Guidelines and SOP MHPSS in Disaster

NATIONAL GUIDELINES AND
STANDARD OPERATING
PROCEDURE-MENTAL HEALTH
AND PSYCHOSOCIAL SUPPORT
IN DISASTER
Mental Health Unit

Sector of Mental Health, Substance Abuse, Violence Injury Prevention
Disease Control Division
Ministry Of Health
Malaysia
NATIONAL GUIDELINES AND STANDARD OPERATING PROCEDURE-MENTAL HEALTH AND PSYCHOSOCIAL
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Acronyms and Abbreviations
AAR After Action Review

CISD Critical Incidents Stress Debriefing
CPRC Crisis Preparedness and Response Centre (CPRC)
CPRC-SHD CPRC State Health Department
CUCMS-DRM Cyberjaya University College of Medical Science-Disaster
Relief and Medicine
DASS Depression Anxiety Stres Scale
DG Director General
DHO-DMC Disaster Health Office Disaster Management Committee
DHOR District Health Operation Room
DOCC Disaster Operations Control Centre
DMHPS Distrist Mental Health Psychosocial Support
IMARET Islamic Medical Association of Malaysia, Response & Relief
Team
JPBP National Disaster Management Committee
MERCY Medical Relief Society Malaysia
MHPSS Mental Health and Psychosocial Support
MOH Ministry of Health
MOH ECDM MOH Executive Committee for Disaster Management
MOH TCDM MOH Technical Committee for Disaster Management
MRA Malaysian Relief Agency
MGKK Majlis Guru Kaunseling Kebangsaan
MSCP Malaysian Society Of Clinical Psychology
NADMA National Disaster Management Agency
NGO Non-governmental Organization
NCD Non-Communicable Disease
PFA Psychological First Aid
PTSD Post Traumatic Stress Disorder
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PERKAMA Persatuan Kaunseling Malaysia

PEKA Persatuan Pendidikan Kaunseling Malysia
SDQ Strength Difficulty Questionnaires
TWG Technical Working Group
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Foreword
Over the last decade we had encountered major disasters around the world.
Regardless of their origin, these events have deeply impacted the population
living in the affected areas. There have been loss of life, serious injuries, destroyed
homes, displacement, and family separation, which have created serious
disruptions and repercussions in people’s lives and their psychosocial well-being.
There often have been importance given to national authorities in its countries and
territories to take measures to lessen the severity of those disasters, with an
emphasis on mitigating the physical and structural impact. Similar efforts should
focus on becoming better prepared in the mental health and psychosocial field to
respond to emergencies and disasters
Different countries affected by the disaster have their own mechanism or plan to
respond depending on the multitude of factors. Some of these factors operated at
the societal and national level, such as having a disaster management plan in place
which would allow state or local governments or affected areas access help readily
in an orderly manner. The many disasters that have been encountered in Malaysia
both natural and man made provided an opportunity to review the lessons learnt
in order to be better prepared to face future disasters. In addition to saving lives
and treating physical injuries, it becomes eminent to have a good understanding
of the mental health reactions of populations to collective trauma. The importance
of having an adequate mental health and psychosocial response system prior to an
emergency becomes a national priority for disaster reduction.
This guideline provides a frame work to psychosocial support to communities
affected by disasters. The National Mental Health policy serves as foundation to
the formation of this guideline. A decentralized mental health system is the best
option for providing the immediate and appropriate response to the needs of the
affected population. The capacity of state and local authorities to organise its
services and mobilize existing resources both governmental and non-
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governmental efficiently and effectively in a systematic manner is explained. The

guideline is prepared based on cultural sensitivities and also take into account the
needs of special groups such as children, women, refugees and the elderly. The
opportunity of training basic knowledge and capacity building for health and
mental health workers in the area of mental health and psychosocial support in
disasters is another important aspect considered in the guideline. Lastly this
guideline can be useful as it provides detailed country specific information in a
systematic format, to facilitate global sharing of experiences of mental health
reform and strategies between policy makers and other stakeholders.
Dato’ Dr Chong Chee Kheong

Deputy Director General of Health
(Public Health)
Ministry of Health Malaysia
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Advisors:
1. YBhg. Dato’ Dr Chong Chee Kheong

Deputy Director General of Health
(Public Health)
2. Dr Norhayati Rusli
Director
3. Dr Toh Chin Lee

Technical Advisor Psychiatric Services
Senior Consultant Child and Adolescent Psychiatrist,
Hospital Selayang
Selangor
4. YBhg Dato’ Dr Ahmad Rasidi bin Saring

Psychiatrist
Hospital Bahagia Ulu Kinta
Editorial
1. Dr Nurashikin Ibrahim
Sector Head of Mental Health Substance Abuse and Violence Injury Prevention
Disease Control Division,
2. Dr Karen Sharmini a/p Sandanasamy

Public Health Physician
Mental Health Unit, Disease Control Division,
3. Nurhuda Basiran
Psychology Officer
Mental Health Unit, Disease Control Division
Secretariat
1. Normala Abdullah
Head Nurse
2. Siti Nuruainain Zainal Abidin

Administrative Assistant,
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Acknowledgement
The Non Communicable Disease Section of Disease Control Division, Ministry of
Health would like to express our gratitude to each and everyone who contributed. We
also are grateful for the support provided towards the preparation of this Mental Health
And Psychosocial Support In Disaster -National Guidelines and Standard Operating
Procedure
Technical Working Committee First Edition 2013
By alphabetical order:-
1. Azriman bin Rosman (Dr)

Public Health Specialist,
2. Devan Kurup (Dr)

Senior Principal Assistant Director
(Surveillance),
3. Eizwan Hamdie binYusoff (Associate Prof. Dr)

Psychiatrist of Medicine,
UiTM Medical Faculty Campus Selayang,
Selangor Darul Ehsan
4. Faisal bin Salikin (Dr)

Emergency Medicine Specialist,
Hospital Kuala Lumpur
5. Fatanah binti Ismail (Dr)

Public Health Specialist
Senior Principal Assistant Director,
Family Health Development Division,
6. Haniza binti Rais (Dr)

Head of Department,
Department of Education Psychology &Counseling,
INSTEAD, UIA
7. Hazli bin Zakaria (Dr)

Psychiatrist,
Malaysian Psychiatrist Association
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8. Jamaiyah binti Haniff (Dr)

Clinical Epidemiologist,
National Clinical Research Centre,
9. Jumari bin Sopaman

Assistant Medical Officer,
Health Development Division,
10. Khadijah binti Minhat

Counsellor,
Counselling Unit,
Wisma Kayu,
11. Lim Chong Hum (Dr)

Psychiatrist,
Hospital Ampang,
Selangor Darul Ehsan
12. Mohd Sabtuah bin Mohd Royali

Senior Assistant Director,
Family Health Development Division,
13. Naniyati binti Shuib

Head Principal Director Psychology,
Management Division,
Public Service Department
14. Nasiumin binti Mohd Nor

Medical Assistant Officer,
Health Development Division Family,
15. Norazura binti Ahmad

Senior Assistant Director,
Counselling and Psychology Division,
Social Welfare Department
16. Norhayati binti Nordin (Dr)

Director and Consultant Psychiatrist,
Hospital Mesra Bukit Padang.
17. Nor Hayati binti Ali (Dr)

Consultant Psychiatrist
Hospital Selayang
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18. Nurashikin binti Ibrahim (Dr)

Public Health Specialist,
19. Omar bin Mihat (Dr)

Head of the MeSVIPP
Mental Health, Substance Abuse and Violence Injury Prevention Sector.
20. Roziah binti Ismail

Public Health Nurse,
Mental Health Unit,
21. Ruhana binti Mahmod

Counselor,
Development Branch,
Medical Development Division,
22. Shahrulnizam bin Husain

Prison Deputy Superintendent and
Intelligence Division,
Prison Headquarter Malaysia
23. Siti Nuruainain binti Zainal Abidin

Administrative Assistant,
24. Suria binti Hussin (Dr)

Psychiatrist,
Hospital Raja Perempuan Zainab II,
25. Toh Chin Lee (Dr)

Technical Advisor Psychiatric Services
Senior Consultant Child and Adolescent Psychiatrist,
Hospital Selayang
26. Tiong Chea Ping (Dr)

Psychiatrist Medicine,
Hospital Bentong,
27. Tuslah binti Abdan

Senior Coordinator, Discipline and
Counselling Management Sector,
Day School Management Division, Ministry of Education
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28. Uma a/pVisvalingam (Dr)

Psychiatrist,
Hospital Putrajaya
29. Zulkifli bin Ghaus (Dr)

Psychiatrist
Hospital Sungai Buloh,
30. Zulkifli bin Muhammad

Assistant Medical Officer,
Health Development Division,
CONTRIBUTORS TO SECOND EDITION 2019
By alphabetical order:-
1. Ahmad Rasidi bin Saring (YBhg Dato’ Dr)

Psychiatrist
Hospital Bahagia Ulu Kinta
2. Ahmad Qabil bin Khalib (Dr)

Psikiatrist
Hospital Duchess of Kent
3. Ahmad Zabidin bin Zakaria (Dr)

Psychiatrist
Hospital Sungai Buloh
4. Anita Devi Jain Sat Pal (Dr)

Family Medicine Specialist
Klinik Jalan Macalister
Pulau Pinang
5. Azlin binti Amat (Dr)

Family Medicine Specialist
Klinik Kesihatan Hiliran
Kuala Terengganu
6. Badiah Yahya (Dr)

Psychiatrist
Hospital Permai
7. Chan Pek Har

Clinical Psychologist
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8. Eizwan Hamdie bin Yusof (Assoc Prof Dr.)

