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The World Health Organization’s Mental Health and

Psychosocial Support (MHPSS) Response after Typhoon


Yolanda (Haiyan): A Case Study

Submitted by:
Louin T. Adayo
11594454

Submitted to:
Dr. Cleo Calimbahin
Development Administration (DVS531M)
The World Health Organization’s Mental Health and Psychosocial Support (MHPSS)
Response after Typhoon Yolanda (Haiyan): A Case Study

I. Executive Summary

Mental health and psychosocial intervention in emergency situations are very important in the
Philippines. The country is one of the most disaster-prone in the world. Hundreds of natural
calamities have bombarded the country in the past decades and continue to do so until now. In the
wake of these natural disasters, the enormous costs do not only include physical and material
damages, but also psychological damages on the victims and survivors. They are as devastating
and far-reaching. Three years ago on November 8, 2013, Super Typhoon Yolanda, international
codename Haiyan, pummeled the central regions of the Philippines. This left a catastrophic toll
never before seen in the history of the Philippines. The impacts were of massive proportions with
6,293 deaths and a total of 16 million people affected. The disaster of the typhoon has particularly
exposed several loopholes in the Philippine Mental Health System. It was severely underdeveloped
that it could not respond adequately to the mental health needs of the affected people. The
Philippine Mental Health System had been weak and fragile even before the typhoon: severely
under budget, inadequate number of mental health workforce, scarce mental health treatment
facilities, insufficient psychotropic medicines, and inappropriate institutional-based, centralized
mental healthcare system. Basically, the status quo of the Philippine Mental Health System then
did not have the capacity to meet the burgeoning mental health needs of the affected populations
after Typhoon Yolanda. Foreign actors and non-government groups had to intervene to offset these
massive inadequacies of the country’s mental health system.

Before and after the disaster, the World Health Organization (WHO) worked hand-in-hand with
the Department of Health (DOH) of the Philippines to compensate the lacks of the Philippine
Mental Health System and provide the needed mental health and psychosocial support to the
survivors, among other priority health needs. WHO rolled out series of training of trainers among
frontline health workers and volunteers on the use of Psychological First Aid (PFA) as the primary
psychosocial intervention for the disaster victims and survivors. As a result, thousands of local
health workers were equipped with skills and knowledge in providing basic mental healthcare in
the community, not only during disaster situations. Because of WHO’s intervention, Region 8

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which was the hardest hit region during Typhoon Yolanda, consequently became the first region
in the country to provide mental healthcare in all three levels of healthcare one year after the
typhoon hit. WHO’s PFA and Psychosocial Intervention after Typhoon Yolanda targeted to
strengthen and improve the mental health services in the country, particularly in the affected areas:
integrate mental health into primary care, prioritize a community-based mental health system,
improve the mental health workforce, integrate PFA into humanitarian response, improve mental
health facilities and sources of medicines. WHO’s efforts and interventions have consequently
enhanced the mental health services in the Philippines, especially in the affected regions, to
provide adequate basic mental healthcare and psychosocial support all the time not only during
emergency situations.

II. Review of Related Literature

The Philippines has been vulnerable to calamities. The country was named one of the most
disaster-prone in the world by Germanwatch’s The Global Climate Risk Index of 2015. The claim
has been supported earlier by the World Risk Index Report of 2014, which revealed that 15
countries have the highest disaster risk worldwide, 8 are island states which includes the
Philippines (Alegado and Guadalupe, 2015). Located in the Pacific Ring of Fire, there are 300
volcanoes in the country, 22 of which are active. Also, 1,200 kilometers long, the Philippine Fault
Zone is one of the longest in the world and a source of earthquakes and seismic activities. From
the 1980s to 2010, there had been over 380 calamities that deluged the country (Conde, 2014).

