Vanuatu Mental Health Newsletter
Latest Data on Mental Health in Vanuatu
In 2018, Vanuatu’s Lifestyle Disease Unit conducted 13 screening sessions for non-communicable diseases (NCDs) across the island of Efate. As part of this screening, all participants were given a Kessler Distress Scale (K10) to assess their level of psychological distress. Of the 748 participants who successfully completed a K10:
- 135 (18%) rated their psychological distress as low
- 213 (28%) rated their psychological distress as moderate
- 300 (40%) rated their psychological distress as high
- 100 (13%) rated their psychological distress as very high
More than half of the population that were screened on Efate have either high or very high psychological distress. However, when looking at the amount of people accessing services from the MindCare Clinic on Efate, only 800 out of 65,800 people saw or were seen by the clinic staff in 2018 (1.22%). This means that there are many people out there with elevated psychological distress who may benefit from assessment and treatment with the Mind Care Clinic.
If you or anyone you know has been very stressed lately and it is starting to impact how you function at work, at home, or with friends and family, please do get in contact with us, and we will try to help out where we can. We can be contacted via the Mental Health Vanuatu Facebook page, or via the contact details at the bottom of the article.
How to Cope with Trauma in Times of Disaster
The World Health Organization’s (WHO) Department of Mental Health and Substance Abuse report that exposure to extreme stressors, such as natural disasters and internal displacement, is a significant risk factor for mental health and social problems.
Both Cyclone Pam in 2015 and the evacuations and relocation from Ambae in 2017 and 2018 are two recent events that had a potentially traumatic impact on a large number of people.
Disasters trigger much mental health and long-term psychosocial challenges, as the instability of the event has shattered people’s normal routines, and can trigger stress, anxiety, fear, loss, grief, depression, ongoing adjustment difficulties and trauma. These distressing events affect entire communities, as people can lose their land, homes and belongings, become separated from family members and other close social connections, and have limited access to basic needs and services, including mental health and psychosocial support.
Furthermore, the host communities that take in evacuees are also impacted by the sudden influx of new people, which can lead to changes in regular routines, increased distress and demands, a feeling of being overcrowded or overwhelmed, and reduced access to the already limited resources that are available.
Mental Health and Psychosocial Support (MHPSS) services are critical for the recovery of affected communities, as they can mitigate the effects of such potentially traumatising circumstances. Vanuatu is amongst the top five most disaster-prone countries in the World, which further highlights the crucial need for a national mechanism and sustainable support infrastructure to address mental health needs during times of emergency.
MHPSS programs following natural disasters aim at the psychological recovery of individual community members as well as the social recovery of communities. Psychological first aid (PFA) training and implementation enable friendly, supportive responses to any individuals who are suffering or are in need of support. Such programs address the various psychological issues of affected individuals and strengthen the capacity of communities for future development. Although everyone is affected in some way by events such as natural disasters or internal displacement, some people are particularly vulnerable in crisis and may need extra help.
What is Trauma?
The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) describes a traumatic experience as exposure to an event that involves death, serious injury (actual or threatened), or sexual violence (actual or threatened). It usually creates intense feelings of helplessness, horror, or fear in the individual.
It is mostly direct exposure to an event that causes trauma, but can also be caused by witnessing an incident that happened to someone else. Other forms of trauma include indirect exposure by hearing about a close friend or family member being exposed to trauma, or through extreme or repeated exposure to aversive details of an event, typically through professional duties, such as first responders to a fatal crash site, or repeated exposure to information of child abuse.
Trauma can create long-standing changes in the brain. Imaging studies have shown heightened brain-stem activity, which controls the fight-or-flight (or freeze) system. This is the brain’s inbuilt survival mechanism. Imaging studies also show increased amygdala activation, which floods the body with feelings of fear. Both of these changes can be quite effective in keeping people safe in times of imminent danger because they allow individuals to scan the environment and react quickly to anything that is perceived to be dangerous.
The problem is that once these areas of the brain become overreactive, they will respond to anything that is potentially similar to a traumatic experience from the past, without first trying to accurately assess the actual level of threat. This makes it more difficult to respond in a calm, rational manner in an individual’s everyday life.