Psychiatrist
Medicine Faculty UiTM (Mara University of Technology Malaysia)
9. Fazil Bin Ahmad (Mej (Dr))

Psychiatrist
Malaysian Armed Forces
10. Fauzan bin Md Tahir (Mejar)

Emergency Response Planner
Malaysia Airlines Systems
11. Haniza binti Rais (Assisstant Prof. Dr)

Kulliyah of Education
Internationl Islamic University Malaysia (IIUM)
Gombak
12. Karen Sharmini a/p Sandanasamy (Dr)

Public Health Physician
Mental Health Unit, Disease Control Division,
13. Khadijah Hasanah Abang Abdullah (Dr)

Psychosocial Team Coordinator Islamic Medical Association of Malaysia, Response &
Relief Team (IMARET)
14. Kenny Lim

The Befrienders
15. Lee Boon Hock

Counsellor
Pahang State of Health Department
16. Maria Zalina Abdul Rahim (Dr)

Psychiatrist and Lecturer
Cyberjaya University College of Medical Sciences (CUCMS),
17. Mazni binti Junus (Dr)

Psychiatrist
Hospital Serdang
18. Maria Suleiman (Dr)

Surveillance Section
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19. Mohamad Abdul Ghani bin Mohamad Khalis (Dr)

Medical Officer NCD
Melaka State Health Department
20. Mohammad Ariffin bin Jasin

Medical Assistant
Hospital Putrajaya
21. Mohd Ku Zaki bin Ku Isa

Medical Assistant
Klinik Kesihatan
Bandar Pasir Mas
22. Mohd Zaliridzal bin Zakaria

Lecturer
Faculty of Leadership and Management
Universiti Sains Islam Malaysia
23. Muhammad Najib (Assoc. Prof. Dr)

Psychiatrist and Lecturer,
Cyberjaya University College of Medical Sciences
24. Murni Binti Mat Amin

Chief Assistant Director
National Disaster Managemnt Agency (NADMA Malaysia)
Prime Minister Office
25. Norazam bin Hj Harun (Dr)

Psychiatrist
Hospital Raja Perempuan Zainab II
26. Noorul Hilal Bin Jurij

Setiausaha,
Perak Malaysian Relief Agency (MRA)
27. Norhameza binti Ahmad Badruddin

Clinical Psychologist
Hospital Permai
28. Noriklil Bukhary Ismail Bukhary (Dr)

Epidemiology Officer
WPKL State Health Department
29. Nordin Mohamed (Dr)

Perlis State Health Department
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30. Nurashikin Ibrahim (Dr)

Sector Head of Mental Health Substance Abuse and Violence Injury Prevention
31. Nurhuda Basiran

Psychology Officer
32. Rohadi bin Mat Daud

Medical Assistant
Mental Health Unit
33. Ruhana binti Mahmud

Head of Counselling Psychology Unit
34. Ruhisha bin Haris (Assistant Director)

Operational Division
Fire and Rescue Department Malaysia
Kuala Lumpur
35. Ruzita binti Jamaluddin (Dr)

Psychiatrist
Hospital Tuanku Fauziah
36. Saiful Affendi bin Mohd Zahari

Head of Counselling Unit
Daily School Management Division
Ministry of Education
37. Sharima Ruwaida Abbas

Social Work Lecturer School of Applies Science,
Universiti Utara Malaysia (UUM)
38. Shahrul Bariah binti Ahmad (Dr)

Epidemiology Officer
Kedah State Health Department
39. Siti Aishah Johari (Dr)

Kedah State Health Department
40. Syed Azam Shah bin Syed Baharom (Mej (PA))

Pegawai Pertahanan Awam KP41
Disaster Managemant and Operation Department
Malaysia Civil Defense Force
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41. Tengku Ahmad Faisal bin Tengku Rahim

Psychology Officer
Department of Social Welfare
Ministry of Women and Family Development
42. Tiong Chea Ping (Dr)

Psychiatrist
Hospital Bentong
43. Uma Visvalingam (Dr)

Pakar Psikiatri
Hospital Putrajaya
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Contents
CHAPTER ONE: INTRODUCTION ........................................................................................................................... 16
1.1 Background.......................................................................................................................................... 16
1.2 Definition of Disaster .......................................................................................................................... 17
1.3 Scope Of The Document ..................................................................................................................... 17
1.4 Objectives of the Document ................................................................................................................ 18
1.5 Policy ................................................................................................................................................... 18
CHAPTER TWO: MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT ..................................................................... 19
2.1 Definition of Mental Health and Psychosocial Support ...................................................................... 19
2.2 Mental Health And Psychosocial Problems In Disaster ...................................................................... 19
CHAPTER THREE: ORGANIZATION OF SERVICES .................................................................................................. 21
3.1 National Disaster Management Agency (NADMA) ............................................................................ 21
3.2 Ministry Of Health (MOH) .................................................................................................................. 22
3.3 Crisis Preparedness and Response Centre (CPRC) ............................................................................. 23
3.4 National Mental Health Psychosocial Support Services Technical Working Group (TWG) ...... 24
3.5 Information Flow ................................................................................................................................. 29
CHAPTER FOUR: MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SERVICE (MHPSS) PROVIDER .................... 34
CHAPTER FIVE: MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT TRAINING ..................................................... 40
CHAPTER SIX: PRINCIPLES OF INTERVENTION ..................................................................................................... 42
6.1 Principles of Intervention .................................................................................................................... 42
6.2 Intervention Cascade ........................................................................................................................... 42
CHAPTER SEVEN: MENTAL HEALTH PSYCHOSOCIAL SUPPORT ACTIVITIES DURING VARIOUS STAGES OF
DISASTER............................................................................................................................................................... 43
7.1 Preparedness Program before disaster/crisis event .............................................................................. 43
7.2 ..................................................................................................................................................................... 44
Pre-Deployment Phase...................................................................................................................................... 44
7.3 During crisis/disaster ........................................................................................................................... 48
7.4 Mental Health and Psychosocial Activities during disaster/crisis ....................................................... 48
7.5 Psychoeducation .................................................................................................................................. 49
7.6 MHPSS responders .............................................................................................................................. 49
7.7 Post Disaster ........................................................................................................................................ 53
CHAPTER 8: DOCUMENTATION, EVALUATION AND TERMINATION OF DEPLOYMENT ..................................... 57
8.1 Documentation and Evaluation............................................................................................................ 57
8.2 Duration of MHPSS ............................................................................................................................ 57
8.3 Demobilisation .................................................................................................................................... 57
APPENDIX ............................................................................................................................................................. 59
MATERIAL AND REFERENCE ................................................................................................................................. 78
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CHAPTER ONE: INTRODUCTION

1.1 Background
Disasters can occur either naturally or due to human factor which can caused injury
or death, destruction to property or environment and disruption towards daily
activities. The handling of disaster requires extensive utilisation and coordination
of resources, equipment and personnel from multiple agencies. It requires detailed
planning and complex strategies over extended period of time.
Disasters and crisis can cause immediate and long-term psychosocial impact on
affected people. Malaysia in recent years have exprienced few major disasters and
crisis such as collapse of Highland Towers in 1993, Tsunami in 2004, Lahad Datu
armed intrusion in 2013 and the unprecented air disaster of MH370 and MH17 in
2014 as well as massive flood in late 2014 and early 2015. These disasters and
crisis have shown that there is crucial needs for mental health and psychosocial
support in addition to physical needs and it needs to be given at an early stage, to
the survivors and thier families who are exposed to acute mental distress which
can pose a risk to their mental health and well being.
The National Security Council Directive Number 20 has laid down the policy and
mechanism of disaster management in Malaysia.
Realizing the needs of mental health and psychosocial support in disaster

management, The National Security Council Directive Number 20 has outlined
that Ministry of Health shall coordinate the mental health and psychosocial
support services for survivors, family members, response workers and
humanitarian aid volunteers . This guideline is being developed to facilitate a
planned and coordinated mechanism in the management of Mental Health and
Psychosocial Support Services (MHPSS) before, during and post disasters.
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This consolidated effort will improve coordination, adequacy and clarity of

measures taken by both government, non-governmental organisations and
volunteers involved in the overall response to disaster.
1.2 Definition of Disaster

According to Directive 20 (National Security Council, Malaysia), a disaster is
defined as a sudden catastrophic events, sudden misfortune or calamity. It is
complex in nature and results in loss of lives on a large scale, destruction of
properties and the environment leading to severe disruption to the activities of the
community affected. It can be classified into 2 types of disasters :
(a) Natural
(b) Man-made disasters
Types of Disasters
Natural Man-made
Example: Example:
 Flood  Fire
 Storm  Road accidents involving
 Landslide hazardous materials
 Tsunami  Air accidents
 Earthquake  High rise buildings and
 Drought structures collapse
 Haze  Railway accidents
 Pandemic  Industrial disaster
 Chemical, biological,
radiological and nuclear
threats
 Dam failure
1.3 Scope Of The Document

