escape (laughing, entertainment)
3. Reframing
4. Praying
5. Taking Action to Rebuild
6. Seeking Social Support

7. Deep Breathing/ Relaxation/ Visualization
Some Tips for Survivors
✓ Follow a normal routine as much as possible.

✓ Be careful not to skip meals.
✓ Exercise and stay active.
✓ Help other people in your community as a volunteer. Stay busy.
✓ Accept help from family, friends, co-workers, or clergy. Talk about your feelings with
them.
✓ Don’t dwell on TV, radio, or newspaper reports on the tragedy.
How do we steer paradigms from victims to VICTORS/ SURVIVORS?
✓ DO highlight adaptive coping strategies.

“Nakakatuwa na kahit na may trahedya, kaya pa rin natin makipagtulungan at
makipagtawanan.”
✓ DO highlight strengths (positive traits).

“Nakikita ko sa’yo na ikaw ay isang taong mabilis bumangon o mataas ang
kakayahan na bumangon sa isang trahedya.”
✓ DO highlight resources.
“Napansin ko sa kwento mo na marami naman ang tumutulong sa’yo, pamilya mo,

mga kamag-anak, kapitbahay a kaibigan.”
Practical Assistance
• Identify needs
“Ano ang pinaka-kailangan ninyo sa ngayon?”
Linking with Services
• Thank them.
• Getting them the help they need – specific station
“Salamat po sa inyo….”
“Dadalhin ko na po kayo sa…. “

Reminder
• If you are going to do PFA, make sure you have a network or are working with other
organizations who can provide for other needs of individuals
• Otherwise, it will just frustrate people if you ask them what their needs are without
being able to help them find solutions
Frequent Needs of People after Crisis Event
• Basic needs: shelter, food, water, sanitation

• Health services for injuries or help with chronic medical conditions
• Understandable and correct information about event, loved ones and available
services
• Being able to contact loved ones
• Access to specific support related to one’s culture or religion
• Being consulted and involved in important decisions
Prepare
• Learn about the crisis event.
• Learn about available services and supports.
• Learn about safety and security concerns.
• Crisis situations can be chaotic.
• They often require urgent action.
Prepare Before you enter a crisis site, try to learn about…

The Crisis Event • What happened?
• Where?
• When?
• How many and who are affected?
Available • Who is providing for basic needs (emergency medical care, food,
Services shelter)?
• When and where can people access services?
• Who is helping, including community members?
Safety and • Is the crisis over or ongoing (aftershocks, fighting)?
Security • What dangers may be in the environment?
• Are there places to avoid due to insecurity or because it is not
permitted to be there?

Prepare • Learn about the crisis event.
• Learn about available services and supports.
• Learn about safety and security concerns.
Look • Observe for safety.
• Observe for people with obvious urgent basic needs.
• Observe for people with serious distress reactions.
• Safety • What dangers can you • If you’re not certain
observe? about safety…DO NOT
• Can you be there GO! Seek help from
without harm to others.
yourself or others? • Communicate from a
safe distance.
• People with • Is anyone critically • Know your role. Try to
obvious urgent injured obtain help for people
basic needs • Does anyone need who need special
rescue? assistance.
• Obvious needs (e.g., • Refer critically injured
torn clothing)? people for care.
• Who may need help to
access services or to
be protected?
• Who else is available to
help?
• People with • How many & where are • Consider who may
serious distress they? benefit from PFA and
• Is anyone extremely how best to help.
upset, immobile, not

responding to others or
in shock?
People who likely Need Special Attention (to be safe, to access services)
• Children and adolescents

– Especially those separated from caregivers
• People with health conditions and disabilities
– People who are non-mobile, or who have chronic illness, hearing/visual
impairments (deaf or blind), or severe mental disorders
– Frail elderly people, pregnant or nursing women
• People at risk of discrimination or violence
– Women, people of certain ethnic or religious groups, people with mental
disabilities
Distress Reactions to Crisis
• Physical symptoms (shaking, headaches, fatigue, loss of appetite, aches & pains)
• Anxiety, fear
• Weeping, grief and sadness
• Guilt, shame (for having survived, or for not saving others)
• Elation for having survived
• Being on guard, jumpy
• Anger, irritability
• Immobile, withdrawn
• Disoriented - not knowing one’s name, where one is from or what happened
• Not responding to others, not speaking at all
• Feeling confused, emotionally numb, feeling unreal or in a daze
• Unable to care for oneself or one’s children (not eating or drinking, not able to make
simple decisions)
Helping people in distress
• Most people recover well over time, especially if their basic needs are met.
• Those with severe or long-lasting distress may require more support.
– Try to make sure they are not left alone.
– Try to keep them safe until the reaction passes or you can find help from
others.

