Cli­mate ac­tion must tackle men­tal health

Philippine Daily Inquirer - - FRONT PAGE - —STORY BY JHESSET O. ENANO

The dam­age wrought by Su­per­ty­phoon “Yolanda” goes be­yond the phys­i­cal. Men­tal health and cli­mate ex­perts agree that for the Philip­pines, one of the coun­tries most vul­ner­a­ble to the cli­mate cri­sis, fac­tor­ing men­tal health into the con­ver­sa­tion is im­per­a­tive for cli­mate ac­tion. Yet for many Filipinos, men­tal health is of­ten merely equated with those who have no men­tal dis­or­der or don’t pose a dan­ger to so­ci­ety.

(Last of two parts)

Nearly two years af­ter Su­per­ty­phoon “Yolanda” (in­ter­na­tional name: Haiyan) slammed into Tacloban City in Novem­ber 2013, Arthur Go­long was no longer afraid of storms. But she had be­come fear­ful of her own mind.

The gay hair­dresser is not sure how it started, but in Feb­ru­ary 2015, she no­ticed cer­tain signs. She was pick­ing up lit­tle things from the ground, like crawl­ing ants. She was hav­ing chills at night, when she could hardly sleep be­cause of an un­con­trol­lable urge to pee. Then there were days when she couldn’t stop walk­ing, even with no des­ti­na­tion in mind.

Lab tests all came back nor­mal. But dur­ing re­search on her symp­toms on the in­ter­net, she was fi­nally able to name what she was ex­pe­ri­enc­ing: anx­i­ety and post­trau­matic stress dis­or­der.

“At that time, I was al­ready telling my sib­lings: When I be­come crazy, just kill me,” she re­calls, six years af­ter Yolanda struck. “I don’t want them to know that Arthur, their com­mu­nity leader, had gone in­sane.”

For Go­long, it was the ter­ri­fy­ing mem­o­ries from sur­viv­ing Yolanda, one of the world’s most pow­er­ful ty­phoons, that trig­gered her be­hav­ioral change. De­spite the psy­cho­log­i­cal ser­vices given to sur­vivors, the 43-year-old is among the hun­dreds, if not thou­sands, who had not re­ceived ad­e­quate men­tal health care im­me­di­ately and years af­ter the storm. (See re­lated sto­ries on Page A8)

She bus­ied her­self with work in their com­mu­nity, but in time she re­al­ized that her fear and trauma had been brew­ing in her head like an­other storm on the hori­zon.

Sound­ness of mind

Wors­en­ing ex­treme weather and se­vere slow-on­set dis­as­ters linked to cli­mate change are ex­pected to af­fect pub­lic health in pro­found ways. But while its im­pacts on phys­i­cal health are clear, such as the ris­ing cases of dengue fever in re­la­tion to warm­ing tem­per­a­tures, its equally pro­found ef­fect on men­tal health is yet to be fully dis­cussed.

Both men­tal health and cli­mate ex­perts agree that for the Philip­pines, one among coun­tries most vul­ner­a­ble to the cli­mate cri­sis, fac­tor­ing men­tal health into the cli­mate con­ver­sa­tion is im­per­a­tive for cli­mate ac­tion.

Psy­chi­a­trist June Pa­gad­uan Lopez says that for many Filipinos, men­tal health is of­ten merely equated with those who have no men­tal dis­or­der or who do not pose a dan­ger to so­ci­ety.

“But when you speak of men­tal health, it’s well-be­ing of the mind,” Lopez says. “It’s be­ing able to cope with the ad­ver­si­ties of life; [it’s hav­ing] that strength, the re­silience, to deal with these chal­lenges in the most ap­pro­pri­ate, pro­duc­tive and cre­ative way.”

Due to this re­al­ity, it re­mains “very dif­fi­cult for peo­ple to un­der­stand that men­tal health is in the core of sur­viv­ing all our chal­lenges re­lated to cli­mate change,” she says.