This document will serve as a comprehensive guideline or planning and
implementing MHPSS, at all phases of response and in all types of disasters and
with most possible target groups. This guideline is also applicable in the event of
a crisis situation such as war, terrorism act, public disorder and demeanor.
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1.4 Objectives of the Document

The objectives of the document are as below:
1. To serve as a reference document to coordinate mental health and
psychosocial support services in disasters
2. To enhance colaboration between agencies in terms of services and resources
3. To develop a system that enable the distribution of appropriate and effective
mental health and psychosocial support resources.
1.5 Policy
The National Security Council - directive Number 20 which includes the policy
and the mechanism of disaster management in Malaysia. Realizing the needs of
psychosocial support in disaster management, The National Security Council’s
Directive No 20 (2012) has outlined that MOH is responsible to coordinate the
psychosocial support services for victims and rescue workers Mental Health and
psychosocial support services for victims, family members and response workers.
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CHAPTER TWO: MENTAL HEALTH AND PSYCHOSOCIAL

SUPPORT
2.1 Definition of Mental Health and Psychosocial Support

The composite term ‘mental health and psychosocial support' (MHPSS) refers to
any type of local or outside support that aims to protect or promote psychosocial
well-being or prevent or treat mental disorders. Support may include interventions
in health, education, or interventions that are community-based. The term ‘MHPSS
problems' covers social problems, emotional distress, common mental disorders
(such as depression and posttraumatic stress disorder), severe mental disorders
(such as psychosis), alcohol and substance abuse, and intellectual disability.
(Inter-Agency Standing Comittee (IASC), 2010)
2.2 Mental Health And Psychosocial Problems In Disaster

Everyone is affected by disaster. The impact can be classified into domains but the
relationship between mental health and psychosocial well being should not be
undermined.
1. Social
• Pre-existing problems e.g Political oppression, belonging to marginalised
group.
• Disaster induced e.g reduced safety, family separation, destruction of
livelihoods and community structures.
• Humanitarian Aid induced e.g overcrowding or lack of privacy in camps,
aid dependancy, undermining of local capacity.
2. Psychological
• Pre-existing problems e.g severe mental disorder, depression, alcohol
abuse
• Disaster induced e.g Grief, non-pathological distress, alcohol and other
substance abuse; depression and anxiety disorders including post-
traumatic stress disorders (PTSD).
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• Humanitarian Aid induced e.g anxiety due to lack of information about

food distribution
3. Factors Predicting adverse Psychological Effects
Not everyone is equally affected by disaster
Risk Factor:-
• More severe disaster
• More extreme experience
• Attribution of disaster
Effects are worse if disaster is attributed to be :-

 Inflicted by others (assault, genocide etc) and others
than
 Unintentional (airplane, crash, industrial explosion)
than
 Purely natural disaster (earthquake huricane)
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CHAPTER THREE: ORGANIZATION OF SERVICES
3.1 National Disaster Management Agency (NADMA)
NADMA is the Lead Agency for Disaster Management. NADMA is responsible

for coordinating the National Disaster management and responsible for
establishing and ensuring all policies and management mechanisms of the National
Disaster followed and implemented at all levels of disaster management.
Determination of the level of disaster as categorised by National Security Council
Directive No. 20 described in the figure below (see Figure 1):
F IGURE 1 : ORGANIZATIONAL STRUCTURE FOR D ISASTER MANAGEMENT IN MALAYSIA (ADAPTED FROM

NATIONAL SECURITY C OUNCIL D IRECTIVE NO . 20, (2012) ).
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3.2 Ministry Of Health (MOH)

MOH will be the lead agency in coordinating the provision of mental health and
psychosocial support services to the affected people including victims and
response personnel during disaster as in National Security Council Directive
No.20 (2012). Upon the needs of Mental Health And Psychosocial Support, the
mental health care providers either from Ministry of Health, NGO’s or Social
Welfare Department will report to the district health office to be coordinated before
being mobilised (see figure 2).
LEVEL 3 National Disaster

Federal Disaster Management
Operation Control
and Relief Committee On-scene
Chairperson : Deputy Prime Minister Centre
(NDOCC) Post
Health Member : Director General of
Health
Director for Internal Security
and Public Order, Royal
Malaysia Police (RMP)
National Crisis
Preparedness & Response
Centre, MOH
(NCPRC)
 Health Centre
(MHPSS)
LEVEL 2  Mental
State Disaster Management State Disaster On-scene
and Relief Committee Operation Post Health Care
Chairperson : State Secretary Control Centre Providers
Health Member : State Health Director (SDOCC)  Social
State Chief of Police
Officer, Royal Malaysia Welfare Dept
State Crisis Preparedness Police (RMP)  NGO’s
& Response Centre, State
Health Dept.
(SCPRC)
LEVEL 1
District Disaster Management District Disaster On-scene
and Relief Committee Operation Control Centre Post
Chairperson : District Officer (DDOCC)
Health Member : District Medical
District Police (OCPD),
Officer of Health
Royal Malaysia Police
District Health (RMP)
Operation Room
(DHOR)
STRATEGIC LEVEL TACTICAL LEVEL OPERATIONAL

LEVEL
F IGURE 2: ORGANIZATIONAL S TRUCTURES OF MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SERVICES DURING
D ISASTER /CRISIS
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3.3 Crisis Preparedness and Response Centre (CPRC)

CPRC in MOH was established as part of the overall strategies in preparedness of
effective management of disasters, outbreaks, crises and emergencies (DOCE)
related to health. CPRC is placed under the Surveillance Section of the Disease
Control Division, Ministry of Health Malaysia.
Function:
 Central command and coordination for all outbreak/disaster response
activities
 Compile and monitor all information on outbreak/disasters response activities
 Coordinate inter and intra agencies co-operation
 Determining additional resources needed and coordinates its mobilization
 Updating and analyzing information / data
 Provide on formation to the public
 Preparation and dissemination of daily report
 Preparation of press release / statement
 Preparation of information for the outbreak/disaster Task Force
Any type of disasters, outbreaks, crises and emergencies (DOCE) will have mental
health and psychosocial effects on those affected either on a short or long term
basis. As such, mental health and psychosocial support management and
implementation is critical for supporting coordination and smooth response
towards crisis/violence/terrorism either at ministry, NGO or other agency involved
in operating the crisis/violence/terrorism/warfare management plan. As in Figure
3 (see figure 3), is reference to response teams available under Crisis Preparedness
and Respons Centre (CPRC) whenever there is a disaster or crisis.
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Crisis Preparedness and Response

Centre (CPRC)
Public Health Emergency Medical Medical Forensic Mental Health

Response Response Response
Psychosocial
Support
(MHPSS)
F IGURE 3: CRISIS PREPAREDNESS RESPONSE CENTRE AND RESPONSE TEAM
3.4 National Mental Health Psychosocial Support Services Technical

Working Group (TWG)
The Mental Health Psychosocial Support Services (MHPSS) TWG will be
activated and form based on the needs during crisis and disaster (see Figure 4).
The TWG is responsible to plan, implement and monitor mental health and
psychosocial support services during the disaster . This TWG comprises of experts
from goverment and non-govermental agencies in the area of mental health and
psychosocial support services.
1. Term of Reference For National Mental Health And Psychosocial Support
TWG
 Provide technical advise to Director General(DG)/ Minister of Health on
related issues in mental health and psychosocial support
 Supporting MOH in implementing directives for all levels of
crisis/disaster
 Coordinate the psychosocial support services within various agencies
and NGO
 Plan for the provision of training and support for the response personnel
 Evaluate post disaster effectiveness of the intervention provided with the
view to suggest further improvement
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MOH Executive Committee for

Disaster Management (MOH
ECDM)
MOH CPRC-based *MOH Technical Committee for

CPRC MOH Disaster Management (MOH
committee for
Disaster TCDM)
Management (MOH
CCDM)
State Health Department
CPRC -SHD
Disaster Management
Committee
District Health Office Disaster

Operations
Management Committee (DHO
Room-DHO
DMC)
* MOH Technical Committee for Disaster Management (MOH TCDM)

1. Technical Working Group: Pandemic/Communicable Disease
2. Technical Working Group: Mass Casualty Incident (MCI)
3. Technical Working Group: Environment-Linked Disasters
4. Technical Working Group: Chemical/Biological/Radiological/Nuclear/explosives (CBRNe)
5. Technical Working Group: Mental Health Psychosocial Support Services (MHPSS)
MOH HQ Level
State and Districts Level
F IGURE 4: ORGANISATION C HART FOR MOH D ISASTER MANAGEMENT COMMITTEE DURING D ISASTERS (ADAPTED FROM
D ISASTER MANAGEMENT P LAN M INISTRY OF HEALTH MALAYSIA (2015) APPENDIX 7)
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2. Action Plan of Mental Health Response In Disaster
The action plan of mental health response in disasters is carried out at