Located in the Western Pacific Ocean, the country lies along the typhoon belt of the North Pacific
Basin in the Pacific Ocean where 75% of typhoons originate. Typhoons regularly develop from
these naturally warm ocean surfaces. Also as an archipelago, the country lacks natural barriers
against these storms. An average of 20 tropical cyclones enter Philippine waters annually with 8
to 9 typhoons making landfall. These trigger related disasters like landslides and massive flooding,
and cause enormous social and economic damages. With 36,389 kilometers of coastline, the
country is also vulnerable to storm surges and tsunamis. Coastal communities are particularly at
risk. Furthermore, with the threat of climate change and increasing ocean-surface temperature, the

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risks of these typhoons striking more off-season, more frequently, and more violently are
significantly exacerbated (The Climate Reality Project, 2016).

On November 8, 2013, Typhoon Yolanda, international codename Haiyan, hit the central regions
of the Philippines. It was a Category 5 tropical cyclone that achieved maximum sustained winds
of 195 miles/h (315 km/h). The typhoon created 15 to 19-foot storm surge that wiped out coastal
communities and villages. Yolanda was named one of the strongest tropical cyclones to make
landfall in recorded history (Santos, 2013). The typhoon caused a very enormous toll. 16 million
people were affected (3.4 million families) all in all. Hardest hit areas were in central Philippines:
Region 4A, 4B, 5, 6, 7, 8, 10, 11, and CARAGA. A total of 4.1 million people were displaced.
6,293 lives were lost. 28,689 people were injured. 1,061 went missing. 1.1 million houses were
damaged (551,000 were totally annihilated and the rest were partially damaged) (Counahan et al,
2015). The National Disaster Risk Reduction and Management Council (NDRRMC) reported that
the typhoon caused a total damage worth Php 89.6 billion (NDRRMC, 2014).

Even before Typhoon Yolanda hit, The World Health Organization (WHO) already offered
assistance to the Philippine government. WHO offered its full support to the Department of Health
(DOH) in its preparedness efforts. In a meeting by NDRRMC on November 6, 2013, WHO
convened with key operational agencies of the government, humanitarian agencies, and UN
agencies active in the country. On November 11, 2013, the Government of the Philippines declared
a national state of calamity in the provinces of Leyte, Samar, Iloilo, Cebu, Capiz, Aklan, and
Palawan. Simultaneously, within 72 hours since the typhoon hit, the WHO Representative chaired
the first meeting for the Health Cluster coordination. WHO partnered with DOH and both became
co-leaders of the Health Cluster that would provide the health needs of the hard hit areas. Both
organizations would work on giving emergency healthcare services and establishing a long-term
rehabilitation of health services for the affected populations as well (WHO, 2014). Because of the
scale and complexity of the Yolanda disaster, WHO mobilized a Grade 3 response - the highest
internal emergency category which required an organization-wide mobilization of support for the
country. Emergency operations were activated in all 3 levels of the WHO: WHO Philippines
(designated as Emergency Management Team), WHO Western Pacific Regional Office
(designated as Emergency Support Team), and the WHO Headquarters (WHO, 2014). In addition,

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experts and staff especially from donor countries who donated money to the organization, and
other international non-governmental organizations (INGOs) and groups joined the WHO
Emergency Team.

One of the top priorities identified by WHO where it would provide immediate and urgent
healthcare needs to the affected population is mental health and psychosocial support. Other
priority areas included obstetric and neo-natal care, trauma care, chronic conditions, infectious
diseases, and management of the deceased. The organization believed that people, during and after
emergencies, are at a greater risk of suffering from a range of mental health problems. Hence,
WHO committed in strengthening and scaling up the provision of mental health and psychosocial
support to the affected population. (WHO, 2004). By November 22, 2013, WHO had a total of
$348 million funding requirements for its Philippines Typhoon Haiyan-Yolanda Action Plan. Of
the $38,066,310 allotted for the Health Cluster, $3,000,000 was the initial budget for mental health
and psychosocial support intervention in affected populations (WHO, 2013).

