Magazine article Clinical Psychiatry News

Perspective

Magazine article Clinical Psychiatry News

Perspective

Article excerpt

There is an agreed-upon system of physical first aid in response to disasters in this country, but no such consensus exists for psychiatric first aid. Instead, in the face of large-scale disasters, community mental health providers scurry around, trying to mobilize a response by creating infrastructure.

In my experience with disaster mental health in Chicago, the disaster-management infrastructure has to be in place before the crisis hits. Otherwise, crisis-management efforts are hampered by delayed response times, poor communication among volunteers and mental health care providers, avoidable confusion, and damaging misinformation.

Social and political obstacles can also create problems. With respect to Hurricane Katrina, one such obstacle was the apparent absence at the disaster-planning table of anyone knowledgeable about the nature of the homeless, poor, and illegal residents of New Orleans--those who for political purposes are invisible, since they aren't counted by the census and don't show up on unemployment rolls.

Had there been some understanding of just how many of these people lived in the city, neither the federal government nor the Red Cross would have so grossly underestimated the number of people who would seek shelter at the Superdome--nor would they have been so unprepared to deal with physical, social, and emotional needs of the huge numbers of evacuees.

Community mental health centers could have been and should have been prepared for this disaster. The reality is that psychiatric emergency and crisis services are major components of a comprehensive community mental health system. If the staff and administrators of community mental health centers understand this reality, they will always be prepared, because the kernel for the disaster response will be an ongoing process.

Trauma is part and parcel of the mental health business. Treatment of traumatized women, children, veterans, and the provision of psychiatric emergency services are ubiquitous to mental health practice; thus, trauma-related services and emergency practices should already be happening in these centers. It is not rocket science for mental health workers to tweak the tools they have to be more useful to people in the throes of disaster-related trauma.

In the immediate aftermath of a large-scale disaster, the first step is to meet the survival needs of those involved. Next is to open channels of communication, being clear and honest about what steps are being taken to provide help; making promises that are not kept helps shatter hope and faith in government support systems that are supposed to come to the aid of patients. …

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