In­di­rect im­pact

Med­i­cal doc­tor Glenn Roy Paraso, a mem­ber of the Na­tional Panel of Tech­ni­cal Ex­perts of the Cli­mate Change Com­mis­sion (CCC), says the ef­fect of cli­mate change on men­tal health may be in­di­rect, thus harder to mea­sure. For ex­am­ple, a strong storm can cause the loss of lives, which can be eas­ily counted. But the ef­fect of los­ing loved ones on sur­vivors or the chang­ing weather pat­terns on the men­tal well-be­ing of farm­ers and fish­ers and their liveli­hood and eco­nomic and food se­cu­rity is much harder to mea­sure.

These in­di­rect im­pacts have longer and last­ing ef­fects that can go be­yond a sin­gle event, Paraso says.

While acute stress is a com­mon re­ac­tion to ad­verse weather events, it may de­velop into chronic psy­cho­log­i­cal con­cerns if left un­treated. Some dis­or­ders may also crop up years af­ter the dis­as­ter, as in Go­long’s case.

“We had stress de­brief­ings af­ter Yolanda, but when you re­turn to your home—if you still have one—you won’t even re­mem­ber what you did [in those ses­sions],” Go­long says. “You will just see how poor your con­di­tions are. You will be left to won­der what will hap­pen to you in the fu­ture.”

For­tu­nately in her case, a team of psy­chol­o­gists had been vis­it­ing their com­mu­nity when her symp­toms emerged. Go­long says she was un­sure what her fate would have been if she hadn’t re­ceived their help.

Ab­sent in cli­mate plan

De­spite these re­al­i­ties, men­tal health and psy­choso­cial ser­vices re­main largely ab­sent in Philip­pine cli­mate ac­tion pro­grams.

Green­peace South­east Asia ex­ec­u­tive di­rec­tor Yeb Saño, a former CCC com­mis­sioner, says that while the im­pact of cli­mate change on men­tal health has been gen­er­ally dis­cussed in the coun­try’s cli­mate adap­ta­tion plans, there is still no “very com­pre­hen­sive pro­gram” that ad­dresses men­tal well-be­ing in the con­text of a chang­ing cli­mate.

Most of the dis­cus­sions then, he said, had also been cen­tered on post­dis­as­ter re­sponses to psy­cho­log­i­cal needs.

A look at the Na­tional Cli­mate Change Ac­tion Plan for 2011-2028 re­veals that men­tal health and psy­cho­log­i­cal well­be­ing are not in­cluded in the coun­try’s frame­work strat­egy in deal­ing with cli­mate change. Yet re­sponses to the other im­pacts of cli­mate change on health are laid down in this plan.

Whether men­tal health ser­vices are in­cor­po­rated in the lo­cal cli­mate change ac­tion plans in cities and towns thus re­mains a big­ger ques­tion.

“I think we are very far away from our des­ti­na­tion when we talk about be­ing able to ad­dress men­tal health in the con­text of cli­mate change,” Saño says. “I don’t even see a plan or a pro­gram at the na­tional level or any­where else that tries to ad­dress this in a very com­pre­hen­sive and in-depth man­ner.”

But Paraso ac­knowl­edges that in­te­grat­ing men­tal health in cli­mate change re­sponse can be dif­fi­cult be­cause it is qual­i­ta­tive in na­ture. And while stud­ies have been done in other coun­tries, there is still a dearth of lo­cal stud­ies ad­e­quately show­ing the link be­tween the two, and al­low­ing its in­clu­sion in the govern­ment’s plans.

Un­pro­cessed thoughts

For Marinel Ubaldo, who sur­vived Yolanda’s wrath in the small town of Matari­nao in

East­ern Sa­mar, the ab­sence of ad­e­quate psy­choso­cial sup­port left her and oth­ers still reel­ing from the storm’s psy­cho­log­i­cal toll.

“There was no pro­cess­ing of our trauma, as if we were ex­pected to just be okay af­ter the dis­as­ter,” says the 22-year-old who is now a so­cial worker. “Un­til now we still carry what hap­pened to us.”