The Philippine Mental Health System

Even before Typhoon Yolanda, the Philippine Mental Health System had been in a weak and
fragile state already. The country is faced with scarce resources that would aid in disaster response
and coping. A WHO Assessment Instrument for Mental Health Systems (AIMS) 2007 Report
showed that only 5 percent of the total health budget in the Philippines is allocated to mental health.
A significant portion of this allocation only goes to the operation and maintenance of mental
hospitals. In 2014, the DOH budget was P80.17 billion, however, the bulk was spent for the cure
and treatment of communicable diseases or the visible diseases. Non-communicable diseases like
mental disorders only got scarce budgetary allocations. Discussions on the budget allocation for
2015 did not mention mental health. Also in 2016, despite the 41 percent increase in the DOH
budget, the support given to mental health services, operation, and facilities was still little (Mogato,
2016). Carolina Rayco, a program manager of the Philippine Mental Health Association (PMHA),
a non-profit and private mental health advocacy organization, said that there would be more people
doing things for mental health if there is a budget for it. Such budget would enable DOH and other
mental health advocacy groups to train frontline mental health workers, to improve the mental

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health system, and to raise awareness about the importance of mental health across the country
(The Manila Times, 2014).

On top of the lack of financial resources, human resources for mental health are also severely
inadequate. In 2014, there were only 490 psychiatrists in the country catering to more than 100
million Filipinos (Fransisco, 2014). That is 0.46 psychiatrists per 100,000 population ratio. The
distribution of psychiatrists is also unequal, with majority of psychiatrists concentrated only in
large urban areas. Remote and rural areas do not even have mental health professionals and do not
have access to basic mental health services. Table 1 shows the rate of the rest of the mental health
workforce per 100,000 population in 2014.

Table 1. Mental Health Workforce


(rate per 100,000 population) in 2014

Psychiatrists
0.46
0.85 Other medical doctors

Nurses
0.07
Psychologists

Social workers

0.49 Occupational therapists

0.06
0.07 0.07 Other mental health workers

Source: Philippine Mental Health Atlas country profile (WHO, 2014)

Table 2 shows that there is only a 0.49 psychiatric nurse per 100,000 population ratio in the
country, 0.49 psychologists per 100,000 people, 0.07 other medical doctors (not specialized in
psychiatry) per 100,000 people, 0.07 social workers, 0.06 occupational therapist, and 0.85 other
mental health workers ((including auxiliary staff, non-doctor/non-physician primary health care
workers, health assistants, medical assistants, professional and paraprofessional psychosocial
counselors). In total, there is only a 2.0 mental health worker per 100,000 population ratio in the

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country (WHO, 2014). Moreover, only 5% of the general practitioners in the country have
knowledge on the management and assessment of common mental health disorders like depression
(Fransisco, 2014). The number of mental health personnel in the country is enormously inadequate
to serve the mental health needs of the Filipinos.

Furthermore, mental health facilities in the country are also significantly insufficient for the mental
health needs of the people. They are unevenly distributed too. Of the 5,465 psychiatric beds allotted
by the DOH, the National Center for Mental Health in Mandaluyong City already has the bulk
with 4,200 beds. The rest of the 1,265 hospital beds for mental disorders are distributed to the rest
of the country. The ratio is only 4.9 psychiatric inpatient beds per 100,000 population in the
country and annual admission for inpatient care is at 6.7 per 100,000 population (WHO, 2014).
Six Regions - Ilocos, Calabarzon, Davao, Northern Mindanao, ARMM, and CARAGA, which has
over 31 million people, do not even have inpatient psychiatric facilities (Shahani, 2014). In the
wake of Yolanda, Tacloban City’s Eastern Visayas Regional Medical Center (EVRMC) Psychiatry
Department did not even have in-house capacity. The hospital only maintained a small clinic for
outpatient consultation and counseling. Even those suffering from psychosis and already
displaying violent behavior were still treated as outpatients (Torres, 2014).