Listen • Make contact with people who may need support.
• Ask about people’s needs and concerns.
• Listen to people and help them feel calm.
• Make contact • Approach respectfully.
• Introduce yourself by name & organization.
• Ask if you can provide help, find safe/quiet place.
• Help person feel comfortable (water, blanket).
• Try to keep them safe.
• Ask about • Although some needs are obvious, always ask.
needs & • Find out person’s priorities - what is most important to
concerns them.
• Listen & help • Stay close to the person.

people feel • Do not pressure them to talk.
calm • Listen in case they want to talk.
• If very distressed, help them feel calm & make sure they
are not alone.
Help People Feel Calm
• Keep your tone of voice soft and calm.

• Maintain some eye contact.
• Reassure them they are safe and that you are there to help.
• If someone feels “unreal,” help them to make contact with:
– Themselves (feel feet on the floor, tap hands on lap)
– Their surroundings (notice things around them)
– Their breath (focus on breath & breathe slowly)
Listen with compassion by using your:

Eyes - giving the person your undivided attention
Ears - hearing carefully their concerns
Heart - with caring and showing respect
Good Communication: Things to Say and Do
• Try to find a quiet place to talk and minimize outside distractions.

• Stay near the person but keep an appropriate distance depending on their age, gender
and culture.
• Let them know you hear them, for example, nod your head and say…”hmmmm.”
• Be patient and calm.
• Provide factual information IF you have it. Be honest about what you know and what
you don’t know. “I don’t know but I will try to find out about that for you.”
• Give information in a way the person can understand - keep it simple.

• Acknowledge how they are feeling, and any losses or important events they share with
you, such as loss of home or death of a loved one. “I’m so sorry…”
• Respect privacy. Keep the person’s story confidential, especially when they disclose
very private events.
• Acknowledge the person’s strengths and how they have helped themselves.
Good Communication: Things NOT to Say and Do
• Don’t pressure someone to tell their story.

• Don’t interrupt or rush someone’s story.
• Don’t give your opinions of the person’s situation, just listen.
• Don’t touch the person if you’re not sure it is appropriate to do so.
• Don’t judge what they have or haven’t done, or how they are feeling. Don’t say…”You
shouldn't feel that way.” or “You should feel lucky you survived.”
• Don’t make up things you don’t know.
• Don’t use too technical terms.
• Don’t tell them someone else’s story.
• Don’t talk about your own troubles.
• Don’t give false promises or false reassurances.
• Don’t feel you have to try to solve all the person’s problems for them.
• Don’t take away the person’s strength and sense of being able to care for themselves.
Link • Help people address basic needs and access services.

• Help people cope with problems.
• Give information.
• Connect people with loved ones and social support.
Link: Basic needs
• What needs do they request?

• What services are available?
• Don’t overlook the needs of vulnerable or marginalized people.
• Follow-up if you promise to do so.
Link: Help people cope with problems
Distressed people may feel overwhelmed with worries…

• Help them prioritize urgent needs (what to do first).
• Help them identify supports in their life.
• Give practical suggestions how they can meet their needs (e.g., registering for food
aid).
• Help them remember how they coped in the past and what helps them to feel better.

Positive coping strategies (adjust for culture)
Help people use their natural coping mechanisms to regain a sense of control:
• Get enough rest.
• Eat as regularly as possible and drink water.
• Talk and spend time with family and friends.
• Discuss problems with someone you trust.
• Relax: walk, sing, pray, play with children.
• Exercise.
• Avoid alcohol or drugs, caffeine, nicotine.
• Attend to personal hygiene.
• Find safe ways to help others.
Link: Give information
• Find accurate information before helping.