3 levels which are national, state and district levels. At each level, there
will be coordinators (national, state and district).
i. National
At the national level, Mental Health Unit, Disease Control Division of
Ministry of Health shall be responsible as a focal point in coordinating the
mental health and psychosocial support activities and also is part of the
Ministry of Health Technical Committee for Disaster Management (MOH
TCDM). This include the scope as follows:
• Assess and plan psychosocial mental health and psychosocial needs (e.g
funding, logistic, facilities) during disaster/crisis situation
• Coordinate necessary resources to provide psychosocial support
• Activate and coordinate the mobilization of mental health and
psychosocial support teams
• Provide training to response worker/volunteers on psychosocial
response
• Establish and maintain directory and database of resources (personnels
trained in providing mental health and psychosocial support)
• Compile and analyse data on mental health and psychosocial support
activities
• Collaborate and liaise with other agencies
• Provide report to higher management level of Ministry of Health-
Director General of Health, Deputy Director General (Public Health),
Director of Disease Control Division
ii. State
At state level, coodination of the mental health and psychosocial support
activites will be coordinated by the Non-Communicable Disease (NCD)
Section, State Health Office. The NCD coordinator will also get the
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involvement of the state psychiatrist and report to the state commander of

CPRC. The coordinator is responsible to
• Assess the situation to determine the level and extent of the disaster in
the state
• Plan and evaluate mental health and psychosocial needs (funding,
logictic, facilities)
• Coordinate the mental health and psychosocial support activities
• Determine the type of mental health and psychosocial support required
• Determine the cacpacity to manage the disaster
• Plan and provide training for Mental Health and Psychosocial support
team at state level
• Recommend appropriate mental health and psychosocial support
resources
• Evaluate post disaster effectiveness of the intervention provided with a
view to suggest further improvements
• Liaise with Mental Health Unit, Disease Control Division of Ministry
of Health
• Provide technical advice to State Health Director on matters/issues
related to Mental Health and Psychosocial Support
• Collaborate with other agencies in providing mental health and
psychosocial support services at state/district level.
• Compile and analyse data on mental health and psychosocial support
activities and report to National CPRC.
• Maintain directory of personal trained and providing mental health and
psychosocial support.
• Assessment of situation upon request from other agencies
• Determine the type of assistance required
• Recommend the plan of action in the management of Mental Health
Response
• Provide necessary resource
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• Evaluate after a disaster on the effectiveness of the intervention

provided with a view to suggest further improvements
• Coordinate with other agencies at state level
• Assess situation on the need to stand down
iii.District
At District level, District Health Officer is held responsible to coordinate
the mental health and psychosocial support services. Their roles and
responsibilities are as follows :
• Assess the needs of the current situation to determine the level and
extent of the disaster in the district
• Determine the capacity to manage the disaster
• Determine the type of assistance required
• Coordinate necessary resources and logistics support
• Compile and analyse data on MHPSS activities at the district and report
to the state CPRC.
• To liase with ( Non-Communicable Disease Section, State Health
Office.
• Maintain directing of personal trained and providing mental health and
psychosocial support.
• Recommend training and support for field personnel
• Compile resource database
• Coordinate with other agencies which also provides mental health and
psychosocial support services e.g. JKM, KPM, NGO regarding at
District level
• Evaluate after a disaster on the effectiveness of the intervention
provided with a view to suggest further improvements.
• Advise District Health Office Disaster Management Committee
regarding matters related to mental health and psychosocial support
services.
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iv.MHPSS at relief centre

Social Welfare department will be the lead agency in coordinating services
at relief centres (during floods). Other agencies and NGO’s who would
wants to provide MHPSS at the relief centre they can either;
i. Report to the relief centre for their services to be coordinated by the

welfare department and the list of these agencies and NGO’s will be
shared with district CPRC
OR
ii. Report to District CPRC and be mobilised to the relief centre based on
communication between District Health Officer/District MHPSS
Coordinator at the District CPRC and Social Welfare Department
coordinator
3.5 Information Flow

The workflow in response to disaster will depend on the Level of Disaster
1. Level 1 Disaster
A local incident that is controlled and has no potential to spread. It is not
complex and has a low probability to cause a loss of life or property. It does not
significantly impair the daily activities of the local population. The authorities
at the district level have the ability to control and handle the incident through
their agencies with or without limited outside aid.
At Level 1(see figure 5):

• upon receiving notification of a situation perform need assesment on
mental health and psychosocial support services.
• Activate the deployment of MHPPS team to respective location
• For deployment of MHPSS to temporary shelters it is based on request
from Social Welfare Department.
• Report MHPSS activities to state DHOR and CPRC.
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Disaster
District Health Operation

Room (DHOR) activated Hospital Director Alerted
MHPSS service need assessment

done by District Health Officer
(DHOR)
Yes
Need?
Team Deployed
No
Continuous monitoring and

assessment of MHPSS needs District MHPSS Hospital MHPSS
team Deployed team Deployed
Report MHPSS
activities to DHOR and
State CPRC
F IGURE 5: FLOW OF INFORMATION AND A CTION OF MHPSS SERVICES AT LEVEL 1 DISASTER /CRISIS
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2. Level 2 Disaster
A more serious incident that involves a wider area or more than two districts
and has the potential to spread. It is likely to cause extensive loss of life or
property. It destroys infrastructure and significantly airs the daily activities of
the local population. It is more complex than a level 1 Disaster and is more
demanding in terms of search and rescue efforts. It can and should be managed
by the authorities at the state level with or without limited outside aid.
At level 2 (see figure 6):

• Upon receiving notification of a situation from district health operation room,
State MHPSS coordinator will identify the immediate needs of MHPSS
services requirements.
• For deployment of MHPSS to temporary shelters it is based on request from
Social Welfare Department.
• State MHPSS to coordinate and facilitate the deployment of state MHPSS
resources to the various sites.
• All MHPSS activities will be reported to state CPRC and National CPRC
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Disaster involving more

than 1 district
State CPRC, State Health

Hospital Director Alerted
Department activated

by NCD Officer
Yes
Need Team Deployed

No
Continuous monitoring
and assessment of
MHPSS needs District MHPSS Hospital MHPSS
team Deployed team Deployed
Report MHPSS
activities to State
CPRC/National CPRC
F IGURE 6: FLOW OF INFORMATION AND A CTION OF MHPSS SERVICES AT LEVEL 2 DISASTER / CRISIS
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3. Level 3 Disaster
An incident that results from a Level 2 Disaster, and is more complex or
involves a wider geographical region or more than two states. It can and should
be managed by the authorities at the central level or with foreign aid.
At level 3 (see figure 7):

• Upon receiving notification from state MHPSS coordinator, of National
MHPPS coordinator will consider request by affected state.
• If level 3 activation has been declared, national CPRC will notify other state
CPRC on the MHPSS requirement.
• If required, the National MHPSS coordinator will facilitate and coordinate
the deployment of resources/volunteers from other states or other countries /
international organisation to the various centres in the affected states.
• All activities on MHPSS services will be reported to State and National
CPRC.
Disaster involved more

states/ National disaster
States request help at

national level
National level coordinates Mental

Health Psychosocial Services
Activate mental health

psychosocial team
Report MHPSS
MHPSS team deployed to activities to State
affected states CPRC/National CPRC
F IGURE 7: FLOW OF INFORMATION AND A CTION OF MHPSS SERVICES AT LEVEL 3 DISASTER / CRISIS
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CHAPTER FOUR: MENTAL HEALTH AND PSYCHOSOCIAL

SUPPORT SERVICE (MHPSS) PROVIDER
4.1 Function of MHPSS provider

1. To provide Psychological First Aid for health workers, victims and
response workers from other agencies involved in the disaster including
CISD session.
2. To make a continuous risk assessment during the disaster.
3. To make referal to psychiatrist if necessary
4. To establish a good rapport with other agencies in the field during the
disaster while providing the best psychosocial responses services.
4.2 Disasters Response Workers Criteria

1. Preparation and Readiness
A volunteer should be
• able to understand the increasing level of stress
• able to cope with stress
• able to ensure loved ones can accept that she/he will be away and may
risk harm to self.
• willing to undergo training, briefing and debriefing session on their
return
• able to care and are empathetic towards those who are suffering
• able to work as a team member and accept views and opinions of others
• able to express his or her own emotional issues freely
• not trying to achieve an unrealistic wish through volunteering
• not carrying too much ‘baggage’-physical and emotional!
• able to feel satistisfied with small succeses
• equipped with the knowledge and skills appropriate for the community
he or she serving
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2. Resource Person
Mental Health Unit, Disease Control Division of Ministry of Health shall
maintain a directory of trained personnel in Mental Health and Psychosocial
Support Services (MHPSS). This includes:
• Psychiatrists
• Family Medicine Specialists
• Public Health Specialists
• Medical Practitioners eg General Practitioners
• Psychology Officer ( Clinical Psychologist, Counsellor, Psychologist
form other agencies)
• Environmental Health Officers/Assistants
• Medical Social Workers
• Paramedics
• Registered NGOs/Volunteers
 Members of the public may offer their services through various
registered non-governmental organisations (NGOs) e.g PERKAMA,
Tzu Chi, IMARET, MRA, MERCY, MGKK, PEKA, CUCMS - DRM
response team, Malaysian Society of Clinical Psychologist (MSCP)
 NGOs should ensure that their volunteers are appropriately trained in
mental health and psychosocial support before they are deployed.
 NGOs offering mental health and psychosocial support services should
report to District Mental Health and Psychosocial support coordinator
for coordination of deployment.
 It is the responsibility of the NGOs to ensure that their volunteers are
physically and mentally fit to assume their roles e.g that they do not
have any illnesses that may jeopardise their own safety or the safety of
others during disaster relief work.
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4.3 Role And Responsibilities During Disaster/Crisis.

