Abstract
This case study explores the impact of implementation of emotional well being workshops in disaster affected areas in Myanmar after Cyclone Moca devastates the coastal region in May 2023. The community in the area has already been struggling and grappling with many crises and challenges due to man made disasters and faced an additional blow from nature. In order to address the mental and emotional well being of people in the area, international non government organization and Counselling Corner, a mental health service in Myanmar with the aim to improve the well being of people, worked together and organized emotional well being workshops using art and clay as medium. Underpinning various theories, workshops are designed to improve mental health awareness, emotional expression and community resilience. The workshop outcomes, from the feedbacks of participants, indicates the increasing mental and emotional well being, sense of community and increase in mental health awareness. This case study highlights the need for intervention in disaster affected areas and impact of such interventions and the need to fill the gap in mental health care.
Introduction
In May 2023, a devastating cyclone struck the coastal community in Myanmar in which financial instability, civil war and political crisis are happening. The residents in Rakhine state have been undergoing one crisis after another since 2012 and now again faced with not just physical destruction but also significant emotional distress. To address the emotional well being of the community members, an International non-governmental organization joined hands with Counselling Corner, the mental health service in Myanmar with the aim to improve the well being of people organized several emotional well being workshops. Workshops are designed for disaster relief and mental health support with the usage of art and clay as medium.
Background
Myanmar, a nation of longest civil war, has been at the center of controversy with genocide and military coup. The residents have been undergoing not only physical and financial stress but also emotional and mental health stress. In May 2023, the residents suffered another blow by nature.
A devastating cyclone, Mocha, hit the coastal region of Myanmar. From the evidence of other research, residents in disaster areas have been shown to experience emotional distress. After disaster, mental health issues and psychosocial problems typically arise and they are interconnected. Individuals and communities might experience mental health stress leading to Post-traumatic stress disorder, anxiety, depression and grief. With the problems of psychosocial aspects like separation of family due to disaster, loss of daily routine, loss of work, loss of control over one’s own daily life, loss of belonging and other problems, people in affected areas suffer a wide range of mental,physical,emotional and behavioural symptoms. Emotional instability, stress reactions, anxiety, trauma and other psychological symptoms are observed commonly after the disaster and other traumatic experiences. These psychological effects have a massive impact on the individual and also on communities. Resilience plays a vital role and acts as an effective measure. Most affected individuals recover with time, with the help of effective post-intervention techniques and their individual strengths.
Thus, to minimize and facilitate the recovery from disaster, emotional well being workshops were hosted. With the help of international non governmental organization, Counselling Corner which is a mental health service in Myanmar with the aim of improving the well being of people, design workshops that aim for disaster relief, mental health well being, emotional distress and increase acceptance,resilience and mindfulness. Two mental health counsellors went to disaster affected areas and acted as facilitators for workshops using art and clay as medium to express emotions.
Theory Background/Conceptualization
The use of artistic methods to treat mental distress and enhance mental health is known as art therapy. Art therapy is a technique rooted in the idea that creative expression can foster healing and mental well-being.
People have been relying on the arts for
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Communication
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Self-expression
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And self healing
Art has become an important part of the therapeutic field and is used in some assessment and treatment techniques.
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Use art to
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Teach participants to name, identify, and recognise their emotions, and their associated bodily sensations.
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Process Emotional experience Through the person identifying and labelling the emotions they have been experiencing
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Communication Between the therapist and the person participating the workshop
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Interpretation What comes up in the sessions
Workshops are designed with supportive-expressive art therapy which is non-directive i.e participants decide what is important to focus on. While the facilitator of the workshop is the guiding hand, participants have to be actively involved in process which include being vulnerable, opening up, and committing to the process.
The expressing with art workshop is designed so that participants can express their emotions that are hard to express. By using art as a medium, participants communicate their emotions through their drawings, colorings and their artworks on paper.
For the clay workshop, clay is natural, the medium of art. It is a unique and powerful tool in therapy. This clay workshop is also nondirective.
It is a combination of different theories such as:
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Critical incident stress management
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Art therapy
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Humanitarian Theory and
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Experiential Learning Group Theory
This approach works to influence how people think, feel, and act, promoting better communicating skills, self-reflection, insight, and emotional growth. Through exploring the interrelationships among emotion, cognition, and change, This approach develops a powerful, clinically relevant theory of human functioning. When someone feels a maladaptive emotion such as shame or guilt one can benefit from regulation in order to prevent from becoming overwhelmed by those emotions, thereby creating an opportunity to make sense of them. By sharing and developing practical experiential sensing skills and strategies, participants feel empowered to be able to manage their own mental health and wellbeing while also modelling self-care for their families and communities.
