'The community itself is expected to lead and facilitate its own recovery' 

Kerrie Kelly MAPS is a member of the APS Disaster Preparedness and Response Reference Group who has a particular focus on community response to disasters. Kerrie lived in the tropics for a number of years and became accustomed to living with cyclones, and now resides in Kyogle in NSW, where floods are common.

Aside from your personal experience, how did you become involved with disaster preparedness and recovery?

In 2006, I was contracted to evaluate the psychosocial components of the community recovery response to Cyclone Larry. This cyclone was the first disaster of sufficient scale to test the new recovery arrangements introduced by the Council of Australian Governments (COAG) in 2004, across all three tiers of government (local, State and national). It was the first natural disaster in Queensland where the Department of Communities, rather than mental health services, became the lead agency responsible for restoring community wellbeing, and it contributed along with several lead agencies to a very fluid and dynamic process of community recovery.

What were the main lessons from Cyclone Larry that apply to other disasters?

It is clear that the new Community Recovery framework has revolutionised disaster mental health in Australia. The community rather than the individual is now seen as the primary focus for prevention, preparedness, response and recovery activities. This is a much more holistic and dynamic process which also involves economic and physical elements, and the provision of information, grants, accommodation and investment to strengthen community preparedness for the next natural disaster. The increased scope and complexity demands a high level of planning, communication and coordination, and all agencies are required to structure their services on the same set of principles.

What should we as psychologists be alerted to here?

The ‘old' way of responding to disasters by gathering mental health practitioners (often from outside the area) to provide short-term crisis intervention has become redundant. Debriefing, in particular, is out. Individual interventions have been replaced with community-based recovery interventions delivered primarily by non-mental health specialists. The community itself is expected to lead and facilitate its own recovery, assisted by a range of service providers, including psychologists.

This community-wide approach is supported by a raft of research which shows that while a degree of psychological distress is common in the early aftermath of natural disasters, this will not necessarily progress to disorder. In most cases, reactions settle spontaneously as people use their natural coping strategies and social support networks and start to rebuild their lives and recover from their experiences. Resources need to be invested in rebuilding or replacing lost social and other resources, while individual-focused interventions should be reserved for those who are most distressed, have depleted social resources to begin with, or who suffer devastating resource loss. Given the long window of service uptake, post-disaster mental health services need to be integrated into the primary care system and psychologists are expected to contribute to the sustained recovery of their own communities through existing health services and programs such as Better Access, ATAPS and community health.

While mental health interventions following natural disasters have tended to focus on preventing posttraumatic stress disorders, there is a lack of clarity about the timing, nature and target groups, and whether they constitute preventative or treatment interventions. We need guidelines for community-level interventions to promote recovery, in keeping with the World Health Organization's view that PTSD is not necessarily the main disorder resulting from disasters. We should cease to be preoccupied with PTSD and focus instead on a range of possible mental health problems and disorders and on ‘social' rather than ‘mental health' interventions following disasters (World Health Organization, 2003).

Is there a take-home message for psychology/psychologists?

As well as changing its focus away from PTSD, the psychological community needs to adapt its practices and terminology to reflect the disaster management concepts now in use throughout Australia: the ‘all hazards' and all agencies approach, and the prepared community. All agencies involved in disaster response have had to reorientate their services away from a traditional crisis response role, toward a more holistic, integrated and longer-term approach. This opens the door for community psychologists to contribute to disaster mental health by identifying risk and protective factors that influence community resilience and recovery following disasters, and by becoming involved across the cycle of disaster management: prevention, preparedness, response and recovery.

Reference

World Health Organization. (2003). Mental health in emergencies: psychological and social aspects of health of populations exposed to extreme stressors. Geneva: World Health Organization. www.who.int/mental_health/media/en/640.pdf

InPsych February 2011