1. State NCD Officer / Public Health Physician / Family Medicine Specialist
• Needs assessment
• Coordinator /secretariat to state MHPSS committee/coordinators of pre
and post deployment
• Liaison with National CPRC/ MH unit
• Compile PFA returns at state level
• Returns/Daily Reports to CPRC and mental health unit
2. Psychiatrist
• Selection criteria of psychosocial response workers
• Specialist services including referral
• Pre and post deployment plan
• Provide the needs for clinical interventions
3. Medical Officer / medical practioners
• Clinical Assessment
• Medical Needs
• Medical Records
• PFA
4. Psychology Officer
• Initial Psychological Asessment
• Crisis Intervention
• Psychological First Aid (PFA)
• Daily Reports on psychological interventions and PFA sessions provided
5. Paramedic
• Triaging
• Accompany Patient
• Record keeping
• Psychological First Aid (PFA)
• Facility and equipment
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4.4 MHPSS Team Members

1. At State Level
 Epidemiology Officer/ Public Health Physician
 State Psychiatrist
 State Family Medicine Specialist
 Psychiatrist
 District Health Officers
 Psychology Officer
 Social Worker
 State Health Education Officer
 State Matron
 State Medical Asisstant
 NGO
2. At District Level
 District Public Health Physician (NCD)/Family Medicine Specialist /
Medical Officer
 District Psychiatrist
 District Family Medicine Specialist
 Psychology Officer
 Social Worker
 District Matron
 District Medical Asisstant
 Health Education Officer
 District Education Department (Counselling Unit)
 NGO e.g MERCY Malaysia
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4.5 Mental Health Care of Response Workers

1. Stressors associated with disaster work:
 Exposure to dead bodies
 Fatigue
 Exposure to toxic agents
 Physically unfit
 Unfamiliar with surrounding and working environment
 Group stressors
 Lost of loved ones
 Experiencing stress related physical symptoms such as headaches, upset
stomach, poor concentration etc.
 Feeling of tired of the disaster and prefer not to talk, think or associated
to the disaster during time off
 Feeling of frustration or guilt for not be able to meet the families and are
unavailable to them physically and emotionally.
 Feeling of frustration with family and friends when contacted them
because they may not be able to understand the disaster experience
especially if the famliy members or friends become irritated.
2. Minimizing Stress During Disaster Operation.

The following are some ways to minimize stress during a disaster operation:
 As much as possible, living accomodations should be personal and
comfortable. Mementos from home may help disaster workers to keep in
touch psychologically.
 Regular exercise consistent with the present physical condition and
relaxation with some activity away from the disaster scene may help
 Getting enough sleep and trying to eat regular meals even if the workers
are not hungry. Avoid foods high in sugar, fat and sodium. Taking vitamin
and mineral supplements may help the body to continue to get the
nutrients.
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 Excessive use of alcohol and coffee should be avoided. Caffeine should

be used in moderation
 Time alone on long disasters operations is important but they should also
spend time with coworkers. Experienced and new relief workers should
spend rest time away from the disaster scene and talking about normal
things
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CHAPTER FIVE: MENTAL HEALTH AND PSYCHOSOCIAL

SUPPORT TRAINING
The mental health impact on the disaster response workers can be reduced through
comprehensive and regular pre-disaster training. Training helps both workers and
volunteers to better deal with the possible emotional consequences of a disaster.
Resources and budget needs to be allocated for training, exercises, tools and materials
used during intervention.
The mental health psychosocial support service providers should undergo training by
Ministry of Health. The module used are to be shared with the various ministries,
agencies and NGOs dealing with mental health and psychosocial support.
Evaluation and feedback should be done to assess the effectiveness of training and
services provided.
Components of training
Preparedness/ Readiness Knowledge Skills
 Personal and  Types of disaster  Basic survival skills
Professional  Mental Health Impact of for disaster
Readiness disaster responders
 Basic survival skills  NSC Directive 20  Basic helping skills in
for disaster response  Basic needs during disaster
workers disaster  Psychological First
 Criteria of disaster  Helping skills Aid
response workers  Ethics in disaster  Psychological
 Impact of disaster on Assessment
mental health of response  Relaxation techniques
workers
 Self care and how  Critical Incident
response workers can Stress Debriefing
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manage their own mental  Simulation exercise

health needs.
 Information on emotional  Training in the
mental health
and psychological impact
aspects of
(short and long term) of
disaster on individuals. disasters may be
consolidated by
This will include:
participation in
 Pre disaster mental
regular exercises
health and
in which disaster
psychosocial
conditions are
problems
simulated. Such
 Disaster induced
simulation
mental health and
exercises need to
psychosocial
be as realistic as
problems
possible and thus
 Humanitarian aid
would require
induced mental
careful planning
health and
and
psychosocial
implementation.
problems.
 Art therapy
 Recognition and
 Crossroad
management of
distressing feelings,
anxiety, depression, post
traumatic stress disorder
and other mental health
conditions that may
occur.
Training in mental health and psychosocial support in disaster is a MUST
for all team members
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CHAPTER SIX: PRINCIPLES OF INTERVENTION
6.1 Principles of Intervention

Mental health care by mental
specialized (psychiatric nurse,
psychologist, psychiatrist, etc.)
Specialised
Services Basic mental health care by
Primary Health Care doctors.
Focused, non- Basic emotional & practical
specialised supports support by community workers
Family tracing and
reunification, supportive
parenting programs, Community and family support
educational activities Advocacy for basic
services that are safe,
Basic services and security socially appropriate and
protect dignity
F IGURE 8: I NTERVENTION PYRAMID FOR MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN EMERGENCIES (I NTER -AGENCY
S TANDING C OMITTEE
(IASC), F IGURE 1 (2010))
6.2 Intervention Cascade
1. In disasters, people are affected in different ways and need different kinds of
support. All layers of the intervention pyramid are important
and should ideally be implemented concurrently (see Figure 8).
2. Following the needs assessment, DMHPS coordinator shall activate mental
health and psychosocial support services who in turn shall coordinate the
agencies and NGOs providing mental health and psychosocial support.
3. During the initial response, attention will also be given to those who are in
need of MHPSS including PFA.
4. Intervention should be given simultaneously at all layers of the intervention
pyramid.
5. Referrals for further intervention of survivors done on daily basis, home
visits to those survivors who had evacuated the relief centres, tracking down
survivors’ mental health who had decided to take shelters temporarily at
places aside from the designated relief centres.
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CHAPTER SEVEN: MENTAL HEALTH PSYCHOSOCIAL

SUPPORT ACTIVITIES DURING VARIOUS STAGES OF
DISASTER
7.1 Preparedness Program before disaster/crisis event
1. Interagency meeting for coordination between KKM with other agencies

and ensuring all agencies do their own Psychological First Aid (PFA)
training
2. Target – responders with
• KKM
• Other agencies : JKM, PBT, Bomba, APM, ATM, PDRM,
• NGO
3. Content of Training
• Psychological First Aid
• Preparation before, during and after deployment
• Basic Mental Health (MH) helping skills
• Mental Health impact of disaster
• Managing loss and grief
• Simulation
• Psychological First Aid (PFA) training evaluation form
4. Outreach Program
• Identifying potential affected locations and community
• Visiting people, schools, surau or mosque in the community to promote
services
• Identify local people eg. Community Leaders, Religious Leader and
provide education on mental health disaster.
5. Educating the community
• What to do and where to go when disaster happens
• The effects of disaster to community
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6. Awareness through disseminations of information:

• Flyers, pamphlets, brochures, tip sheets, posters
• Billboard
• Radio, TV, media and social media promotions
• Lists of referral agencies
7. Recruitment of Mental Health and Psychosocial Support Team
• Repressentatives from zones and districts
• Screening volunteers for readiness
• Those who have undergone training
7.2 Pre-Deployment Phase
The pre deployment phase is intended to establish preparedness of emergency

responders prior to their deployment to crisis/disaster area. In this phase baseline
parameters such as
• Physical health
• Emotional wellbeing
• Immunisation status
are taken to interpret their health status. Information on what to expect upon arrival
is provided to alert them on the crisis/disaster situation.
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Pre-Deployment Flowchart
Disaster Notification
Responders Identified and Screened
Responders stationed at the

disaster meeting point
Pre-deployment briefing
session
Mobilization of responders to
affected areas
Report to the responsible

coordinator at the field.
End
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Pre-Deployment Procedure
No Flowchart Activities Roles and
Responsibilities
1 Disaster Notification Declaration of Disaster JPBP
Emergency when (Jawatankuasa
necessary be made in Pengurusan
administrative and Bencana Pusat/
executive regulations by National Disaster
the prime minister on the Management
recommendation JPBP, Committee)
subjects to the laws and
procedures of the
government in force.
2 Responders Identified Agencies involved will Relevant

and Screened identify responders and agencies/MOH
baseline health parameters
taken to assess their
physical and emotional
well-being prior
deployment. This includes
immunization when
required. Information on
the nature of crisis/disaster
as well as the meeting
point will be briefed.
3 Responders stationed at Soon as arrival at the Respective state
the disaster meeting meeting point, the Coordinator
point responders must report to
their respective
coordinators.
4 Pre deployment briefing At the meeting point, Respective state
session at the respective responders will be briefed Coordinator
state about the current situation
of the crisis/disaster
including MHPSS needs
Components of pre -
deployment briefing
 Disaster: site, time,
number of victims,
teams, logistics,
available resources and
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services, safety and