• Keep updated.
• Make sure people are informed where & how to access services - especially
vulnerable people.
• Say ONLY what you know – don’t make up information.
• Keep messages simple & accurate, repeat often.
• Give the same information to groups to decrease rumours.
• Explain source & reliability of information you give.
• Let them know when/where you will update them.
Link: Social support
• Social support is very important to

recovery.
• Keep families together & children with caregivers.
• Help people contact friends and loved ones.
• Give access to religious support.
• Affected people may be able to help each other - bring them together.
• Make sure people know about how to access services (especially vulnerable people).
Ending your assistance
• Use your best judgment of the person’s needs and your own needs.
• Explain you are leaving and, if possible, introduce them to someone else who can
help.
• If you linked them with services, be sure they have contact details and know what to
expect.
• No matter what your experience, say goodbye in a good way, wish them well.
Risks for children and adolescents

• In crisis, they lose familiar routines, environment, and people that make them feel safe.
• Cannot meet basic needs or protect themselves.
• Separated children are of special concern.
• Risk of being trafficked, sexually exploited, recruited to armed forces.
• Girl children at special risk for abuse, exploitation, stigmatization.
Things you can do for children and adolescents…
• Keep together with loved ones.

– If unaccompanied, link them with a trustworthy child protection network/agency
or try to find their loved ones.
– Don’t leave them unattended.
• Keep safe.
– Protect them from distressing scenes, injured people, destruction, upsetting
stories, media.
• Listen, talk and play.
– Be calm, talk softly, relate on their eye level, and use language they can
understand.
– Listen to their views on the situation.
• Remember they also have strengths.
People with chronic health conditions or disabilities
• Crises can worsen many health conditions (physical and mental disorders).
• Help them to…
– Get to a safe place
– Meet basic needs
– Access medical care and medications
– Link with a protection agency or other support
– Access information on available services
People at risk of discrimination or violence
• They may be….

– Left out when basic services provided
– Left out of decisions about aid or where to go
– Targeted for violence
• Help them to….
– Find safe places to stay
– Connect with loved ones & trusted people
– Have information on available services or link them directly to services

Examples of Psychological First Aid
1. Family Support Services

– involve assisting the affected family with their particular and specific needs during and
shortly following a crisis. (helping them with their activities of daily living, making
arrangements for them (including phone calls).
✓ provision of warm blanket, clothing, tents, etc.
✓ food assistance – provision of a cup of noodles,
✓ warm broth, etc.
2. Information Support Services – provision of appropriate information
3. Tracing Services – helps locate missing relatives
4. Reassurance – statement that help is forthcoming (if indeed coming), provide sense of
security
5. Presence of crisis workers – human service providers especially if they are in uniform
with clear identification i.e. NCMH-DOH
6. Rituals - i.e. allowing victims to go through grieving rituals
7. Other support structures - this usually involves provision of a support structure to help
the victims/survivors go through the different phases of a critical incident. E.g. Cebu Pacific
plane crash, MV Princess of the Stars Sea tragedy
Reminder
Do’s
• Practice empathic listening skills
• Respect people right to make decisions not to disclose
• Be aware of your own biases and set them aside
• Respect people’s privacy and their stories
• Behavior appropriately according to survivor’s age, gender & culture
Don’ts
• Force people to share their stories
• Give simple reassurances or promises you cannot keep
• Tell people what they can or should not think or feel
• Lecture or preach
• Pray over them without asking if they want it
• Criticize service workers/operations in front of survivors

Summary: Ethical Guidelines
Do’s
• Be honest and trustworthy.
• Respect a person’s right to make their own decisions.
• Be aware of and set aside your own biases and prejudices.
• Make it clear to people that even if they refuse help now, they can still access help in
the future.
• Respect privacy and keep the person’s story confidential, as appropriate.
• Behave appropriately according to the person’s culture, age and gender.
Don’ts
• Don’t exploit your relationship as a helper.
• Don’t ask the person for any money or favor for helping them.
• Don’t make false promises or give false information.
• Don’t exaggerate your skills.
• Don’t force help on people, and don’t be intrusive or pushy.
• Don’t pressure people to tell you their story.
• Don’t share the person’s story with others.
• Don’t judge the person for their actions or feelings.
Practise self and team care
• Before:
– Are you ready to help?
• During:
– How can you stay physically and emotionally healthy?
– How can you support colleagues and they support you?
• After:
– How can you take time to rest, recover and reflect?
Seek support from someone you trust when you…
• Have upsetting thoughts or memories about the crisis event

• Feel very nervous or extremely sad
• Have trouble sleeping
• Drink a lot of alcohol or take drugs to cope with your experience
• Consult a professional if these difficulties persist more than one month.

