How to treat mental health disorders arising after natural disasters like flooding or cyclones?

Treatment of Mental Health Disorders After Natural Disasters

The immediate priority is addressing basic needs (food, shelter, safety) followed by universal provision of Psychological First Aid (PFA) to all disaster-exposed individuals, with mental health triage to identify those requiring immediate psychiatric referral. 1

Immediate Response Framework

First Priority: Basic Needs and Safety

• Ensure basic survival needs are met before any psychological intervention: food, shelter, safety, supervision, communication, and family reunification 1
• This foundational step is essential for emotional support and represents the first line of psychological stabilization 1

Second Priority: Universal Psychological First Aid (PFA)

All disaster-exposed individuals should receive PFA, which accelerates natural healing and promotes effective coping 1, 2

PFA core components include:

• Psychoeducation: Provide timely, accurate information to facilitate adjustment and understanding 1
• Appropriate reassurance: Correct misconceptions that unnecessarily increase perceived risk (avoid false reassurance) 1
• Coping strategies: Supply practical information about likely reactions and effective distress management techniques 1
• Resource identification: Help individuals identify family supports and community resources 1
• The "Listen, Protect, and Connect" model is specifically designed for non-mental health professionals 1

PFA can be delivered by trained non-mental health professionals, including healthcare staff, teachers, and community workers, making it scalable for mass disasters 1, 2

Mental Health Triage: Identifying High-Risk Individuals

Immediate Psychiatric Referral Indicators

The following symptoms require immediate mental health services 1:

1. Dissociative symptoms (detachment, derealization, depersonalization—appearing confused, distant, daydreaming, or aloof)—this is the strongest predictor of later PTSD 1
2. Extreme confusion or inability to concentrate or make simple decisions 1
3. Extreme cognitive impairment or intrusive thoughts 1
4. Intense fear, anxiety, panic, helplessness, or horror 1
5. Depression at the time of the event 1
6. Uncontrollable and intense grief 1
7. Suicidal ideation or intent 1
8. Marked physical complaints from somatization 1

Risk Factors Requiring Enhanced Monitoring

Pre-existing factors 1:

• Previous psychopathology, significant losses, attachment disturbances, limited coping skills, or prior traumatic events 1
• Lower socioeconomic status resulting in fewer post-disaster resources 1

Disaster exposure factors 1:

• Personal injury or death/injury of close contacts 1
• Direct witnessing of deaths, physical proximity to disaster, extent of personal loss 1
• Exposure to horrific scenes (including through media) 1
• Child's perception that their life was in jeopardy 1

Post-disaster stressors 1:

• Separation from parents or caregivers 1
• Property loss, relocation, disruption of daily routine 1
• Parental difficulty coping, substance abuse, or mental illness 1
• Lack of supportive family communication 1
• Lack of community resources and support 1

Addressing Secondary Stressors and Bereavement

Many mental health problems after disasters stem not from the traumatic event itself, but from cascading secondary stressors 1

Common secondary stressors include:

• Financial strain from unemployment or underemployment 1
• Marital conflict and domestic violence (documented to increase after disasters like Hurricane Katrina) 1
• Parental depression and substance use 1
• Child abuse (increases after major disasters) 1
• Temporary housing problems causing interpersonal conflict 1
• School/peer group changes from relocation 1

Assessment must explore both the disaster event AND current life circumstances to identify whether symptoms relate to trauma or secondary stressors 1

Bereavement Support

• Provide timely information about funeral/memorialization involvement 1
• Enlist school personnel support 1
• Connect families to community bereavement services 1
• Free resources available at www.aap.org/disasters/adjustment and www.grievingstudents.org 1

Special Considerations for Children

Caregiver Support is Critical

When caregivers struggle to cope, refer them for services—children's adjustment depends heavily on caregiver functioning 1

Media Exposure Management

• Limit media coverage viewing for all family members (television, radio, internet, social media) 1
• Parents should preview recorded coverage before children view it 1
• Avoid graphic details and excessive information 1
• Turn off entertainment devices and provide physical family togetherness 1

School-Based Interventions

• Schools are cost-effective, accessible sites for reaching broad populations of affected children 1
• Schools should have established crisis response guidelines and trained teams 1
• All school staff should have basic PFA and bereavement support skills 1
• Resources available at www.schoolcrisiscenter.org and www.grievingstudents.org 1

Developmental Considerations

• Children should be informed about disasters as soon as information becomes available 1
• Help children identify practical actions to help others (reduces powerlessness) 1
• Anticipate and prepare for trauma triggers (anniversaries, severe weather, emergency vehicle sounds) 1
• Address survivor's guilt and self-blame early to prevent long-term adjustment problems 1

Evidence-Based Interventions

Strengthening Protective Resources

Individual, interpersonal, and community resources protect against psychosocial resource loss and improve outcomes 3

Key protective factors:

• Individual resilience (personal coping abilities) 3
• Interpersonal resources (family ties, social support) 3, 4
• Community resources (social capital, community engagement, economic development, trust in leadership) 3

Post-disaster interventions should strengthen family and community ties to increase social support and community connectedness 3

Social Support Dynamics

Two conflicting patterns emerge after disasters 4:

1. Initial mobilization of received social support (mutual helping and solidarity) 4
2. Subsequent deterioration of perceived social support and sense of community 4

Social support is critical for coping but unfolds in a complex matrix of benefits and liabilities 4

Long-Term Intervention Approach

Traditional multi-session counseling during and shortly after disasters has questionable effectiveness 2

Crisis-focused psychological interventions are preferred as acute phase alternatives 2

PFA serves as a platform for psychological triage, complementing traditional psychological and psychiatric interventions 2

Interventions must be culturally appropriate and tailored to community needs, delivered across pre-, peri-, and post-disaster periods 5

Common Pitfalls to Avoid

• Do not tell children they should not be worried—this undermines their ability to own feelings and learn coping strategies 1
• Do not provide false reassurance—correct misconceptions but remain truthful 1
• Do not focus solely on the traumatic event—assess secondary stressors and current life circumstances 1
• Do not overlook caregiver mental health—parental functioning directly impacts child outcomes 1
• Do not allow excessive media exposure—this worsens outcomes for all ages 1