Resources for people working with affected communities

Guidelines for provision of psychological support to people affected by the 2009 Victorian bushfires

>> Download PDF version of guidelines  

Many people have been affected by the trauma of the bushfires, ranging from those directly exposed to the fires to those with contact only through what they have seen in the media. Most people will recover from traumatic events without professional intervention. Some, though, are likely to need psychological support to help them cope. This information sheet provides summary guidelines on the three levels of psychological support that can be offered to people affected by disasters such as the Victorian bushfires.

It is important to remember that the large majority of people affected by disasters have no experience of needing helping agencies or understanding of why they should accept help. Therefore care needs to be taken to assist them to become clients of the recovery system and to provide education regarding their needs. Contact with people affected by the disaster should always be non-intrusive.

It is vital that psychological support is integrated with formal coordinated recovery efforts and provided with an understanding of the devastating impact that disasters have on the social cohesion of communities.

LEVEL 1: Psychological first aid in the immediate aftermath

Shock, distress and disbelief are normal reactions in the immediate aftermath and for days and up to weeks following a traumatic event. People may be stunned and dazed, particularly with such a sudden, devastating disaster as this one. In this state, people have a tendency to think very narrowly, and not effectively, about personal survival. This may result in unfair guilt or blame. Some people will experience grief, anger, anxiety and depression, and feelings may become intense and sometimes unpredictable. Acute traumatic stress with sleep and appetite disturbance may be a normal response to a life threat, and tends to subside once people feel safe again.

In the immediate hours to first weeks following a disaster, the current best practice mental health recommendation is Psychological First Aid (PFA) to restore a sense of safety and order. PFA is aptly provided by disaster relief workers or mental health workers who provide early assistance to people affected by disasters or emergencies. For the majority of people, this type of aid will be sufficient.

LEVEL 2: Skills for psychological recovery in the following weeks and months

In the weeks and months following the disaster, specific psychological support may be appropriate for facilitating psychological recovery in people affected more severely by the bushfires. This includes people who:

• Are not starting to feel any better after two weeks
• Are still feeling highly anxious or distressed
• Are finding that their reactions to the traumatic event are interfering with home, work or relationships
• Need help to develop specific coping skills.

An evidence-informed model called Skills for Psychological Recovery (SPR) has been developed to facilitate recovery of people affected by recent disasters. Rather than a formal mental health treatment, SPR is an intermediate, secondary prevention model to teach people basic skills. For many people it will be enough. If SPR doesn't help to alleviate distress as effectively as is needed, it is appropriate to refer for more intensive mental health intervention. Additionally, if serious issues are revealed in the initial assessment, immediate referral is required.

LEVEL 3: Mental health interventions when more intensive treatment is required

A minority of people exposed to severe trauma (10-20%) will be at risk of developing more persistent mental health conditions, and will require more intensive intervention. Proper clinical assessment is required before treatment with evidence-based interventions, which typically involve specialised cognitive behaviour therapy techniques. Medication is useful as a second line treatment.

Useful resources

Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder 

• Download condensed Guidelines  (614kb)
• Download full Guidelines  (1.9mb)

Counselling must hit the right targets (The Age, 10 February 2009)
By Professor Mark Creamer FAPS, Director of the Australian Centre for Posttraumatic Mental Health
www.theage.com.au/opinion/counselling-must-hit-the-right-targets-20090209-8287.html

Psychological First Aid: Field Operations Guide  
National Center for Posttraumatic Stress Disorder
www.ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_psyfirstaid.html

Australian Child & Adolescent Trauma, Loss & Grief Network (ACATLGN) 
www.earlytraumagrief.anu.edu.au

Australian Centre for Grief and Bereavement
www.grief.org.au/bushfire_support.html 

Red Cross Resources for children: After the Emergency
www.redcross.org.au/ourservices_acrossaustralia_disasteremergencyservices_resources-for-children.htm 

APA Help Center: Recovering from the Wildfires 
www.apahelpcenter.org/articles/article.php?id=162

APA Disaster Response Network: Helping communities in times of crisis
www.apa.org/practice/drnbrochure.pdf  

APS Tip Sheets

APS Tip Sheets inform clients about a range of psychological issues and how psychologists can help. They are a useful resource for private practitioners and other health professionals, especially GPs.

Preparing for and coping with the threat and experience of natural disasters

• View Tip Sheet

Understanding and managing psychological trauma

• View Tip Sheet

Psychological Preparedness brochure

The following brochure, Psychological Preparedness, provides some helpful tips for managing emotions during the bushfire season.

• Download Psychological Preparedness brochure  (196kb)

APS Disaster Register

Psychologists interested in offering services to those affected by the bushfires can register this interest via the email link below. Please include your name and APS Member number (or contact details if you are not an APS Member) and details of any disaster response training and/or experience that you have completed. In addition, psychologists interested in participating in disaster response training in the near future can also register their interest via the email link below.

• disasterregister@psychology.org.au

APS Ethical Guidelines on co-ordinated disaster response, pro bono, or voluntary psychological services

APS members can access the APS Ethical Guidelines on co-ordinated disaster response, pro bono, or voluntary psychological services at the following link:

• View Ethical Guidelines