Psychosocial recovery following community disasters: An international collaboration

Ample evidence demonstrates that disasters of both natural (e.g. floods, bushfires, earthquakes) and human origin (e.g. interpersonal violence, terrorism, major life-threatening accidents) can result in adverse mental health outcomes among those directly or indirectly exposed (North and Pfefferbaum, 2013). While the majority of those affected recover over the first few months, disasters often mark the start of a complex series of secondary stressors (such as the need to relocate or rebuild, fear of a recurrence and legal, financial and compensation issues). Evidence from Australian and international disaster research demonstrates that, although some will experience no problems and others only minor difficulties that resolve with time and naturally occurring support, a substantial minority will go on to develop clinical or sub-threshold psychiatric conditions which, for some people, will persist for many years (North and Pfefferbaum, 2013). These conditions, which may include depression, anxiety, posttraumatic stress disorder (PTSD) and substance use disorders, not only cause great personal suffering and distress but also interfere with family, social and occupational functioning. The cost to the community in both human and financial terms is enormous and is recognised by global agencies as one of the most urgent public health issues (Deloitte Access Economics, 2016). Public sector health and mental health services, as well as charities and non-government organisations, routinely respond rapidly following disaster with a view to (1) preventing disorder where possible, (2) intervening early for those who develop initial symptoms and (3) facilitating access to treatment for those with diagnosable conditions. Multiple challenges arise in attempting to deliver this type of response in the context of a complex and chaotic post-disaster setting, and several practice guidelines, such as those produced by the Inter-Agency Standing Committee and the Royal College of Psychiatrists, are available to guide such intervention programmes. It is now internationally accepted best practice to provide three levels of intervention matched to those three aims (Forbes et al., 2012). Early universal strategies are targeted at the whole population. Currently, ‘psychological first aid’ (or Level 1 intervention) is the universal prevention strategy of choice and is designed to enhance individual and community resilience and to foster cohesion and mutual support (although it is recognised that there is little empirical data to support psychological first aid). At the other end of the spectrum, substantial research now exists to guide evidence-based pharmacological and psychological interventions for diagnosable psychiatric conditions following disaster and trauma (Level 3). The middle level (Level 2) aims to assist the substantial number of people who develop ongoing disabling and distressing adjustment problems or sub-clinical psychiatric disorders. Unfortunately Level 2 interventions have been largely neglected until recently. This is a problem not only because psychological dysfunction at this level causes significant distress, economic loss and functional impairment but also because these adjustment problems pose a risk for escalation into serious psychiatric disorders if not effectively addressed. Moreover, in the aftermath of disaster, there can be substantial numbers of people who suffer these adjustment or sub-clinical psychiatric problems, which overwhelms the resources of many health systems. Some attempts have been made to develop and implement these Level 2 interventions targeted at survivors with adjustment problems and subclinical disorders. The goal is to assist adjustment to their disaster experience, to help them manage the ongoing stress routinely involved in the post-disaster environment and to minimise the chances of a deterioration into serious psychiatric disorders. Interventions are usually delivered by locally based health and welfare practitioners from a diverse range of backgrounds who may, themselves, have been affected by the disaster. Since the capacity for learning new information Psychosocial recovery following community disasters: An international collaboration