Managing mental health in natural disasters

i
Assessment of Professionals’ View on Managing Mental
Health Problems as a Result of Exposure to Natural
Disaster (Cyclone) in Bangladesh
By
Nazmun Nahar
2012
Supervisor
John Kinsman, Ph.D.
Umea International School of public Health
Epidemiology and Global Health
Department of Public Health and Clinical Medicine
Umeå University

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Ban Ki-Moon, UN Secretary-General said “Climate change affects every aspect of society,
from the health of the global economy to the health of our children. It is about the water in
our wells and in our taps. It is about the food on the table and at the core of nearly all the
major challenges we face today.” (gender, climate change and health , WHO, 2012)

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DEDICATION
This thesis is dedicated -
to my parents and my lovely family.
to my best friend Saria Mahima (Swarna), Mohsina Ferdousi and Shahenour
Akter and
to all of the Bangladeshi people particularly those who suffers every year by
cyclone.

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ACKNOWLEDGEMENT
It is a great pleasure for me to thank those who help me to make this thesis possible. I am
sincerely thankful to my supervisor John Kinsman who has given me support in many ways
to complete this work. Sometimes I was confused and stuck with few issues but he was all the
time encourage and support me to overcome my problem. His cooperation, valuable time and
suggestions have helped me to complete my work. I am really grateful to Kjerstin Dahlblom
who also supported me in several ways.
I owe my deepest gratitude to the wonderful person Sabina Bergsten who helped me in many
aspects in my two years life in Umea, Sweden. It is a honor for me to show my respect to my
teachers Malin Eriksson and Nawi Ng. it’s my great pleasure to express my thanks to all the
teachers and friends who helped me to have a wonderful life and learning environment in
Umea.
I would like to thanks to the department of public health and clinical medicine at Umeå
University in Sweden, for giving me such valuable opportunity to pursue my postgraduate
studies at Master programme in Public Health.
I love to say thanks to my friend Huyen Le Thu who always guides me to deal with every step
in Umea life.
Thanks to my sweet family who always try to give me the best. I really want to say a special
thanks to my father who always gives me the moral support and encouragement to go
forward.
I would also like to acknowledge the support and assistance given me by my friends Dewan
Mahbubul Alam and Mohsina Ferdousi who always inspire me and encourage me to go my
own way. A special thank of mine goes to my teacher Dr. Mahmudur Rahman and my friends
Ishrat Sharmin Rahman, Mostofa Kamal Shikdar, Shaffat Shariar.
I would like to acknowledge and thanks to all of my informants who gave their valuable time
and information to complete my work. Besides them I want to take opportunity to thanks all
the people who directly or indirectly give me support to continue my work.

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ABSTRACT
Background: Cyclone is one of the most powerful devastating natural disasters for the
whole world. Every year Bangladesh strike by this cyclone which has a huge impact on life.
Impact of cyclone is so strong that it makes peoples life vulnerable psychologically. This
psychological or mental health issue related to disaster is still a hidden/ignorance thing in
the country like Bangladesh. The main purpose of this study was to explore the natural
disaster related mental health problem and know which policy or programme was necessary
to overcome this situation by using the views of professionals’.
Methodology: Qualitative research methods were administered on mental health
professional and NGO workers to investigate the condition of natural disaster related mental
health issues in Bangladesh. The study respondents were Bangladeshi citizens with working
experience in natural disaster in Bangladesh. In depth telephone interview used to gather the
data from respondents. Here Content analysis used as a method to analyze the data. Results
of the study were categorized into separate section.
Results: This study revealed that natural disaster like cyclone has many psychological
impacts on population. People can be suffered by post traumatic stress disorder, anxiety,
panic, acute stress reaction, sad feelings due to cyclone. Children and female are more
vulnerable to that event. Lack of awareness one of the main reason to overlook the mental
health problem related to cyclone. Our mental health professional is not enough to give the
mental health service for disaster affected population. Another issue is we do not utilize our
professional properly due to lack of knowledge, lack of awareness. We also need to think
about alternative way to give the people proper psycho social service/support.
Conclusion and Policy Recommendation: By making psychosocial support team,
awareness building for disaster affected people we can avoid many horrible incidents. We do
not have adequate programme to do this. Without policy we cannot move forward and we
have no specific mental health policy for disaster management. Finally the recommendation
of the study was if we want to reduce disaster related mental health problem we need to make
a strong exclusive mental health policy under the Ministry of Health and Family Welfare.
Government should take the main responsibility to make such policy and NGO’s,
International NGO’s need to collaborate to make and implement this policy in proper way.

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Acronyms
NIMH- National Institute of Mental Health
DGHS-Director General of Health Services
PG (IPGMR) - Institute of Postgraduate Medicine and Research which renamed as
Bangabandhu Sheikh Mujib Medical University (BSMMU)
IFRC- International Federation of Red Cross and Red Crescent Societies
DMC- Dhaka Medical College
PTSD-Post Traumatic Stress Disorder
WHO- World Health Organization
NGO- Non-governmental organization
CPP- Cyclone Preparedness Programme
GOB- Government of Bangladesh
LGRD- Local Government and Rural Development

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Glossary of Terms
Mental Health- According to WHO (2011) “Mental health is defined as a state of well-being in
which every individual realizes his or her own potential, can cope with the normal stresses of
life, can work productively and fruitfully, and is able to make a contribution to her or his
community.”
Anxiety - people fill with unrealistic fear, irrational fear and feel anxious mild and severe
form.
Acute Stress Disorder- After the traumatic event if the symptom like PTSD developed to a
person within 2 days which can be exist maximum 1 month. But if it exist more than 1 month
then it identify as PTSD. (Butcher. N.J et al, 2010)
Depersonalization- When person experience his/her own self and own reality temporarily
lost then it called depersonalization. (Butcher. N.J et al, 2010)
Post Traumatic Stress Disorder- Posttraumatic stress disorder (PTSD) is a common reaction
to the exposing of traumatic event. There are many symptom of PTSD like re-experiencing of
the traumatic event, avoidance, numbing and hyper arousal. This symptom need to be
present for at least one month and it causes the impairment of individual’s regular
responsibilities. (Bryant, R, 2009)
Psychiatrist- Mainly psychiatrists are those who are physician but specialized in mental
health field.
Clinical Psychologist-Clinical psychologist are mental health professional with highly
specialized in mental health field. In Bangladesh who has completed their M.Phil on clinical
psychology they become clinical psychologist.
Psycho Drama- It’s a new concept in Bangladesh. There are few people now using psychiatric
technique to reduce mental health problem -they use drama, action. Psychodrama is a
therapeutic technique to deal with problems where it uses action methods, sociometry, role
training, group dynamics. By the using those method can get rid off from their problems and
it helps them for their personal growth. (Psychodrama - National Coalition of Arts Therapies
Associations, 2012)

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TABLE OF CONTENTS
DEDICATION ii
ACKNOWLEDGEMENTS iii
ABSTRACT iv
Acronym v
Glossary of Terms vi
1 INTRODUCTION 01
1.1Climate Change and Natural Disaster 01
1.2 What is Cyclone? 01
1.3 Natural Disaster Situation in Bangladesh 03
1.3.1 Cyclone and Vulnerability 04
1.3.2 Cyclone 1970 05
1.3.3 Tropical Cyclone Marian (1991) 05
1.3.4 Super Cyclone 'SIDR' (2007) 06
1.3.5 Cyclone Aila (2009) 06
1.4 Natural Disaster and Mental Health 08
1.5 Impact of Natural Disaster on Mental Health- Studies in Bangladesh 11
1.6 Natural Disaster Related Government, NGO’s Activities in Bangladesh 12
1.6.1 Role of Red Crescent Society- Cyclone Preparedness Programme(CPP) 12
1.7 Existing Policy and Programme 13
1.7.1 Climate Change and Health Promotion Unit (CCHPU) 14
1.7.2 The Comprehensive Disaster Management Programme (Phase II) 15
1.7.3 National Plan for Disaster Management 2010-2015 15
1.8 WHO Framework for Mental Health and Psychosocial Support
after Tsunami 16

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1.9 Administrative Unit and Health Sector in Bangladesh 18
1.10 Mental Health Professionals Situation in Bangladesh 19
2 OBJECTIVES 19
2.1 Main Objective 19
2.2 Specific Objectives 20
3 METHODOLOGY 20
3.1 Qualitative Research 20
3.2 The Role of the Researcher 20
3.3 Description and Selection of Respondents 21
3.4 Data Collection 22
3.5 Data Analysis 23
3.6 Ethical Consideration 25
3.7 Challenges 25
3.8 Trustworthiness 25
4 RESULT 26
4.1 Natural Disaster and It’s Impact on Mental Health 26
4.2 Who are Vulnerable? 30
4.2.1 Age Issues 30
4.2.2 Gender 32
4.3 Shortage of Mental Health Professional and Ignorance of Mental Health 32
4.4 Mental Health Component in Disaster Management-
Role of Government, NGO, Community 35
5 DISCUSSION 38
5.1 Natural Disaster and It’s Impact on Mental Health 38
5.2 Who are Vulnerable? 39
5.3 Shortage of Mental Health Professional and Ignorance of Mental Health 39
5.4 Mental Health Component in Disaster Management-
Role of Government, NGO, Community 40

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5.5 LIMITATIONS 42
6 CONCLUSION 42
7 POLICY RECOMMENDATIONS 43
REFERENCES 47
APPENDIX- 1 55
Maps of Bangladesh 02
Table-1 22
Table-2 24
Figure-1 04
Figure-2 16
Figure-3 18
Figure-4 23
Figure-5 44
Photographs 07

