Public Mental Health Intervention Following Disaster

file000202866289Another mass tragedy calls upon mental health professionals to apply their skills and knowledge towards helping the public cope with trauma and loss. Since 2001, we have learned a great deal about this, and as a result, there are now evidence-informed guidelines and practices for (a) conducting needs assessments, (b) screening and identifying emerging trauma-related psychopathology, (c) raising public awareness, (d) and providing evidence-based treatment when necessary. A highly informative paper published in the September 2011 volume of the American Psychologist is worth revisiting. The paper, Postdisaster Psychological Intervention Since 9/11 by Patricia Watson, Melissa Brymer, and George Bonanno summarizes the work to date in this area. Although most individuals exposed to disaster will recover naturally, a portion of affected individuals will present with clinical needs – some immediately after the event and others at a later date. As summarized in Watson, Brymer, and Bonanno (2011), we can use what we know about risk factors to inform and enhance screening. A number of these are summarized in the article and include subsequent stressors, parental response to trauma (for children), lack of social support, and degree of loss. In addition, knowledge of protective resources can inform ways of bolstering the public’s ability to cope with the trauma. This is particularly true for factors that are malleable and amendable to intervention. To borrow from Hobfoll’s Conservation of Resources (COR) theory, trauma, such as the recent bombings in Boston, precipitates individual resource loss, which may include external resources such as transportation, mobility, or co-parenting, as well as internal or psychological resources such as self-efficacy, humor, or religion. In fact, research has shown that resource loss is associated with deleterious outcomes above and beyond the effects of the trauma itself (Hobfoll, 2011). However, there is evidence that this relationship is negatively mediated by subsequent resource gain – accomplished by replacing the loss or substituting the resource with one of greater or equal value (Hobfoll, 2011). These efforts, though, are costly in that they demand utilization of existing resources, and so individuals with sufficient resources may be mobilized to maintain, acquire, and enhance resources, but those with insufficient resources may actually be more vulnerable to additional loss and negative consequences (Hobfoll, 2011). Perhaps we can focus on helping these more vulnerable individuals realize and acquire the resources they need. One of the most powerful resources is social support. The advantage of this model is that enhancing resources, like social support, does not necessitate professional mental health workers, but rather, this work can be delegated in part to families and communities and other helpers. In other words, this is knowledge that can be shared that will provide the public with tools for recovery. A good place to start is by revisiting Watson, Brymer, and Bonanno (2011), as they consolidate specific guidelines for post-disaster responses that were generated by expert consensus.

Please comment below if you have other suggestions or links to relevant literature.

Damion J. Grasso (web editor)

References Cited:

Hobfoll, S. E. “Conservation of resources theory: Its implication for stress, health, and resilience.” The Oxford handbook of stress, health, and coping(2011): 127-147.