Benefits of workshops
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To improve Socialising skills and creative skills
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To improve healthy coping
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To improve to express own feelings and emotions
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To improve sense of self
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To improve self understanding and coping skills
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For the mitigation of the impact of a stressful incident or traumatic experience
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For the facilitation of the normal recovery processes and a restoration of adaptive functions in psychologically healthy people who are distressed by an unusually disturbing event
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A screening opportunity to identify group members who might benefit from additional care.
Method
Workshop design
First, to increase mental awareness and to be able to make sense of the reactions, the importance of mental health were first explained and emotional reactions were discussed first. As participants could share and relate to the emotional reactions that they were suffering, they could make sense of their emotions. This facilitates the sharing session of emotions and raise mental health awareness which is pivotal in increasing resilience and acceptance. Facilitator also set ground rules of non judgemental, confidentiality and listening and being with each other throughout the workshop.
First facilitator asked participants to draw/paint or make clay work for whatever they feel at the moment, and explained that they do not have to judge themselves or others for their artwork, practising non-judgement about emotions and expressing them. To help with the process, soothing and calming music is turned on. Facilitator let participants be creative with their artwork with various materials such as crayon, pencil, colored pencils and various tools for clay making.
Facilitators encourage participants to focus on their emotions, feelings, sensations and express them while listening to music.
Then participants shared their own self-work and emotions and facilitators listened to each of their stories and emotions and facilitated reflection and emotional processing. Facilitators would give psychoeducation when it is needed to raise mental health awareness and participants would share their own coping mechanisms. As participants listened to each other, they start to feel they are together and increase resilience as a group.
Sharing emotions and listening to each other's stories could be heavy afterwards. Thus, as the ending session of the workshop, each facilitator performed grounding activity using five sense and breathing exercise.
Results
Total of 8 workshops were done for 151 participants. Participants shared their distress regarding work, family, loneliness due to being away from home and feelings of being trapped and struck because of facing political, financial and social problems, their grief of losing home and work due to storm, and last not least they also talked about their coping methods while going through all those distressing events.
After each workshop, participants were asked open questions about their feedback regarding the workshop. Their feedbacks could be categorized and summarized into five groups
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Increase Emotional Awareness
They shared feedbacks of becoming aware of their emotions and increase self reflection
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Understanding of Mental Health
They became aware of mental health and its importance
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Community building and connection and resilience
After the workshop, they felt that they are not the only one with stress, worry and unhappiness and gained strength to keep going and felt like they became one
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Desire for more workshops
They want to have more workshops with context in relation to their state.
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Increase Mental and emotional well being
They felt relaxed and peaceful after workshop and it help them to keep going with life
Conclusion
After doing all workshops, amazing resilience among residents can be seen. Nevertheless, the impact from disaster and other crises are imminent and the emotional and mental distress can be seen. After doing intervention by using workshops, residents could learn about mental health and their reactions and learnt more healthy coping strategies and increase resilience as a whole community. The last but not least, mental health gap in community need to be filled to increase awareness and well beings of people.
Lessons Learned & Discussion
Barriers to overcome
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Mental health awareness
Mental health has been stigmatized and people do not know about mental health. They feel shameful to talk about mental health and thus it is important to raise mental health awareness first.
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MHPSS supporter training
There have been very few resource persons to provide MHPSS.
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Language Barrier
There were some difficulties faced when communicating emotions regarding language.
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More mental health service
In those areas, there has been so little mental health services. Thus, more funding and collaboration with INGOs would be required.
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Place difficulty
In those areas, there had been some difficulty with finding a place to do workshops and sometimes places are tight for number of participants
Recommendation and Discussions
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Mental Health Awareness:
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Conduct community awareness campaigns to educate residents about mental health, its importance, and debunk common myths and stigmas.
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Collaborate with local community leaders, schools, and healthcare facilities to organize mental health awareness workshops and seminars.
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Integrate mental health education into school curricula to ensure a sustained approach to awareness and destigmatization.