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1 INTRODUCTION
1.1 Climate Change and Natural Disaster
Natural disasters create several types of threats on human life. Every year we lost mankind,
many types of resources for this disaster. People also suffer a lot economically, physically and
mentally for this problem. One of the reasons of natural disaster is the climate change.
Climate change has huge serious consequences for the global which can be long term or
intensive. One of the main categories of climate change is the ‘extreme weather events’ which
are responsible for natural disasters. It includes:
• Extreme or severe temperature highs – heat waves
• Many types of Storms like windstorms, hurricanes, cyclone etc.
• High levels of precipitation, and associated flooding
• Lack of precipitation, and associated drought
(Climate Change and Natural Disasters: Scientific evidence of a possible relation between
recent natural disasters and climate change, 2006)
National Earth Science Teachers Association (NESTA)(2011) mentioned that some scientist
assumed that probably hurricane will come frequently and other said because of the global
warming the power and duration of storms will be increased.
A report Yale school of forestry & environmental studies said (2012, as cited in Mendelsohn.
R et al 2012 ) “Greater vulnerability to cyclones is expected to increase global tropical damage
to $56 billion by 2100—double the current damage—from the current rate of $26 billion per
year if the present climate remains stable.”
1.2 What is Cyclone?
Cyclone, tropical storm, hurricanes, typhoon are same types of disaster but addressed by
different names. Along with many other Asian countries Bangladesh also situated in the
Typhoon/cyclone belt or the same path way to tropical cyclone. The tropical storm typhoon
arises in Indian Ocean areas then it called Cyclones. (Meteorological hazards: Tropical
storms, hurricanes, cyclones and typhoons, 2012)

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The maps of Bangladesh below show the disaster track and condition in Bangladesh-
Map-1
Map of Bangladesh showing the affected
area by Cyclone Sidr (Xinhua/AFP Photo)
Map -2 Cyclone-prone areas of Bangladesh
(adopted from National Plan for Disaster
Management 2010-2015, 2010)
Map 3. Cyclone storm tracks over
Bangladesh (Banglapedia, 2008)

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1.3 Natural Disaster Situation in Bangladesh
Bangladesh is a tropical country with an approximate geographical surface area of 143,998
square kilometers with more than 162 million of population and the population density is
1126.6 per square kilometer which means it is one of the most densely populated countries in
the world (UN data, 2012). It is the largest delta in this world formed by three rivers named
the Ganges, the Brahamaputra and the Meghana. Due to geographical location Bangladesh is
one of the worst victims of natural disaster. The global warming issues also makes the
condition more vulnerable to natural disaster. The sea level is rising year by year according to
the United Nations Environment Programme (UNEP) projecting a sea level rise of 1.5 meters
which would cause submerge 16% of the land of Bangladesh and which will be affected more
than 17 million population. (International Environmental Data Rescue Organization, 2010).
Environmental risk advisory firm Maplecroft made a list for most vulnerable to natural
disaster and they recognized Bangladesh as the “extreme risk” rating for natural disaster.
They analyzed past 30 years disaster record and publish this on their Natural Disasters Risk
Index. (International Environmental Data Rescue Organization, 2010). Preventinonweb.net
published their report form 1980 to 2010 where they mentioned within this time Bangladesh
affected by 234 natural disasters which caused death toll for 191,836 people.
(prventionweb.net)The most common natural disaster in Bangladesh is tornados, tropical
cyclones, and floods.
Climate change has a severe and long term effect on Bangladesh. It is assumed that due to
climate change frequent and severe floods, tropical cyclones, storm surges, and droughts will
be increased and sea level also rising which could result in the displacement of millions of
people as 'environmental refugees'. (Bangladesh climate change strategy and action plan
2008, 2008)
Ali, A (1999, p. 109) mentioned that in future probably Bangladesh will be one of the most
vulnerable countries of the world due to climate change. UNDP also identified Bangladesh as
the most vulnerable country in this world to cyclone (Bangladesh climate change strategy and
action plan 2008 , 2008)
Bangladesh suffers every year due to this tropical cyclone. Tropical cyclone arises from the
Bay of Bengal and most of the time it is come with storm surges. Bangladesh is vulnerable to
this cyclone due to many reasons – firstly the location at the triangular shaped head of the
Bay of Bengal, the sea-level geography of its coastal area, then it is highly density country and
it doesn’t have strong coastal protection system. Cyclone hit the country almost every year

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and 40% storm surges (of total global) are attacked in Bangladesh (Bulletin of the World
Health Organization, 2011).
Field Investigation on the Impact of Cyclone SIDR in the Coastal Region of Bangladesh,
(2008) mentioned on the report that between 1981 to 1985 Bangladesh faced 174 cyclones
which formed in Bay of Bengal. Which monthly recorded as follows: 1 in January, 1 in
February, 1 in March, 9 in April, 32 in May, 6 in June, 8 in July, 4 in August, 14 in
September, 31 in October, 47 in November and 20 in December.
WHO (2006) on Emergency Response and Preparedness showed the death toll of disaster
from 1987 to 2001 in Bangladesh
Figure-1 : Pie Chart Adapted from Emergency Response and Preparedness Country Emergency
Situational Profiles Bangladesh, 2006
1.3.1 Cyclone and Vulnerability
The factor related to vulnerability is important for natural disaster. This vulnerability can be
differs due to age and gender. Commission on the Status of Women (CSW) is looking for the
gender issues. A discussion paper on gender, climate change and health by WHO(2012, p. 01)
says “Among women, an expectation that they fulfill their roles and responsibilities as carers
of their families often places extra burdens on them during extreme climate events. For men,
their expected role as the economic provider of the family often places extra burdens on them
in the aftermath of such events.” In the 1991 cyclone destroyed a lot in Bangladesh when we
lost 140, 000 lives and the death rate was 71 per 1000 for women, compared to 15 per 1000
for men among 20-44 age range population and among this cyclone affected people 90 %
8%
2% 1%
89%
Major killer disaster in Bangladesh
(1987-2001)
Floods (41,383 deaths)
Epidemics (9943 deaths)
Others -Ferry disaster,
accidents (6500 deaths )
Tropical Cyclones (463,818
deaths)

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were women. Study also showed that women, young and people who belongs to low
socioeconomic status have more risk to anxiety-mood disorders after disasters. (WHO, 2012)
1.3.2 Cyclone 1970
One of the most deadly tropical storm of all time happened in Bangladesh (on that time it was
East Pakistan) on 8th November 1970. It hit the coastal area of Bangladesh and
approximately 300,000-500,000 people were killed by this cyclone. (1970- The Great Bhola
Cyclone, 2010-2011)
For the same disaster another report said that death toll was officially more than 500,000.
38,000 marine and 77,000 inland fishermen were affected by this. More than 20,000 fishing
boats were damaged, huge number of cattle lost (more than one million), house, educational
institutes were damaged respectively-400,000 and 3,500. (Field Investigation on the Impact
of Cyclone SIDR in the Coastal Region of Bangladesh, 2008)
1.3.3 Tropical Cyclone Marian (1991)
Severe tropical Cyclone Marian when attacked in Bangladesh (April 29-30, 1991) on that time
approximately 13.4 million people lived on that affected area. It causes a massive loss for the
coastal region the death toll was approximately 139,000, with an equal number of injured.
The estimated loss by the report of Government of Bangladesh Was-
- 780,000 homes were demolished
- 9,300 schools damaged or demolished
- 655 health centers damaged or destroyed. Agriculture and farming sector had affected
severely in Chittagong region. (The Bangladesh Cyclone of 1991, 4/4/12)
Another report says about The Great Cyclone of 1991 -it was very strong wind which mainly
attacked the coastal islands of Chittagong like Nijhum Dwip, Manpura, Bhola and Sandwip.
The estimated loss was at about Tk 60 billion. The death toll was approximately at 150,000.
(Field Investigation on the Impact of Cyclone SIDR in the Coastal Region of Bangladesh,
2008)

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1.3.4 Super Cyclone 'SIDR' (2007)
On 15th November 2007 Cyclone Sidr (very severe cyclonic storm Sidr) hit the coastal area of
Bangladesh. By the Sidr 30 districts were affected among them 4 were severely affected and
8 were moderately affected. 2.3 million Houses damaged and 55,000 people injured. In total
18.7 million people were affected. Sidr took lots of life it also mentioned that 3,406 people
were died and 1.001 were missing. This report estimated that about 2 million people lost their
employment due to this event. (Cyclone Sidr in Bangladesh -Damage, Loss and Needs
Assessment for Disaster Recovery and Reconstruction, 2008)
A Field Investigation on the Impact of Cyclone SIDR in the Coastal Region of Bangladesh
reported that the total damages by Sidr nearly $450 million. Patuakhali, Barguna and
Jhalokati District affected a lot by this event and the storm surge was over 5 metres (16ft). On
that time it reported that at least 3,447 deaths happen. (Field Investigation on the Impact of
Cyclone SIDR in the Coastal Region of Bangladesh, 2008, ch. 2, p. 15)
On the other hand World Bank reported that overall 30 districts in Bangladesh and 2 million
families and 9 million people were affected by Sidr. Nationwide power problem happened
more than 24 hours. A team of the Government of Bangladesh (GoB) and international
experts estimated that the total damage was approximately Taka (BDT) 115.6 billion (US$1.7
billion). The death toll was not that much big compare to other past cyclone but the effect of
the event was severe and long term. (Project Information Document (PID) appraisal stage,
The World Bank, 2012)
1.3.5 Cyclone Aila (2009)
On 25th May 2009 cyclone Aila attacked Bangladesh and West Bengal. Six coastal districts
were affected by this. Most of the villages submerged by flood water. Red Crescent report
(2009) said that on that time 190 people were died. By this disaster it was assumed that
243,000 houses have been fully destroyed and over 373,000 partly damaged. They
mentioned that on that time more than 7,103 people injured and more than 3,928,238 people
were affected.