Table 2. Mental Health Treatment Facilities in the Philippines (2014)


Inpatient care (total facilities)
Mental hospitals 3
Psychiatric units in general hospitals 14
Residential care facilities 15

Outpatient care (total facilities)


Mental health outpatient facilities 46
Mental health day treatment facilities 4

Source: Philippine Mental Health Atlas country profile (WHO, 2014)

Table 2 shows that there are only 3 mental hospitals for inpatient care in the Philippines. Also,
only 14 general hospitals have psychiatric units available. The total number inpatient residential
facilities are only 15. As for outpatient care, there are 46 mental health outpatient facilities in the
country and there are only 4 mental health day treatment facilities existing. (WHO, 2014)

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Moreover, the country lacks an enabling national mental health law. There is no mental health
legislation and law that would comprehensively govern the provision of available, equitable,
accessible, affordable, and quality mental healthcare and services, the promotion of mental health,
the protection of the rights of people suffering from mental disorders among others. Segmented
polices guiding the provision of mental health services exist. These standalone policies are part of
promulgated laws like the Magna Carta for Disabled Person, Penal Code, Family Code, and the
Dangerous Drugs Act. However, there is still an absence of a standalone mental health law. Several
mental health bills were passed in the legislative houses in the past, but they never pushed through
(The Manila Times, 2014). The Philippines remains as one of the few countries in the community
of nations without a national law tackling mental health problems (Mogato, 2016).

Furthermore, treatment of mental disorders in the Philippines is still largely centralized and
institutional-based. Institutionalization and admission to mental asylums remain as the image of
mental health system in the country. Solitary confinement opens significant risks of impinging on
the human rights of the patients. Available studies also show that if a case is not advanced and
severe, extended isolation and seclusion that comes with institutionalization aggravates a patient’s
condition. This mental healthcare set-up also encourages stigma against patients (Shahani, 2015).
Alternatives to institutionalization like community-based treatment should be developed. 98% of
common mental health problems could be treated in home and community settings. The
institutional image of mental health has to change. The provision of more short-stay units or acute
psychiatric units for the care of the seriously ill and more community-based care must be
strengthened (Meshvara, 2002).

Mental Health and Psychosocial Support (MHPSS)

During humanitarian emergencies like natural catastrophes, the prevalence of mental disorders in
a population increases by 6-11%. It is not uncommon in emergency situations that mental health
and psychosocial problems develop in affected populations. People who were exposed to life-
threatening situations, people who lost key social connections like families and friends, and
individuals who experienced trauma are at a greater risk of developing mental disorders. Mental
health conditions like post-traumatic stress disorder (PTSD), disaster-induced depression, anxiety

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disorders are triggered in humanitarian disasters (WHO, 2014). Also, natural disasters like
Typhoon Yolanda wash away maintenance medication for those with existing mental health
problems. Hence, people with pre-existing mental disorders are at a significant risk of relapse
because of non-medication. (Geronimo, 2014).

Furthermore, the number of people suffering from severe mental health problems like psychosis,
severe anxiety, and disabling depression could increase by up to half, from a baseline of 2-3% on
an average (WHO, 2014). A year after Yolanda, WHO diagnosed an estimated 800,000 people
suffering from different forms of mental disorders. 80,000 of them needed further psychiatric
support and assistance (Geronimo, 2014). Even seven months after the typhoon, a number of locals
were mindlessly roaming the streets. Some were greasy, some naked, and some were decent-
looking. Others preferred to sit and stand only in one corner, unmindful of the scorching heat or
rain. Dr. Lyn Verano, the chairperson of the Psychiatric Department of the Eastern Visayas
Regional Medical Center (EVRMC) located in Tacloban City, validated that psychiatric cases were
rising after the typhoon. Most of the cases of EVRMC were from the provinces of Samar, Leyte,
and Biliran. Cases ranged from depression to schizophrenia. (Torres, 2014). Table 3 shows the
increasing trend of psychiatric cases in EVRMC after the typhoon hit central Philippines.

