Day 7: More About Disaster: Disaster and its Effects to Mental Health

Due to the fact that there’s so many things related to disaster, I’ve separate them into 2 posts.

Natural and Man-made disaster may cause:

• Death
• Injury
• Financial loss
• Mental disorder, etc.

The psychological impact of disaster is often immeasurable. Whereas the physical injuries caused by disaster can be visualized, it is much more difficult to identify the psychological trauma that many experience as a result of a disaster event.

Mental health issues stemming from disasters are becoming increasingly integrated into post-disaster assessment, with more emphasis on mental health being an urgent aspect of public health relief. The mental health community stresses that providers and disaster relief personnel need to have a meaningful understanding of the psychological and social needs of victims in a disaster.

Victims of disaster can be classified into 3 groups:

1. Primary casualties suffer physical injury and acute psychological sequel as a consequence or may experience psychological harm alone.

2. Secondary casualties include affected relatives and friends of primary casualties and witnesses of the event who were not directly affected.

3. Tertiary victims are rescue workers and healthcare providers.

Disasters can provoke specific emotional reactions that take on a variety of different psychological responses, affecting primary victims (those directly involved in the disaster) and secondary victims (such as relatives, co-workers, and schoolmates). Other people who can experience mental health issues (or tertiary victims) include onlookers, rescuers, body handlers, health personnel, evacuees and refugees.

[In a disaster, remember that the victims are not only the one experiencing the it; but also their family and friends and also the people involved in helping the disaster victims]

Before determining what interventions are needed after a disaster event, it is important to understand the phases of mental health disturbances after disaster. To describe things easier, there are 3 responses of mental health disturbances:

Phase 1: Pre-impact phase

This phase occurs before the event takes place. The stressor of this phase is worry. Response to this stress normally includes: denial and anxiety.

Phase 2: Impact phase

This phase occurs when the disaster is actively occurring. Some small percentage of individuals remain calm and high functioning; whereas an equal percentage demonstrate disorganization, confusion, and other serious coping difficulty. The majority of individuals during the impact phase are found to temporarily have a blunted response, demonstrating lack of emotion, and evidence bewilderment.

Phase 3: Aftermath Phase (also called the recoil or post-impact phase)

During this phase, emotional reactions vary widely and range from relief at personal survival to survival guilt, feelings of self-consciousness, emotional liability and numbness.

If based on dr. Bambang’s Hastha Yoga’s lecture, mental health that are related to phase after a disaster can be further elaborate into 3 more phases:

(a) Critical Phase: Acute Stress Disorder (< 1 month following extreme stressor)

acute stress reactions – characterized by absence of emotion; lack of response to external stimuli; total inhibition or outward activity and random movements; persons being stunned or shocked; and psychosomatic symptoms such as tremor, palpitations, hyperventilation, nausea and vomiting

(b) After Critical Phase: Post-traumatic Stress Disorder (PTSD) (> 1 month or can be decades following extreme stressor; but it can occur immediately for those who has had traumatic experiences previously)

Post-traumatic stress disorder (PTSDs) – it is defined as:

“an anxiety disorder that can develop after exposure to a terrifying event, or ordeal in which grave physical harm occurred or was threatened”

The criteria of a PTSD require:

• Exposure to a traumatic event
• Re-experiencing of the event
• Persistent avoidance of stimuli associated with the trauma
• Persistent increased arousal
• Duration of B, C, D of more than a month
• Clinically significant distress or impairment

Specific individuals might have a typically higher risk of severe stress and lasting PTSD, such as those with a history of other traumas, chronic mental illness and psychological disorders, chronic poverty and recent emotional strain. On the other hand, the National Center for PTSD states that some factors might be protective, including: social support, higher income and education, successful mastery of past disasters and traumatic events, reduction of exposure to trauma, and provision of regular and factual information about the emergency.

(c) Prolonged stressors: Enduring personality change after prolonged catastrophic experience (> 2years)

(adjustment disorders or enduring personality change)

Traditionally, disaster medicine has focused solely on the medical and surgical needs of individuals, and little effort was made to meet the emotional and psychological needs of disaster victims and workers. In recent years, those interested in disaster management has given increased attention to the psychological consequences of disaster. As a result, the body of evidence identifying those at risk, documenting signs of emotional trauma and supporting interventions after disaster has grown significantly.

Experts recommended some early intervention actions.

Early intervention is defined as:

“The provision of psychological help to the victims and survivors within the first month after a critical incident, traumatic event, emergency, or disaster aimed at reducing the severity or duration of event-related distress. For mental service providers, this may involve psychological first aid, needs assessment, consultation, fostering resilience and natural supports, and triage, as well as psychological and medical treatment”

Psychological (mental health) intervention:

1. Meet local primary health center or emergency services professionals

• Manage emergency psychiatric symptoms (major depression, agitation, etc.)
• Ensure the availability of psychopharmaca 
• Continue the administration of psychopharmaca for chronic mentally ill people who have taken the drug previously

2. "Psychological first aid"

• Active listening
• Empathy
• Access the basic needs
• Don't push to speak
• Avoid from secondary stressors
• No medication

3. Activities and programs that involved certain group of people

• Cultural and religious activities
• Involve youth and adults to the programs
• Refreshing activities
• Go to school again
• Involves and facilitates widow, widower, orphan, etc.

If acute phase prolonged, give training to the whole community.

               

[Note: Any specific treatment for PTSD or any other psychological problems will not be discussed in here. Thank you for your attention. (^^.)]

REFERENCES:

1. Disaster Medicine
2. Dr. Bambang Hastha Yoga: Disaster Management in Mental Health