The hippocampus, an area of the brain that is responsible for memory, can also be severely affected by traumatic events. The more extreme, unexpected and inconsistent an event is with previously held beliefs about themselves, the world or other people, the harder it is for the brain to fully process and integrate this experience. Some of it remains unprocessed or “stuck”, which then reduces the capacity to move on from the traumatic event and process and integrate subsequent information that is taken in by the senses.
Re-experiencing symptoms, such as flashbacks and nightmares, are thought to be the brain’s attempt to correctly process and integrate the traumatic experience. As scary as this can be, it generally does help in healing and resolving trauma symptoms over time. Unfortunately, with Post-traumatic stress disorder (PTSD), the brain continues to be unable to fully process and integrate what has taken place. This can lead to devastating consequences for the individual that is suffering from the condition, especially if they don’t understand their symptoms or what to do with them when they occur.
How to Best Respond to Each Cluster of Trauma Symptoms:
There are four clusters of symptoms that indicate that a person is suffering from an acute stress reaction in the first month after exposure to a traumatic event or a post-traumatic stress reaction after a month. Even if you do not have all of these symptoms, it can still be helpful to know what is occurring at the time when you do experience these symptoms after trauma and what you can do about it.
A: Intrusion symptoms – This includes intrusive memories, traumatic nightmares, dissociative reactions, such as flashbacks, and marked physiological reactivity and intense or prolonged distress after exposure to trauma-related stimuli or reminders.
When these intrusive symptoms occur, our brain rushes back to the past and starts to think and feel the same way that it did when the traumatic event was taking place. The mind feels that it is in imminent danger, and the initial feelings of intense helplessness, horror or fear come rushing back in.
What I have found to be most effective when this occurs is a process called grounding, as it helps people to reconnect with their senses in the moment, and brings their brain back from the past (where they were in danger) to the present (where they are safe).
Next time an intrusive symptom occurs, ask yourself the following:
- What are five things that I can see right now?
- What are four things that I can touch/feel right now?
- What are three things that I can hear right now?
- What are two things that I can smell right now?
- What is one thing that I can taste right now?
Once you are reconnected with the present, ask yourself “Am I safe right now?” If you are in danger, remove yourself from the situation. If not, then you are not at risk of harm and instead need to focus on reducing your distress through relaxation or self-soothing activities.
The more that these activities can engage you and your senses at the moment, the better, as it will help you to continue to feel present and safe. Grounding must occur first though, or the brain will want to stay in a hypervigilant state to protect you from the perceived threat, even if the danger is only a memory in your head.
B: Avoidance – Persistent avoidance of distressing external (people, places, conversations, activities, objects or situations) and/or internal (thoughts or feelings) reminders of the trauma
Avoidance of any reminders of the trauma in the first month after the incident is actually a good thing, as it can lower your arousal levels and reactivity, assisting your recovery.
Ongoing avoidance of these reminders, particularly after month, is not recommended, however, and may prevent a full recovery. Chronic avoidance prevents processing and integration of the traumatic event and sometimes means that people begin to avoid more and more things that may seem dangerous when they are logically quite safe.
Gradual exposure to the things that you fear (as long as they are relatively safe) is essential in the treatment of any anxiety disorder, including PTSD. I have gone through the steps of how to do this in my first article titled “Feel the Fear and Do It Anyway”. I personally followed these steps to challenge myself to get outside at night more and stop hiding when cars came past. It did get more comfortable with each time as I realised that my fear of being attacked was much higher than the actual probability of it occurring (it’s never happened again).
Also, remember that we cannot entirely run away from our thoughts and feelings. Acceptance and Commitment Therapy teaches Defusion and Expansion skills to help us better manage our thoughts and emotions. Research shows that these are more effective long-term strategies than continually avoiding internal reminders of trauma through drugs and alcohol, emotional eating, meaningless distractions or by keeping busy all the time (which only tires you out further and makes you more likely to feel out of control and react emotionally).
C: Negative alterations in cognitions and mood – including inability to recall key components of the trauma, persistent and distorted negative beliefs and expectations about oneself, others or the world, or blame of self or others for causing the traumatic event or its consequences, persistent negative emotions, including anger, fear, horror, impending doom, guilt and shame, diminished ability to experience positive emotions, as well as loss of interest and engagement in previously important activities, and feeling isolated, alienated, detached or estranged from others.