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Photographs- Top Left- Khalilur Rahman, who lost 11 members of his family including his wife and his
other children, cries holding his only survived daughter(Sidr)
Top Right- After the cyclone deadbody on the tree(sidr)

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Middle Left- UN agency reported that like this at least 150 fishing trawlers disappeared and 1,000
fishermen were missing(Sidr)
Middle Right- Woman cry after she found her seven years old kid deadbody in a paddy field.(Sidr)
Bottom Left- 80 years old lady weeps after losing her grandson during Sidr
Bottom Right- A village condition in Shatkhira after the cyclone Aila
(Photo credit- CBS News, Times Photos, AFP, The Guardian-UK, SOS-Arsenic, Reuters )
1.4 Natural Disaster and Mental Health
There are several common mental health problem can be raised after the disaster according
to a editorial report from Indian Journal of Psychiatry it has been said that Anxiety,
Depression problems are more common among disaster affected population. Substance
abuse also one of the main problem that can be happened in the society after the disaster.
Aggression and anger can be appeared after the disaster (Rao.T.S.S, 2004). The mental
health problem depression defines by the WHO (2012) as one of the common mental health
disorders in all over the world. Depression has some sign and symptom like- depressed
mood, loss of interest and pleasure, guilt feelings, sleep disturbance, appetite problem, lack of
energy and poor concentration. These problems can be chronic or recurrent and it makes a
significant impairment to a person and person is not able to take care his everyday
responsibilities in proper way. The cause of many suicidal cases is depression. It also says
that globally we lost 850,000 lives due to depression.
Another common mental health disorder is PTSD or post traumatic stress disorder. WHO
explained that PTSD develop after some traumatic or terrible event. In PTSD person
experience intrusive memories, avoidance of specific thing related to disaster, sleep
problems, irritability and anger, lack of concentration and excessive vigilance.
Butcher. N.J et al (2010, p. 160 ) explained in his book about the symptom of PTSD which are
clustering in three main areas:
1) Repeatedly experience about the traumatic situation and it come as nightmare or
unwanted memory.
2) Person tries to escape those stimuli which are related to his/her trauma and become
emotionally numb.

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3) Hyper-arousal develops which is responsible for sleep disturbance, intolerance to noise
and exaggerated startle response
Professor Richard Bryant from School of Psychology, University of New South Wales (2009)
mentioned that after the huge disaster people can be suffered by many problems Sleep
problems, worry, maladaptive substance use, and interpersonal conflict and which are not
always identify by the usual diagnostic categories. These problems can be influenced
individuals, families and communities and which does not recognize as mental health issues.
It also mentioned that second position for the mental health disorder related to natural
disaster is depression and which followed by various anxiety.
Cyclone, tsunami are deadliest types of natural disasters in the world. The tsunami attacked
Asia and Africa (On 26 December 2004). Sri Lanka had an unbearable damage by this
Tsunami it reported that this Tsunami caused 31 187 deaths, 4280 missing, 23 189 injured,
and 545 715 displaced. Psychosocial problem also was big issue. (Hollifield et al, 2008)
Research found that after 3 or 4 weeks of disaster 14–39% of children (sample) had post-
traumatic stress disorder (PTSD) another study by Wickrama & Kaspar reported that 4
months after the Tsunami 19.6% mothers and 41% adolescents had the problem of PTSD.
(Hollifield et al, 2008) Another research reported that the tsunami developed a large number
of posttraumatic stress reactions among people of Aceh and North Sumatra in Indonesia
(Elizabeth et al, 2008).
World Health Organization estimated that among the Tsunami affected people 20–40%
suffers from some types of psychological distress. (Carballo et al, 2005). Research also said
“WHO also estimated that another 30–50% would experience moderate to severe
psychological distress that might resolve with time, or mild distress that could become
chronic.” (Carballo et al, 2005).
In 2004 tsunami disaster northwest of Indonesia, India, Thailand, Sri Lanka had lost more
than 200 000 individuals which make this tsunami one of the deadliest natural disaster in
this world. In Thailand 5395 individuals died on that time. One research administered
damaged provinces named Phang Nga, Krabi and Phuket among displaced and nondisplaced
poulation from February 15 to 22, 2005. The result of the study shows that 12% of displaced
peoples and 7% of non displaced peoples in Phang Nga and 3% of nondisplaced peoples in
Krabi and Phuket were suffers by PTSD symptoms. Anxiety symptoms found among 37% of
displaced people and 30% of nondisplaced people in Phang Nga and 22% of nondisplaced
people in Krabi and Phuket. Whereas the symptom of depression found in 30% of displaced

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peoples and 21% of nondisplaced peoples in Phang Nga and 10%of nondisplaced peoples in
Krabi and Phuket. Prevelance rate of PTSD, anxiety and depression were significantly high
among displaced people compare to non displaced people. Result by using bivariate analysis
showed that there was some demographical variables had an impact on PTSD, Anxiety and
Depression. It said that PTSD, anxiety and depression were significantly higher among them
who had low education, no income and age between 35 to 54 years. Women reported more
anxiety and depression symptoms and Buddhist people reported more PTSD symptoms. This
study also showed that symptom of anxiety and depression was more common than the PTSD
symptoms among tsunami survivors in Thailand. (Van Griensven F, 2006)
A study administered on Swiss tourist who directly experienced the Tsunami, 2004. Result of
this study shows that among 342 respondent 50 (16.8%) developed post traumatic stress
disorder, 17. 8% affected by anxiety disorder and 8% developed depressive disorder. 12.3%
of untreated tourist also fulfill PTSD symptom 38% who received psychiatric treatment were
still suffering PTSD after two and half an year of the tsunami.( Kraemer B et al, 2009)
Hurricane Katrina was another strong tropical cyclone which attacked United States in
2005. After hurricane Katarina more than 1.5 million people were homeless and almost
250,000 homes damaged those who survived they migrate or relocate many places like
Colorado. For many people this displacement was permanent. This catastrophic disaster
Hurricane has a severe impact of lives which leads to many long term or short term
psychological problems like posttraumatic stress disorder (PTSD) and depression (Martha et
al, 2009).
Another study said that after Hurricane Katrina more than one million people are displaced
and more than 270,000 permanently relocated survivors (U.S. House of Representatives,
2006). This migration makes the people vulnerable and they loss their social support which
leads them to get mental health problems. It also focuses the discrimination towards specific
people who were affected by racism. Coping behavior played an important role for PTSD to
hurricane affected young people it explained that Hurricane affected children showed
avoidant coping mechanism like blame, anger and social withdrawal. (Pina et al cited in
Journal of Clinical Child & Adolescent Psychology, 2007, p. 565).
Researchers now believe that exposure to a natural disaster is one of the key factor to develop
PTSD. (Russoniello et al, 2002)

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Children and adolescent are more vulnerable to cyclone. Study on children and adolescents
after one year of a super-cyclone in Orissa, India showed that majority of children suffered by
PTSD who experienced the cyclone. (Nilamadhab K et al,2007).
1.5 Impact of Natural Disaster on Mental Health- Studies in
Bangladesh
The concept of mental health is relatively new in Bangladesh and most of the time the
problem related to mental health is unrecognized and unaddressed.
A report on Climate change, disasters and psychological response in Bangladesh (2011) stated
that there was a survey conducted by the Association of Psychiatrists 2 months after the
cyclone Sidr of November 2007. They assessed 750 survivors among them they found that
25.2% had post-traumatic stress disorder, 17.9% had major depressive disorder, 16.3% had
somatoform disorder and 14.6% had a mixed anxiety and depressive disorder. More ever
17.1% people lost their family members and 82.9% were homeless.
A team of psychological therapists from the Bangladesh Therapeutic Theatre Institute of
Chittagong was working with Sidr affected people. They expressed to Action Aid Consultant
Psychiatrist Dr Raj Persaud that "There are a number of children here who are very
traumatized. Some cannot remain standing, some have become uneasy, some have become
restless and some have become stiff. There are some children who cannot hold a pen properly
now. The image of waves and pain of losing family members have disturbed them
psychologically." (Action Aid, 2008)
One study conducted by ‘Social assistance and rehabilitation for the physically vulnerable’
(SARPV, 1996) on Tornado affected population in Tangail district after the four and half a
month of the disaster where they assessed the psychological effect caused by disaster among
women and children and the need of psychological assistance. Result showed that 66% of
disaster affected total sample were traumatized and who needed emergency psychological
help where as 80% of women who experienced this disaster needed the same psychological
assistance. This result also expressed that 80% of affected children also required
psychological assistance who were below 12 years of old. Psychiatric diagnosis used for only
14 cases among 150 subjects by using Diagnostic and Statistical Manual of Mental Disorders
(DSM-III-R). it showed that all the women were psychiatrically ill and those who were above

12
50 all were diagnosed as psychiatric problematic because of the disaster.(Chowdhury et al,
2006).
1.6 Natural Disaster Related Government, NGO’s Activities in
Bangladesh
We have many programme and organization who are working for disaster like
 Cyclone Preparedness Programe (CPP),
 Flood Forecasting and Warning Centre(FFWC),
 Bangladesh Meteorological Department, Armed Forces Division,
 Fire Service and Civil Defence Directorate, Bangladesh Coast Guard, Public
Works Department, Local Government Engineering Department (LGED),
 Institute of Water and Flood Management (IWFM),
 The Coastal Association for Social Transformation Trust (COAST Trust),
 Disaster Research, Training and Management Centre (DRTMC),
 Bangladesh Red Crescent Society.
Few have very strong role in disaster management. But among these large number of
activities no activities is focused for disaster related mental health issues.
1.6.1 Role of Red Crescent Society-Cyclone Preparedness Programme(CPP)
After the 1970’s cyclone UN requested to Red Cross to help the disaster affected people. In
1972 Red Cross come with The Cyclone Preparedness Programme (CPP) of Bangladesh. In
June 1973, the Government of Bangladesh approved this new CPP programme. This
programme is doing a lot of work in Bangladesh. CPP plays a very important role in disaster
time this programme work for dissemination of Cyclone Warning, evacuation, rescue, first
aid and emergency relief work. The programme has 49,365 trained volunteers among them
16,455 female volunteer. These volunteers mainly work for-
a) Warning b) Shelter c) Rescue d) First aid e) Food and clothing. (CPP, 2012)
They have pre and during disaster, normal time and post-disaster activities.
After the Sidr IFRC started to help most affected families to build community resilience to
prevent disasters. Volunteer student trainers from the Department of Clinical Psychology at
Dhaka University were involved to give psychosocial training to Bangladesh Red Crescent

