Mental-Health Intervention for Disasters

Factors that Facilitate Positive Outcomes and Prevention

There is much evidence to suggest that a number of factors help to facilitate positive outcomes and prevention1. These include:

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 encouraged.
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 distress2. 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 upset.
* 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 interventions.
* 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 respondents3. 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.