Self and team care
• It is best for helpers to be connected with an agency or group to ensure safety and
good coordination.
• Check in with fellow helpers to see how they are doing, and have them check in with
you.
• When your helping role in the crisis is over, be sure to take time for rest and reflection.
• Talk about your experience with a supervisor, colleague or someone else you trust.
VIII. PSYCHOSOCIAL PROCESSING
HISTORY
• PSYCHOSOCIAL INTERVENTION was first used in the Philippines in 1990 after the
Killer Quake in Central Luzon
• CISD Mitchell model was used as introduced in the country by Ms. Shiela Platt
• Has been used in the many disasters in the country since then

PSYCHOSOCIAL PROCESSING
- a process used by a mental health professional or by a health care provider to
assist people in crisis & to transform these victims of crisis into victors (survivors)
- A direct PSP intervention for individuals or groups of individuals aimed at:
✓ Helping them reestablish equilibrium & harmony after the disaster;
✓ Regaining personal control
Critical/ Traumatic Incident

• Any event causing unusually strong or overwhelming reactions which have the
potential to interfere with work during the event or thereafter in the majority of those
exposed.
– A tool used by crisis workers, for the victims to deal positively with the severe
emotional impact of crisis, provide education about current & anticipated stress
responses and information about stress management.
– Used in identifying commonality & differences in the participants’ reactions
– A Phase in Crisis Management
– A group session allowing the ventilation and sharing of experiences, feelings, and
reactions during the critical incident.
– Useful in Providing:
✓ Ventilation of Intense Emotion
✓ Exploration of symbolic meaning of the event to those exposed
✓ Group support under catastrophic conditions
✓ Initiation of the grief process within a supportive environment
✓ Reduction of the Fallacy of Uniqueness – that the participant is alone in his
feelings
✓ Reassurance that intense emotions under catastrophic conditions are normal
✓ Preparation for the possibility of the development of a variety (Emotional,
Cognitive, Behavioral, Physical, Spiritual) symptoms in the aftermath of a
serious crisis
✓ Education regarding normal and abnormal stress response syndrome and
management
✓ Encouragement for continued group support and/or professional assistance
Mass Casualty Incidents

1. Ozone disco disaster
2. Lung Center Fire
3. Payatas tragedy
4. Earthquake of 1990
5. Mt. Pinatubo eruption in 1991
6. Armed Conflict in Mindanao
7. Rizal day bombing (Series of bombings)
8. Quezon Disaster (Typhoon)

9. Landslide in Guinsaugon, Leyte
10. Wowowee stampede
Target Population - NORMAL PERSONS who are capable of functioning effectively but due
to Crisis, they show signs of emotional stress
Purposes
• Share Experience
• Determine how C.I. Affects & responses to Stress
• Identify Coping Styles
• Develop Contingency plans
Requirements
• Venue
• Facilitator
• Arrangement
• Participants
• Group Size
DEBRIEFING PSYCHOSOCIAL PROCESSING

(J. Mitchell model) (Based on the TRAUMA Framework)
Introduction Re-Establishment Of Safety
Sharing of Facts & Feelings Telling & Retelling
Finding Commonality
Coping with Stress Reconnection
Contingency Plans Organizing For Community Action
Impressions/ Evaluation
Parts of PSP
• Introduction / Re-Establishment of Safety
🞂 1st Task – to establish the survivor’s safety
🞂 RECOVERY – based upon :

◦ EMPOWERING THE SURVIVOR
◦ CREATING CONNECTIONS
◦ RESTORING CONTROL TO THE PERSON
Final Goal: USHER THE SURVIVOR TO GROUP ACTION with others “WHO SHARE THE
SAME WISH TO RECOVER”

