In Kerala, doctors are helping survivors deal with the aftermath of disasters

P. Divakaran, 65, stood beside the road where his sister and three other family members were killed when a landslide caused by heavy rains demolished their house almost a year ago.

"Even after 11 months, the mortal remains of my sister have not yet been recovered. Still I am afraid to hear the sound of rain," he told the Thomson Reuters Foundation in Upputhodu village, in southern India's Idukki district.

This month, Idukki, in Kerala state, has again been battered by torrential monsoon rains and landslides that killed at least five people and forced about 1,400 to evacuate to shelters, known locally as relief camps.

This year's danger hit an area, alongside other parts of the ecologically fragile Western Ghats mountains, where local people had yet to recover from the trauma and stress they experienced from the disaster in August 2018.

That was the worst recorded in local history, with 51 deaths and destruction estimated at 2.1 billion rupees (almost $30 million). But the damage was also reflected in a jump in the number of people suffering mental health problems.

In the year to July 2019, the Idukki District Mental Health Programme saw 4,678 patients, up about 25% on the previous year.

"It has been found that the flood has caused various mental ailments. Depression and anxiety were mostly prevalent. This is the reason for the rise in the number of patients," said Amal Abraham, a doctor with the programme.

The tiny, picturesque mountain village of Upputhodu has again been lashed by severe rains this month, in a place where many still bear the mental scars of the flash flood a year ago.

Divakaran was diagnosed as suffering from "adjustment disorder", a condition that causes feelings of sadness and hopelessness after unexpected disasters.

He has now improved after receiving medication and counselling, said Joe Sunny, a mental health doctor at Thiruvananthapuram Medical College.

Thaghachan, 60, also underwent treatment for psychological problems after the 2018 disaster.

"I am afraid to hear even the noise of an aeroplane flying over our village," he said. "It brings back horrible memories of last year's disastrous landslide."

Flight to safety

Nine in 10 villagers in Upputhodu who spoke to the Thomson Reuters Foundation over two days in late July appeared to be still haunted by the after-effects of what they experienced.

P. Geetha, a state-employed social health activist who has been keeping in regular touch with families in Upputhodu, said 42 out of 250 homes in the village were vacant.

"They all migrated due to relentless stress," she said. Many have gone to neighbouring districts where they feel safer, she added.

S. Pramod was a chronic psychiatric patient who suffered from depression for more than a decade before the 2018 disaster. "Flood-related stress has aggravated my ailment," he said.

Full state-level data on those who have sought psychological help could not be obtained because people visiting private hospitals and practitioners are not registered by the government.

But the Kerala State mental healthcare programme offered at community health centres saw patient numbers almost double in 2018 to about 25,000, from 14,000 the previous year.

Dr P.S. Kiran, state nodal officer for mental health, said flood-related stress was one of the main reasons for the "abysmal rise".

As the first anniversary of the flood approached, S. Krishnan, associate professor in the Department of Psychology at Thiruvananthapuram Medical College, warned that flashbacks could trigger further stress and trauma for the victims.

Help at hand

The Kerala government has announced a second stage of its effort to manage mental health problems after disasters, aiming to bring psychosocial support closer to people's doorsteps.

It has deployed almost 17,650 trained mental health workers across the state and set up a free helpline for counselling.

In Mariyapuram village in Idukki district, help has been at hand since the flood.

A year after it was hit by a flash flood, there are still traces of crumbled hills, boulders strewn on river beds, collapsed houses and faces that show the strain.

Two weeks after the disaster, a team of mental health experts from the Thiruvananthapuram college visited houses all over the village, offering help to about 1,000 flood survivors.

"Scrupulous intervention in relief camps, schools and door-to-door visits helped us to find 50 people suffering (from) flood-related mental disorder," said Sunny.

Counselling and medicine were provided, said the doctor who was involved in the mission.

Despite struggling with limited financial resources, the Mariyapuram village council has ensured follow-up measures.

A permanent psychological counsellor was appointed at the family health centre, with children offered regular sessions in schools.

Dolly Jose, president of the village council, said a new centre was due to be set up to help people recover from mental health problems by enabling them to participate in activities like handicrafts.

Root causes

After 11 months, Dr Sunny returned to check on his patients.

"Most of the people who were earlier suffering from flood-related mental ailments are today recovered," he told the Thomson Reuters Foundation.

But while environmentalists have praised the initiative, they said it was important to deal with the underlying causes of people's anxiety.

"Deforestation, rampant mining, encroachment etc have triggered the intensity of the floods and landslides," said V.S. Vijayan, former chairman of the Kerala State Biodiversity Board.

"Unless and until we ensure faultless environmental protection measures, we won't be able to root out the real fear."

Psychological experts are worried that this year's flooding in Kerala will compound anxieties in existing patients and bring a wave of new suffering – but hope they are better prepared.

Heavy monsoon rains this month have caused 80 landslides in the state, as well as flooding. More than 160 people are dead or missing, nearly 3,000 homes have collapsed and close to 300,000 people were evacuated to safer shelters, according to official data.

"We know the seriousness. Mental health experts are being deployed in relief camps," said state doctor Kiran.