The com­mu­nity fac­ing the Pa­cific Ocean and ac­ces­si­ble only by boat or on rough roads was largely aban­doned af­ter Yolanda struck. Au­thor­i­ties thought ev­ery­one had died, Ubaldo says, and for days they had nei­ther food nor wa­ter.

“For me, our un­pro­cessed emo­tions felt like an added vul­ner­a­bil­ity to us,” she says. “Even now, strong winds are enough to trig­ger fear, and we would panic, we wouldn’t know how to sur­vive.”

Lopez says pro­cess­ing these emo­tions are im­por­tant be­cause peo­ple can­not move on and re­build their lives with­out the op­por­tu­nity to re­cover.

“So you’re deal­ing with 100 mil­lion Filipinos who keep on deal­ing with dis­as­ters right and left, and not be­ing able to find the time and space and the ap­pro­pri­ate ser­vice for those men­tal health con­se­quences,” she says.

Adap­ta­tion mea­sure

Be­yond be­ing a way to cope, men­tal health is also an adap­ta­tion mech­a­nism for both in­di­vid­u­als and the com­mu­nity, Paraso says.

“Men­tal health is a big chunk of how we should be adapt­ing to [cli­mate change] … but it is re­ally the ele­phant in the room,” he says. “To be men­tally well is to sur­vive in this world. If you have a men­tally well com­mu­nity, we’re well off to re­spond even if we’re faced with 10 Yolan­das be­cause we can al­ways stand up af­ter it.”

But en­sur­ing a men­tally ca­pa­ble com­mu­nity will not hap­pen overnight, Paraso says. Low aware­ness on men­tal health and per­sist­ing stigma re­main as road­blocks, along with lack of fund­ing and re­sources to in­cor­po­rate these in the health care sys­tem.

Lopez, how­ever, finds hope in the re­cently passed men­tal health law, which aims to pro­mote and en­hance men­tal health ser­vices.

She notes that while the law does not specif­i­cally pro­vide for fund­ing or re­sources in con­nec­tion with cli­mate change, it should al­low for a com­pre­hen­sive men­tal health ser­vice in­cor­po­rated in the Philip­pines’ pri­mary health care sys­tem.

Be­yond re­silience

Filipinos are of­ten touted as re­silient, but this should not be con­tin­u­ously used as an ex­cuse for the govern­ment and other stake­hold­ers to do noth­ing, Saño says.

Re­silience is im­por­tant in cop­ing with the ever-chang­ing world, but re­ly­ing solely on in­di­vid­ual re­silience also pre­sents dan­gers, ac­cord­ing to psy­chol­ogy pro­fes­sor Pierce Do­cena.

“We need to re­mem­ber that we also have com­mu­nity re­silience. Re­silience at the in­di­vid­ual level is also af­fected by fac­tors big­ger than the in­di­vid­ual, like poli­cies and phys­i­cal struc­tures,” he says, adding:

“The re­spon­si­bil­ity now is not on the per­son alone, but also on the govern­ment to put up an en­abling en­vi­ron­ment where peo­ple will be more re­silient.”

As Ubaldo builds back a life up­ended by Yolanda, she re­fuses to sim­ply bank on re­silience as a cop­ing mech­a­nism. She has be­come a cli­mate ac­tivist, us­ing her voice to retell her com­mu­nity’s har­row­ing ex­pe­ri­ence as both a warn­ing and a les­son to the world.

“If I ac­cept that I’m re­silient enough, it’s like ex­pect­ing that these su­per­ty­phoons are al­ready my way of life,” she says. “But why can’t we make ways to en­sure that Yolanda will never hap­pen again?”

—DEMIE DANGLA/CON­TRIB­U­TOR

‘YOLANDA’ SHRINE A ship pushed in­land dur­ing the on­slaught of Su­per­ty­phoon “Yolanda” now serves as a memo­rial to the tragedy and a sym­bol of re­silience for the peo­ple of Tacloban City.

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