The aim of all disaster mental-health management should be the
humane, competent, and compassionate care of all affected. The
goal should be to prevent adverse health outcomes and to enhance
the well-being of individuals and communities. In particular, it
is vital to use all appropriate endeavors to prevent the
development of chronic and disabling problems such as PTSD,
depression, alcohol abuse, and relationship difficulties.
Factors that facilitate positive outcomes and prevention
There is much evidence to suggest that a number of factors
help to facilitate positive outcomes and prevention
(1). These include the following:
It is crucial to recognize people's strengths as well as the
suffering they have experienced. While survivors' suffering must
be acknowledged, and compassion and empathy conveyed to them, it
is also important that those who care for them believe in and
support their capacity to master this experience.
Information and education help people's understanding and
should be an integral part of the support and care systems.
Preparation prior to disaster, information about what has
happened, education about normal responses to such events,
training in what to do to help psychological recovery,
information centers and ongoing information feedback to affected
communities, all help people's mastery and recovery.
Sharing the experience. Many people may display a need to tell
the story of their experience, to give testimony, both to
externalise it and obtain emotional release, and to gain
understanding and support from others. This varies enormously. It
may occur spontaneously as natural groups come together after the
disaster. However, there will be others who may not feel ready or
who may choose not to talk about their experience. Those involved
in the mental health response should be aware of these variable
needs and be supportive of what the survivor wants.
Supportive networks are critical and should be retained,
reinforced and rebuilt. These networks help people in the ongoing
recovery process, both through the exchange of resources and
practical assistance, and through to the emotional support they
provide to deal with the disaster and its aftermath. Community
groups may develop to facilitate support, and should be
Possible obstacles to seeking help
Several studies have pointed out that following a disaster or
terrorist event, such as the Oklahoma City bombing, many of those
in closest proximity to the disaster do not believe they need
help and will not seek out services, despite reporting
significant emotional distress
(2). Sprang lists several potential reasons for this:
Some people may feel that they are better off than those
more affected and that they, therefore, should not be so
Some may not seek help because of pride or because they
think that distress indicates weakness of some sort.
Some individuals may not define services they receive as
mental-health intervention, especially if such intervention is
unsolicited (e.g., lectures, sermons, discussions, community
rituals). Indeed, because the goal of many disaster
mental-health workers is to have interventions be a seamless,
integrated part of an overall disaster effort, those who
receive these services may not recognize them as mental-health
Many individuals are more apt to seek informal support from
family and friends, which may not be sufficient to prevent
long-term distress for some.
It is critical to address this hesitance about seeking help.
Nearly half of the individuals studied who were directly exposed
to the Oklahoma City bomb blast had an active postdisaster
psychiatric disorder, with PTSD being diagnosed in 1/3 of the
(3). Major Depression was the disorder most commonly
associated with PTSD. No new cases of substance abuse were
observed, which is consistent with previous findings. Symptom
onset of PTSD was rather immediate, usually within one or two
days, and few other cases developed after the first month.
Generally, there are three stages of intervention, each
requiring a different level of involvement:
Emergency phase: the immediate period after disaster
Early postimpact phase: any time from the day after the onset of the disaster until approximately the eighth to twelfth week
Restoration phase: marked by the implementation of
long-term recovery programs, generally beginning at about the
eighth to twelfth week after the onset of the disaster
Initial mental-health interventions
Initial mental-health interventions are primarily pragmatic,
as reflected by the following stages:
Find ways to protect survivors from further harm and from
further exposure to traumatic stimuli. If possible, create a
shelter or safe haven for them, even if it is only symbolic. The
fewer traumatic stimuli people see, hear, smell, taste, and feel,
the better off they will be. Protect survivors from onlookers and
Kind and firm direction is needed and appreciated. Survivors
may be stunned, in shock, or experiencing some degree of
dissociation. When possible, direct ambulatory survivors:
Away from the site of destruction
Away from severely injured survivors
Away from continuing danger
The survivors you encounter at the scene have just lost
connection to the world they are familiar with. A supportive,
compassionate, and nonjudgmental verbal or nonverbal exchange may
help them experience a reconnection to the shared societal values
of altruism and goodness. However brief the exchange, or however
temporary its effects, such relationships are important elements
of the recovery or adjustment process. Help survivors
With loved ones
With accurate information and appropriate resources
With where they will be able to receive additional
The majority of trauma survivors experience normal stress
reactions. However, some may require immediate crisis
intervention to help them manage intense feelings of panic or
grief. Signs of panic include trembling, agitation, rambling
speech, and erratic behavior. Signs of intense grief may include
loud wailing, rage, and catatonia. If you see these signs of
panic and grief, attempt to quickly (1) establish therapeutic
rapport, (2) ensure the survivor's safety, (3) acknowledge and
validate the survivor's experience, and (4) offer empathy.
