APA-IPS: Disaster psychiatry – Nepal, Ebola, and beyond
EXPERT ANALYSIS AT THE INSTITUTE ON PSYCHIATRIC SERVICES
The first goal after a disaster is to ensure physical safety. After that, teams try to protect those traumatized from additional trauma. Emotionally overwhelmed and disoriented survivors must be stabilized, and medications generally are not recommended during this part of the process. Medications might be helpful in cases involving addiction or sleep, but such cases are exceptions, Dr. Garcia said. In general, the same strict clinical criteria for use of psychiatric medications are applicable in postdisaster environments and are specific to the episode and the individual. PFA attempts to be culturally informed and delivered in a flexible manner, Dr. Garcia said. “It’s evidence informed but not evidence based. So, we need more research.”
PFA, along with effective risk communications, frequently are the mainstay of an effective mental health response. Where PFA informs the “what” of the mental health conversation, risk communications, as Dr. Grant H. Brenner pointed out at the meeting, is the key “how” of getting the right message out the right way. Dr. Brenner, DPO board member, is a faculty member of Mount Sinai Hospital, director of the William Alanson White Institute Trauma Service, and an editor of Creating Spiritual and Psychological Resilience: Integrating Care in Disaster Relief Work (New York: Routledge, 2009).
After the Ebola work on the ground, volunteers often found complicated terrain in the United States. As the example of the single New York City Ebola patient showed, medical and psychological preparedness and the ability of the authorities to effectively communicate safety information to the public were tested. DPO worked with a nonprofit group called More Than Me to offer mental health support services to returning volunteers and to the few people who were under quarantine orders in New York.
Each disaster is different, but a few common themes are apparent. “There’s huge value in presence and human touch,” Dr. Koyfman said.
DPO offers training sessions for new volunteers. Psychiatrists interested in volunteering can send a message to info@disasterpsych.org or call 646-867-3514. For more on risk communication, check out the information on emergency preparedness and response provided by the Centers for Disease Control and Prevention. Other useful resources are the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disaster and Resiliency in the Face of Disaster and Terrorism: 10 Things to Do to Survive (Personhood Press, 2005).
ghenderson@frontlinemedcom.com
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