It is now several months after the devastating bushfires in Victoria, and people are in the process of recovery in its many forms. The APS has been highly involved in the bushfire recovery efforts, which has included taking stock of the disaster to anticipate the psychosocial needs of affected people over the coming months and years.
What was most tragic about the Victorian bushfires was the sheer scale of the disaster with the massive loss of life and numbers of people who were severely affected. The official death toll from the 7 February fires stands at 173. According to the Victorian Department of Human Services there were 822 hospital presentations, 133 hospital admissions and 22,500 people registered with the Red Cross National Registry and Inquiry Service. Approximately 7,500 people were displaced from their homes, and many of these people will remain in temporary accommodation for some time. Over 2,000 homes were destroyed and, of particular relevance for children in the regions, three schools, three kindergartens, one child care centre and three maternal and child health care centres were amongst the numerous buildings reduced to rubble.
As cold weather sets in, and the immediate post-disaster energy of the emergency phase fades, people are beginning the long, hard slog of rebuilding. In the coming months they may be more at risk of depression, despondency and exhaustion as the reality of the challenges emerges. These stories are beginning to appear in the media, and in the increased numbers of referrals for counselling.
While we know that the majority of those who survived the bushfires will cope well using their own personal resources and the support of family and friends, the sheer size of the catastrophe and the thousands of people who have been affected means that there are still significant numbers of people at risk of developing persisting mental health problems. Factors that increase the likelihood of a person developing longer-term problems include aspects of the actual disaster experience together with personal characteristics such as temperament, personal history, prior or current mental health issues, age, gender and level of social support. This particular disaster on 7 February presented many of the classic risk factors - loss of family or friends, experience of a direct life threat, and being threatened in a place normally considered to be a safe haven such as the family home.
According to child psychiatrist Associate Professor Brett McDermott (2009), much is known, too, about specific factors that increase risks for children developing mental health problems (most notably posttraumatic stress disorder [PTSD]) following a disaster. Those children more at risk are typically young females who thought they would die as the result of the disaster, had no prior history of mental health problems, had family or friends who died, were evacuated during the disaster, lost their home, and have been relocated to a non-affected community. McDermott claims that up to 70 per cent of PTSD can be predicted with relatively few screening questions. Indeed, if only one question can be asked, it should be, "Did you think you were going to die?", as a child who answers "yes" has an eight-fold increased risk of developing PTSD. Interestingly, notes McDermott, parents are not good at identifying PTSD, largely because they don't know the right questions to ask. He therefore advocates widespread screening for PTSD in schools in affected regions between four to six months after the disaster, especially for children in late primary school and up to Grade 8.
Predicting exact numbers of people needing psychological support is difficult, but according to Bryant et al. (2009), estimates can be calculated on the basis of the number of people who died or lost their homes. For example, if there is an estimated five bereaved people for each deceased person, it is possible that 300 people may develop persistent complicated grief. Of course, there are also many community members who did not lose homes, but suffered traumatic or other crisis experiences during the fires and continue to suffer the chronic consequences of living in a severely disrupted community. It is therefore likely that up to 2,000 people may experience some form of mental health condition as the result of the fires (Bryant et al., 2009). While predicting these numbers and the proportion of those who will seek mental health services is difficult, what we do know is that the number of people who will need mental health care will significantly outnumber the trained mental health practitioners available.
The Victorian Government Department of Human Services and the Commonwealth Government Department of Health and Ageing have been working together with disaster experts from all of the relevant health professions in Victoria (GPs, psychiatrists, psychiatric nurses, psychologists, social workers and occupational therapists) and the Australian Centre for Posttraumatic Mental Health to develop a training and education package to upskill mental health professionals in Victoria. The package is based on the imperative that the mental health response needs to be consistent with international standards of best practice for post-disaster recovery. There is also international recognition that the most effective responses are those that are fully integrated into the government disaster recovery plan and with existing and ongoing services in the regions affected.
The education and training package that has been developed includes three levels of training, as follows:
The first train-the-trainer workshop for the delivery of level 2 training in SPR was held at the APS National Office in May for 30 mental health professionals. These trainers will run workshops through all of the affected regions in Victoria, initially for practitioners providing services through Divisions of General Practice under the Access to Allied Psychological Services (ATAPS) program, and then for other health professionals likely to be providing psychological support for bushfire survivors. Level 3 training will follow in June, and additional disaster-specific training workshops may be scheduled according to demand over the coming months and years.
There are likely to be demands made upon mental health workers for months and years to come. To care for mental health practitioners' own professional and personal support needs, the APS has established a 24-hour call-back support line for psychologists and other health practitioners, and web-based resources are being developed for all professional groups.
Community support is now critical to help people rebuild their social and community networks. Ideally, the psychological help should be provided at the community's initiative, and the focus should be on increasing the capacity of local people and resources rather than bringing in outsiders, as well as taking care that help is integrated with ongoing services in the regions. Recently, a community rebuilding event was held in Marysville that illustrates these principles. Rather than recruiting psychologist volunteers from around the State, the event organisers were encouraged to use local services to support people attending the rebuilding event. Utilising such local support also helps with continuity of care further down the track.
As a contribution to community recovery, the APS is providing information to a fortnightly community newsletter produced by the Victorian Bushfire Reconstruction and Recovery Authority.
In March the APS established a disaster response network (DRN), which evoked an overwhelming response from over 800 Victorian psychologists who completed a survey to join the network. The DRN survey will be extended to psychologists from other States and Territories in the coming months. The survey asked psychologists to identify where they have significant experience in working with trauma and grief and loss. Many psychologists reported having this experience, although fewer are experienced in working in the disaster context. This is in part due to the fortunate reality that Australia has had relatively few large scale disasters in the past. The DRN enables the APS to facilitate referrals when requests for experienced psychologists are received. The information from the DRN survey will be linked to the APS referral service.
An expectation of being on the DRN is that members will undertake ongoing professional development in the area. We hope that members will avail themselves of the upcoming training in SPR and clinical interventions if they are going to be working with bushfire survivors. These are excellent opportunities to add knowledge about working in a disaster context to members' existing skills of working with trauma and loss. Training opportunities will be advertised in the coming months.
The response to the Victorian bushfires has enabled the establishment of models of care that can be used to respond to future disasters. Unfortunately, one thing we can be fairly sure about is that there will be more devastating bushfires, floods and cyclones, and these will occur more frequently than the once-in-a-generation events we used to expect. Experts are now revising expectations of the frequency of the extreme conditions like those experienced on Black Saturday to once every five to ten years. It is imperative, therefore, that continued efforts go into psychological preparedness, and climate change mitigation and adaptation.
It is thus timely and appropriate that the APS Board has established an Environmental Threats and Climate Change Reference Group. This Group will assist the APS to identify environmental priorities and to foster the involvement of psychologists and the application of evidence-based approaches in the increasingly urgent cause of responding to climate change.
Bryant, R., Creamer, M., Forbes, D., Raphael, B., Gordon, R., Coghlan, A. (2009). Scoping document for mental health response to Victorian bushfires. Discussion paper prepared for Victorian Bushfire Cross-Professional Education and Training Working Group.
McDermott, B.M. (2009). Children and disaster: Trauma, evidence and best practice. AGPN Post Bushfires Forum, Melbourne (April 2009). Accessed 17 May 2009 from www.primarymentalhealth.com.au.