Table 3. Psychiatric Cases in EVRMC (Leyte, Samar, and Biliran Provinces)


Jan. 2013 Nov. 2013 Dec. 2013 Jan. 2014 Feb. 2014 March 2014
512 212 205 227 370 475
(GMA News, 2014)

In January 2013, 10 months before the typhoon, there were 512 psychiatric cases recorded by the
hospital. The figures went downward towards November 2013 when Yolanda struck. However,
cases were rising from 227 in January 2014 to 370 in February 2014 to 475 in March (GMA News,
2014). The rising pattern is in line with the belief that common mental disorders after disasters
including depression, post-traumatic stress disorder, and anxiety manifest 3-6 months after a
disaster (Geronimo, 2014). Moreover, although not everyone will develop persistent mental health
problems after a disaster, there are still a number of individuals who will experience trauma

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responses like anxiety and depressive disorders. Hence, it is imperative to treat those with chronic
and enduring symptoms (Chaparro and Mitchell, 2015).

WHO collaborated with DOH to implement the use of Psychological First Aid (PFA) in all affected
areas. PFA is different from psychological debriefing as the former is done by encouraging
listening and then identification of symptoms that need further specialized services. The latter is
done by encouraging the victims to recall details of a psychologically traumatic event. Available
studies show that psychological first aid is more effective and less intrusive. (WHO, 2014).

WHO stepped in with its partner DOH to offset the severe inadequacies in the mental health
services in the affected regions. WHO assisted DOH in the following areas: A) Coordinating of
MHPSS activities, B) Providing PFA training to local health workers and setting up of MHPSS
groups to address the mental health conditions produced by the disaster, C) Purchasing of
psychotropic medicines, and D) Providing pre-fabricated outpatient clinics in key areas to reduce
overcrowding in mental health in-patient areas and improve privacy (WHO, 2014).

Moreover, apart from WHO and DOH, other UN agencies, NGOs, academic institutions, faith-
based groups, and individual citizens stepped in to fill in the gaps in providing additional mental
health and psychosocial support to the affected people. By December 2013, WHO held workshops
with DOH entitled, “Public Mental Health in Humanitarian Emergencies for Adults and Youth”
The Role of Psychology”. A further document to guide practitioners was produced after. This
guide on psychological first aid was developed by WHO and its partners to guarantee that the best
practices and standards are consistently applied in humanitarian settings. The guide was made in
order for WHO and its partners to do better for mental health of disaster affected populations.
Then, WHO distributed copies of this guideline to key NGO networks, national professional
organizations, and government representatives. Simultaneously, WHO rolled out a series of
training for trainers on PFA. Contrary to its name, psychological first aid covers both
psychological and social support (WHO, 2016). Dr. Ronald Law, a DOH mental health specialist,
stated that PFA is a practical and powerful tool, that it is something to be disseminated to all health
workers in the country (WHO, 2016).

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By March 2014, WHO had been implementing core and supplemental training on the Mental
Health Gap Action Program (mhGAP) in Tacloban and Ormoc to primary healthcare doctors and
nurses. mhGAP is the larger global drive of WHO to strengthen services for mental, substance
abuse, and neurological disorders especially for low- and middle-income countries. Also, WHO
supported work that provided extended care including outpatient facilities and multidisciplinary
training. One year after Typhoon Yolanda hit, WHO was able to train 300 community workers and
70 health professionals in MHPSS (WHO, 2014). By December 2014, more than a year after the
disaster, the Eastern Visayas Region (Region 8), which was the hardest hit region after Yolanda,
became the first region in the Philippines that had the capacity to provide mental healthcare at all
three levels of healthcare (WHO, 2014).

WHO’s MHPSS intervention has positively influenced the national mental health system and the
those particularly in the affected regions. DOH has requested WHO to roll out PFA trainings all
over the country and to possibly help in overhauling the entire Philippine mental health system.
WHO has supported the National Program Committee for Mental Health on policy development
and implementation. This included curriculum development, mental health legislation, information
systems for mental health, improving the drug supply and the provision of inpatient beds. WHO
also provided policy support and technical assistance in the selection, procurement, storage, and
distribution, and use of mental health medicines. All stakeholders have hoped that all the works
and responses to the Yolanda disaster will inspire a consequent improvement in the mental health
services in the country (WHO, 2014). Furthermore, WHO and its partners target that all frontline
workers in all regions of the country will be capable of providing basic mental healthcare and
psychosocial support (WHO, 2014).