security concerns
 Deployment
duration/schedule
 List of volunteers
 Next of kin of
responders
 PFA form (return)
content.
Mental health and physical

health screening
5 Mobilization of Mobilization of responders Respective states
responders to affected will be scheduled based on coordinator
areas the situation of the
crisis/disaster (Level 1,
level 2, or level 3).
The coordinator will
decide which responders
will be deployed to the
selected crisis/disaster area
based on the victims
MHPSS needs.
6 Report to the responsible Once arrived at the Disaster/crisis area
coordinator at the field affected areas, the coordinator
responders must report to
the field coordinator.
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7.3 During crisis/disaster
During crisis or disaster, Mental Health and Psychosocial Support Services will be
provided to those in need. The purpose of Mental Health and Psychosocial Support
Services is to protect and promote psychosocial well-being or prevent or treat
mental disorders. The types of services provided are, based on interventions in
health, education, or interventions that are community based. Some of the mental
health and psychosocial problems that might occur during and/or post disaster are
social problems, emotional distress, common mental disorders (such as depression
and post-traumatic stress disorder), severe mental disorders (such as psychosis),
alcohol and substance abuse and intellectual disability.
7.4 Mental Health and Psychosocial Activities during disaster/crisis
Mental health and psychological support services will be provided based on the 8
core action principles of PFA (described as below) and 3 action principles of PFA
by WHO (World Health Organization) which is LOOK, LISTEN and LINK (
Appendix 2).
Psychological First Aid (8 core action principles)

1. Contact and Engagement
The goal is to respond to survivors and to engage in a non-intrusive and
supportive manner
2. Safety and comfort

The goal is to help meet immediate safety needs and to provide emotional
comfort.
3. Stabilization
The goal is to reduce stress caused by a traumatic event
4. Information gathering
The goal is to assess the immediate where the survivors.
5. Practical Assistance
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The goal is to create an environment where the survivor can begin to solve
problem
6. Connection with social supports

The goal is to assist survivors to connect or re connect with primary support
systems.
7. Coping information
The goal is to offer verbal and written information on coping skills and the
concept of resilience in the face of disaster.
8. Linkage with collaborative services

The goal is to inform survivors of services that are available to them as well as
the list of referral agencies.
7.5 Psychoeducation
Awareness through the dissemination of information through pamphlets,

billboard, radio, TV and social media
7.6 MHPSS responders
Provide psychological support through regular ventilation, relaxation and sharing

session to ensure responders not exhausted or suffer burnout
1. Schedule protected time for rest and spiritual activities (nonstop work for
more than 8 hours)
2. For disaster responders with psychological distress, they will be assessed
and given psychological intervention. However, if they are deemed unfit by
the clinician to continue his or her duty, they will be relieved from duty.
This will be documented in the Psychological Assessment form.
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Mental Health Psychosocial Support Services Intervention Flow
MHPSS Initial Assessment

and Early Detection
Psychological First Aid/Psychosocial intervention
No
Recommendation for
referral
Yes
Psychological Intervention Psychiatric Services
Well/improved Signs or symptoms of Follow up

psychiatric Illness
Discharge
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Mental Health and Psychosocial Support Services Procedure

No Flowchart Activities Roles/Responsibilities
1 MHPSS Initial  Triage for those who are  MHPSS
Assessment and Early distress disturbed mental coordinator
Detection state and behavioural
disturbance
 Identify strength and risk
factors
Tools may be used :
 Depression, Anxiety and
Stress Screening
(DASS) (Appendix 4)
 Strength and Difficulty
Questionnaires (SDQ)
(Appendix 5)
2 Psychological First Basic helping skills,  Front liners who

Aid/ Psychosocial effective communications have received PFA
Intervention skills especially active training as a part
(examples of items listening of state, district or
used for  Breathing exercise, local emergency
Psychological First relaxation technique management plan
Aid activities refer to  Movement activities
Appendix 1)  The Different parts of  Front liners may
me include health and
 Cross roads allied health
 Puzzle professionals,
 Emotional Freedom search and rescue
Techniques workers,
 Physical activities- firefighters,
message, tai chi policemen, local

government
officers,
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volunteers,
teachers etc
3 Recommendation for Assess the urgent needs of Front liners
referral the affected people for
referral
4 Psychological Assist survivors in the Psychology Officer
Intervention management of the post-
traumatic event tasks
(informing others, making
calls, rescheduling the
person’s daily routine).,
providing a safe place to
talk about either the events,
the survivor’s symptoms, or
whatever else is important
on the survivor’s mind.
5 Psychiatric Services To perform medical Psychiatrist
assessment, treatment and
consultation
6 Discharge Once the survivor’s Respective states
psychological and psychiatrist or
emotional state have psychological officer
improved, they will be or coordinator.
discharged and followed up
at least a month after
disaster/crisis event.
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7.7 Post Disaster
Post Disaster phase are initiatives taken in response to a disaster with a purpose to
achieve early recovery and rehabilitation of victims and responders in helping
them return to their daily routine.
The purpose of this phase is to inform responders on the signs and symptoms they
may experience in the first few weeks after returning from the crisis/disaster area.
Health assessment will also be conducted in making sure the responders are
mentally and physically stable.
The responders/victims will be advised on things and matters need to be taken care
of which may include the following:
1. Maintaining a healthy diet, routine exercise, adequate rest/sleep

2. Spending time with family and friends
3. Paying attention to health concerns
4. Meeting neglected daily personal tasks (e.g. paying bills, mow loan, shop for
groceries)
5. Reflecting upon what the experience has meant personally and professionally
6. Getting involved in personal and family preparedness.
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Post Deployment Session Flowchart
Post deployment of
volunteers
Mental Health
Alert card
Refer to MH profesional if there is

any signs or symptoms
Return documentation to
CPRC
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Post Deployment Procedure

No Flowchart Activities PIC
1 Post deployment During this session, health CPRC,/NCD/PKD/
session location and assessment session will be individual agency
logistic conducted coordinator
Tools:
 K10 (appendix 6)
 DASS
Debriefing session will be
conducted if necessary
2 MH alert cards Mental health alert card will be NCD/PKD/individual
(appendix 3) given to all responders involved agency coordinator
distribution
3 Referral to MH During assessment, responders MH professionals
professional identified to have psychological
issues will be referred to mental
health professionals such as
medical officers, counsellors,
clinical psychologists or
psychiatrist for referral and
follow up
4 Return All documentations on data and NCD officer/PKD
documentation to MHPSS activities will be
CPRC reported to CPRC for record
purposes (example of return and
report; see Appendix 7-10).
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Post Disaster Review /After Action Review (AAR)
1. Feedback and follow up session for survivors and families and community
2. Post Deployment discussion for MHPSS
3. Post Deployment Intervention
4. Bereavement Management
5. On going assistance for psychiatric referral and psychological intervention

follow-up when indicated
(eg: when involved death of family members, those survived or witnessed
traumatic event)
6. Public education and community out reach
7. Revisit community: Meeting the survivors and affected community for

potential long term squeal (after 6 months)
8. PTSD
9. Depression
10. Pathological Grief: Delayed or prolonged
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CHAPTER 8: DOCUMENTATION, EVALUATION AND

TERMINATION OF DEPLOYMENT
8.1 Documentation and Evaluation
Documentation of all activities and actions taken pertaining to disaster should be

done and logged appropriately.
Activities should be reported on daily basis and reported to the commander of the
Disaster Operational Room at the District/State/ National CPRC.
8.2 Duration of MHPSS
Depending on the severity of the event, the deployment and involvement of the
MHPSS team should not exceed 3 weeks
Upon completion of their deployment, the team will hand over their responsibility
to the subsequent team.
8.3 Demobilisation
The decision to terminate MHPSS service is taken by CPRC (Crisis Preparedness

Respons Centre) MOH, DOCC (Disaster Operations Control Centre) and MHPSS
service coordinator.
1. Handover and Exit
• Define the details of services that will be handed over and identify which
service will be terminated.
• Guide and inform the counterpart that will take over the delivery of the
service
• Inform and confirm all matters with regards to administrative procedures
and logistics with the cooperation of CPRC and the authority
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2. Debrief
Debriefing session involving all who have participated in the response would
be called to signify the formal termination of emergency period and stand
down of operation and to proceed to the next phase of relief and
rehabilitation.
• Internal debriefing session should be done with team members in order to
provide support mentally and emotionally as well as to discuss and analyse
the challenges and suggest methods for improvement
• External debrefing session can be conducted with CPRC and other
agencies which mainly focused on the services provided as well as lessons
identified.
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APPENDIX
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APPENDIX 1: PFA (PSYCHOLOGICAL FIRST AID) KITS
• Crayons, colour pencils, A4 papers, Stress Ball, Balloons, Playdoh, Blob

Tree, Body Outline.
• Other equipments/ acccessories
• Hand Sanitizers
• Brochures
• Tissue paper
• Mineral Water
• Energy Bars/Snacks
• Cross Road Cards
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APPENDIX 2: PFA (PSYCHOLOGICAL FIRST AID) PRINCIPLES
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APPENDIX 3: MENTAL HEALTH ALERT CARD
MENTAL HEALTH ALERT CARD

