As Kerala adjusts to life after floods, health officials race to tackle mental health problems

Late in the night on August 14, the church bells tolled in Varappuzha in Kerala’s Ernakulam to warn residents that floodwaters were rising. Among those who left their homes for relief camps were Nediyanthara Francis, 63, and his wife Mary, 55.

Six days later, they came back to find that all their belongings were underwater, even the furniture and kitchen utensils. Francis, a carpenter, is adept at fixing things. But it took the couple three weeks of hard work to remove the mud and make the house they had built with their life’s savings liveable again.

A month later, they were sleeping only fitfully.

Mary wakes up several times each night, imagining the church bells reverberating again.

If she has delusions, Francis has nightmares. “I feel the Periyar river might breach its banks and submerge our house soon,” he said.

In the same village, sisters Meenu, 15, Geethu, 14 and Neenu, 10 have fallen silent. They spent six days in a relief camp with their father Madhu and mother Shyni. When they came back, they saw their books buried under the sludge of the flood and began to scream.

Before the flood, they were lively children who used to crack jokes and made fun of each other all the time, their mother said. Now, they have turned gloomy.

Meenu appears for her Class 10 exams next year. She had set herself the target of scoring 80%. But after the floods, she is struggling to concentrate in class. She said that the images of the floods often flash through her mind.

The floods in August affected nearly 55 lakh people in 981 villages across Kerala, killing 483. They left not only a trail of devastation in their wake, but also a growing number of people burdened with grief, stress and anxiety. The state’s health department has already tended to 1.85 lakh people with post-traumatic stress symptoms and referred 1,525 for specialised psychiatric treatment. Four suicides related to flood-related stress have been reported so far, three of them in Ernakulam.

Psychiatrists said the people who lost their homes, property, crops or cattle in the floods will need continuous mental-health support. How well equipped is the state to provide it?

State at work

Since the floods abated, Kerala’s health department has worked with the National Institute of Mental Health and Neurosciences to train 16,671 volunteers to provide psychosocial first aid to people afflicted with disaster-related stress.

Dr K Sekar, head of psychiatric social work at the mental health institute, said people hit by disaster often develop post-traumatic stress symptoms. “They have to be given psychosocial first aid,” he said, explaining the need for training volunteers. “People should talk to them and empathise with them. Delay in healing the symptoms may lead to severe complications.”

Sekar claimed the volunteers have already brought about significant change on the ground.

Kerala has some 600 psychiatrists and 400 clinical psychologists. According to the State Mental Health Authority officials, it has the highest number of mental health professionals in the country.

Worrying situation

But despite the health department’s efforts, many people are still struggling with stress and anxiety.

“I have to spend huge sums of money to rebuild my home and my workshop,” said CG Anil. “I cannot get sleep these days.”

Anil is from Vaniyakkad village in North Paravur, one of the areas worst affected by the floods in Ernakulam district. The village, situated on the banks of Pashni Canal, a tributary of the Periyar river, was submerged on August 15, driving its 362 families into relief camps. They returned on August 22, only to see their homes and shops in ruins.

M Sajitha, a teacher, said her fellow villagers’ behaviour has changed after the floods. “Frustration has gripped our village,” she said. “Men and women are picking quarrels over minor issues. I have witnessed many scuffles involving members of the same family. People do not trust each other these days.”

KA Vidyanandan, a North Paravur municipal councillor, agreed with Sajitha. “People hit by floods have become short-tempered,” he observed. “They get angry at the drop of a hat.”

The reason may be their inability to resume normal life, Vidyanandan contended. “The foul smell of mud hangs around all homes though they have been washed multiple times with detergent,” he explained. “They lost their beds, clothes and cooking utensils. Farmers lost income-earning cattle, goats and chicken. Small traders with loans are in a debt trap now. So it is natural they are living under severe stress.”

For many people, the floods compounded existing problems. Francis has heart disease (he suffered heart attacks in 2013 and 2015), while Mary has hyperthyrodism. In May, Francis underwent eye surgery after a piece of wood pierced his retina. In June, Mary slipped on the slippery floor of her house and broke her knee. The continuing misfortunes have wrecked the family’s financial situation. Of the flood relief financial assistance of Rs 10,000, provided by the state government, only about Rs 2,500 is left now. They do not have enough money to buy a new bed. “I am already neck-deep in debt,” said Francis. “I don’t have the means to repay loans. So I am going to sleep on the floor.”

Dr PS Rosamma, medical superintendent of North Paravur Taluk Hospital, said the number of people who need counselling has increased after the floods. “People are completely heartbroken,” she said. “The majority of them are senior citizens, women and children.”

In Kadamakkudy, a cluster of seven islands in the Periyar river about 15 km south of North Parvur, the suicides of PM Jayan, 36, a mechanic, and Rocky Rocky, 68, a daily wage labourer, have cast a pall of gloom.

MF Prasad, a member of the local gram panchayat, feared the “mental health situation” could get worse. For now, residents are getting support such as essential provisions from both the government and voluntary organisations. It may not continue for long and people will feel isolated when the supply stops,” he said.

Dr Pyari Joseph, consultant psychiatrist at Government General Hospital, Ernakulam, who coordinates the district’s mental health programme, said people with depression are likely to grow in number after a few months. “We are expecting more such cases six months after the floods,” she said. “That is when people will get a better sense of their exact losses. But we are equipped to face the scenario.”

She, however, said early intervention by the trained volunteers has helped reduce stress among the people. “We have deployed field staff to meet people,” she added. “They talk to people, console them, assure them of all support. The approach has reduced the mental trauma of flood-affected people.”

Helping children

The National Institute of Mental Health and Neurosciences is working with the Kerala education department to devise new teaching methods for students in flood-hit areas. “Children will take more time to forget the horror of the floods, so there is a need to focus more on them,” said Sekar. “We will train teachers in providing psychosocial aid which will boost the morale of the children. We will also train them in using art therapy and play therapy. The next six months are crucial for the children.”

Leena Joshi, former director of the non-profit Apnalaya, said it will take much work to bring Kerala’s flood-hit children “back to life”. “They should be allowed to express themselves through paintings, art or dance,” she added. “It is the best way to bring them back to life. They are our future.”

Joshi also asked the government to organise temporary medical camps where flood victims can come and share their anxiety and grief. “It can lead to the formation of self-help groups that will bond people together,” she added.