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Additional Considerations

There are numerous other considerations when responding to disasters internationally. No article, book, or training program can answer all of the questions that come up for DMH providers in all of the unique and challenging settings in which they find themselves. Perhaps what is most important, then, is for well-trained DMH responders to have sufficient awareness to be able to identify and ask the questions, rather than making assumptions that may lead a responder down a non-helpful path. Examples of questions to be considered in developing this understanding include (Miller, 2012; Summerfield, 2004):

  • • How are tragedy and loss understood?
  • • How are risk and adversity faced and managed?
  • • What allows people to feel hopeful?
  • • What are acceptable reactions after a tragedy?
  • • What are acceptable ways to express distress?
  • • What are acceptable forms of help-seeing?
  • • What serves as just compensation?

Another frame for considering the appropriateness of Western response interventions in non-Western settings was proposed by Hanlon, Fekadu, and Patel (2014). These included feasibility, equity, sociocultural acceptability, contextually acceptable outcomes, and affordability. Feasibility involves ensuring that the intervention can be implemented and sustained appropriately with the existing mental health resources available in a given location. Equity refers to the importance of making services available to vulnerable and disadvantaged groups so as not to reinforce the inequalities that exist between and within communities. This may necessitate moving beyond what is convenient in order to overcome barriers to services for these groups. Sociocultural acceptability involves considering how the intervention fits, or does not fit, with the worldview of the people involved, including their conceptualization of the causes of disorders, patterns of helpseeking, and modes of intervention and healing. Relatedly, contextually acceptable outcomes refers to targeting the interventions toward outcomes that are meaningful and important to the people being helped; that is, while symptom reduction is often the focus of Western-designed interventions, this may be less important to the people receiving the intervention than other potential outcomes such as improved social relationships, poverty reduction, etc. Affordability in terms of both direct and indirect costs to individuals, caregivers, and health systems should be considered.

Finally, it is essential that DMH responders enter each setting with a sense of cultural humility in which they are aware of their own culturally embedded assumptions about the world, and then suspend those assumptions in order to understand the subjective experiences of the people they are there to help. This awareness of one's own cultural assumptions is difficult yet critical. As described by Edward T. Hall:

Culture hides much more than it reveals and strangely enough what it hides, it hides most effectively from its own participants. Years of study have convinced me that the real job is not to understand foreign cultures, but to understand our own.

(Hall, 1959, p. 39)

References

Bemak, E, & Chung, R.C.-Y. (2011). Post-disaster social justice group work and group supervision. Journal for Specialists in Group Work, 36, 3-21.

Brown, L.S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.

Chung, R.C.-Y. & Bemak, F.P. (2012). Social justice counseling: The next steps beyond multiculturalism. Thousand Oaks, CA: Sage.

Eaton, J., De Silva, M.. Rojas, G., & Patel, V. (2014). Scaling up for mental health services. In V. Patel, H. Minas. A. Cohen, & M. Prince (Eds.), Global mental health: Principles and practice (pp. 297-334). New York, NY: Oxford University Press.

Hall, E.T. (1959). The silent language. Greenwich, CT: Fawcett.

Hanlon, C., Fekadu, A.. & Patel, V. (2014). Interventions for mental disorders. In V. Patel. H. Minas, A. Cohen. & M. Prince (Eds.), Global mental health: Principles and practice (pp. 252-276). New York, NY: Oxford University Press.

Inter-Agency Standing Committee (2007). The IASC guidelines on mental health and psychosocial support in emergency settings. Geneva: IASC.

Miller. J.L. (2012). Psychosocial capacity building in response to disasters. New York: Columbia University Press.

Summerfield, D. (2004). Cross-cultural perspectives on the medicalization of human suffering. In G. Rosen (Ed.), Post traumatic stress disorder: Issues and controversies (pp. 233-247). New York, NY: Wiley.

Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York, NY: Free Press.

 
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