- Address issues of BODILY INTEGRITY:
physical safety, health needs; mx of post traumatic sx;
- Development of a plan for future protection’
- Enhancement of sense of competence & self esteem
Introduce:
✓ SELF
✓ PARTICIPANTS
– What session is all about - DEFINE
– Guidelines: Confidentiality, Non-judgmental, Respect, No Right/Wrong answer,
Openness, Mobile phones on silent mode
• Facts & Feelings/ Telling & Retelling

• *** Survivor is given the opportunity to TELL THE STORY OF THE TRAUMA
• Gives the chance to systematically review the meaning of the event, to self &
significant others
• EXPERIENCE (“Ano ang nangyari? Ano ang mga naramdaman/ naisip mo noon?”)
✓ FEELINGS then …
✓ FEELINGS now… (“Kumusta ka na ngayon?”)
✓ MEANING OF CRISIS (“Ano ang tingin mo sa mga nangyaring yun sa iyo? Ano
ang naging kahulugan nun sa iyo?”)
– differences
– commonality
– universality
• Stress Responses/ Finding Commonality

✓ Physical
– Headache
– Dizziness, faintness
– Tightness in the throat/Stomach
– Chest pains
– Pounding Heart, Shortness of Breath
– GUT reactions (Diarrhea/Constipation)
– Allergies
– Muscle tensions, Cramps
– Loss of Energy/ Restlessness
– Overactivity
– Increase Perspiration
– Rapid Pulse
– Extended Fatigue
– Feeling tired, Drained

– Frequent Physical ailments
✓ Emotional
– Fear
– Shock & denial
– Anger & frustration
– Bargaining/ Remorse or Guilt
– Depression
– Acceptance/ Resignation/ Helplessness
✓ Cognitive
– Disbelief
– Confusion
– Inability/difficulty to concentrate
– Absentmindedness
– Racing thoughts
– Preoccupation
– Difficulty in making simple decisions
– Paranoia/ Suspiciousness
– Reluctance to begin projects
– Feeling of Overload
– Problems with prioritizing
✓ Behavioral
– Uncalled for Aggressiveness, Irritability
– Accident Prone
– Nervous tics/ mannerisms
– Absenteeism
– Withdrawal
✓ Spiritual
– Declining investment in others
– Doubt of value system/ religious beliefs
– Questioning major life areas (profession, employment, etc)
– Self pre-occupation
– Disillusionment
– Blaming God for what happened” Kasalanan ng Diyos”
– Attributing the disaster to God “Parusa ng Diyos”
– Resignation/ Acceptance “Bahala na ang Diyos/Ipasa-Diyos na lang”
– Directing one’s anger to God “Walang Diyos/ Anong klaseng Diyos Ka?”
• Coping Styles/ Reconnection

• *** Survivor faces the task of CREATING A FUTURE
• What they have done to cope? (“Ano ang mga ginawa mo nun? Pano mo
nakayanan?”)
✓ Praying - universal coping

✓ Positive & Negative Coping Styles
• Contingency Plans/ Organizing For Community Action

• *** The survivor has constructed a COHERENT SYSTEM OF MEANING & BELIEF
encompassing the Trauma story…
• He is now ready TO FACE THE ISSUE OF THE PRESENT… and the FUTURE
• The survivor has constructed a COHERENT SYSTEM OF MEANING & BELIEF
encompassing the Trauma story…
• He is now ready TO FACE THE ISSUE OF THE PRESENT… and the FUTURE
• Ano ang balak mong gawin ngayon?

