Mental Health in Disasters

Mental Health in Disasters

At a time of disaster, as we are currently experiencing with the Covid-19 pandemic, many people will be emotionally affected, some to the extent that it affects their overall wellbeing. This likelihood includes staff as well as patients. For some this will be a low-grade constant underlying anxiety, for some it can manifest as an acute stress disorder, some as a sense of hopelessness or even depression, and for some it may exacerbate a pre-existing or predisposing condition.

Preparation

  • Most people have innate resilience. Harnessing skills they have used before can help with this new situation
  • Consider, ahead of time, the behaviours (such as practical tasks), feelings and thoughts that may be required or encountered
    • This will include buying enough stores for 2 weeks, including medication
    • Downloading a mindfulness or exercise at home app
    • Downloading e-books or movies to watch, finding jigsaw puzzles, knitting
  • Developing a community of local people who can support each other with errands if someone is quarantined
  • Ensuring that friends and relatives know how to contact you – phone, Skype, Zoom, Messenger, Viber, Facetime, Whatsapp etc.

Psychological support and mental health care

Level 1 – Early response information and support – useful for everyone

Level 2 – Simple psychological strategies – for those with persisting problems

Level 3 – Formal mental health interventions – for the small number who need them

Level 1:  Early response, information and support

Includes 5 principles:

  1. Promote safety
  2. Promote calm
  3. Promote connectedness
  4. Promote self-efficacy
  5. Promote hope
  • Promote safety
    • Know what the signs are and seek medical attention if you need it. Do not battle on.
    • Isolate yourself if you need to. Properly.
  • Promote calm
    • Limit exposure to social media if appropriate.
    • Only access evidence-based and reputable sites.
    • Keep people accurately informed including on what is being done to help.
  • Promote connectedness
    • To family, community and culture.
    • Especially if you are an extrovert and you are used to being with people
    • Set up regular times to talk to colleagues, family and friends.
  • Promote self-efficacy
    • Self-efficacy can enhance resilience.
    • Having a sense that you are doing something useful for yourself and others eg emphasizing that social distancing is helping more vulnerable people, finding out who you can support by phone, with errands, shopping etc.
    • For doctors, this may include doing telephone triage or telehealth if you are unable to go to work if you are vulnerable yourself or are in quarantine.
  • Promote hope
    • Maintain hope that ‘this too will pass’.
    • The world may never be the same again but the majority of us will survive this.
    • If people are religious or spiritual, encourage this.
    • Maintain as many everyday rituals as possible eg getting up, showering, dressed, make-up etc as you would if you were going to a workplace.

What is NOT included in a level 1 response:

  • It is NOT helpful to encourage people to talk about what is happening if they don’t want to. If they DO want to, then listen compassionately.

 

Level 2:  Simple psychological strategies

  • For people with more persistent symptoms which are affecting their coping, problem-solving or decision-making
  • Find out more at psid.org.au (Australian Centre for Posttraumatic Mental Health)

Skills for psychological recovery

  • Prioritise Needs
    • Ask about the most important concerns and prioritise
  • Assist with problem-solving
    • Eg structured problem solving techniques and taking a step by step approach
  • Positive activities
    • Encourage both pleasurable activities and meaningful/productive activities. A sense of control over life and feeling of normality can be helpful
  • Techniques for anxiety and hyper-arousal
    • Eg mindfulness, controlled breathing, planning ways to respond when confronted with reminders of the event
  • Promote helpful thinking
    • Similar to CBT – consider which thoughts are helpful. Help people put their thoughts and feelings into words
  • Promote healthy social connections
    • Family, friends, pre-existing supports or new ones

 

Level 3: Formal mental health interventions

  • For those with diagnosable mental health conditions
    • PTSD, depression, anxiety, complicated grief, substance use disorders
  • Although the rates of all of these may increase following a disaster, most people will recover and not develop a formal mental health disorder

 

Further references:

http://www.psid.org.au/

In Western Australia, the Doctors Health Advisory Service (DHASWA) provides:

  • a website that details resources available to help stressed doctors dhaswa.com.au.
  • a list of GPs and Psychiatrists interested in treating doctors and medical students.
  • a 24/7 call advice line that any doctor or medical student can ring if they are feeling overwhelmed or simply want to talk to someone. The line is staffed by experienced GPs who will listen and provide advice on further action if needed. Call 08 93213098.