Mental health care for disaster survivors

Thousands of photographs show the scene at Rana Plaza: family members waving photos of loved ones at cameras. Rescuers with deep fatigue in their eyes. Survivors being carried from the stinking wreckage, blinking in the sunlight, gasping and weeping.
Many survivors were taken to the hospital in deep psychological shock. Some, say the doctors, are in frank psychosis, lacking a grasp on reality.

In the weeks and months to come, many survivors will continue to experience mental distress. Trauma is a normal response to a disaster like this one. A traumatized person can have panic, nightmares, anger, the inability to stop thinking about danger they have endured, and deep fear of future danger. The ministers have said that Rana Plaza victims will be provided with psychosocial care. This is good. It is necessary.

But here is a hard truth: there is much less mental health care available in Bangladesh than they need.

Before the Savar incident, Bangladesh had no functioning action plan for emergency psychosocial care. Pre-existing coordination of governments, hospitals, NGOs, and communities can help everyone take immediate, effective action to manage trauma after a disaster. Without it, health care workers and community members often must invent methods of care by themselves. There were lots of creativity in the previous week in Savar.

Bangladesh needs more than a plan: it needs mental health workers. Bangladesh has less than 100 psychiatrists, only about 1% of the 7500 mental health doctors the country needs. There are very few clinical psychologists, no clinical social workers, no mental health shastha sebikas, and just a few mental health researchers.
In fact, the field is scorned. There is tremendous stigma against mental illness in Bangladesh. Sometimes people who need mental health services are not treated as fully human.

But people who need mental health services now are survivors of a terrible crime. They are workers whose human rights were so badly disrespected they nearly died. They are the rescuers who risked their own lives in unstable rubble. They are families who received an injured relative, a dead body, or nothing at all. These people have every reason to feel traumatized, and every right to receive help, now and for as long as they need.

Thirty-two people were removed from Rana Plaza after the initial 72-hour search deadline had passed. A man was saved 110 hours after the building collapsed. These tough, resilient people knew how to endure in the worst of circumstances. If we give proper mental health care to people like this, many of them will get well.
For some, the climb back to mental health is short. For others, it is long. From research, we know that some can even get stronger after enduring life-threatening danger. The purpose of mental health care is to make their healing faster and more complete, to assist with post-traumatic growth, and to help those who would not get well on their own.
Right now, the lack of mental health care in Bangladesh is a terrible problem. We need more mental health care workers, better coordination between health care providers, and more funding to be able to serve people.

We also need the public to better understand who mental health workers are. This week, it is easy to explain.

In the midst of this disaster, there was an unlikely hero. Kamrul Islam is a rickshaw-wallah, aged 28. For much of Kamrul's life, he has belonged to a class of people that the wealthy sometimes disdain and even call "tui." He is so poor that his body is rail-thin.

But at the ruined factory, his lean form was a benefit. He was small enough to fit into the tightest spaces in the rubble, yet strong enough to carry a survivor out unassisted. Sliding into the small holes cut in the concrete and steel, he searched for live humans by torchlight. At least one woman owes her life to him.

A poor man has little to give away. Few people call him valuable. But at Rana Plaza it was Kamrul the rickshaw-wallah who was very valuable. It was he who could give the most. Disaster turned the world upside down.

Mental health is the rickshaw-wallah of Bangladesh's health care: lacking money, disrespected, a "tui" profession. But when disaster turns the world upside down again – and we know it will – we will be your Kamrul Islam, the powerful body that fits perfectly in the narrow space between you and health.

Let's build Bangladesh's mental health system immediately, to serve survivors now and in the future.

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M. Sophia Newman, MPH, is a mental health researcher in Dhaka.