The devastating flood in the Bhote Koshi River has not only destroyed homes but also claimed lives across Rasuwa, Nuwakot, and Dhading districts. Many are still searching for their loved ones. Psychiatrist Dr. Sagun Ballabh Pant explains that fear, insomnia, and anxiety after such disasters are common reactions, but timely psychosocial support is essential. He suggests applying the principle of ‘Look, Listen, and Link’ to hear the affected individuals, understand their needs, and connect them with available services.
The catastrophic flood in the Bhote Koshi has swept away houses and lives in Rasuwa, Nuwakot, Dhading, and other affected districts. Many witnessed their spouses or children being carried away before their eyes. Numerous people continue to search anxiously for missing relatives. Survivors remain haunted by the trauma of the flood — suffering from sleeplessness, easily startled by minor sounds, with vivid flashbacks and dreams of lost loved ones. Such distress is not necessarily a sign of mental illness; rather, it is the mind’s natural abnormal response to an extraordinary situation. However, without timely listening, understanding, and support, these responses can develop into depression, anxiety, and severe mental health issues in the future.
In an interview with Pushparaj Chaulagain, psychiatrist Dr. Sagun Ballabh Pant discussed mental health and counseling needs following the disaster. Symptoms such as fear, insomnia, and anxiety have emerged among flood survivors. How should mental health be approached after major disasters? Those affected can be broadly categorized into two groups: first, individuals directly impacted who are recovering; second, those who have lost family members or themselves endured hardships. Additionally, police, military personnel, social workers, journalists, health professionals, and rescue teams may exhibit various psychological symptoms. Nevertheless, not all these symptoms should be classified as mental illnesses; many are normal emotional reactions given the exceptional circumstances.
Those who were directly involved, lost loved ones, or narrowly survived often experience grief. Losing family, home, and future prospects can induce feelings of despair, fear, and insecurity. These signs are not mental disorders and generally diminish over time. How should one communicate with those in grief after major incidents? People may enter an emotional shutdown called ‘denial’, wherein they may resist talking spontaneously. Many might not wish to share their pain with others. In such situations, forcing conversation is harmful. Patience and reassurance such as, “I understand you don’t want to talk now, but whenever you feel ready, I am here to listen,” can encourage them to open up when ready.
Psychological first aid principles involve ‘Look, Listen, and Link’. What does this mean? ‘Look’ refers to assessing the affected person’s immediate needs — food, shelter, family status. ‘Listen’ means patiently hearing what they express. ‘Link’ involves connecting them to necessary services and support, such as regular medication, clothing, and psychosocial assistance. The flood has also impacted children and persons with disabilities who require support like wheelchairs or other aids. How can children who lost their parents be assisted? They should be given factual, age-appropriate information. If all family members are safe, they must be told accordingly; if some have died, the truthful situation should be explained without false hope, as this can have long-term consequences. Children should be maintained within routines and provided immediate necessities. Since young children may not express feelings verbally, an environment that encourages expression through writing, drawing, coloring, or role play should be fostered.
Mental health issues in children are not always evident. Sudden behavior changes, startling during sleep, loss of appetite, or withdrawal may indicate distress. Forcing children to speak is counterproductive; they should be provided with a natural environment to share feelings. How to create such an environment? Regular routines, songs, dance, play, and entertainment opportunities are essential. If schools cannot operate, volunteers can conduct classes in tents or camps. What is the likelihood of long-term psychological issues? Current symptoms are not illnesses and might abate over time. However, persistent symptoms such as prolonged fear, hypervigilance, nightmares, hopelessness, and detachment might develop into serious mental health conditions. Therefore, immediate emotional and psychosocial support is crucial.
How can community, society, and government coordinate to reduce mental health problems? Those affected must feel supported by mutual aid. Communities should ensure no individual feels isolated. Local governments should activate structures to provide counseling, necessary assistance, and rehabilitation planning for affected families. Victims should be encouraged to adopt a positive outlook and actively participate in recovery. Festivals and holidays can amplify loneliness for survivors; hence, communities must sensitively engage them in social activities. Moreover, harmful content that aggravates trauma must be avoided on social media.
Some bereaved individuals have attempted suicide. How can we support people at risk? Previous experiences show that unified community support reduces suicide risk. Currently, relief and assistance have mitigated this problem. However, as relief diminishes after a few months and villages may become deserted, needs increase. Those who lost homes and families may question, “Why should I live?” increasing suicide risk. Hence, victims must share their suffering and openly discuss it with experts or counselors.
How to extend mental health services to the community? It is important to acknowledge that stress, fear, and insomnia experienced after disasters are normal reactions and to provide appropriate care and promotion within communities. Providing basic information to children as well as opportunities for play and recreation is vital. The message, “If you encounter problems, seek help; speak openly; you are not alone; we are here,” should be widely disseminated. Not only psychiatrists but also health workers, police, military, and volunteers can offer initial assistance. Confidential and well-organized counseling services at camps, community centers, and other public venues will be beneficial.
What is the first step in starting counseling? Recognizing that emotional responses are normal is essential. One can share feelings not only with psychiatrists but also with trusted confidants. Encouraging neighbors to ‘listen a little’ can be supportive. Crying is a valid emotional expression. Listeners should avoid prejudice or comparing pain as this can worsen distress. The key principle of current psychosocial support is ‘Look, Listen, and Link’ — carefully observe the person, patiently listen without rushing, and connect them with services.
How can survivors protect their own mental health? Self-care is critical for disaster survivors. Develop regular sleeping and waking routines. Keep the body active through walking and light exercise. Remaining idle and dwelling on sorrow can intensify psychological distress. Eat balanced, nutritious food. Practices such as meditation, yoga, or religious activities may calm the mind. Avoid negative content on social media; instead, engage with positive and hopeful material. Participating in group activities or camps helps foster comfort. However, if persistent sleep difficulties, loss of interest, or lethargy occur, confide in a trusted person and seek professional help as needed.
