Assessing mental health needs after a major disaster: experience from the Pakistan earthquake, 2005

Objectives: Three months after the 2005 earthquake in Pakistan, we carried out a mental health needs assessment on behalf of the World Health Organization (WHO) in one district. Here, we share our experience, to illustrate the challenges of undertaking such an assessment, under extreme circumstances and in resource‐poor settings. Materials and methods: We analysed service utilization data and conducted surveys of psychological problems in two tent villages using the GHQ‐12. In addition, we carried out a thematic analysis on data from a series of semi‐structured interviews with local people and field notes during key meetings and visits. Results: We found that, before the earthquake, mental health service provision in the district was extremely limited or non‐existent. We found evidence of considerable post‐disaster psychological distress and high service utilization. Notable themes from the interviews included lack of mental health service provision before the earthquake, and a reduction in social stigma associated with using mental health services after it. We found a readiness for participation in mental health promotion and support for integration of mental health services into primary care on the part of health care workers and community workers. Conclusion: Our findings are consistent with expectations of an increase in existing psychological morbidity post‐disaster. Results also support the integration of mental health services in primary care and the use of community‐based approaches to promote mental health. Given the extreme circumstances, our assessment was necessarily restricted; nevertheless, even such a limited exercise can yield valuable insights to inform service development.