✓ Ano ang mga plano mo sa hinaharap? (Pananaw sa kinabukasan)
• Closing the Session

✓ Can be done in several ways:
– Ask participants to say a word or two of support/ comfort addressed to the group
– Meditation/ relaxation exercise
– A song
– A Prayer (use with caution)

PSP FOR CHILDREN: MODIFIED CISD FOR SPECIAL CLIENTS
ARTS – as a medium
• Drawings of children have an assessing and helping value.
• By asking the child to draw and later allowing her to talk about his art, one can learn
his inner world – his needs, fears, joys, apprehensions.
• His art is also a graphic representation of the child’s experience.
• Clay, sand, stick can also be used to represent what the child wants to express and
share.
Use of arts
• Feelings are assigned to different colors
• Children can use the colors to express their feelings as they color their drawings.
• Processing is more important as each child shares the drawing and the facilitator is
able to motivate the child to express verbally
• Venue for rapport building
• Graphic representations of the child’s experience, needs, joys, hopes and innermost
feelings otherwise not expressed verbally
• Enriches the facilitators’ pool of information

PSP for Children Using Play
Use of Play
• builds rapport
• relaxes the children
• serves as entry point
• medium to convey messages
• it is a natural way of expressing needs, feelings
• helps children work out their fears
NOTE:
• These activities are just avenues for children to narrate or share their experience &
express their feelings/ reactions.
• To assure them that even extreme reactions are normal, experienced by normal
people subjected to an abnormal situations.
Pitfalls that you can ponder on to improve your conduct of PSP

1. Using untrained member
2. When there is no mental health worker to refer extreme cases
3. PSP/ Debriefing is not a therapy
4. When there is inadequate facts
5. Inadequate networking/ coordination
6. Poor community approach
7. Lack of emphasis on confidentiality
8. Inadequate support for facilitators
9. Writing notes on the session
10. When it is intrusive
11. Lack of input on the part of the facilitator (educational aspect)
12. Role of the psychosocial care provider is not clear to the group/
organization/community affected
13. Facilitator is LATE in the session
14. When participants are seated apart
15. None or not enough EYE CONTACT
16. When FACILITATOR’s body language seems not to convey concern/warmth/sincerity
17. Late comers/ other disruptions
18. Language barrier
19. No follow-up/ appropriate referral
20. No buddy system/ back up (in case FACILITATOR becomes highly emotional)
21. Accepting too many groups to be processed during the day

Stress Management Techniques
• Talk it out
• Escape for a while (change of environment)
• Work off your anger
• Give in occasionally
• Do something for others
• Take one thing at a time
• Make yourself “available”
• Schedule your recreation
Some Suggestions to Handle Stress

• Try physical activity
• Talk to friends
• It’s OK to cry
• Create a quiet scene
• Avoid self-medications
• Find time for fun
• Avoid being alone
• Check your tasks. Get organized.
• Reduce time urgency
• Know your limits – practice acceptance
• Take care of yourself – watch your habits
• Shun the Superman image
• Go easy with criticism
• Give the other fellow a break
ISANDOSENANG “S” – IWAS STRESS
• Smile
• Siesta
• Sports
• Socials
• Scheduling
• Speak to me
• Spirituality
• Sounds & songs
• Self awareness
• Stress debriefing
• Sensation techniques
• Sensible diet & exercise

IX. VULNERABLE GROUPS
Vulnerable – the state of being unprotected against harm, injury or attack
Groups with Special Needs

• Children/ infants
• Older persons
• PWDs (physical/mental/substance abuse/developmental)
• Women
• First Responders/ disaster response personnel
• People w/ past traumatic experiences
• Ethnic & cultural groups
• Parents w/ dependent children
• Bereaved spouses/partners
• Economically disadvantaged groups
Children
• Listen to what they say both in words & their behavior
• Observe what children do as you talk to them or as they play
• Typical Responses: fear, anxiety, regressive behavior, difficulty sleeping, physical
reactions, difficulty concentrating
Helping a Child
• Help by helping the parents
• Keep familiar routines
• Talk about what happened (as appropriate)
• Find opportunities to participate in decision-making
Seek professional help when the child is experiencing typical stress reactions longer
than 1 month after the Critical event or any of the following:
• Suicidal or homicidal ideation/ behavior
• Hopelessness/ helplessness
• Physical problems
• Alcohol or drug abuse
• Hyperactivity
How to Know When Your Child Has Recovered

Although people deal with trauma in very many different ways, some signs of eventual
recovery include:
• the ability to talk about the tragedy openly with family and friends;