Exposure-based treatments, particularly cognitive processing therapy is essential for addressing the extreme shifts in cognition and beliefs that can take place after trauma, particularly if they are preventing you from doing the things that you used to enjoy.
Writing about how your beliefs and feelings have changed or explaining these changes to a friend that you can trust can help you feel more connected and better in time, but should be done in collaboration with a therapist if you are concerned about how you may react.
If you ever feel disconnected after a traumatic event, any type of movement tends to be the best strategy to reconnect you to what you are feeling in your body. This could be playing sport, doing yoga or Pilates, weight lifting, walking or running outside, or even dancing. Anything that helps you get out of your head and into your body or the world around you (as long as it is safe).
D: Alterations in arousal and reactivity – trouble falling asleep or staying asleep, difficulty concentrating, feeling jumpy or easily startled, and being super alert or watchful.
Learning emotional regulation and distress tolerance skills are both critical to managing arousal levels, which then diminishes reactivity.
Emotional regulation skills include adequate rest, recovery, leisure and socialising, or ensuring that things are in the right balance. Too much work and stress without sufficient breaks will slowly increase our arousal levels over time. Ensuring that we minimise caffeine and alcohol intake, eat a healthy well-balanced diet and get a consistent 7 hours of sleep each night also help us to lower our arousal levels and better regulate our emotions.
Distress tolerance skills include relaxation and mindfulness skills, as well as a distraction at times. By practising these on a regular basis when you are feeling calmer, it then becomes easier to implement them when you are most distressed so that things do not become too overwhelming for too long and you are able to not panic and calm yourself down.
IF THESE STRATEGIES DON’T HELP?
Sometimes a referral to a Psychologist, Psychiatrist or Mental Health Nurse will be important to give you the best chance of making a full recovery.
Only 8-12 sessions of 60-90 minutes of therapy can make a big difference.
OTHER TIPS FOR COPING DURING TIMES OF DISASTER:
- Plan ahead, that is, don’t leave things to the last moment. Think about what it is that you have to do.
- Do you have to travel?
- Will you have people visiting?
- Will you have to spend more money?
- Do you have to buy special things like more food or water or other necessities?
- Be realistic.
- You cannot do everything and meet everyone’s expectation.
- your health, personal situation and family structure, may have changed. Make sure that your expectations on yourself and others are consistent with this.
- Your home or business may have been affected by a natural disaster or accident.
You may need to reconsider what you plan to do based on this information.
- Learn how to say “NO” and this could be a difficult thing to do both personally and culturally.
- Saying NO does not mean that you do not care or that you are not respectful.
- Sometimes we do not have the time, health or resources to say YES and then follow through.
- Saying YES to please someone and then becoming very stressed is not good for your health.
- Take some time to think things through before you make important decisions.
- Reach out for help. When you are stressed and do not have the resources or health or time, talk to someone that you trust and talk things through.
- Tune into your feelings. You may be going through a difficult time, so try to admit to yourself if you are sad or angry. Give yourself the time and opportunity to improve.
- Try to resolve issues if possible. Focus on what is in your control and what is a priority. As much as you will want to fix everything at once, this is not possible.
- Stay healthy. Don’t eat foods that you know cause you to feel unwell or will be bad for your health like too much sugar or fatty foods.
- Don’t drink too much alcohol or kava or other beverages that may make you feel better temporarily but worse in the long-run.
- Go for a walk with your friends or family. Talk to your friends and family about their lives and yours to keep you connected.
- Every day take a few moments to be alone and free from distractions. Breath slowly and deeply and try to clear your mind.
- If you are lonely or sad or grieving, make sure you try to mix with others or if that is too difficult try to engage in community events. A church service or watching a sporting event could be helpful.
- If despite your best efforts you cannot manage and feel depressed or feel that life is out of control you may need to seek help from a friend, a church pastor, another person you trust. If this is not available, please seek professional help.
For more information or advice please contact:
Mind Care Clinic
VILA CENTRAL HOSPITAL
Mental Health Clinic
NORTHERN PROVINCIAL HOSPITAL
Mental Health Clinic
Mental Health Clinic
D.A. MoH Port Vila December 2018