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MHPSS Supporter Training:
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Collaborate with local NGOs, INGOs, mental health organizations, and professional bodies to offer training programs for mental health support personnel.
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Establish partnerships with local and international organizations to provide funding for training initiatives and capacity building programs.
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Develop an accessible online platform for training modules and resources, enabling remote training for individuals in remote or underserved areas.
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Language Barrier:
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Translate educational materials and resources related to mental health and emotional well-being into local languages to ensure broader accessibility.
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Recruit bilingual mental health professionals or volunteers to act as interpreters and facilitate effective communication during workshops.
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Train mental health professionals in local languages to improve communication and understanding between mental health support providers and the community.
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More Mental Health Services:
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Advocate for increased government funding and investment in mental health services, particularly in disaster-prone areas.
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Collaborate with international and national organizations to establish mental health clinics and centers in the affected regions, providing accessible and ongoing support.
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Utilize telehealth technology to provide virtual mental health consultations and support, bridging the gap in areas with limited access to in-person services.
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Place Difficulty:
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Establish partnerships with community centers, schools, or local organizations to use their facilities for workshops, ensuring adequate space for participants.
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Organize smaller, more frequent workshops to accommodate the limited space and resources, ensuring that every interested participant can benefit from the workshops.
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Develop a mobile workshop model, equipped with the necessary materials and tools, to reach remote or confined areas where finding a suitable location is challenging.
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By implementing these recommendations, the emotional well-being workshops can effectively address the identified barriers, enhance community participation, and ensure a meaningful and lasting impact on the mental health and well-being of the affected population.
References
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Samuel T. Gladding (1992),Counseling as an Art: The Creative Arts in Counseling., American Association for Counseling and Development
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Makwana, N. (2019). Disaster and its impact on mental health: A narrative review. Journal of Family Medicine and Primary Care, at: https://doi.org/10.4103/jfmpc.jfmpc_893_19.
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Seto, M., Nemoto, H., Kobayashi, N., Kikuchi, S., Honda, N., Kim, Y., Kelman, I. and Tomita, H. (2019). Post-disaster mental health and psychosocial support in the areas affected by the Great East Japan Earthquake: a qualitative study. BMC Psychiatry, at: https://doi.org/10.1186/s12888-019-2243-z.
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Canino, G., Bravo, M., Rubio-Stipec, M. and Woodbury, M. (1990). The Impact of Disaster on Mental Health: Prospective and Retrospective Analyses. International Journal of Mental Health, at: https://doi.org/10.1080/00207411.1990.11449153.
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Frances Mao & Rajini Vaidyanathan(2023) Cyclone Mocha: Myanmar’s Rakhine state declared disaster area.. BBC. 15 May. Available at: https://www.bbc.com/news/world-asia-65595693
Appendix
Feedbacks from participants translated to English language that are categorized into five groups in Results section.
“I became aware of own emotions”
“I wish that there would be more workshops like this”
“I became to realize about mental health and its importance”
“As a group, we became one”
“expressing emotions feel great”
“Feels relaxed and light”
“Thanks for sharing knowledge”
“Want to have more workshops”
“Increased self-reflection”
“ A chance to express emotions”
“Once a month or once every two months should be done”
“Increased knowledge”
“Happiness”
“Feels validated”
“Glad to be able to express emotions”
“Reduced stress for a moment”
“Brain development”
“Feels comfortable”
“Relaxed and peaceful”
“Valuable training”
“Satisfied”
“A lot to think about” “awareness and self reflection”
“Remembarance of childhood”
“Glad to have a chance to be openly artistic”
Thank you for increase well being skill”
“Because of this workshop, I knew that I am not only a person who have stress, worry and unhappiness but everybody have stress, worried and unhappiness and so we have to keep going fighting!”
“This workshop help me to keep going with my life”
“Want to have more workshops and psychosocial support in North Rakhine state”
“Want to have more workshop which address the context in state”
Hein Htet Lwin Oo has always been genuine in trying to understand people and listen to them. He has been always interested in Psychology and when he went through hard times during Covid, he noticed other people around him were going through tough times of their own and he wanted to find out how best to help them. Thus, he signed up for the Basic Counselling Training and completed up till the Advanced Counselling Training at Counselling Corner, through scholarships provided by Counselling Corner. Once completed he decided that he will use all his knowledge and skills to support other people and he has been pursuing his passion in counselling since then.