Medication may be appropriate and necessary.
It is necessary to be aware that the needs of individual
members of a community may vary greatly. The following early
intervention strategies can yield positive results:
Provide direct services as soon as is feasible after the
event, which may require temporarily bringing in outside
experts. However, it is of the greatest importance that needs assessment,
planning, and service delivery be done in full coordination
with local providers. Outside help should at no time be
imposed; respectful, coordinated interfacing with local
resources, however limited these may be, is essential.
Empower local care-providers to assume increasing
responsibility for delivering services in their community. This
can be achieved by providing in-field training from the beginning of the
intervention. Encouraging local providers increases
professional self-esteem and helps local resources expand
Work with key community figures and leaders, local media,
and governmental institutions to make them aware of the
benefits of early community-based interventions.
It is important to recognize that care-providers from
within a community may themselves be overwhelmed and/or
traumatized. Therefore, ensure that comprehensive
professional support and supervision are available for them so
that they may also attend to their own mental-health
Basic principles of emergency care
It is helpful to remember several basic principles or
objectives of emergency care.
Provide for basic survival needs and comfort (e.g.,
liquids, food, shelter, clothing).
Help survivors achieve restful and restorative sleep.
Preserve an interpersonal safety zone protecting basic
personal space (e.g., privacy, quiet, personal effects).
Provide nonintrusive ordinary social contact (e.g., a
"sounding board," judicious uses of humor, small talk about
current events, silent companionship).
Address immediate physical health problems or exacerbations
of prior illnesses.
Assist in locating and verifying the personal safety of
separated loved ones or friends.
Reconnect survivors with loved ones, friends, and other
trusted people (e.g., AA sponsors, work mentors).
Help survivors take practical steps to resume ordinary
daily life (e.g., daily routines or rituals).
Help survivors take practical steps to resolve pressing
immediate problems caused by the disaster (e.g., loss of a
functional vehicle, inability to get relief vouchers).
Facilitate resumption of normal family, community, school,
and work roles.
Provide survivors with opportunities to grieve their
Help survivors reduce problematic tension, anxiety, or
despondency to manageable levels.
Support survivors' local helpers through consultation and
training about common stress reactions and stress management
Psychological first aid
The Psychological First Aid Field Operations Guide (early
release for Hurricane Katrina response) was created by the
Terrorism Disaster Branch of the National Child Traumatic Stress
Network and the National Center for PTSD as well as others
involved in disaster response. Production of this information was
supported by SAMHSA.
It is an evidence-informed modular approach for assisting
people in the immediate aftermath of disaster and terrorism: to
reduce initial distress, and to foster short and long-term
adaptive functioning. It is for use by mental health specialists
including first responders, incident command systems, primary and
emergency health care providers, school crisis response teams,
faith-based organizations, disaster relief organizations,
Community Emergency Response Teams, Medical Reserve Corps, and
the Citizens Corps in diverse settings.
For further information on Disaster Mental Health
Interventions, please refer to the Disaster
Mental Health Services Guidebook for Clinicians and
Institute of Psychiatry and Centre for Mental Health. (2000).
Disaster Mental Health Response Handbook. North Sydney:
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See last Reviewed/Updated Date below.