Tarek Kareem Harris – A Doctor’s Guide to Mental Health in Disasters and Emergencies. No triggers -flashing lights.

			In 2005, I was traveling in Southeast Asia,
		

			I decided to stop in Singapore. And there were members of my family who had stopped in Indonesia, I
got news in Singapore via the news travels, that there had been a tsunami, this was going to be a
very big disaster. And for 48 hours, I couldn't contact my family at all. And in the next few days
and weeks, the whole world learned about the massive unfolding humanitarian catastrophe.
		

			Very soon after the physical effects of a war or a disaster, the mental consequences start setting
in. And if you don't get involved early on, to prevent the risk factors of mental disorder, then
you're going to get a problem which is far more expensive and far more long term than any physical
recovery. People generally adjust after breaking an arm or a leg, or recovering from some severe
disease. But the mental scars can affect functioning in all the ways that we consider essential to
humanity, broken relationships, depression, post traumatic stress, adjustment reactions, addictions,
and impacts even on generations afterwards, children's children can be affected by a traumatic
		

			memory that their parents or their grandparents suffered with, which changed the way they looked at
life.
		

			For anyone who might find it useful, what I've learned about mental health, in disasters, and what
can be done by those who are observing those who are affected, or those who are simply contemplating
these things, because we need to all learn from the disasters that we go through, but also from the
situations that our brothers and sisters are facing. First of all, let's try and define the people
who are affected. In the case of Beirut, those who are affected by the explosion.
		

			There are secondary, third, fourth, and even fifth and sixth level victims if you think about it,
there are the family and friends of those primary victims. There are victims in terms of emergency
and rescue personnel. from things like 911, or situations of war and first aid, we see how badly
many professionals and lay people are affected from giving of themselves in terrible situations
where they witness dramatic injury, or have to make extremely difficult decisions, which might
involve having to decide to treat one person over another. There are members of the community who
offer help the entire city of Beirut, and possibly the whole nation is going to be in a state of
		

			mourning, and shock. And all people there I'm sure will be feeling some kind of consequence. Even if
they're not directly affected, there are those who work for chance might have been directly
involved. And they suffer from things such as survivor guilt, these phenomena can be equally strong
and disabling in the longer term. So if we're considering what the consequences are, and how to
help, let's try and break this down in the core terms of Islamic psychology, when somebody is living
their life, and suddenly the person feels a great loss of control. This is the knifes being
affected. If they were purely intellectual, they would just look at the disaster and go Okay, well,
		

			I need to move house or I need to find a doctor. But with the knifes, it's not as simple as that.
Enough is almost like a timid child inside of you who is now scared, who's feeling alone, who's
angry, who wants to conquer the disaster, or wants to run away, we have to pay attention to that
part in order to nurture it back. And what we have to do is, therefore, to calm it and call forth
the intellect call forth the heart, the sense of purpose that a person has, and the sense of control
that a person has over their immediate environment. When we can get hold of those things for
somebody, we find that they function a lot better, and they can sue their own cells, they can
		

			propagate the same sort of information to other people they come across. So we can get a virtuous
chain of people who are all there for each other. evidence for this kind of work is extremely good.
If you do this kind of work, you are going to prevent mental health problems longer term, and the
economy itself will do better because people are more proactive, and people will adjust, people will
find jobs, and people will generally be happier and more productive if they are guided through
something so unexpected and negative, such as a disaster. So we come on to the principle of
psychological first aid. psychological first aid is a system whereby you can take care or administer
		

			some kind of treatment to people who have faced disaster.
		

			It's not as scary as it sounds. And in fact, most of it sounds like common sense. But what do we
know about common sense?
		

			times of disasters, it tends to evaporate, right? Because people aren't thinking clearly, they're
shocked. They're stunned. They've lost their role. So in order to regroup, and to give people back
their sense of control, there are a number of steps. Firstly, comfort and console, help them to feel
that their feelings are valid, and that if they feel shocked or lost or angry, or if they feel that
this is not happening, that these things are normal,
		

			they must be protected from further threatened distress. So they must be taken away from any area
which which is still at risk, they must be given immediate physical care. So whatever injuries they
suffer, need to be patched up as soon as possible. In the immediate aftermath of a disaster, you
will see an influx of various agencies who are all there trying to provide people with the help, you
need to give goal oriented and purposeful behavior. What that means is instead of taking a person
and telling them to take risks, it's actually counterintuitive. You actually give them the purpose
and help them to find a role, they might be well enough to consider helping up with some of the
		

			cleanup, they might have skills that can be used even after the disaster, cooks can be asked to cook
again, mothers will be mothering again, they may be obviously doctors and other professionals who
can resume their job, if they're physically able, these things might sound a little bit cruel, but
actually they're extremely helpful, because a person then can revert to the things that they're good
at. Mechanics can start fixing cars, painters can get involved with rebuilding, and what have you.
		

			To have a purpose is possibly one of the greatest things that separates us from animals. It gives us
a meaning to life. And restoring that meaning to life is perhaps one of the best gifts that you can
give to somebody who has endured something as awful as a disaster. You should help with reunion with
loved ones, people should be allowed the opportunity and it should be set up for them to be able to
go to a place and just talk things over over a coffee. There's no need for formal therapy. But
people do need to feel that it's okay to talk.
		

			Survivors need to be linked with sources of support, and other measures taken to give them a sense
of control. The main thing that we want to do is give them a sense that their life is still
potentially within their control, they can only move forward with their life, one second at a time
like everyone else. identifying those who need further help is also a useful thing to do. And it's
part of psychological first aid.
		

			Further down the line, there may be a need for other things depending on how a person evolves after
the disaster, but it's usually several weeks afterwards, that you'll start seeing problems emerge.
And you'll need to identify those people, there may be people who are developing post traumatic
stress, or depressive disorder. And those people who had mental health conditions before are
obviously more at risk. People who are isolated and who have no source of social support are also at
greater risk.
		

			It's at that stage that you can be a bit more formal things like debriefing things like retraining
people who may have lost a role, helping people to reclaim an identity and redefine their community,
to make sense of something and to move on. A community is very much like a very emotional person.
And emotions can be contagious. If there's confidence, and there is vibrancy in a community, then it
will move forward, and it will find its feet. Beirut is especially known for having that kind of
enthusiasm for life, perhaps because it has lived on the edge of war and destruction for so many
years. But that shouldn't be assumed to automatically happen, my heart goes out. And I'm sure all
		

			our prayers go out to all of those who have suffered in the disaster.
		

			The information I'm telling you now is stuff that I've learned over the years and where I have
advised where I have been of use in situations where there has been some kind of natural or manmade
disaster. I hope this small video is in some way useful. And I hope that all those people who are
watching can think about ways in which they can be useful to and I hope that with enough subscribers
and followers it can be easily accessed by those who need it. I hope to see you again in the next
video. And if you have any specific questions, please do put them in the comments or DM me on my
Instagram.
		

			I recognize that this might be painful to even watch. And if anyone is struggling know that you're
not alone and know that your feelings are quite valid. For the next couple of minutes you'll just
hear the sounds of water and nature. And I hope this brings you back to calmness and to the present
moment or
		

			All you need to do is focus on slow breathing
		

			and saying Alhamdulillah
		

			everything is within the control of God. He has seen and written all, never for one minute, believe
that things are unpredictable to him.
		

			We can't understand why he makes certain things happen. But we must know that whatever goes on, if
we reach out to Him He will help us.
		

			What's alone