It is now approaching two years since the day we lived through the devastating 7.8 magnitude earthquake. These two years have been a rollercoaster ride of emotions for most of us, a time of fear, anxiety, anger and frustration, punctured by brief glimmers of hope.

According to disaster mental health experts, there is a four-staged cycle of emotions that most people or a community go through after a massive disaster of this scale.

The first phase, which occurs immediately after disaster, is commonly known as the “heroic” phase, where most of the people want to help and reach out to others. During this phase in Nepal, there was an overwhelming response from the people within and beyond the country who worked tirelessly to help those in desperate need. Despite the widespread damage, many lives were saved and the injured were treated timely.

This is followed by the “honeymoon” phase, which lasts from few days to around six months after the disaster. This is the stage when most people are usually calm and feel relief of having survived the disaster. There is a strong sense of community and shared emotions of having gone through the struggles together. In contrary, the third stage is “disillusionment”, which usually takes place between six months to one year after disaster when most people feel resentment, anger and frustration because of the delays in reconstruction, rehabilitation and the lack of support. This is also the phase when international support and media focus begins to shift away from the disaster.

The fourth stage is reconstruction, which can last for several years after a disaster. Most people are able to return to a sense of normalcy by this time. However, the emotions seen during this stage can also vary widely according to the emotional and financial status of the survivors, the way a person dealt with the previous three stages and the actual level of resources or support that are available to the person. We are currently in this fourth phase of the disaster recovery in Nepal.

When we look back at the past two years, most us have gone through a similar strain of emotional experiences—we have been through psychological trauma in some way or the other. For some, this was easy to cope with, whereas, for many, the traumatic experiences continue to haunt them even after all this time. Though a majority of Nepalis demonstrated amazing resilience, there are

some who have been left behind and have not been able to move on. This struggle is most evident for people of vulnerable age-groups like children and adolescents, in particular those who have been direct victims of the earthquake.

“I still dream of the ground shaking violently and houses collapsing. I often see myself shivering; being left all alone in the dark,” said a 13 year-old-boy from Khalte, Dhading who lost his brother and his home to the earthquake. Many adolescents from districts severely affected by the earthquake continue to experience fear and nightmares. In a study, in which we are exploring the after effects of earthquake, many responded that earthquakes, even the occasional minor aftershocks, continue to terrify them.

Adolescence, in general, is a sensitive time for every individual. We all go through this complicated phase where we struggle with identity crises, hormonal changes and a slew of emotional rifts. The challenges faced by adolescents in general could be compounded by natural disasters like an earthquake. Unlike adults, it is difficult for adolescents to comprehend their emotions clearly, leaving them susceptible to developing more complex symptoms of psychological trauma than adults. The manifestations of these traumas could be either immediate or might appear later in their lives. The symptoms could range from violent behaviour problems like anger and aggression to less noticeable symptoms like sadness, guilt, low self esteem and emotional numbing.

It is believed that 50 percent of the mental health problems begin before the age 14. If the symptoms are not recognised early, the consequences could be disabling and debilitating in the long run. However, not all adolescents who have experienced such trauma or are currently going through a difficult phase would need specialised care. Many of these adolescents can be helped through psychosocial support at home or at schools and such intervention would play a big role in preventing the need for advanced care in the future.

Psychosocial support is about helping individuals cope with difficult life situations and it doesn’t require an expert to provide such support. It is a continued process

that is helpful in recovering from psychological challenges faced by anyone in the long run. Psychosocial well being is a situation in which children’s basic social and emotional needs are adequately met. It is crucial for healthy and balanced development of any children and adolescent as they grow into adulthood. There are many ways in which schools and parents can promote psychosocial wellbeing, provided they have a structured guidance.

In a recent group interview with school teachers, a secondary level school teacher from Nilkantha Municipality, Dhading said, “We did receive training a few days after the earthquake that taught us how to help students cope with the immediate crisis, however, that was just one-off. We do not know how to continue to help those who have been through a difficult phase and have lost a lot. They do not show typical symptoms that indicate they need to be referred to medical facilities. They function well with their daily activities, but we do wish we could ease their pain and help them better.”

Problems like these are more common place than it is let on, and can be addressed through structured psychosocial support at schools or communities, where a large number of children and adolescents can be reached out to at once. At schools, the support should include creating children-friendly and protective environment, supportive classroom interactions, opportunities for play, creative, recreational and life-skills activities, individual assistance such as counselling for students who need some more advanced help. Teachers too can respond to students’ basic psychosocial needs through their classroom practices and daily interaction with students. It is important for the teachers and schools to tell their students that it is ok to feel sad, afraid, confused, angry or guilty. It is also equally important to emphasise that they were not responsible for the disaster or the crisis that befell their lives. It is crucial that platforms are opened up on discussing the distressing events in groups and to listen to students’ thoughts and fears without being judgmental. This would also help teachers to identify the ones who would need more advanced treatment so that they can be referred to specialised centres, and to notify parents and guardians accordingly. However, for teachers to be able to provide the right kind of psychosocial support, such programmes need to be formalised within the school curriculum.

Our country, unfortunately, is still at an early stage when it comes to addressing mental health problems at the community level. Though mental health problems have been talked about more openly after the earthquake, psychosocial support programmes targeting school-going children faced by earthquake remain inadequate. There were many immediate psychological first aid programmes organised during the first phase of the recovery period by dedicated teams of national and international mental health experts. However, follow up and long lasting programmes related to psychosocial support programmes in formal education system or even at community levels are not in place yet.

As schools and parents become more open in discussing mental health issues, it is also essential to understand that every stage of the disaster recovery has its own challenges. It will still take time for affected children and adolescents to heal completely. With that in mind, parents, teachers, health experts, educationists, one and all, need to continue this conversation and promote the right kind of psychosocial support for the most vulnerable.

Buildings and infrastructures might eventually be rebuilt, but we need to remain aware that physical damages are but a tip of the iceberg, and mental scars too need to be brought to the limelight. For those already left behind, the time may not come again.

Dr Dhital is a public health expert whose current research focuses on behaviour change communications and adolescent health