• the ability to effectively manage and cope with the many emotions that may be
associated with the tragedy;
• the ability to resume usual day-to-day routines; and
• the ability to resume social and academic activities in an effective manner.
The Elderly
• Typical Reactions:
✓ Wish to connect w/ family, past friends
✓ Increased dependence on family, refusing assistance from authorities
✓ Fear of mortality
✓ Negative view of the future
✓ Regression
✓ Use of denial
✓ Immediate fear – anger – frustration
✓ Concentration & communication difficulties
✓ Physiological responses
Helping the Elderly

• Ensure safety
• Give factual information
• Reassure by giving information about normal reactions
• Be supportive & build confidence
• Identify secure attachments & relationships
• Talk about the event
• Be aware of cultural backgrounds
• Facilitate access to aid & support services
• Ensure that they are not isolated
• Establish routine
• Help them to maintain their sense of community & preserve cohesion
Persons with Disabilities

• People who have disability are “people first”
• Their needs & reactions are going to be the same as others.
• But, their disabilities/ problems associated w/ their disability can create special
challenges for both the person & those who work with them.
• After a disaster, people with disabilities:
✓ May need assistance in negotiating the “second disaster”
✓ May need some accommodations within shelters
✓ May need assistance in replacing lost prescriptions.
Remember when you seek advice to:

• Always link w/ existing services to their disabilities
• Seek advice if these are evident or suspected:

– Suicidal ideation
– Homicidal ideation
– Depression (more than 2 weeks)
– Active hallucinations/ delusions
– Rage; Aggression
– Inability to care for self or carry out ADL
Women
• Tend to be more vulnerable to psychosocial effects of the disaster & likely to have
more psychological problems than their male counterparts
• More prone to depressive & anxiety & psychosomatic signs
• *** able to provide higher levels of strength & ability to support others
Strategies to help
• Involve them in community activities
• Involve them in ongoing relief activities (arranging group games, teaching activities for
children, identifying sick people in the community
• Encourage them to form self-help groups to find ways of coping with their feelings &
current situation
• Extend special care to pregnant & nursing mothers (adequate nutrition, medical care,
safety & privacy)
Sources of Stress for Disaster Workers

1. Disaster Event stressors
- personal loss/ injury
- traumatic stimuli /gruesome
- sights/activities
2. Occupational Pressures
- time pressure/ work overload
- physical/ emotional demands
- work environment
3. Organizational Pressures
- role conflict/ ambiguity
- confusion on the chain of command
- Organizational conflict
Helping the Helpers

• Additional Challenges for helpers:
✓ Feeling guilty over privileged access to food, shelter, etc.
✓ Facing moral & ethical dilemmas
✓ Being exposed to anger & lack of gratitude

✓ Being detached from personal support systems
✓ Being frustrated with policies & decisions of supervisors
X. BURN-OUT
BURN-OUT
– a state of exhaustion, irritability, & fatigue which markedly decreases worker’s

effectiveness & capability
– Characteristics:
• Chronic emotional exhaustion
• Depleted energy
• Impaired enthusiasm and motivation
• Diminished work efficiency
• Diminished sense of personal accomplishment
• Pessimism and cynicism
– may occur after a prolonged period of time on a job or even a short time in a very
intense situation
Warning Signs of Burn-out

• Cynicism of wounded ideals
• Feeling unappreciated or betrayed by the organization
• Loss of enthusiasm
• Grandiose beliefs about own importance
• Heroic but reckless behavior
• Neglecting personal safety and physical needs
• Mistrusting colleagues and supervisor
• Antisocial behavior
• Excessive tiredness
• Inability to concentrate
• Symptoms of illness or disease
• Sleep difficulties
• Inefficiency
• Excessive use of alcohol and tobacco and drugs
Common Sources of Burn-out

• Pressure to succeed all the time
• Need to generate excitement
• Lack of intimacy with people around you
• Areas of life are disproportionate
• Inability to relax
• Lack of self-discipline
• Inflexible once you’ve taken a stand

• Indentifying too closely with activities
• Always worried about preserving your image
• Taking yourself too seriously
• Have unclear goals
• Excessive other care, too little self-care (taga-salo)
• Low and inconsistent peer and social support
• High organizational conflict
• Lack of opportunities for professional dev’t
• Idealistic expectations for authorities/superiors
• Insufficient incentives
Management
• Be aware, be alert and recognize the symptoms
• Official temporary relief from work
• Rotation of worker to low/moderate/high stress tasks
• Briefing/debriefing, buddy-buddy system
• Limit exposure to high stress assignment
VICARIOUS TRAUMA
Basic Information about VT