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Society volunteers at the district and also in the community to help Sidr affected people.
Among 42000 volunteers some of them got very limited briefing on psychosocial issues
during other trainings. (Psychosocial interventions A handbook, 2009)
I have contact through the phone with the Director of Cyclone Preparedness Programme
(CPP) he mentioned that they do not have any programme related to mental health issues.
When disaster comes after that as a response they do some psychosocial activities as
temporary basis. But it is not ongoing process. But they need to think about long term
programme not only for the emergency phase.
1.7 Existing Policy and Programme
Psychosocial support in community is administered in many countries after tsunami some of
them are very successful programme. Specially Maldives did good in this sector. Sri Lanka,
India, Thailand, Indonesia these all countries applied psychosocial support for community.
In Bangladesh there is no psychosocial issues includes in disaster management. Dr
Satyabrata Dash, Psychosocial Support Programme Delegate of International Federation of
Red Cross and Red Crescent Societies mentioned in a research that international red cross
society conducted psychosocial assessment of the Cyclone SIDR affected areas an
‘Assessment team’ along with the IFRC Field Assessment and Coordination Team from 3rd-
15th December, 2007 and they found traumatic stress symptoms among community people
due to the cyclone and distress due to the dead bodies laying around and lack of other basic
needs. (Dash. S, 2009)
Dr. Dash (2009) stated about UN Rapid Assessment Report (2007) which mentioned that
“Health promotion, trauma and psychosocial counseling are urgent” for the cyclone affected
people. Government of Bangladesh assisted by World Bank, UN Agencies and the
International Development Community (2008) also stress on psycho social need for the Sidr
affected population. But on that time Bangladesh does not have any National Mental Health
Policy after that event a draft National Plan for Disaster Management, 2010-2015 developed
in Bangladesh. We have Ministry of Food and Disaster Management and under this ministry
we have Disaster Management Bureau (DMB, 2012). This Disaster Management Bureau has
strategy to reduce the risk of disaster where they talks about preparedness, response,
recovery and mitigation. They stressed Government involvement and make self-reliance of
the community people. The Ministry of Food and Disaster Management (MoFDM) has a
mission to reduce the risk of disaster. They have an agenda where they stated-

14
“To achieve a paradigm shift in disaster management from conventional response and relief
to a more comprehensive risk reduction culture, and to promote food security as an
important factor in ensuring the resilience of communities to hazards”
To deal with the natural disaster we have many committees and councils. These committee
and councils are working in national, inter-ministerial, city corporation, district, upazila,
pouroshava and union level. But we do not make any specific committee who can only
responsible to think disaster related mental health issues.
1.7.1 Climate Change and Health Promotion Unit (CCHPU)
Climate Change and Health Promotion Unit (CCHPU)(2012) under the Ministry of Health &
Family Welfare which has some activities. This unit mainly focus on Health Promotional
activities coordination, Capacity building, Using e-Health and Telemedicine, Research,
Monitoring, Evaluation and Coordination of Emergency Medical Service (EMS) and School
Health Promotion Planning and climate change related project formulation and
implementation.
This unit has also FM radio named Nolta where they are broadcasting several things related
to climate change and natural disaster.
This unit have a current project named “Risk reduction and adaptive measures in the context
of climate change impact health sector in Bangladesh” this project objective focus on conduct
research, monitor disease patterns and make useful adaptive measures for climate change
impact on health. But in specific term they have few objectives where they talk about
comprehensive psycho social factor. Two of the objective related to mental health issues
where they mentioned comprehensive and participatory planning for climate resilience in
specific areas. They stated about health impact of climate change by doing comprehensive
study on psycho-social support for women and gender relations. Climate Change and Health
Promotion Unit (CCHPU, 2012) have four levels training in National, District, Upazilla (Sub-
District) and Community. They have already conducted training in District and Upazila level
training for health professional.
CCHPU (2012) mentions about comprehensive study on psycho-social support but without
policy it is difficult to convey the message through training or any other form.

15
1.7.2 The Comprehensive Disaster Management Programme (Phase II)
The Comprehensive Disaster Management Programme Phase-I programme successfully
completed in December 2009 and after that it start again as The Comprehensive Disaster
Management Programme Phase II with the partner organization DFID, EU, Norway, Sida,
AusAID, UNDP and Bangladesh Government. This project time frame is January 2010 –
December 2014. There are six main area of focus for CDMP Phase II and they express these
by six types of outcomes. For these six outcomes of CDMP there are many activities they
explains but no point explain about psycho social or mental health related activities.
1.7.3 National Plan for Disaster Management 2010-2015
In 2010 a national plan for disaster management has launched by Disaster Management
Bureau, Disaster Management & Relief Division in Ministry of Food and Disaster
Management
The Draft National Policy on Disaster Management has described some important policy
which focuses mainly on prevention emergency response and post-disaster recovery,
community involvement for preparedness programmes and involvement of local government
bodies would be necessary for the strategy, integration of structural mitigation with non-
structural measures.
This national disaster management plan work by following our administrative unit which are
exist in district, upazila, union, pouroshava/city corporation level.
Bangladesh has tried to reduce the disaster and they have created a model to minimize the
risk and emergency response management efforts in Bangladesh. This model has three key
elements which main goal is reduce the risk in more comprehensive way. These three main
keys are defining and redefining the risk environment, managing the Risk Environment and
Responding to the threat environment.
In disaster management ministry make a plan of action for Bangladesh on the basis of 2004
Tsunami, and based on several exercises, workshops, seminars and meetings. In this action
plan they have included the mental health part. About hundred pages of “National Plan for
Disaster Management” have one of the targets explained in develop and establish post
disaster recovery and reconstruction mechanism. In this target they has mentioned the
Action Agenda for 2010-2015 for the mental health related issues as “Enhance recovery

16
schemes including psycho-social training programmes in order to mitigate the psychological
damage of vulnerable populations, particularly children, the elderly and the disabled, in the
aftermath of disasters”. This plan will be implemented by the relevant ministry. This is really
a very small part of the plan and not clearly defined how to work for the mental health issues.
1.8 WHO Framework for Mental Health and Psychosocial Support
after Tsunami
WHO’s framework shows how mental health and psychosocial support can be worked. It
mentioned that the entire mental health problem needs to be solved by within their own or
adjacent districts. There are four different levels for this which are presents below-
Figure-2: Optional Mix of Services Within One District (This figure adapted from WHO Framework for
Mental Health and Psychosocial Support after the Tsunami, 2005, p. 14)
COMMUNITY MENTAL HEALTH TEAMS:
(levels 1 and 2)
Primary health care system or mobile/outreach facilities can provide mental health service
which express in level 1 and level 2. This work mainly in community basis but in general
hospital can have own ward to give the support. The mental health team should be
multidisciplinary with one medical doctor with mental health skills, three nurses of which
one nurse is specialized in non-medical (psychosocial) support, and three technicians (nurse

17
aides/community health workers/paraprofessional health staff) who are trained and
supervised in nonmedical (psychosocial support). Number of team members should be 3/4.
Team member should be trained on mental health issue. External help is necessary for make
the team but primary health care workers need to appoint within the community.
CARE AND SUPPORT ACTIVITIES OUTSIDE THE FORMAL HEALTH SECTOR:
(levels 3 and 4)
This level focuses on-
(a) Strength the pre existing community resource (give training to traditional healers,
teachers, religious leaders, women leaders and other community leaders in providing
support)
(b) For local solution involve community people with mental health and social activities
(c) Address social factors to minimize social sufferings (income generating or educational
activities)
(d) Structured social services like community social work,
(e) Strengthening community networks
SEARO also focus the training for community level workers who have clear idea about their
own culture. Problem can be eradicated comparatively quickly if the approach is community
based. Community level workers can identify those cases who needs clinical services.
Mental health and psychosocial support is not only base on specialization like psychiatrist or
counselors. It is also can be done by community people by giving training on mental health
issues like psychosocial firs aid, identification of person who need extra care.
Self and family care can be increased by giving psycho social education.
This four level system has three important components which are (a) referral, (b) supervision
and (c) competent care for vulnerable groups.
(a) REFERRAL- It should be from more specialized to less specialized care and also in
opposite way. Say severe mental health problem identified by community leader need to be
referred to primary health care or person with simple problem identified by level 1 mental
health team can be referred to level 2. This procedure works within 4 levels of services.
(b) SUPERVISION- It is essential part for the team. Without supervision problem will be
increased more in mental health. This supervision need to be given for community mental
health team by outsides experts (not from community, from other district). Team also need

18
some support primarily from the experts to supervise primary care workers duty. Counseling
type’s psychosocial work within level 3 also needs supervision.
(c) COMPETENT CARE FOR VULNERABLE GROUPS – it should be in all levels and need to
focus the integrating care specially for vulnerable group
(WHO Framework for Mental Health and Psychosocial Support after the Tsunami, 2005)
1.9 Administrative Unit and Health Sector in Bangladesh
We need to know the administrative unit and health sector information to utilize these for
our disaster management
Figure 3: Administrative Units as on 2008 of Bangladesh (Adapted from Health Bulletin
2010)
Health infrastructure in Bangladesh divided into national, divisional, district, upazila (sub-
district), union, ward and village levels under Directorate General of Health Services
(DGHS). We have a big number of community health workers. In ward level we have
community clinic which is one for 6,000 people so we have established 10,723 independent
community clinics. The union and upazila facilities work for community clinic service. We
have 20,841 are for health assistants (HA), 4,196 for assistant health inspectors (AHI) and
1,399 for health inspectors (HI). The Directorate General of Family Planning (DGFP) has
almost 13,500 full-time community healthcare providers (CHCP) for community clinic.
(Healthcare Network of Bangladesh under the Ministry of Health and Family Welfare, Health
Situation of Bangladesh , 2011)
These health care staff can play important role to mitigate disaster related mental health
problem if we can utilize them in proper way.
village
Wards 40,482
Unions 4,498
Upazillas(Sub-districts) 483
Districts 64
Division 7

