The March 2015 floods, and the 7.5 earthquake in October 2015 left the people of Charum Oveer, a remote village near Chitral, with not only severe damage to local infrastructures and housing and no sources of electricity but also, with severe psychological and physical traumas. The village has a population of 1600, with 140 houses, most of which were damaged or lost in the disaster. Many survivors of the earthquake are now living with PTSD, flashbacks, anxiety, depression, loss of appetite and suicidality.
Two weeks after the earthquake, Karachi Relief Trust (KRT) sent a mental health worker, a remedial teacher and a disaster response expert to conduct a needs assessment of those affected. In the next few weeks, the organization carried out a telepsychiatry program which consisted of online clinics and counseling sessions through skype with counselors in Karachi for those suffering from trauma from the earthquake. The project is among the first of its kind in Northern Pakistan where the delivery of healthcare to remote regions is being realized through technology, satellite Internet and online clinics. This particular project was focused on conducting preventive mental health activities through their telepsychiatry program. The program will run until August 2016.
Originating Entities and Funding
Karachi Relief Trust is a disaster management organization founded in 2005. Most of the project was directed and funded by KRT, with resources help from other organizations. Supernet helped with discounted rates for satellite internet, Buni provided discounted solar panels, the Pakistan Association for Mental Health, Aga Khan University’s psychiatry department and the Aman Foundation’s mental health program Mashal helped with the execution and development of the program. The program was co-coordinated with Taskeen, a national mental health awareness initiative led by Taha Sabri. Taskeen took lead in developing a mental health response team for the region.
The participant selection process was open to the general public in Chitral, especially those who either self-identified as suffering with trauma, or those who were identified by members of community as showing signs of mental health issues. Both organizations note that a particular reason for the success in participant recovery and turnout is attributed to the high education and literacy rates in the region. Women, in particular, were keen to seek medical help.
There were there stages of the project:
- Selection of patients for treatment through medical diagnostics
- Training locals, chosen by community elders, to deliver services
- Two-fold delivery of services by locals and online counselors
Deliberations and Decisions
Members of the Taskeen conducted 2 sessions, 2 hours each at the local jamaat khana on mental health awareness and crisis prevention that were attended by 160 people. With 60 men, and 100 women (10% of the population), the initial mental health team facilitated and created different spaces for therapy from art, to storytelling to meditation.
A month into the project, the goal transformed from disaster relief intervention to capacity building to help community members identify and respond to common mental health problems on their own. The organizations and participants proved that that the assumption that people in small villages will refuse counseling services for mental illness and trauma in fear of being seen as “crazy” was incorrect. Instead, they found that people, especially older women, were very willing and curious to learn and heal.
18 villagers were chosen by community elders and leaders through a roundtable style forum and word-of-mouth for special training as mental health workers and introduced to basic counseling tools, ways to conduct trauma therapy, screening tools to help with diagnosis and empathy training. It is not stated in the media coverage how local individuals were chosen and by what criteria of competency. One requirement was that the individuals needed to have personal experience living with mental illness.
By November 2015, the local newly trained mental health workers had screened 500 people and diagnosed 57 individuals with PTSD or depression. The group of selected patients was then shortlisted for online telepsychiatry sessions in December. Following December, each patient saw a psychiatrist in Karachi through Skype once a week. Some counseling sessions are still on-going.
Influence and Outcomes
Taskeen’s follow-up surveys show that 70 percent of the patients have improved, 10 percent dropped out of treatment, 10 pc have other underlying illnesses, and 10 pc have showed no improvement. The villagers that were trained to provide basic counseling services, identify those suffering from mental health in the community and raise awareness continue to remain active health service delivery agents.
Criticism and Analysis
As noted by the organizations, limitations of the program include inadequate infrastructure to offer more comprehensive healthcare for mental health rehabilitation, the remoteness of the village as a problem for patients who need more healthcare like bloodtests from nearby cities and internet connectivity issues. Other limitations included language barriers and inability to treat severe cases of mental health distress