To the traveler / volunteer coming back as a disaster responder,
If you have any of the following symptoms:
❑ Easily anxious
❑ Feeling extremely sad/hopeless/helpless
❑ Feeling guilt
❑ Easily irritated /angry
❑ Flashbacks /nightmares of the disaster
❑ Difficulty in sleeping
❑ Crying without any specific reasons
Seek professional help from nearest clinic/hospital and present this card for further
assessment.
To the Doctor
The person presenting this mental health alert card has been deployed as a disaster
responder. The disaster was
……………………………………………………………………………………………………………………………………….
If the person presents with symptoms related to mental health problems, kindly perform
further assessment and appropriate intervention for him/her.
TIPS ON MANAGING YOUR MENTAL HEALTH

UPON RETURNING FROM MISSION
 Do not be alone
 Talk to someone that you trust or share your feelings about the events that you have
experience
 Try to eat even if you do not have the appetite
 Pay extra attention to rekindling your interpersonal relationships with your family
members and friends, continue to communicate.
 Try to get back to your normal routines
 Manage your stress by relaxation techniques, enough sleep, balance diet and exercises
 Practice deep breathing exercises or other forms of relaxation techniques
 Anticipate that you will experience recurring thoughts or dreams and they will
decrease over time
 Give yourself time and chance to recover from the memories of events
THANK YOU FOR YOUR CONTRIBUTION
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APPENDIX 4: DEPRESSION ANXIETY STRESS SCALE (SARINGAN

MINDA SIHAT)
SARINGAN MINDA SIHAT
Nama : ________________________________________________________________________
I/C No : ________________________________________________________________________
Jantina : ________________________________________________________________________
Umur : ________________________________________________________________________
Bangsa : ________________________________________________________________________
Pekerjaan :_________________________________________________________________________
No Telefon :_________________________________________________________________________
Tarikh : ____________________________________________________________________________________
Ceraikan keratan ini untuk disimpan oleh klien
KEPUTUSAN SARINGAN MINDA SIHAT
Nama : ____________________________________________ Tarikh : _____________________
Jantina : Lelaki/Perempuan Umur : ____________________
Ujian Keputusan
Stres Anzieti Kemurungan
DASS
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SARINGAN MINDA SIHAT
SOAL SELIDIK DASS
Langkah 1 : Sila baca dan jawab soal selidik DASS
Langkah 2 : Masukkan skala markah jawapan ke dalam ruangan kosong dibahagian 2, mengikut soalan
(S) bagi setiap kategori (Stres,Anzieti dan Kemurungan)
Langkah 3 : Jumlahkan skala markah bagi setiap kategori bagi mengetahui tahap status kesihatan mental
anda
Langkah 4 : Sila isikan keputusan dalam bahagian 3 dan isikan dalam keratan di muka hadapan.
BAHAGIAN 1
Sila baca setiap kenyataan di bawah dan bulatkan jawapan anda pada kertas jawapan berdasarkan jawapan 0, 1, 2 atau 3 bagi
menggambarkan keadaan anda sepanjang minggu yang lalu.Tiada jawapan yang betul atau salah. Jangan mengambil masa yang terlalu lama
untuk menjawab mana-mana kenyataan.
Please read each statement and circle number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There
are no right or wrong answers. Do not spend too much time on any statement.
Skala pemarkahan adalah seperti berikut :

The rating scale is as follows :
0 Tidak langsung menggambarkan keadaan saya

Did not apply to me at all
1 Sedikit atau jarang-jarang menggambarkan keadaan saya

Applied to me to some degree, or some of the time
2 Banyak atau kerapkali menggambarkan keadaan saya

Applied to me to a considerable degree, or a good part of time
3 Sangat banyak atau sangat kerap menggambarkan keadaan saya

Applied to me very much, or most of the time
1. Saya dapati diri saya sukar ditenteramkan

0 1 2 3
I found it hard to wind down
2. Saya sedar mulut saya terasa kering

0 1 2 3
I was aware of dryness of my mouth
3. Saya tidak dapat mengalami perasaan positif sama sekali

0 1 2 3
I couldn’t seem to experience any positive feeling at all
4. Saya mengalami kesukaran bernafas (contohnya pernafasan yang laju,tercungap-

cungap walaupun tidak melakukan senaman fizikal)
0 1 2 3
I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in
the absence of physical exertion)
5. Saya sukar untukmendapatkan semangat bagi melakukan sesuatu perkara

0 1 2 3
I found it difficult to work up the initiative to do things
6. Saya cenderung untuk bertindak keterlaluan dalam sesuatu keadaan

0 1 2 3
I tended to over-react to situations
7. Saya rasa menggeletar (contohnya pada tangan)

0 1 2 3
I experienced trembling (eg,in the hands)
8. Saya rasa saya menggunakan banyak tenaga dalam keadaan cemas

0 1 2 3
I felt that I was using a lot of nervous energy
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9. Saya bimbang keadaan di mana saya mungkin menjadi panik dan melakukan
perkara yang membodohkan diri sendiri
0 1 2 3
I was worried about situations in which I might panic and make a fool of myself
10. Saya rasa saya tidak mempunyai apa-apa untuk diharapkan

0 1 2 3
I felt that I had nothing to look forward to
11. Saya dapati diri saya semakin gelisah

0 1 2 3
I found myself getting agitate
12. Saya rasa sukar untuk relaks

0 1 2 3
I found it difficult to relax
13. Saya rasa sedih dan murung

0 1 2 3
I felt down-hearted and blue
14. Saya tidak dapat menahan sabar dengan perkara yang menghalang saya
meneruskan apa yang saya lakukan 0 1 2 3
I was intolerant of anything that kept me from getting on with what I was doing
15. Saya rasa hampir-hampir menjadi panik/cemas

0 1 2 3
I felt I was close to panic
16. Saya tidak bersemangat dengan apa jua yang saya lakukan
0 1 2 3
I was unable to become enthusiastic about anything
17. Saya tidak begitu berharga sebagai seorang individu

0 1 2 3
I felt I wasn’t worth much as a person
18. Saya rasa yang saya mudah tersentuh

0 1 2 3
I felt that I was rather touchy
19. Saya sedar tindakbalas jantung saya walaupun tidak melakukan aktiviti fizikal
(contohnya kadar denyutan jantung bertambah, atau denyutan jantung berkurangan)
0 1 2 3
I was aware of the action of my heart in the absence of physialexertion (eg, sense of
heart rate increase, heart missing a beat)
20. Saya berasa takut tanpa sebab yang munasabah

0 1 2 3
I felt scared without any good reason
21. Saya rasa hidup ini tidak bermakna

0 1 2 3
I felt that life was meaningless
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BAHAGIAN 2
Panduan Mengira Skor :-
Masukkan skala markah jawapan bagi soalan (S) bagi setiap kategori.
STRES
Soalan S1 S6 S8 S11 S12 S14 S18 Jumlah
Markah
ANZIETI
Markah
KEMURUNGAN (DEPRESSION)
Markah
Selepas dijumlahkan, sila rujuk kepada petak skor saringan dan terjemahkan jumlah skor untuk mengetahui tahap status
kesihatan mental anda.
SKOR SARINGAN
Kemurungan Anzieti Stres
Normal 0-5 0-4 0-7
Ringan 6-7 5-6 8-9
Sederhana 8-10 7-8 10-13
Teruk 11-14 9-10 14-14
Sangat teruk 15+ 11+ 18+
BAHAGIAN 3
Isikan keputusan (normal,ringan,sederhana,teruk atau sangat teruk) dalam jadual di bawah
KEPUTUSAN UJIAN DASS
Ujian Skor Tahap
Stres
Anzieti
Kemurungan
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APPENDIX 5: SQD: Screening Questionnaire for Disaster Mental

Health
Instruction:
“People who have experienced [repeat the traumatic event] often report that their lives
have changed dramatically and they are constantly under various kinds of stress. Have
you experienced any of the symptoms listed below in the past month?”
GENDER : MALE FEMALE AGE :
Q1 Have you noticed any changes in your appetite ? Yes No

Perubahan selera makan
Q2 Do you feel that you are easily tired and/or tired all the Yes No
time?
Letih dan lesu
Q3. Do you have trouble falling asleep or sleeping through Yes No
the night?
Sukar untuk tidur / masalah untuk tidur
Q4. Do you have nightmares about the event? Yes No
Sering mimpi buruk tentang situasi yang dialami
Q5 Do you feel depressed? Yes No
Sedih dan tidak bermaya
Q6 Do you feel irritable? Yes No
Gelisah dan cepat marah
Q7. Do you feel that you are hypersensitive to small noises Yes No
or tremors
Q8 Do you avoid places, people, topics related to the Yes No
event?
Q9 Do you think about the event when you do not want to Yes No
Q10 Do you have trouble enjoying things you used to enjoy? Yes No
Rasa tidak seronak dalam aktiviti seharian
Q11 Do you get upset when something reminds you of the Yes No
event?
Q12 Do you notice that you are making an effort to try not to Yes No
think about the event, or are trying to forget it?
Cuba usaha untuk melupakan situasi buruk yang dialami
SQD-P: Q3 + Q4 + Q6 + Q7 + Q8 + Q9 + Q10 + Q11 + Q12 =
SQD-D: Q1 + Q2 + Q3 + Q5 + Q6 + Q10 =
SQD-P: 9-6 = Severely affected (possible PTSD)