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1.10 Mental Health Professionals - Situation in Bangladesh
Mental health issues have given a low priority in Bangladesh. Every year a total of 5,812
physicians pass out from medical colleges completing their education among them there are
very few choose the psychiatry as specialization.
WHO (2005) report expressed that mental health expenditure from government is very low
in Bangladesh which was only 0.44% percent of the health budget where is WHO suggested
that it should be minimum 5% of health budget. Dr. Golam Rabbani told in an interview that
we have just 134 psychiatrists in the country (which he refers in a research by the National
Institute of Mental Health, published in June 2011 ) (IRIN, 2011) and another psychiatrist
Dr. Helal Uddin Ahmed mentioned to bdnews24.com (2011) that in Bangladesh we have 190
mental health experts for the whole country which indicates that we have only one mental
health expert for nearly 1,400,000 people (due to unavailable web information we cannot
estimate the appropriate number of psychiatrist )
A very small number of clinical psychologists are working in Bangladesh. There is only one
institute in the whole country where they teaches clinical psychology. Bangladesh Clinical
Psychology Society has only 30 members. (Bangladesh Clinical Psychology Society, 2011).
Dr. Mahmudur Rahman (Ex Chairman and Prefessor, Clinical Psychology, Dhaka University)
who is now working as Senior Clinical Psychologist (HOD at Department of Clinical
Psychologyin Princess Marina Hospital, Gaborone) in Botswana told me over the Skype that
we have almost 40 clinical psychologist and 80 students who did not complete M, Phil but
still can work as clinical psychologist. He mentioned that we do not utilize properly this
manpower to mitigate the mental health problem in Bangladesh.
2 OBJECTIVES
2.1 Main Objective
Primary objective of this study is to understand the effect of natural disaster (cyclone) on
mental health in the settings of Bangladesh and how to deal with this problem. To explore
this situation I will use qualitative methodology.

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2.2 Specific Objectives
Through conducting interviews with mental health professionals/GO’s/NGO’s officials I want
to explore following specific objectives
- To identify natural cyclone’s impact on mental health.
- To explore the types of mental health problem can arise from the natural disaster like
cyclone.
- To identify an appropriate policy strategy that will help to minimize these problems.
3 METHODOLOGY
For this study we used Qualitative research method to collect and analyze the data. The in-
depth interviews have been taken over the phone to know the impact of natural disaster on
mental health and how policy can help us to minimize the problem.
3.1 Qualitative Research
Qualitative designs show multi dimensional views like social justice thinking, ideological
perspectives, philosophical stances and systematic procedural guidelines ( Richard S. Baskas,
2011). Qualitative research is interpretive and naturalistic approach which tries to explore
and describe the beliefs and behaviours in a particular environment. (Draper. K.A, 2004)
Research on social problem is feasible through qualitative method and it is also good for
constant comparison (B. G. Glaser, 1965). The aim of the qualitative research is explore,
interpret, and describe personal and social experiences in particular cultural perspective.
Qualitative approach can be hypothesis generating, inductive or exploratory. It’s focus to
explore and understand the meaning (Finlay, L, 2007).
3.2 The Role of the Researcher
Like any other qualitative research here also researcher needs to think about her role as
insider or outsider. Mainly qualitative researcher seeks to make a respectful and close
relationship with participants. It can be created through observation or interview. Qualitative
researcher plays an interpretative role by analyzing the data, writing the report for this
he/she uses the historical, social, cultural context for the study. (Lodico et al, 2010) here

21
researcher worked as insider and outsider both. I am from Bangladesh like all of the study
participants and somehow I belong to the respondents group because of my psychology back
ground. So many times clearly understand the position of respondents due to same socio
cultural and academicals background. But I am outsider as well because I do not have any
experience to work with natural disaster issues.
3.3 Description and Selection of Respondents
I have used purposive sampling and followed the snow ball sampling procedure. Firstly I
have contacted with five NGO workers and three Clinical Psychologist to know the condition
of disaster management programme in Bangladesh. I have used some selection criteria to
select participant-
1- NGO workers who have experience in disaster management field but our special focus
were mental health or psycho-social worker.
And
2- Psychiatrists who worked for natural disaster
And
3- Clinical Psychologist/ Mental Health professionals.
Before starting the interviews I have made contact with a clinical psychologist and a NGO
worker to ask the list of mental health professionals and NGO workers who is/was working in
mental health sector and who was work for mental health in disaster management in NGO
consecutively. After getting the list I was directly contact with few of them and they helped
me to select other participants. Eight of the respondents of this study live in Bangladesh.
During the interviews five were inside the Dhaka city, two were in Cox’s Bazar and one was
nearby Dhaka city. Only one of the respondent is still working in disaster management
related mental health field rest of them now works for other fields. One of the respondents
was not directly work for mental health sector but he worked in Sidr operation where their
NGO had psycho social team for disaster affected people. Researcher took two interviewed
with trainee clinical psychologist who did not finish their studies when they worked in the
field.
One of my informal respondents was one senior clinical psychologist (ex Chairman and
Professor, Clinical Psychology, Dhaka University) who is now working as Senior Clinical
Psychologist (HOD at Department of Clinical Psychology in Princess Marina Hospital,
Gaborone) in Botswana.

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Description of respondents-
Serial no. Job Position Institute Gender
1 Trainee Clinical Psychologist Educational Institute/NGO Male
2 NGO worker (worked for Sidr) International NGO Male
3 Psycho-Social Support worker/official International NGO Male
4 Trainee Clinical Psychologist Educational Institute/NGO Female
5 Psycho-Social Support worker/official International NGO Male
6 Psychiatrist National Institute of Mental Health Male
7 Psycho Dramatist NGO Male
8 Psychiatrist (Government) National Institute of Mental Health Male
9 Clinical Psychologist Educational Institute Male
Table- 1: List of respondents
3.4 Data Collection
Data collection method for the study was in depth telephone interview. First I have contact
with them over the phone and explained my topic and objectives. For each interview during
first call I asked to the interviewee for their suitable time for real interview. First call was
mainly for introduction and building some sorts of rapport between interviewee and
interviewer. When they agreed with me to give the interview then the questionnaire has sent
to most of them (which I have included as Appendix -1) in advance by email. I have contact
each participant on that certain time when they preferred to give me the interview. I have
followed a questionnaire guideline for the interview. During the interview if any question
arises I took note on a paper and asked the interviewee about it. Qualitative interviewing is
useful to understand individuals’ attitudes and values. Open ended and flexible question
helps us to get considered response than close question and it also provide interviewees
views, interpretation of events, understanding, experiences and opinions. (Clive Seale,
2004,182 Pp.) . I needed to contact with one of respondent two times. When I have
transcribed the interview I felt some gap so again I needed to contact with him for
clarification. The interviews duration was 43 minutes to 65 minutes. All of the interviews
recorded by a multimedia player. Three of the interviewees needed to reschedule their time.
During four of the interviews I needed call them more than once due to network problem.
The interview was in Bengali and it was taken by the researcher alone. The interview
questionnaire was English but it was translated in Bengali for the respondents. Respondents

23
were free to talk and they found it is a interesting topic. They willingly provide other people
names who can be my respondents. Three of respondent told that it is the very good topics
and they wish if I have finished this and publish it then it will make the Government aware
about the situation. All interviews have done using power-voip phone call (computer assisted
phone call) to respondents mobile. All of these interviews have taken from January till
March, 2012.
I have also contact (4 times) with Action Aid Bangladesh to know their activities related to
disaster management. I made phone call to CPP office Dhaka and they suggested to talked
with their Director. Then I needed to contact with the Director (Ops) of CPP to know about
their ongoing cyclone preparedness activities.
3.5 Data Analysis
After taking interviewed all the interviews were transcribed. The transcription was in Bangla
so I needed to translate these in English. Firstly I have translated two of the interviews made
meaning unit to condensed unit and code. But after that I have started to read the Bangla
transcription very carefully. I read every transcription several times and reached to the
category which I have translated later. Here I have followed the qualitative content analysis
to analyze the data which explained by Graneheim and Lundman (2004).
Qualitative content analysis mainly deals with contextual meaning of the text. It holds the
large amount of text into few categories. Text data can be various types like print or verbal
which we gather through survey, interviews, focus group discussion or print media.
Qualitative content analysis is a subjective interpretation of text. This interpretation follows
some systematic step. According to Krippendorf, K. (2004). “Content analysis is a research
technique for making replicable and valid inferences from texts (or other meaningful matter)
to the contexts of their use”. Here researcher use manifests content which means the obvious
meaning of the text. (Graneheim and Lundman, 2004).
Researcher follows the steps below to analyze the text-
Figure- 4 : The process of content analysis
Meaning
Units
Condensed
Units
Codes CategoriesText

24
A meaning unit consist a group of words or sentences which has the same meaning.
Condensed meaning unit means the data put together in different way. (Baxter, 1991). By the
abstraction of text researcher reach to codes and categories.
The development of categories is the main and centre outcome of content analysis. When we
categorize the information we follow our research question. Categories are descriptive and
which try to answer the question “what”.(Krippendorff, 1980)
Meaning units Condensed units Codes Category
Mental health concern, problem and
impact
On that time of disaster they faces many
mental problem for various reason one is
fear another one is suddenly the
environment has changed. Roads
destroy. Close people relatives die which
makes them mentally pressurized.
if I want to give a term I need to think.
There are some common problem like
anxiety, depression, without this I met
something which I can say this. Like one
type of PTSD where children are afraid of
darkness. If this disaster happened at
night they are afraid of darkness. I can
include it into PTSD.
This types of major boldly example we
have if anyone can knowledge he easily
can recognize how the change of
behavior was so strong. There was a
whole change.
Mental health
problem can be fear,
mental
pressure
Many loss happens
due to the disaster.
Terms of mental
health problems-
depression,anxiety,
PTSD.
Symptom of PTSD
Changes of
behavior is very
strong
Natural
disaster’s
effects
Types of
Mental health
problems
Symptoms of
Mental health
problems
Natural
disaster and its
impact on
mental health
Table- 2: Examples of meaning units, condensed meaning units, codes and category from content
analysis of this study.