The Psychological First Aid (PFA)

In the past decades, there has been an increase in research on the appropriate mental health and
psychosocial support intervention for survivors of disasters. The Inter-Agency Standing
Committee (IASC) proposed the Pyramid for Mental Health and Psychosocial Support for
Emergencies.

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The first step at the bottom of the pyramid and the most basic intervention is ensuring the basic
needs, safety, and wellbeing of the survivors. The second step is providing intervention to
survivors displaying mild to moderate psychological reactions to the trauma they have been
exposed to. Family and community response service like family reunification, supportive parenting
programs, provision of livelihood, formal and non-formal education activities, mass
communication on constructive coping methods, community healing ceremonies, and activation
of social networks (like youth clubs and women’s groups) are all examples of these interventions
for the second phase. The third step of the pyramid suggests interventions that provide focused but
non-specialized care (either individual, family, or group interventions) to survivors who may still
be suffering from mild to moderate mental health disorders. These interventions include basic
mental health care or PFA. The top of the pyramid, the last step are specialized services provided
by psychiatrists and/or psychologists to survivors with more advanced and severe psychological
cases (Hechanova et al., 2015). See Table 4 below for the Pyramid for MHPSS for Emergencies.

Table 4. The Pyramid for Mental Health and Psychosocial Support for Emergencies

Professional treatment
Severe psychological
by psychologists or
disorders
Specialized psychiatrists
services

Focused (person-to- Individual, family, or


Mild, moderate
person) non-specialized group interventions
health disorders
PSYCHOLOGICAL FIRST AID
support

Mild psychological distress that


are natural reactions to the crisis
Community and family support

General population Providing basic needs, safety, and security


affected by the crisis Basic services and security

(Hechanova et al., 2015)

In WHO’s Psychological first aid: Guide to field workers, PFA is described as a supportive,
humane response to someone suffering and someone who may need support. PFA is a practical

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support process and a psychosocial intervention for survivors. It involves helping victims feel
calm, comforting survivors, and boosting their self-efficacy. (a) Promoting sense of safety, (b)
promoting calming, (c) promoting sense of self- and community efficacy, (d) promoting
connectedness, and (e) instilling hope are the five core principles that facilitate positive adaptation
after trauma where PFA is based from (Hechanova et al., 2015). Eight steps are needed to
accomplish these core principles. They are contact and engagement, safety and comfort,
stabilization, information gathering, practical assistance, connection with social support,
information on coping, and linkage with collaborative services (Brymer et al., 2006). On the other
hand, WHO summarized PFA into 3 action principles (3Ls): look, listen, and link. Look includes
checking for safety, checking for people with urgent basic needs, and checking for people with
serious distress reactions. Listen involves approaching individual needing support, listening and
helping people feel calm, and asking about survivors’ needs and concerns. Lastly, link involves
assisting people meet their basic needs and access services, providing essential information,
helping people cope with problems, connecting survivors with key social support and loved ones,
and helping people connect to further services (WHO et al, 2011).

PFA is deemed to be more effective, more humane, and non-intrusive compared to psychological
debriefing or professional counseling. With PFA, survivors are not asked to recall and analyze
events that happened and put them in a timely, chronological order. An increasing number of
studies show that psychological debriefing slows down the recovery process of disaster survivors
and is counterproductive. With literatures showing the positive implications of PFA, it is now the
favored psychosocial intervention during post-disaster emergency phase (WHO et al., 2011). After
the Haiti Earthquake in 2010, PFA had been found to be an empowering and useful psychosocial
support for victims and survivors. Likewise, after Hurricane Katrina in 2005, PTSD scores of
children who were given PFA were significantly reduced. The children who were provided with
PFA thought that it helped them a lot. Additionally, in the aftermath of Hurricane Gustav in 2002
and Ike in 2008, responders felt that PFA was an appropriate intervention for responding. They
even recommended it to be used in future disaster response (Hambrick et al., 2014). Contact and
engagement, safety and comfort, and practical assistance were the core actions perceived as the
most useful to survivors (Allen et al., 2010).

