Providing psychological support to patients during or after a disaster

Distress, denial and disbelief are common reactions people may show for days and sometimes up to weeks after a disaster. In the initial hours and days, people may be stunned and dazed, particularly in response to a sudden and devastating disaster.

Common themes that patients express following a disaster are:

• difficulty falling and remaining asleep,
• anxiety,
• uncertainty about the future and what they can do to feel safe, supported and happy again,
• disruption to normal routines and patterns of life, adding to uncertainty, and
• irritability, anger and frustration.

The most important provisions in the first hours to weeks after a disaster are safety, comfort and the support of family and friends. GPs can help to ensure their impacted patients feel safe and have the support of family members, friends and their community.

A stunned mental state can leave people relatively unaware of their own safety and vulnerability. A brief medical assessment allows:

• assessment of physical injuries,
• a review of changes to pre-existing physical and mental health conditions,
• time for contact and talk,
• the affected person to feel reassured and seen.

People affected by an emergency or disaster can experience a range of problems over different amounts of time. However, those who have had the following experiences are considered to be at greater risk of facing problems in early weeks, months or years following a disaster:

• belief that they were about to die,
• loss of a loved one (including pets),
• pre-existing and chronic health problems,
• lack of support systems or connections,
• very severe or disabling injury,
• exposure to multiple deaths or injuries of others,
• pre-existing vulnerabilities, including socioeconomic disadvantage, or
• preexisting trauma from previous incidents

Specialist help may be needed after one month if a person:

• still feels upset, very teary or fearful most of the time,
• has changed behaviour compared to before the trauma,
• can't function in normal activities,
• has worsening relationship issues,
• is overusing or abusing substances,
• feels jumpy or is experiencing disturbed sleep,
• is dwelling on the event,
• is unable to enjoy life, or is experiencing numbness or withdrawal, and/or
• is experiencing overwhelming grief that prevents functioning.

GPs may assess and refer those patients with persisting symptoms that disrupt daily functioning on for specialist mental health treatment.

The following psychiatric syndromes can present following a disaster or other form of trauma:

• major depression,
• major anxiety disorders,
• post-traumatic stress disorder,
• substance abuse,
• major behavioural change,
• psychosomatic complaints, and
• panic disorder.

Following a disaster or traumatic event, children may become:

• withdrawn and quiet,
• irritable or angry,
• prone to headaches and/or stomach aches,
• more likely to regress to younger behaviours (i.e., thumb sucking, bedwetting, baby talk),
• clingy,
• prone to overreacting to minor hurts, both physical and emotional, and
• prone to behavioural problems.

If a child continues to be acutely distressed and unable to function beyond the first week following an event, an assessment by a mental health professional is required.

The Australian Childhood Foundation provides guidance to parents and carers in the form of a printable PDF on building safety for children who have experienced trauma. You may wish to print copies for your practice’s waiting or consultation rooms.

Further useful resources can be found below.

The following mental health resources are available to support community and your team in the wake of traumatic events:

• Emerging Minds: Community Trauma Toolkit
• Phoenix Australia: Centre for Post traumatic Mental Health
• The Australian Psychological Society: Psychological First Aid: A guide to supporting people affected by disaster