5-4 = Moderately affected
3-0 = Slightly affected (currently little possibility of PTSD)
SQD-D: 6-5 = More likely to be depressed
4-0 = Less likely to be depressed
APPENDIX
Journal from A Simple Interview-format Screening Measure for Disaster Mental Health: An instrument 6
newly developed after the 1995 Great Hanshin Earthquake in Japan
- The Screening Questionnaire for Disaster Mental Health (SQD)
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APPENDIX 6: KESSLER PSYCHOLOGICAL DISTRESS SCALE (K10)
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APPENDIX 7: K10 (MALAY VERSION)

SARINGAN K10
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APPENDIX 8: MOH MENTAL HEALTH PSYCHOSOCIAL SUPPORT

SERVICES REPORTING FORMAT (MHPSS)
MOH MENTAL HEALTH PSYCHOSOCIAL SUPPORT SERVICES REPORTING

FORMAT (MHPSS)
CONTOH FORMAT PELAPORAN PERKHIDMATAN KESIHATAN MENTAL DAN

SOKONGAN PSIKOSOSIAL KKM
Date/Time
Tarikh/Masa
Place
Tempat
What happen?
Apa yang telah terjadi?
Please describe how and why
Bagaimana/kenapa ia terjadi
Number of individuals involved
Bilangan individu terlibat
Number of family members

involved
Bilangan keluarga terlibat
Jumlah kes
Total cases: Kumpulan Umur Total Cases
Age group/sex Age Group Lelaki Perempuan

(Male) (Female)
0-1
Jumlah kes:
1-5
kumpulan umur/jantina 6-18
19-50
> 50
Jumlah
Mental health status examination
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Pemeriksaan status kesihatan

mental
Number of individuals given PFA
Bilangan individu yang diberikan

PFA
Psychosocial interventions given
(relaxation therapy,art
theraphy,play therapy, others)
Intervensi psikososial yang

dilaksanakan
(Terapi relaksasi, terapi lukisan,

terapi mainan, lain-lain)
Number of cases referred to

Psychologist/Medical
officer/psychiatrist/others
agencies (name of agency)
Rujukan ke
Pegawai psikologi/Pegawai
Perubatan/Pakar Psikiatri/Agensi
lain (nama agensi terlibat)
Number of individuals given

debriefing
Bilangan individu yang diberi

debriefing
If referred :
Diagnosis
Sekiranya dirujuk :
Diagnosis
Report by:
Laporan oleh:
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APPENDIX 9: Data Collection of Mental Health and Psychosocial Support Services during Disaster/Crisis
Date: Name of Providing Agency:
Location: Name of the focal point:
Event: Contact Details of the focal point:
Referral to
Number Individual Group session
Number of Numbers of Other Activities Specialist/Psychology
of session (PFA) (PFA) Notes
No. District team being MHPSS Officer
existing
mobilised responders Relaxation Psycho-
teams Staff Public Staff Public Staff Public
Activities education
Total
NATIONAL GUIDELINES AND STANDARD OPERATING PROCEDURE-MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN DISASTER
APPENDIX 10: Data Collection of Mental Health and Psychosocial Support Services during Disaster/Crisis
(Referral to Psychiatrist)
Date: Name of Providing Agency:
Location: Name of the focal point:
Event: Contact Details of the focal point:
Category Age Sex Diagnosis Notes
Bipolar D/O
Depression
Anxiety
Others
No. District
PTSD
MOH
Public <10 10 -19 20-60 > 60 L P
staff
Total
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NATIONAL GUIDELINES AND STANDARD OPERATING PROCEDURE-MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT IN DISASTER
APPENDIX 11: Report on the coverage of Mental Health and Psychosocial Support Services Provided for MOH staff
and other Agencies
Location: Date:
Event:
Agency: Ministry of Health Malaysia
Organization Number of MOH workers Percentage of MOH workers

No. District Numbers of involved (Event...) Notes
MOH staff given PFA given PFA (% of coverage)
Other Agencies: _________________
Organization
Percentage of people given PFA
No. District Other Numbers of involved (Event...) Number people given PFA Notes
(% of coverage)
agencies
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APPENDIX 12: Checklist for Disaster Response Workers
NO Mental Health Component for Disaster Response Workers Status Notes
Health Response Workers have completed Psychological

1 First Aid training.
Petugas kesihatan telah menerima latihan ‘’Psychological

First Aid’’ (PFA) atau Bantuan Awal Psikologi
Health Response Workers have completed DASS assesment

2 before being sent to the disaster/crisis field
Petugas kesihatan telah menjalani saringan * DASS/SSKM

bagi memenuhi kriteria untuk bertugas di lapangan
(deployment)
* DASS- Depression Anxiety Stress Scale
SSKM – Saringan Status Kesihatan Mental
3 Pre deployment briefing session including talk on mental

health preparedness in Disaster Response Workers
component have been conducted for health response
workers.
Petugas kesihatan diberi taklimat/’briefing’ pre-deployment

tentang persediaan kesihatan mental petugas (Mental
Health Preparedness in Disaster Response Worker)
4 Booklets and pamphlets on mental health being provide for

Health response workers
 Psychological and emotional reactions of Disaster

Response Workers
 Stress Management
 Breathing Techniques
 Psychological First Aid
Petugas kesihatan dibekalkan dengan risalah/booklet

berkaitan kesihatan mental
 Reaksi Tekanan pada Pekerja Bencana

 Tangani stres
 Latihan Pernafasan
 PFA
Post Deployment session conducted for Health Response

5
workers who has just return from deployment.
Petugas kesihatan yang kembali dari bertugas di lapangan
menerima mental health post-deployment briefing
SUPPORT IN DISASTER
MATERIAL AND REFERENCE
1. National Security Council Guideline (Directive No.20) Prime Minister

Department. (2012)
2. IASC Reference Group for Mental Health and Psychosocial Support in

Emergency Settings (2010). Mental Health and Psychosocial Support
in Humanitarian Emergencies: What Should Humanitarian Health
Actors Know? Geneva.
3. World Health Organization, War Trauma Foundation and World Vision

International (2011). Psychological first aid: Guide for field workers.
WHO: Geneva.
4. Outbreak and Disaster Management Sector. Surveillance Dection.

Disease Control Division, Ministry of Health Malysia. (2015) Disaster
Management Plan Ministry of Health Malaysia.
Page | 78

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NATIONAL GUIDELINES AND

Mental Health Unit

Acronyms and Abbreviations

AAR After Action Review

PERKAMA Persatuan Kaunseling Malaysia

governmental efficiently and effectively in a systematic manner is explained. The

Dato’ Dr Chong Chee Kheong

1. YBhg. Dato’ Dr Chong Chee Kheong

3. Dr Toh Chin Lee

4. YBhg Dato’ Dr Ahmad Rasidi bin Saring

2. Dr Karen Sharmini a/p Sandanasamy

2. Siti Nuruainain Zainal Abidin

Technical Working Committee First Edition 2013

1. Azriman bin Rosman (Dr)

2. Devan Kurup (Dr)

3. Eizwan Hamdie binYusoff (Associate Prof. Dr)

4. Faisal bin Salikin (Dr)

5. Fatanah binti Ismail (Dr)

6. Haniza binti Rais (Dr)

7. Hazli bin Zakaria (Dr)

8. Jamaiyah binti Haniff (Dr)

9. Jumari bin Sopaman

10. Khadijah binti Minhat

11. Lim Chong Hum (Dr)

12. Mohd Sabtuah bin Mohd Royali

13. Naniyati binti Shuib

14. Nasiumin binti Mohd Nor

15. Norazura binti Ahmad

16. Norhayati binti Nordin (Dr)

17. Nor Hayati binti Ali (Dr)

18. Nurashikin binti Ibrahim (Dr)

19. Omar bin Mihat (Dr)

20. Roziah binti Ismail

21. Ruhana binti Mahmod

22. Shahrulnizam bin Husain

23. Siti Nuruainain binti Zainal Abidin

24. Suria binti Hussin (Dr)

25. Toh Chin Lee (Dr)

26. Tiong Chea Ping (Dr)

27. Tuslah binti Abdan

28. Uma a/pVisvalingam (Dr)

29. Zulkifli bin Ghaus (Dr)

30. Zulkifli bin Muhammad

CONTRIBUTORS TO SECOND EDITION 2019

1. Ahmad Rasidi bin Saring (YBhg Dato’ Dr)

2. Ahmad Qabil bin Khalib (Dr)

3. Ahmad Zabidin bin Zakaria (Dr)

4. Anita Devi Jain Sat Pal (Dr)

5. Azlin binti Amat (Dr)

6. Badiah Yahya (Dr)

7. Chan Pek Har

8. Eizwan Hamdie bin Yusof (Assoc Prof Dr.)

9. Fazil Bin Ahmad (Mej (Dr))

10. Fauzan bin Md Tahir (Mejar)

11. Haniza binti Rais (Assisstant Prof. Dr)

12. Karen Sharmini a/p Sandanasamy (Dr)

13. Khadijah Hasanah Abang Abdullah (Dr)

14. Kenny Lim

15. Lee Boon Hock