The manualized Mental Health Integrated Disaster Preparedness (MHIDP) intervention was developed and implemented in order to improve preparedness, mental health, and social cohesion. As part of the intervention, groups of 15-20 community members participate in 3-day workshops, each led by two local co-facilitators. Facilitators are lay mental health workers (Haiti) or junior clinicians (Nepal) employed by SLM and TPO, and trained and supervised by University of Colorado psychologists in partnership with local senior clinicians. Unique elements of MHIDP include:
- Small group discussion: Small group discussions involve community members sharing opinions and debating topics such as local idioms of distress, beliefs about the cause of mental disorder symptomology, related stigma for mental health, and local preparedness techniques, rather than simply receiving content from the facilitators.
- Experiential components: Experiential components include opportunities to practice new coping skills, such as breathing and relaxation techniques, and interactive and engaging means of sharing content such as a ‘hot potato’ game to teach community members about physiological reactions to stress.
- A peer-based framework: The peer-support approach entails creating numerous opportunities for community members to provide and receive social support regarding mental health needs and to encourage collective approaches to disaster preparedness.
The 3-day intervention curriculum is structured in the following format:
Day 1: Ground rules and the importance of the peer support framework are introduced, followed by discussion about types of psychosocial reactions to disaster-related stress and associated coping strategies (such as self-soothing and relaxation skills). Specific skills, including self-reflection, self-calming, grounding, mindfulness and muscle relaxation are practiced together.
Day 2: Participants continue the mental health and peer support focus by sharing stories about post-disaster “moments of safety” followed by an art-based activity entailing creation of culturally specific symbols of safety. The topic of disaster preparedness is introduced, including discussions regarding links between common cultural attributions for disasters and motivation for preparedness. Facilitators introduce common scientific explanations for disasters such as earthquakes and floods and share recommended preparedness strategies. This is done without discouraging pre-existing cultural and religious beliefs, or indigenous approaches to preparedness, which participants are encouraged to maintain alongside new information5.
Day 3: During the final phases of the intervention, participants work on providing disaster and mental health related peer support to one another, drawing on techniques associated with Psychological First Aid (PFA) through role-playing a variety of brief disaster scenarios. Day three also entails discussion about the impact of disasters on particularly vulnerable groups – children and those with more serious mental health challenges – and practical skills training for supporting these individuals. Finally, a “Tree of Hope” exercise is used to encourage individual goal-setting and future planning, and a “Forest of Hope” is constructed to demonstrate community-level resilience through collaboration. The workshop concludes with a “mini disaster simulation” in which participants demonstrate skills learned throughout the 3 days. During the closing ceremony, participants receive certificates and disaster preparedness materials and discuss achievements and next steps.