25
3.6 Ethical Consideration
Ethical consideration has maintained for the whole studies from the beginning to end.
Researcher took the verbal consent from the respondents. Most of the respondents have
received questionnaire and a letter of support from the supervisor for this study. Before
taking each interview interviewer asked respondent about the recording issue and purpose of
the study as well and when they gave permission to record their voice then researcher played
the recorder. Confidentiality also maintained to this study by expressing all the data
anonymously.
3.7 Challenges
I have made contact with ten people over the phone or Skype (contact only one by Skype).
After phone contact I have sent questionnaire and my supervisor permission letter to seven of
them by email. One of the seven people was not our respondent because he lost his father
three days before I contact with him so I decided to not to take his interview.
I needed to contact several times for most of the interview. One respondent was missed the
first appointment due to network problem then I took interview in another day. I needed to
phone an interviewee more than five times within a day because he did not reach his home on
expected time. Then when I took his interview several times line was disconnect.
I have faced another problem during recording of one interview. When I have finished that
interview I was not able to transfer the interview on my laptop then I asked help to my friend
he told me that may be it because of corrupted file so I needed to transcribe this record
through the multimedia player as soon as possible. During one of interview phone line was
very disturbing so I needed to ask same thing several times.
3.8 Trustworthiness
One of the important issues in qualitative research is trustworthiness which comes by
analyzing credibility, transferability, dependability, confirmability (Dahlgren at al., 2007).
Credibility is the truth value which expresses the ability to capture the aim of the study. It’s
not come by chance or error or any types of misunderstanding. It captures the multiple

26
reality of the study (Dahlgren at al., 2007). In this research we have reached the objective
which we wanted to reach.
Transferability refers to possibility of generalization or applicability of the research. The aim
of a qualitative researcher to find the analytical generalization not the statistical
generalization. The research result will help the reader to make their choice of applicability of
the study. The qualitative research is always context bound. So it is not only researcher work
it also depends on readers to choice the applicability (Dahlgren at al., 2007). Research
information should be detailed enough to understand. (Shenton. K.A, 2004). If the readers
find sufficient similarities between two situations, then the research result of his/her own
situation would be same or similar to this study result.
Then next it comes to dependability which is related to consistency. Which means if this
study were repeated in same context with the same method and participants the results
would be same (Shenton. K.A, 2004). So if you administer this study with the same subjects
and use the same methods the result will be same.
In qualitative research dependability means to consistently change the condition of the
phenomenon of the study for the study participants and for the whole research (Dahlgren at
al., 2007). How the study emerges it also concerns of this in this study researcher interact
with respondents emerges the design by continuous modifying the discussion.
Confirmability means the neutrality of data. (Dahlgren at al., 2007). In this study researcher
tried to maintain this trustworthiness but due to physical distance with the participants
sometimes it was not possible to maintain all the things in strict way.
4 RESULT
The result we have found few important things which we categorize as natural disaster and its
impact on mental health, who are vulnerable? shortage of mental health professionals and
ignorance of mental health, mental health component in disaster management- Government,
NGOs, community.
4.1 Natural Disaster and It’s Impact on Mental Health
All participants expressed their experience about mental health issue related to natural
disaster. Psycho Dramatist/Creative Artist told that after the disaster people feels sorrow and

27
they also feel guilt. They feel guilt because when the disaster comes they need to survive and
for their own safety they bound to leave the child on the wave/water. During the natural
disaster water was so cold the child cried and told the parent he/she is going to sink on the
water but parent did not save him/her because his/her hand became numb. So the guilt
feeling is very strong among them. Feeling frightened, become sad or depressive it also
happens. One of the reasons for depression is related to cyclone warning system. Once before
the Sidr government warn the coastal people about cyclone in Tsunami time but there was
not that much big disaster came though people went to cyclone centre, took shelter on the
tree, did not sleep over night but Tsunami did not effect them. So they overlooked the signal
for Sidr. But when Sidr came they experienced a drastic loss. That is why they felt regret and
depressed for their overlooking behavior (psycho dramatist). After the Sidr people have heard
a rumor that another disaster will come and it will destroy the whole world. So they were
scared. People lost of hope about life. They have also problem in sleeping. Psycho dramatist
explained that after the disaster most of the people felt disgusted, became numb and
hopeless. Even If they recover still they lost their concentration which they had before. After
the Sidr when people heard any sound like car horn they became panic and if they hear any
sounds of clouds or see any lightning they felt frighten as well. They don’t even tolerate if you
speak in loud voice. The scary feeling which developed during the cyclone was exist long term
after the cyclone. Psycho social worker also expressed the same thing that after the Sidr
people felt frightened about car sound even after 5/6 months later of the disaster children felt
frightened to go to school they thought that if they go to school cyclone and flood will come
again.
Respondent mentioned that he has heard that one guy found his sons dead body and buried
him after that he became imbalance. (NGO worker)
Our one respondent trainee clinical psychologist explained about a case of a person who was
fisherman. He went to fishing with another thirty-four fishermen among them he had two
brothers. After the disaster he was the only one who survived. This traumatic event made him
lonely, introvert, aggressive, felt no interest for work.
People become aggressive and attacking after losing many lives. Psychiatrist respondent
includes syndrome and disease pattern of mental health problem by using Diagnostic and
Statistical Manual of Mental Disorders (DSM IV) like reluctant, depersonalization,
indifferent, withdrawal, and lack of interest. He shared a traumatic event. After the Sidr he
met a parent with his seven years old daughter who lost eight members of his family out of
ten. Father and daughter sat silently, did not show interest for relief. They became careless.
He mentioned -

28
“Another extreme example is one parent had two children. When the wave came he
hold both of them but he need to catch a tree tightly to survive so when he did it the
current was so strong it drag one child from his armpit. After that he just speechless
you can consider as reluctant. Father and daughter just sat on the road totally
numb. Everyone is running for food or medicine but they don’t have any reaction
about this. You can say depersonalization.”
The effect of natural disaster is explained by the psychiatrist - people become helpless and
feel uncertainty about the future, sometimes they become silent or become too talkative. The
problem of acute stress reaction is more than the depression. When people are in acute stress
disorder they experience anxiousness, become panic, worried. They cannot accept the reality
and there are denials among them. They always think which they lost and develop phobia.
Affected people go through the confusion about life. Psychiatrist mentioned that disaster
affected people developed many types of psychological problems. Few of them develop
anxiety, cry a lot, go through withdrawal, feel guilt, and develop self harming behavior,
increases suicidal ideas. This phase exists 36 to 48 hours. When it continues it turns to acute
stress disorder. people faces anxiety, sadness, flash back of natural disaster, cry silently, sleep
disturbance, develop irritability, suddenly outburst, cannot control the anger, grow learned
helplessness after few days it become disorder which are the symptom of depression. But
when it continues more than two weeks they develop PTSD.
One respondent explained that he saw a case in Barguna (one of the severely affected coastal
districts by Sidr) one person was behave not normal way after lost his wife and two daughters
he was moving around and ask everyone that anyone see his kids. He is spending his life in
this way. Now he is totally out of control. Counseling will not work on him anymore. You can
say he become mentally imbalanced. (psycho social worker)
One psychiatrist described that they went to Barguna (a district) 17/18 days after the Sidr
there were no road and transport so they needed to by motorbike. The tidal bore flooded
everywhere and he saw an empty land with lots of mud where one person and his daughter
sat silently. They did not answer any question later he knew that this gentle man lost his wife
and two of his son during the Sidr. They found one dead body of his son and did not find
others. After that moment he became totally silent and spent all the time to the place where
he had a house.
A psychiatrist described his experience that when they went to a “gucchogram” (cluster
house- that was a programme for housing where many houses built in line and house is one
after another like school) they saw almost 40 houses were there and in front of those houses
there were 20 graves (graveyard).

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Clinical Psychologist mentioned that natural disaster has impact on family relations,
psychological and social factors as well. It has impact on every psychological part of a human
being. It breaks down the whole self of a person. And it also influences family bondage family
status and family culture. Besides this person experience a change in his surroundings which
is different from before. So the impact is in the whole psycho social content. She mentioned
clinical psychologist are not work for diagnosis criteria but still she mentioned her experience
related to mental health feature - which can be anxious feature, some depression feature and
some PTSD feature these gave a mixed feature in a person. She described how breakdown
can be happened of a person. May be before the disaster the person had high self confidence
but after the disaster his previous confidence disappeared. He felt he was unable to protect
others and he was not able to do many things which made him guilt.
She mentioned that reaction depends on the severity of natural disaster. If the natural
disaster is severe then problem also last longer and person suffers more. The person suddenly
recognizes that many people disappeared with whom he/she used to spend his/her time. It is
a heavy pain for him/her. Suddenly one event killed many people which are really difficult to
accept. There are many missing works to accept the reality. As a reaction of this event peoples
self care destroyed. Their activity, motivation level become low. She shared another case of
one “grihostho barir bou” (house wife who has their own home, domestic animal, ducks and
hen, and working only for own family) who worked for raising her own ducks and hen and
took care the family. During the cyclone she lost her two young children, her mother and her
one brother. After disaster she left her all household work. She has changed from talkative to
silent, did not take care her only daughter. She behaved like outsider of the family. She had a
plan to give marry off her son soon. During cyclone she lost her son so others told her she
need to take baby again which was totally unacceptable and shocking for her. She did not
have any interest to sexual life. Her existence feeling destroyed.
People lost many things so it has a strong impact on their mind. One psycho social worker
mentioned that after the natural disaster person detached from the old environment,
detached from the normal life start to think that he/ she lost everything. Excessive thinking
makes him deviant. He become distressed and cannot cope with the situation. Person loss his
mental strength and also become super sensitive because of the loss.
Trainee clinical psychologist explained another case after the cyclone he met a man who was
boat man and it was his family profession whose father was also a boat man but after the
cyclone he feels frighten to go to the sea. He cannot go there and he left his profession. He
bound/force to change his profession because of his extreme fear. He was not able to work
for another profession but he force to do another work to earn money. He did not get any
psychotherapy or counseling. He never can back to the sea which was not possible for him

