Post Earthquake and Tsunami Mental Health Care in Aceh

The 2016 Aceh earthquake struck the Indonesian island of Sumatra with a Mw of 6.5 in Aceh province on December 7, 2016. The shock was reported to be at a depth of 13 km, categorized as a strong, shallow earthquake. The epicenter was in Pidie Jaya Regency, 164 km (102 mi) southeast of the province’s capital, Banda Aceh. Approximately 104 people died in the quake, with at least 1,000 people injured.

Hundreds of people panicked and ran through the streets as the earthquake struck, with eyewitnesses stating that most people were crying and screaming as their memories of the massive 2004 earthquake were triggered. Hundreds of people evacuated to higher ground, fearing that a tsunami would occur. No tsunami occurred but the fear of one is ever present with memories of the previous disaster.

Mental health interventions are key to help disaster victims cope and adapt to the psychosocial trauma. Five days after the earthquake a psychosocial needs assessment was conducted in Pidie by the Ministry of Health’s Mental Health team and partners in collaboration with the Aceh Community Mental Health Nurses (CMHN) trained and developed after the 2004 tsunami. This was followed by a Psychological First Aid (PFA) intervention designed to assist victims.

On December 26, 2004, a 9.15 magnitude earthquake occurred off the western coast of the Sumatra Island of Indonesia in the Indian Ocean. During the earthquake, the seabed rose by as much as 20 meters in some areas—displacing an estimated seven cubic miles of water and causing tsunamis across the Indian Ocean.

The tsunamis, which it produced, killed some 230,000 people in 14 countries. The death toll in Aceh, Indonesia, was 126,741; 93,285 people were missing; 500,000 were displaced; and 750,000 lost their livelihoods.  The tsunami affected the city of Banda Aceh, Sumatra, (population approx. 400,000) and more than 100 villages on Sumatra.

The experience in Aceh has provided an invaluable lesson for Indonesia and the world in disaster response.

I was based in Indonesia in 2005, shortly after the tsunami. After a recent visit back to the country and the December earthquake, I find myself reflecting on the mental health aspects based on the experience of the Health Services Project (HSP) working three and a half years in Aceh. USAID allocated an additional USD 5.6 million for activities in Aceh.

HSP was given additional funds to work in Aceh after the tsunami. From 2005-2008 JSI staff worked closely with the Ministry of Health (MOH) to provide technical assistance for district planning and budgeting, facility reconstruction, advocacy, community mobilization, behavior change communication, supportive supervision, and improving quality of and access to health services.

HSP’s mental health and psychosocial program achieved its most ambitious goal: the successful development of a household-to-hospital continuum of mental health care in Aceh Besar.

But why is that important? What is different? Prior to HSP’s support, Aceh’s two psychiatrists and sole mental health treatment facility were located in Banda Aceh. The mental hospital was notorious for its overcrowded and under-resourced conditions. There was no mental health expertise at the district or sub-district level, and no community support for individuals with serious psychiatric disorders. Moreover, the civil conflict and tsunami had disrupted social structures that had historically provided support and protection to women and children, making them more vulnerable to psychosocial problems.

JSI’s assistance enabled three new levels of mental health and psychosocial care and support. First, through the project’s support to the community mental health nursing (CMHN) approach, which was developed in close collaboration with the MOH, School of Nursing at the University of Indonesia (UI), Aceh Besar DHO, Aceh Psychiatric Hospital, Asian Development Bank (ADB) and World Health Organization (WHO). The CMHN program established two trained mental health nurses per 30,000 residents, operating out of the sub-district health center (Puskesmas). Nurses attended a rigorous and highly structured training program, and then received intense supervision from senior mental health nurses from UI. At the village level, HSP also established psychosocial volunteers who identified and addressed issues facing women and children. Volunteers received technical support from a national nongovernmental organization, PULIH, as well as ongoing assistance from local Acehnese organizations. Finally, HSP built and equipped a 10-bed acute care psychiatric unit on the campus of the Jantho District Hospital, representing state-of-the-art standards for inpatient mental health care facilities.

HSP’s assistance resulted in psychosocial and mental health programming that is fully integrated into the Acehnese public health system structure, increasing replication potential. And because the technical and implementing partners for this initiative are established Indonesian agencies, JSI is hopeful the model can be replicated on a wider scale throughout the archipelago.

It came as no surprise that Aceh was chosen to host Indonesia’s Annual Mental Health Conference in June 2008. Over 400 mental health professionals gathered from across Indonesia, giving Aceh the opportunity to showcase its significant accomplishments in developing a human rights-based mental health system. To that end, the community mental health nursing system and the Jantho acute care psychiatric unit in Aceh Besar figured prominently. During a site visit to the Jantho unit, the Bupati (Mayor) introduced visitors to people who had received treatment through the new system. They spoke of how much their lives had changed, and noted that with families and communities alert to the best ways to offer care, there was renewed hope for all. The Aceh Declaration on Comprehensive Hospital and Community Mental Health Services, signed by conference participants, underscored the message of hope. The declaration takes a firm stand on “protecting the human rights of people with mental illness and their families [as] both a legal and ethical obligation and a government priority.”

It is significant that the psychosocial needs assessment which was conducted five days after the December 2016 earthquake and Psychological First Aid intervention included the Aceh Community Mental Health Nurses whose training was supported by JSI’s Health Services Project after the 2004 tsunami.

The Ministry of Health’s Mental Health team and partners collaboration with the Aceh CMHNs to provide emergency assistance to the earthquake victims is a clear reflection of the Aceh Declaration on Comprehensive Hospital and Community Mental Health Services.