The Essentials of Disaster

Mental Health
Assessment & Treatment
The Acute Phase
Assessment
 Assessment
• Environment
• Engagement
• Assessment format
• Knowledge of risk factors
• “Normal responses”
• Common symptoms & diagnoses
 Environment / Logistics
• Psychological & physical safety of the
disaster mental health professional
• Identifying those that may benefit from
attention (PFA etc.)
• Identifying acute patients
• Location of clinical work
• Referrals for ongoing care
• Coordination with local Emergency
Departments
 Engagement: Who?
• Physically injured
• Other survivors
• Rescue/recovery workers and other
responders
• Surrounding community
• “Community” formed by the media
• Multiply affected individuals
 Who?
In thinking about the potential range of people and needs you may
encounter in the disaster setting, consider the following table:

Assessment Item Survivors Bereaved Responders Economically Community at

impacted large
Acute Disaster
Safety needs

Physical needs

Medical needs

Mental health needs

 Engagement: How?
• Observe the scene
• Individuals
• Groups
• Integration with other services
• Informal conversation
• Indirect inquiries
• Referral from other agencies
 Assessment: Basics

• Hierarchy of needs
• Medical needs
• Food, water, shelter
• Reuniting with family/friends
 Assessment: Exposure
• Scope of event
• Proximity to event
• Duration of event
• Personal loss and injury
• Extent of prior warning
• Uncertainty
 Vulnerability
• Prior exposure to trauma such as disaster
• Prior psychiatric history
• Problems of living prior to the disaster/low
socioeconomic status
• Lack of perceived or actual social supports after
the event
• Presence of “secondary stresses”
• Female
• Middle age
• Ethnic minority

(Norris et al., 2002)(Katz

et al, 2002)
 Resilience Factors
• Physical exercise
• Active coping
• Positive outlook
• Moral compass (e.g., spirituality)
• Social support
• Cognitive flexibility
 Assessment
• Low exposure groups
• Pre-existing psychopathology affects outcome
more than exposure

• High exposure groups

• Extent of exposure overwhelms effects of pre-
existing psychopathology
Post Disaster PTSD Prevalence
• Direct victims: 30-40%
• Rescue workers: 10-20%
• General population: 5-10%

(Neria et. al 2008)

Post-disaster problems ≠
Post-Traumatic
Stress Disorder
 Symptoms
Emphasis in acute stage is on
recognition and targeting of symptoms
 Symptoms
• Intense, transient, and fluid
• Physical
• Emotional
• Cognitive
• Behavioral
 Common symptoms
• Anxiety
• Agitation
• Insomnia
• Mood symptoms
• Psychosis
• Dissociation
• Somatic complaints
 Symptoms
Signs of impairment and duration of
symptoms are critical to assessing severity
of any symptoms
 Urgent Triage
Suicide / self-harm
Homicide / harm to others
Inability to care for self
 Acute diagnoses
• Acute Stress Disorder
• Major Depression
• Reactivated Post-Traumatic Stress Disorder
• Acute Bereavement
• Adjustment Disorder
• Panic Attacks
• Exacerbation of Personality Disorder
• Brief Psychotic Disorder
• Substance abuse
• Delirium
What should we call
acute reactions?
 Stress injuries
Taxonomy based on the causative stressor:

1. Fatigue
2. Trauma
3. Grief

(Figley & Nash, Combat

Stress Injury, 2007)
 Bereavement vs. Major Depression

• Duration
• Suicidality
• Morbid sense of worthlessness
• Marked and prolonged functional
impairment
• Some hallucinations
 Psychological Reactions

• “Stunned”
• “Shocked”
• Feeling abandoned
• Uncommon vulnerability
• Exaggerated rumors
• Intense love / altruism
• Heroism / Industry
Psychological Reactions
• Bewilderment
• Danger
• Confusion
• Impasse
• Desperation
• Apathy
• Helplessness
• Urgency
• Discomfort
 Resilience
• Physical exercise
• Active coping
• Positive outlook
• Moral compass (e.g., spirituality)
• Social support
• Cognitive flexibility
Resilience?