30
due to his frightened feeling. So he was not able to go ever to the sea where he enjoyed his
life. If he can back he can be live well as boat man. May be he is working now on the street to
sell nuts and corns. It has also a great impact on his mind because he forces to do it but in the
deep inner insight he is a boatman. From one side he feels a strong attraction toward the sea
but he cannot go there because he is afraid of sea. He is not satisfied to do his present work
by this his necessity cannot fulfill properly. He felt pain. So it did not solve his problem he
just try to continue his life in an alternative way which makes the problem bigger day by day
or it exist inside him.
4.2 Who are Vulnerable ?
4.2.1 Age Issues
According to respondents children are most vulnerable to natural disaster. They always need
to depend on others in emergency when everyone goes for shelter on that time they need to
wait for others who can help them to go to the shelter home. Sometimes people are not able
to go to shelter house they need to climb on the tree or take shelter on roof top but children
cannot do that. Children are affected more psychologically as well. They need time more than
the adults to come back in the normal life. Their frightened feeling stay longer than others.
Adult have a good chance to communicate with others but children are not able to share their
experience they bear it inside their mind. The experience of natural disaster is very new to
them they never experienced such things they do not even heard about this. One psycho
social worker explained that cyclone was a big disaster for children. On that time they saw
many dead bodies, people cried, they lost home, lost their books, stay in the shelter home, did
not have food, and did not know about their parents’ position which influence them
psychologically. During disaster time sometimes parents keep the child on a high place like
roof top and they drop from that and fall down into the water. School going children lost their
books, natural disaster destroy their school it is a big shock for them and this situation makes
them confused about their role. They do not know what they need to do. They are not only
physically vulnerable they also mentally vulnerable. No one care about children feelings.
After the disaster their attitude and behavior can be changed even their pattern of playing
game also changed. One trainee clinical psychologist experienced and shared
“I went an area after the cyclone where many people died in the cyclone, had many
losses. After this disaster children of this area’s were playing grave /burial, burial.
They made dolls and buried them.”

31
He also mentioned that after this disaster children feel fear. One of the example one child can
not cross a specific place at all because in the disaster time 2/3 people took to the air and died
on this spot and the child saw it so he can’t go through this way. It’s also a symptom of PTSD.
Respondent also mention about the vulnerability of young people. Young’s are also suffers
more than others because no one is ready to know that they have their own psychological
pain. Adult just overlook them and think they can be managed the situation by their selves.
Clinical psychologist said that young doesn’t know how to deal with the situation; they do not
have any guidance so they can be misguided. They are worried about their future and they
cannot cope with the situation. They do not have any space to share their feelings. There is a
big chance for them to start taking the drugs. The age range of this adolescents and young
who are vulnerable is 12/13 to 20/22. They move around like floating people.
Psychiatrist expressed that he thought extreme group people are vulnerable. Extreme group
means children and old. After the disaster when people come to take relief children and old
cannot do it others are push them and they cannot tolerate the pressure of people. But he felt
the most vulnerability depends on the socio economic status. Those who have money in their
bank account somehow they can handle the reality in normal way but poor people who does
not have bank balance or property to sale they become empty hand. So by this way poor are
vulnerable. He mentioned that in Bangladesh most people are poor so among these people
vulnerability also different. Cyclone or tidal bores always affect poor people more. Our most
of the disaster happens in coastal zone where most of the people are impoverish. He said that
he was using his commonsense that those who are responsible to take care for their family /
breadwinner they are more psychologically vulnerable than others. The bread winner needs
to take all the economical responsibility on his shoulder. He mentioned the age issues also in
village, people start their family life earlier than urban so the age range for vulnerability is
20/25 to 40/45 years. (Psychiatrist)
Old are also vulnerable. Old does not have enough stamina when cyclone come people need
to move quickly by running but they cannot. And another is retarded people they are not
many but still they are vulnerable (psycho dramatist)
Why old are vulnerable? Psychiatrist mentioned that because they cannot move easily from
here to there. Normally their lives are miserable because of their old age related disease.
Maybe they are sufferings in asthma, heart disease and so on then when the disaster comes it
is another extra burden for them. Problem will be excessive by multiplying all of the problem.
(psychiatrist)

32
4.2.2 Gender
Respondents also take into account the gender issues. Female are responsible to take care of
the youngest child so she cannot take care of herself during disaster. One mental health
professional mentioned that during the disaster age is vulnerable factor but after disaster
gender is vulnerable. If a young lady lost her husband during cyclone she cannot live alone
everyone try to exploit her even some times relief worker, Upazilla (SUB-DISTRICT)
chairman, Upazilla (SUB-DISTRICT) member those are also doing the same thing. It is really
difficult to protect herself from sexual abuse in the society.
Clinical psychologist mentioned that females are emotionally vulnerable. They cry a lot and
become sad. They can express their feeling. She thought that somehow male are vulnerable
but they cannot express like female. The reaction to the natural disaster for men, they
become addicted to drug by whole group. They have a big chance to become workless/jobless.
They don’t want to do any work always try to focus on external source. They always think how
to take advantage from others. There is a behavioral change among them which is not
positive. She gave an example that says one person was a rickshaw puller before the cyclone.
May be he lost his own rickshaw but he can hire a rickshaw for his work. But he did not do it
properly. May be he pulled rickshaw 8/10 hours before the cyclone but after the cyclone he
work only for 2 hours. He feels very tired. It is not because of his physical injury it is because
of his mental condition. His loss is so strong on his mind he cannot do anything, he feel tired.
He cannot continue any work for a long time he feels scattered so that’s why he prefers to
spent his day by lying on bed, sitting. So naturally he has the problem of earning and that is
the reason he focus to get donation or relief. He slowly becomes dependent.
4.3 Shortage of Mental Health Professional and Ignorance of
Mental Health
Respondents expressed about the shortage of mental health professionals. Respondents
mentioned that in the field of psychiatry we do not have enough professional to meet our
population mental health problem. Disaster is a special situation so we need to think about
our capacity. Respondents mentioned that they know Bangladesh does not have enough
professional but the problem is which it has they do not mobilize them properly. This thing is
common in Government and NGO both sectors. When disaster come both of the institution
think about materialistic help not abstract help like mental health support. They prefer to do
relief work. Psychiatrists give their service only in divisional level they do not provide any
service or support for root level people. After the Sidr many programme has done among
those few were related to mental health which is short term and insufficient. Our problem is

33
not the shortage of professional but the problem is views and attitude towards mental health.
They feel disaster means to help the people by giving relief, tin, money, pure water, quilt but
not anything related to mental health.
One mental health professional express in sad mood that the budget speech talked about the
providing of homeopathic, unani, ayurbedic treatment provider in every upazilla (Sub-
District) but nothing about the mental health professional. Government did not think to
utilize the professional where psychiatrist does not have position in district level hospital.
Respondent also confused about the situation and mentioned that without awareness of
mental health issues it is not possible to work. Where people are fighting for basic needs
there is no way to think for mental health. That is the reason mental health comes to second
line. He also mentioned that it is not possible to make a dramatic change by psychological
help but which can be possible by physical treatment so people do not recognize the mental
health issues. So we need to work for awareness first.
Another trainee clinical psychologist has same feelings. He felt that the socio economic
condition of Bangladesh has not any arrangement for mental health support. People needs
shelter, foods, occupation which are fundamental and we cannot provide properly, in this
situation these costly counseling or psychotherapy can be meaningless. But he also
mentioned that this is not because of socioeconomic status only this is also happened due to
lack of awareness. Psychiatrist and Clinical psychologist feels that government is overloaded
with so many things so they do not have enough time or resource to think about mental
health.
Clinical psychologist, psycho dramatist both shared that due to Sidr many people suffered a
lot by panic feeling. If they heard any sound of wind they felt frightened a lot. But
government doesn’t have anything to do for them. Sometimes you can see government have
something on the paper but in practical life there is no implementation of this. One clinical
psychologist expressed that she is a member of the small executive committee (mental health
issues in disaster preparedness) and she does not know any ongoing programme for mental
health. She also mentioned that in paper something says about a group involvement where
has included only psychiatrist who works with medicine not other else. But in this situation
motivation is necessary rather than medication (More important) which is not psychiatrist
job. Government doesn’t have any initiative for mental health issues and they do not
prioritize mental health.
Respondent mentioned that our mental health professional mainly work in the city. The
involvement of mental health professional with disaster field is very low. If they work outside
the urban they do not involve with disaster issues. They mainly work in hospital base mental

34
health service. No mental health professional think about preventive programme all are
engaged with curative treatment. No connection with field. The reason of the disconnection is
government’s overlooking behavior. Policymakers are not aware about the utilization of
mental health professional if they have knowledge about this even though they don’t want to
take step or attempt to change the situation. Government doesn’t understand the importance
of mental health so they do not give any support to make a positive change in mental health
sector. Psycho social team worker shared his experience
“Our NGO has some part related to government. Government parts staff says
what is mental health? What is psycho social? Where people cannot get food,
lost their homes and you people talking about mental health!”
government officials think it’s a unnecessary things but in Sidr time many community people
expressed to the respondents that mental health is necessary sometimes it needs more than
the food.
Psycho dramatist expressed that during disaster if small kids lost their parents, society think
that after sometime everything will be okay. Kids will not feel any pain for them. The problem
is we totally unaware about the mental health issues.
One mental health professional mentioned that he worked with journalist in Chittagong
where he had a press conference related to mental health. Most of the journalist told him that
they heard the term psychosocial support, mental health but they were not really clear about
the meaning of these words. Respondents worked with local disaster management
community but no one knows about mental health.
In Sidr time mental health issues come to the light and many NGOs started to work for this
but after a certain period it doesn’t work anymore. One clinical psychologist expressed that it
is not possible to continue work without payment. If she wants to work no one will pay her
and she is not eligible /capable (enough money) to do this. she mentioned NGO, government
only works on emergency time.
Respondent mentioned that NGO is trying to work for mental health but they don’t
understand the meaning of mental health. They think a short term training can make a
person mental health specialist. So they have a big knowledge gap in this sector that is why
they cannot get rid off from these types of misconception. One clinical psychologist talked
about the condition of mental health in Bangladesh. NGOs makes proposal arrange training
for short time basis. Do not think follow up or supervision which is necessary for non
professional to work or continue their job. So if those non professional can or cannot manage
their mental health work organization do not bother about this.