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PFA is typically done individually. However, group PFA is also possible. It can be done in group
settings as well. In group PFAs, survivors are able to share their experiences that eases their
negative reactions to the trauma they have been through. Survivors are also able to give and receive
mutual support in group sharing. Psychosocial intervention provided in group settings is found to
also have immediate positive effects on individuals. It has been found that PTSD symptoms are
significantly reduced in the long run. In the Philippines, government worker-survivors after
Typhoon Yolanda, who were provided with group-based PFA, showed significant increase in their
pre- and post-test scores on coping skills and self-efficacy. The participants remarked that the
group PFA enabled them to share stories with people who have been through the same ordeals and
experiences. The components cited as the most useful in the intervention were psycho-education,
the PFA process, the use of group sharing, and the practice of mindfulness (Hechanova et al.,
2015).

The concept and use of PFA in the Philippines is relatively new. There is still little literature about
the availability of PFA in the country. Also, evidence on its use and effects is still limited. It was
only in 2013 when the advocacy for the use of PFA in the Philippines started. When WHO issued
a warning that year on the negative effects of the use of single-incident stress debriefing after
disasters, the Psychological Association of the Philippines (PAP) summoned its responders to use
PFA. Other responders received training on PFA from WHO. The use of Critical Incident Stress
Debriefing (CISD) has been found to agitate survivors as observed by first responders from PAP
who were stationed in the Villamor Airbase operations. Responders adopted the IASC Guidelines
on Mental Health and Psychosocial Support (MHPSS) in Emergency Settings and began the use
of PFA. It was emphasized that PFA and psychosocial interventions should be part of integrated
and long-term solutions and should not only be band-aid and stand-alone solutions. The use of
PFA, which is a flexible process, also has to put into consideration the religious affiliation, race,
culture, differing language, and ethnicity of survivors (Hechanova et al., 2015). A survivor’s
rituals, spiritual and religious beliefs are important in easing their suffering during crisis situations.
It provides meaning to their experience and it gives them comfort and hope (WHO et al., 2011).

There were a number of challenges faced by PFA responders. They were: (a) lack of conducive
venues for the delivery of PFA, (b) lack of referral mechanisms for serious cases and for follow

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up, (c) limited number of trained PFA responders, (d) linking with services, and (e) lack of an
adequate strong disaster response system (Hechanova et al., 2015).

The lack of conducive venues for PFA was one of the challenges reported by responders. PFA
facilitators cited that they had difficulty providing psychosocial intervention in many areas because
of noise. Another challenge was that PFA was not sufficient for people with severe psychological
disorders. Other respondents reported that there was a lack of protocol on what to do for people
who need more specialized services. Vulnerable and at-risk individuals needed to be referred to
other services. However, there were faced with no referral systems and mechanisms for
documentation or follow-up. Another challenge was the insufficient number of people trained to
provide PFA. Respondents had to facilitate group-based PFA to assist as many survivors as
possible. Furthermore, linking with services was also a challenge. Due to poor networking in
government agencies, responders reported that they had difficulty linking survivors to agencies.
WHO describes that a major part of PFA is linking survivors with practical support and social
support like appropriate agencies and family (WHO et al., 2011). Lastly, the lack of a systematic
disaster response system was a hurdle for responders in the delivery of PFA. It limited the focus
and support the responders can give to the survivors. People were running around because they
had to provide psychosocial support and practical assistance at the same time (Hechanova et al.,
2015).

Lastly, responders could summarize the reactions of the survivors on the conduct of PFA into
three: physical and behavioral, cognitive, and emotional. First, expression of gratitude, a change
in their facial expression, and smiling were some of the physical and behavioral reactions among
the survivors after the PFA session. Responders reported that survivors have become more
positive. They were smiling and expressing gratitude immensely as they thought there were people
available to listen and care for them. The knowledge that their needs and concerns were heard
provided them relief. Another reaction responders have noticed is the gradual cognitive change
among the survivors. They were able to understand that their stress reactions to the disaster were
normal. They were able to accept the loss of their loved ones. Survivors have acknowledged that
they were caught unprepared by the calamity, however, they believed that they will be okay. They
had a ‘mas kaya ko na ngayon’ (I can do this) mentality. In particular, survivors were able to

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rethink how they see themselves, from being victims to survivors. Lastly, changes in emotions
among survivors were also observed by the responders. Survivors displayed emotions of relief,
hope, and gratitude as a result of PFA. Stress and burden among them were lessened. The feelings
of hope among survivors could be attributed to the fact that there was available help when they
needed it and that there were people who will care for them (Hechanova et al., 2015).

