Introduction from the APS President, Professor Bob Montgomery FAPS

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The Victorian bushfires, Australia's largest natural disaster to date, have dramatically focused our attention on how we respond to disasters and the key role psychologists have to play. Of course, preceding the fires have been months-long floods in northern Queensland and, as I write this, severe tropical cyclone Hamish is making its way down the coast. That's our country, love it as much as we may.

The special report in this edition of InPsych presents the psychological impact of the Victorian bushfires and what psychologists can do to help trauma survivors to cope and recover from disasters such as this. Psychologists who want to be a useful part of the immediate post-disaster interventions can avail themselves of the training in psychological first aid that you will find described in this InPsych special report. Once survivors are basically safe, we can contribute to the process of psychological skills recovery, also described in this report. As the APS reaches finalisation of a Memorandum of Understanding with the Australian Red Cross, the opportunity will soon be available for members to learn how to be of real use in the immediate aftermath of a disaster and, most importantly, to do no harm.

You will read in the special report that these relatively brief and economical interventions are sufficient to help most survivors heal themselves because most people are reasonably psychologically robust. However, there will always be around 10-20 per cent of survivors for whom this won't be enough. By the time you read this, some flood, fire and cyclone survivors will already be showing the signs and symptoms of long-term posttraumatic stress, particularly depression, PTSD, anxiety, insomnia and substance abuse, and children will be showing their particular nonverbal signs of stress. Recent reviews of research show that evidence-based interventions, within three months of the traumatic event, can not only be palliative but save survivors from developing serious, chronic problems. This is psychologists' special contribution to helping survivors and we need to be certain of our knowledge and ability to deliver evidence-based treatments. This is our long haul task, to help survivors long after the sirens and the media have moved on.

The special report also provides insights into the social processes that occur within communities affected by disasters, and the crucial role of psychological preparedness for future disasters. Much has been made of the devastating realisation that a number of the fires that ravaged Victoria in February were deliberately lit, so we felt it was important to include in this special report an expert article on the nature of intentional firesetting and the motivations underlying it. The special report concludes with an overview of the work the APS has undertaken in response to the bushfire disaster.

It is helpful to understand the progressive unfolding of people's reactions to trauma, as described in the accompanying box, and how essential it is that each evidence-based intervention is tailored to meet the current needs of an individual, taking account of their present state, rather than the needs of the interventionist to feel helpful or to cling to a pet theory.

Two further points need to be made in relation to this special focus on the Victorian bushfires. Australia may have genuine shortages of medical practitioners and nurses but its most dire health professional shortage is of suitably trained psychologists. Since and partly because of the introduction of Medicare items for psychological services, many practising psychologists have full diaries, especially in regional and rural areas. Where do our major disasters often occur and where are the survivors living? Statements of support from Australian and State governments are welcome but they must translate into support for increasing our appropriately trained psychological workforce. Meanwhile you owe it to yourself to lead a balanced lifestyle, including time for self-care. Then the survivors who will still be seeking your help more than a year from now can count on your availability. Sacrifice yourself to try to save everyone and you'll burn out. Then everyone who really needs you has lost you, maybe permanently. You will hear the APS is setting up an ongoing scheme to support our members in the field. Contribute to it. Use it. You owe it to yourself and everyone important to you.

Second, it's no coincidence that the APS response has been led by our Disaster Preparedness and Response Reference Group, coincidentally meeting just after Black Saturday. We suspended our agenda and got to work and you will read how well the APS has responded to our community in this time of crisis. We can be proud of our Society's response to this disaster. But we must not lose sight of the essential contribution we can make in helping people who live in areas that are regularly at risk of disasters. Research has shown that the majority of these people do little or none of the practical preparation urged on them by emergency response organisations with the result that they are more vulnerable to both the physical impact and the psychological aftermath of disasters. Our second long haul task is an ongoing commitment to help our neighbours prepare psychologically and therefore also practically for possible disasters.

So, roll up your sleeves and let's get to work, the work psychologists can most especially do. Watch this space.

 

A model of psychological response to disaster
When a person is exposed to a traumatic event it triggers a series of responses. It is important to recognise the natural variability intrinsic to psychological phenomena and not to insist that every person fits a standard mould, but the following is a good average description. A key message to give to survivors is that these are the normal reactions experienced by normal people in response to traumatic experiences. They are not a sign of weakness, lack of moral fibre, or mental illness. Central to this model is the fact that people normally progress through a range of reactions to trauma and benefit most from interventions suited to their present state and needs, not to some arbitrary theory nor the wish of some to rush naively in to help.

Crisis response while in the traumatic event

  • Shock - even when a traumatic event is predicted, it still comes as a shock
  • Disbelief - ‘This can't really be happening'
  • Realisation - gradual acceptance of the reality of the incident
  • Frozen survival state - an emotionally frozen state in which the person focuses narrowly and not well on personal survival, causing them to do things they later regret or not do things they later regret not doing. This can be a source of posttraumatic self-blame and criticism, causing depression. This frozen state is often mistaken as calmness - ‘They're OK, they don't need any special help'.

Recovery phase once the traumatic event is over

  • Shock - often occurs again, particularly after prolonged events
  • Depression - again an understandable response to the suffering, loss and apparent helplessness experienced
  • Mood swings - seeming OK one day, back in the blues the next; confusing for the survivor and those around them, unless it is recognised as a sign of progress out of depression
  • Anger - also understandable, ‘Look what life did to me'. After a ‘natural' disaster, anger may be directed towards family, friends or associates, resulting in social isolation just when supportive relationships would help. A ‘man-made' disaster may provide a focus for anger but, if it results in a prolonged battle for compensation, can keep survivors stuck.
  • Reflection - thinking about what happened, trying to make sense of it, whether as an individual, a group, or a community. The fundamental purpose of reflection is to regain a sense of safety - ‘If I know why it happened this time, I can protect myself from similar events in the future'.
  • Laying to rest - the successful completion of recovery, so that the traumatic event becomes an ugly memory when prompted, but not one that seriously interferes with quality of life