35
She explained that NGO people think 2/3 days is enough to become a mental health
professional. They do not appoint any mental health specialist for long term or permanent
basis they only hired them for a short term to give staff training. They think if they can
manage the work without professional then what’s the necessity to give a job to a mental
health professional which is an extra economical burden. They do it because of their lack of
knowledge about mental health. Sometimes they appoint a person as mental health counselor
but they give him many works which is not related to mental health. May be that person is
working for four position which is not possible to give a specialist/professional/mental health
personnel. For that reason they don’t want to provide a job for mental health professional.
The organization head or managerial positions personnel’s are the barrier to serve a
permanent job for mental health professional. Clinical psychologist told that many non
professional can be worked as mental health staffs if they get proper supervision.
Overall all the participants focus manly unawareness of government, NGOs and community.
They told that government, NGOs and community do not care because they do not know or
aware about this mental health issue which is totally new concept for them. This is common
for almost all population no differences you can find due to education or social status. One
respondent mentioned that we have stigmatized view to mental health problem. Another
thing is if a person is a bit disorganized or behaves like a different way then all the people
blaming him. They addressed him as mad. Ultimately he has a complicated reaction for this
view of population.
4.4 Mental Health Component in Disaster Management- Role of
Government, NGO, Community
All the participants expressed that there is nothing related to mental health in disaster
preparedness or disaster management. They suggested how to include mental health in
disaster management. They explained how government, NGO’s and community can work for
mental health issues in natural disaster.
We have very little support in mental health field. We need to think about that disaster can
come any time we need to prepare ourselves for that. Government needs to include NGOs
and others to the disaster management. Government need to make a clear mental health
policy for disaster related mental health issues. It should be from top to bottom. Psycho
dramatist said that disaster management in Bangladesh is one of the best in this world but if
we include the mental health issue it will be very well. A mental health team can be made by
psychiatrist, psychologist and creative dramatist. Government should lead this without
government involvement nothing can be changed in Bangladesh.

36
Respondent illustrated that if government starts to give importance on mental health then it
will open the door to make more professional and which ultimately will become a resource
for mental health field. Mental health work can be easily done by others. This disaster
preparedness volunteer is exists all over the world. Before any disaster they go to the specific
area and work for awareness of the population. They also warn people, give signal. There is a
big team to do this. Government Red Crescent, scouts all are doing the same job.
If government take the responsibility then the 10 years work will be done by 1 year. They are
the most powerful instate of the country. Government is the main hero for make the policy.
Government need to think how to make the policy, what is the strategy to convey. Then next
step carry on by implementation. How the message goes through a chain top to bottom they
need to think about this. (psycho social worker)
One psychiatrist explained that it is not possible for us make professional very quickly but
we can train our all field workers like health worker, family planning worker, school teacher,
imam (religious leader), and general physician which are our existing man power. He also
mentioned that last two years they are providing training for few coastal areas by using
training module. All the respondents talked about awareness build up. They stressed that
awareness build up is the one of main thing in mental health issues. Mental health
professional and society has a big role to change the situation. They need to make aware
government and public as well. They need to present the necessity of good mental health. We
have to conduct research about the advantages of good mental health, how bad mental health
impacts our lives if they can present this things then government and others will also feel
interest about this. If government doesn’t start it the process will be very slow. When
government get repeatedly this knowledge then they will aware about mental health issue.
Government should have some order for mental health field. They need to ensure mental
health staffs job. When they will start it people will be automatically aware about this. Then
they can see the professional in front of them now a day it is hidden from them if they cannot
see how they can recognize the necessity. One psychiatrist mentioned
“We can work in emergency basis as soon as possible we can provide training for
local personnel and involve them in service. In long term we can provide training
and supervision /follow up NGO Red Cross volunteers’ activities then we can see a
good structure of mental health near future.”
But we need to careful that issues they can forget these so to avoid this situation we
(professionals) can regularly refreshing or reintroduce this.
Respondents stressed that disaster management work are mainly doing by disaster
management ministry and other organization help them to do this work. But another

37
important role is from international organization who has the power to make pressure on
government. UNDP, Save the Children, Red Crescent these organizations can make
negotiations with government.
NGO can work in small group so it is easy for them to work for mental health intensively but
the thing is the work duration. Mainly they work for short term but we need to think about
long term work. Government need to plan and monitor others work.
International NGO can help more. They have project in many countries related to mental
health issues in disaster management. So we can take their strategy for our disaster
management mental health issues. We need to contextualize this for Bangladesh. One NGO
worker told that there is no mental health strategy in Bangladesh which can be implemented
directly. We need to research on this and he felt we also can include indigenous knowledge in
our mental health programme. By the research we also get what problem can be arises, how
can we deal with these, what’s the intervention, which strategy we can choose.
The organization Red Crescent work directly for disaster management. Red Crescent has a
big volunteer group. If we can provide training for these volunteer related to mental health
issues then they will be a strong manpower to deal with disaster affected population. They
can start their work before any specialist team reach to the society. Psycho dramatist worked
with a volunteer group after the Sidr and he felt that group was totally different from others
because they got some mental health related basic training before.
Psycho dramatist said that disaster is a big issue you cannot depends on professional only
where the number of specialist is very small. To take the challenge to deal with the disaster
you need to make a work force. We can work for it. In Bangladesh we have teachers training
institute for teachers. So when they take training we need to give them a mandatory session
for mental health issues. If you can provide at least the primary knowledge on mental health
they can handle the emergency situation primarily like natural disaster related mental health
problem. We can add mental health our national curriculum in school level as well. For the
disaster management we need to think about preparedness and the awareness about mental
health. This awareness can be start from the school. We can add psychology in school.
One of the respondents told that there was a research has done by NIMH about how to
include mental health issues from 6th grade to 10th grade which was a pilot project and it is
not implemented yet.
In disaster prone areas we can provide some mental health knowledge to community people
like member, imam, leader, school teacher and they can help others. We will provide training
for community focal point after that they will make small group and convey the message.

38
Professionals are outsider and they are not able to come immediately after the disaster. So we
can orient this mental health issues to young, social worker inside the community. If we can
provide some training to identify the mental health problem and how to handle it primarily,
they can be worked as alternative mental health staff. So when volunteer will do relief work,
rehabilitation works after the disaster they can do this mental health work simultaneously. If
they have knowledge they can handle it and can send or refer to mental health professionals
in case of severity.
Psychiatrist brought out that we can include army also mental health issues in disaster
management. After any disaster first response come from the army. They are a very
important manpower in Bangladesh if we arrange training for army it will be a great job for
disaster related mental health issues.
5 DISCUSSION
The study has given emphasis on some important aspect of cyclone and mental health issues
in Bangladesh and it has also explore the lack of mental health policy regarding natural
disaster. all of the participants explained their experience related to natural disaster and
mental health issues and they also expressed their opinion about the necessity of mental
health programme in Bangladesh.
5.1 Natural Disaster and It’s Impact on Mental Health
This study shows the sufferings of mental health problem of disaster affected people We find
that natural disaster has a strong effect on mental health due to this event sadness,
depression, depersonalization, PTSD symptom can be arise. The problem can be continuing
for several years. After one year of Sidr people frightened about any kind of sound which is
loud. Some people even frightened the strong loud voice of others. People can be emotionally
numb due to their loss. Sometimes the loss is so unbearable which makes people totally out
of control. They become mentally ill. People lost their hope of life, they do not have enough
motivation to do work. They just carry their life as object without any hope and dream.
A school base study on hurricane also showed the similar result of PTSD among adolescent
after one year of Hurricane Hugo (Garrison. C. Z et al 1993) in our result respondent
mentioned that the suicidal idea increases after the disaster which we find similar to the
research by Kar. N et al (2004) study result on Super-Cyclone 1999 in Orissa. After the
hurricane Katrina the rate of PTSD increased and it also higher among poor people. Those

39
people who experienced more stressor and property loss they were experience more mental
health problem.( Rhodes et al, 2010) this findings also similar to our result. Our result shows
that due to cyclone people are affected psycho socially in many ways. Researcher says on a
review report that tropical cyclone has behavior health effect which can be long term and
debilitate. (Shultz. M. J et al, 2005).
5.2 Who are Vulnerable?
Natural disaster makes people vulnerable but female are more vulnerable than man. After the
disaster if the girl lost her husband many people wants to misuse her. She can be victimized
by sexual harassment. WEDO (2008) also says that due to natural disaster women decreased
economic opportunities, increased vulnerability, increased violence, harassment and lack of
privacy, increased health risk and mortality risks, and increased responsibilities. In our
country people always think children are small so they do not have enough sense to
understand most of the things specially psychological things. If you give them shelter or food
that is enough for them. They do not understand the devastating event like cyclone has a big
impact on them. Even if they lost their parents by any types of terrible accident our people
still think that everything will be all right after few months. Children will forget everything
but in reality we know that children are identified as most vulnerable group for disaster like
cyclone. Reports on the Buffalo Creek dam collapse in 1972 showed that among 179 children
aged 2 to 15 who were exposed on that event had PTSD symptom after 2 years of the disaster
and the rate of PTSD symptom was higher among girls than boys.(Green. B. L et al, 1991)
Psychiatric reports of 179 children aged 2 to 15 who were exposed to the Buffalo Creek dam
collapse in 1972 were rated for post-traumatic stress disorder (PTSD) symptoms 2 years after
the disaster.
5.3 Shortage of Mental Health Professional and Ignorance of
Mental Health
We have the problem of shortage of enough mental health professional. Our mental health
team runs mainly by psychiatrist. We have very few numbers of psychiatrists in Bangladesh.
Most of the psychiatrist work for the urban area. Another problem is we have mental health
service only in tertiary level. That means our psychiatrist only work in divisional level
hospital and we have psychiatry Department for public medical college hospital. Our
administrative structure consists in Division, Districts, Upazila, Union, Ward and Village. So
most of the people are far away from the psychiatric treatment for normal time where as
disaster is special issue. When we have focused on the other mental health professional the

Managing mental health in natural disasters

Managing mental health in natural disasters

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