Addressing the mental health needs of those affected by the earthquakes in Türkiye

On Feb 6, 2023, two major earthquakes with magnitudes of 7·8 and 7·6 hit our country, Türkiye, as well as Syria, causing severe destruction and representing the European region's worst natural disaster in terms of death toll in over a century. Despite Türkiye being prone to earthquakes, we were not prepared for this disaster, as noted by Turkish doctor Bulut Ezer.1The LancetResponding to the Türkiye–Syria earthquake: what will it take?.Lancet. 2023; 401: 525Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Little progress has been made in disaster planning since the devastating 7·6 magnitude İzmit earthquake in 1999. Inadequate disaster preparedness and responses have led to massive losses of life and population movement, eroding our country's social and economic fabric. This disaster is also taking a heavy toll on our health system and causing unprecedented public health needs, including mental health problems. The trauma and stress associated with the İzmit earthquake had long-lasting negative effects on mental health, highlighting the importance of addressing mental health needs in the aftermath of natural disasters.2Başoglu M Kiliç C Şalcioglu E Livanou M Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: an epidemiological study.J Traum Stress. 2004; 17: 133-141Crossref PubMed Scopus (184) Google Scholar Considering the current scale of the destruction and associated population movement, how the mental health needs of affected people is responded to is of utmost importance to determine the success of the recovery process of our community. On the basis of the Inter-Agency Standing Committee guidelines,3Inter-Agency Standing CommitteeIASC guidelines on mental health and psychosocial support in emergency settings.https://interagencystandingcommittee.org/iasc-task-force-mental-health-and-psychosocial-support-emergency-settings/iasc-guidelines-mental-health-and-psychosocial-support-emergency-settings-2007Date: 2007Date accessed: February 19, 2023Google Scholar we propose a multilayered and multisectoral comprehensive action plan to guide mental health and psychosocial support activities in response to the current emergency. The first step should be to establish a coordinating body to monitor and guide the ongoing activities of multiple humanitarian agencies in the field. This should be initiated by local bodies (eg, the Turkish Ministry of Health) in the form of a disaster coordination working group, and it should include representatives from national and international organisations that work in health and related sectors. The second step should be assessment of mental health needs and should be done with locally adapted measures (eg, the Turkish adapted version of Symptom Checklist-90-Revised)4Dag I Belirti tarama listesi (SCL-90-R)'nin üniversite öğrencileri için güvenirliği ve geçerliği.Türk Psikiyatri Dergisi. 1991; 2: 5-12Google Scholar and in culturally appropriate ways to identify people at high risk of developing mental ill health. The needs of diverse communities, including Alevis, Arabs, and refugees in the affected area, should be carefully considered. Provision of training and strengthening of the local mental health workforce in emergency preparedness and response are essential, considering Türkiye's geographical position in a natural disaster-prone and conflict-affected area. Training should be provided as part of a curriculum of mental health education, including psychology, psychiatry, and social work. Since recovery from the current earthquakes will take years, the wellbeing of local mental health workers and the quality of their services should be supported by continuous supervision and training by experienced mental health professionals. Ongoing professional support and supervision will help to strengthen this workforce. To allocate resources effectively and ensure sustainability of mental health and psychosocial support activities, we suggest a stepped-care approach to service delivery during the recovery phase of the disaster. Stepped care involves a hierarchy of interventions: from scalable interventions provided by community mental health workers with no formal mental health education, to specialised treatments delivered by mental health professionals. After the acute phase of the disaster, survivors of the earthquake could be offered scalable interventions such as Self-Help Plus and Problem Management Plus—interventions developed by WHO for treating common mental health conditions such as post-traumatic stress disorder, anxiety, and depression—which can be offered in individual or group formats.5WHOmhGAP: mental health gap action programme: scaling up care for mental, neurological and substance use disorders. World Health Organization, Geneva2008https://apps.who.int/iris/handle/10665/43809Date accessed: February 19, 2023Google Scholar People whose symptoms of psychological distress do not decrease could be moved to the next level and offered specialised psychological treatments such as trauma-focused therapies. Implementation of this model requires meticulous planning and adaptation based on social, cultural, and economic needs that determine mental health outcomes. It is time to show what we have learned from the past and to prioritise mental health in disaster preparedness and response. We declare no competing interests. Responding to the Türkiye–Syria earthquake: what will it take?“Such things have always happened. It's part of destiny's plan.” The reaction of Recep Tayyip Erdoğan, Türkiye's President, to the devastating earthquakes that struck Türkiye and Syria on Feb 6, betrays a dangerous sense of fatalism, if not an active effort to deflect responsibility. As of Feb 14, the earthquakes have caused more than 35 000 deaths, and injured many more. As the chances of finding survivors under the rubble diminish, a second catastrophe is looming. The widespread destruction of buildings and infrastructure has left more than a million people homeless in Türkiye and displaced 5 million in Syria. Full-Text PDF