Disaster Management: Mental Health Perspective

Abstract

Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.

Keywords: Disasters; disaster mental health; disaster psychiatry; mental disorders; post-traumatic stress disorder; psychiatry; survivors.

Figure 1

Depicts the various phases of disaster and role of mental health professionals. Immediately after the disaster, heroic phase sets in this is followed by honeymoon phase. Disillusionment phase is the longest and prevalence of mental health morbidity is high during this period. * = Anniversary reactions Sources: Modified from Young et al., 1998[7] and published in International Review of Psychiatry, Math et al., 2006[15] and further modified in Math et al., 2013[15]