Study: Time to include mental health services in disaster response

Psychiatrists say disaster-related psychic trauma should be identified, triaged and treated the same as physical injuries

A new university study asserts that emergency planning and disaster response should include consideration for mental health services.

The paper from psychiatrists at the University of Texas Southwestern Medical Center and University of Oklahoma Health Sciences Center, published in the August 7 Journal of the American Medical Association, provides a framework for disaster mental health response that can be used to guide overall response. 

The authors reviewed over 1,000 articles pertaining to the after-effects of disasters on mental health, more than 200 of which showed disasters can exacerbate existing mental health problems and generate new disorders.

“While adverse mental health outcomes following a disaster may not be as apparent as physical injuries such as broken bones, bleeding, and other obvious trauma, our review clearly shows that mental injuries are prevalent and require a similar system for identifying, triaging and treating these individuals, just as you would those with physical injuries,” said coauthor Dr. Carol North, UT Southwestern Medical Center professor of Psychiatry and Surgery, and director of the Program in Trauma and Disaster, VA North Texas Health Care System.

North told Police1 that different disaster-affected populations will have different mental health needs that will vary with regard to the characteristics of the disaster and to their exposures to it. North said nine out of 10 people are likely to experience trauma in their lifetimes. 
For example, she said, it is important to distinguish between those who experience normal distress in a disaster and those in whom psychiatric disorders such as post-traumatic stress are triggered so that people can be treated appropriately. North said her literature review showed PTSD to be the most common disorder associated with most disasters, that nearly one-third of all those exposed to severe disasters will show signs of PTSD, and that nearly one-fourth will exhibit other signs, such as major depression, bereavement and substance abuse.
North also said assessment procedures depend on the exposures and pre-existing vulnerabilities of those being assessed. 
“Triage and referral must be grounded on a careful assessment,” North said.

North said evidence-based treatments are available for patients with active psychiatric disorders, but psychosocial interventions such as psychological first aid, psychological debriefing, crisis counseling, and psycho-education for individuals with distress have not been sufficiently evaluated to establish their benefit or harm in disaster settings.
“Future research is needed to determine the benefits of formal psychiatric treatments applied to disaster survivors and of the psychosocial interventions designed to serve those who experience distress,” she said.

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