In Barangay Anibong, Tacloban City, responders facilitated PFA and other psychosocial activities
particularly among mothers who lost their child/children and/or other loved ones after the typhoon.
They conducted PFA and psychosocial activities for 6 months starting a week from the disaster
until June 2014. After attending PFA sessions for months, responders observed that mothers were
able to accept the loss of their family members. They overcome their fears and they felt safer.
Before they were always deep in thoughts and spaced out. However, after PFA and psychosocial
sessions, they had improved levels of energy and happiness. They went back to their normal lives.
A lot of mothers even became more amicable with others mothers who were attending the sessions.

III. Results and Conclusion

The country’s mental health system and facilities, particularly in Region 6, 7, and 8, had been
weak and fragile already even before the typhoon. Worse, after typhoon Yolanda hit, the existing
services and facilities were further reduced and destroyed while the mental health needs of disaster
survivors and victims were growing day by day. The mental health system and services in the
Philippines, especially in the most affected areas, were hugely underdeveloped, under budget,
massively lacking adequate human resources, medicines, treatment facilities, and appropriate
psychosocial response during emergencies. In short, it did not have the capacity to meet adequately
the burgeoning mental health needs of the affected people.

With the intervention and aid of the World Health Organization, alongside other international
organizations and groups, the Department of Health was supported to meet the growing needs of
the people. WHO, who firmly believes that mental health is as important as physical health, began
working to promote community-based mental health and integrate mental health skills into the
primary health care system. WHO believes that 98% of common mental health disorders could be

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treated in home and community settings. The organization rolled out trainings on the conduct and
delivery of psychological first as the primary psychosocial intervention and basic mental health
care for emergencies. Moreover, WHO trained a large number of community workers and local
health professionals in the identification, treatment, and support of people with mental health
problems. As a result of WHO’s efforts, 300 community workers and 70 health professionals were
trained in Mental Health and Psychosocial Support (MHPSS) one year after the disaster. Also by
December 2014, the Eastern Visayas Region (Region 8), the hardest hit region, became the first
region in the Philippines to provide mental health care in all three levels of health care (WHO,
2014). After this, WHO together with the DOH and other health partners continued to train 1,200
more community workers and health professional to further address the mental health needs of the
typhoon affected areas.

Dr. Socorro Campo, a health officer in the municipality of Salcedo in Eastern Samar was one of
the first trainees of the trainings rolled out by WHO. She said that, “Before, I would have to send
people hours away to get treatment but now, we are able to treat people in our own community
who we know and are close to. Jimmy Sabulaw was one of Dr. Campo’s patients who struggled
with a mental health problem. He was out of job when he started seeing Dr. Campo and could not
sleep every time it started to rain. Dr. Campo would talk to him every week and give him
medication. As a result, Jimmy started working again and delivered water within his community.
Jimmy’s situation is evidence that when survivors feel safe, connected and calm, and have access
to support and services, and feel that they are able to help themselves after a disaster will be able
to recover long-term (WHO, 2016).

The mental health and psychosocial efforts undertaken by WHO in Regions 6,7, and 8 have made
positive impacts at the national level consequently. The program of WHO had positively
influenced the operation and design of the national mental health system. The DOH secretary at
that time requested WHO to work with them to roll out the trainings nationwide. Moreover, DOH
and WHO also worked together on a proposal to overhaul the whole mental health system in the
country. The psychological first aid and mental health and psychosocial program of WHO, indeed,
have come a long way. It has made lasting positive effects, not only in the areas affected by
typhoon Yolanda, but in the entire country as a whole.

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