In the wake of the tsunami disaster, Indonesia is launching its biggest ever mental health drive for traumatised survivors - many of whom have never heard of psychological counselling before.

While the physical toll of the catastrophe is clear in the devastated towns of Aceh province, the invisible costs are more difficult to define in a country where people shun treatment for mental health problems such as anxiety and depression.

“We have 650,000 refugees who are in a very unstable emotional condition,” Yulizar Darwis, who heads the mental health division of Indonesia’s Health Ministry, said on Tuesday.

“We should reach all of them - if not, we estimate that between 20 and 50 percent could have serious mental problems.”

More than 100,000 people died in the province on the northern tip of Sumatra island in the Dec. 26 earthquake and killer waves that followed.

To respond, the ministry has launched a 1.3 billion rupiah ($140,000) programme funded by the United Nations World Health Organisation, to establish guidelines for treating survivors and send counsellors to affected areas.

In cooperation with the Indonesian Psychiatric Association and other groups, the programme will draw on the experiences of Indonesian counsellors who have responded to earlier social crises, including a brutal separatist struggle in East Timor and unrest in the Moluccas.

NO TIME TO LOSE

Indonesian psychologists said the unprecedented scale of the tsunami tragedy, which has left coastal swathes of Aceh virtually wiped clean of human habitation, meant a huge challenge for the country’s mental health experts.

Many of the worst hit areas are remote, and traditional community support structures for mental health - ranging from extended family to religious institutions - have been badly damaged by the disaster.

Aid workers in Aceh report rising numbers of survivors exhibiting what Western psychologists would call post-traumatic stress disorder with symptoms ranging from sleeplessness to depression, rage and despair.

“Severe stress and grief are commonplace and people are too terrified to return to their seaside homes for fear of tsunamis in the future,” international relief group Medecins sans Frontieres (MSF), which has four psychologists working in the area, said in a statement.

Even those who show no immediate effects may be at risk.

“When a tragedy like this happens, sometimes the problems don’t emerge immediately. It can take years,” said Seto Mulyadi, a child psychologist and head of Indonesia’s National Commission for Child Protection.

Children will be a particular focus of the counselling programme, which will develop “play-centred” programmes aimed at easing shocked children back into normal social routines despite the devastation around them.

“We need to stimulate their spirit,” said Lita Sarana, head of health at the Indonesian Red Cross Society, which is also involved in the counselling drive.

Acknowledging the stigma surrounding mental problems in Indonesia, as in many Asian countries, health ministry’s Darwis said counsellors would rely on simple communication rather than complex psychological analysis to help people cope.

“We will not explicitly say that they have mental disturbances, and we will not take them to mental hospitals except for those suffering serious problems,” he said. “We will approach them in the refugee camps, try to talk to them and see what their problems are.”