• It is secondary traumatic stress where the carer gets traumatized vicariously through
exposure to trauma clients. (Anne Pearlman and Karen Saakvitne)
• Also known as “emphatic strain,” secondary victimization,” or “compassion fatigue”
• It characterizes the cumulative effects of working intensely with patients and or
survivors of traumatic events over time.
• It may change and alter carer’s self-capacities and belief systems permanently.
• Symptoms
– Deregulated affective states (fear, anxiety, anger, sadness)
– Sympathetic identification with your clients/victims
– Altered stress tolerance, threshold and coping patterns
– Altered self-capacities in terms of self-care, sense of meaning, attitudes, values
and world view
– Altered conception of spirituality, the meaning of life and death
A-B-C of Self Care
A - AWARENESS
B - BALANCE
C - CONNECTION
The Serenity Prayer

God grant me the serenity to accept the things I cannot change; courage to change the
things I can; and wisdom to know the difference.


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Republic of the Philippines

I. DISASTERS AND MHPSS

WARNING OR THREAT Days before actual If warning is If no warning, may

HEROIC STAGE Prior to Impact up Struggle to Fear, anxiety,

RECONSTRUCTION Several years Normal Satisfied with

Key Concepts of Disaster

MHPSS as a Program in the Over-All Disaster Response

MHPSS TWG in the Philippines (Members)

1. National Disaster Coordinating Council – Office of Civil Defense (NDCC-OCD)

Amended Cluster Approach in the Philippines

CLUSTER GOVERNMENT LEAD

MHPSS Domains vs. Responsible Lead Agency

DOMAINS (IASC Guidelines on MHPSS) AGENCY

1. Provision of basic psychosocial services

Psychological – relating to or Influencing the mind or emotions

The GOAL in Disaster Management (Health Sector)

MHPSS Core Strategies

Scope of Public Health vs. Public Mental Health

The 7 Aspects of Well-Being

where σ is yield stress, E is Young's modulus, and ε is strain.

Factors promoting resilience

Coping - is a way to protect, delay, avoid or manage stress.

How do people usually cope with stress?

✓ KAPWA (external reality) – consists of adaptive or maladaptive changes in our

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 10 | P a g e

STRESS & TRAUMA

Traumatic Stress Reactions

Some Symptoms that may lead to PTSD

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 11 | P a g e

1. They are NOT ALONE

Stages of Trauma Recovery

2. TELLING & RETELLING

3. FINDING COMMONALITY & RECONNECTION

4. ORGANIZING FOR COMMUNITY ACTION

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 12 | P a g e

Grief - subjective feelings, precipitated by the deaths/loss of loved one

1. WHO THE PERSON WAS?

The Four Tasks of Mourning

1. To experience the pain of grief

Normal Grief Responses

1. Tightness in the throat or heaviness in the chest.

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 13 | P a g e

- Disbelief - Dry mouth

- Sleep / Appetite Disturbance - Restless/agitation

5 STAGES OF 5 STAGES OF 4 PHASES OF

1. Shock & Denial 1. Alarm 1. Numbness of Protest

Two General Forms of “Abnormal” Grief

1. Variants of the critical grief process – (When it is pathological/complicated)

2. Grief reactions w/ disorders which replace the grief reaction:

Goals of Grief Counseling

More Specific Goals that Correspond to the 4 Tasks of Mourning:

1. To increase the reality of the loss.

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 15 | P a g e

1. Help the survivor actualize the loss.

Goals of Grief Therapy

Procedures for Grief Therapy

✓ Rule out physical disease

Hindrance to Adequate Grieving

2. Circumstances Surrounding the Loss

Mental Health and Psychosocial Support (MHPSS) Participant’s Manual 16 | P a g e

Clues to Unresolved/ Complicated Grief Reaction

When is Mourning Finished?

✓ When the TASKs OF MOURNING are accomplished

CHILDREN AND GRIEF