Mental health disaster intervention has evolved rapidly since 1989. In addition to their environmental impact, Hurricane Hugo and the Loma Prieta Earthquake had a major programmatic impact on the American Red Cross. As noted in the article by Jane Morgan, recognition of post-disaster emotional stress among relief workers and victims, promoted the creation of a disaster mental health plan that has been included in the Red Cross' revised overall disaster plan.

These disasters also had a significant impact on an international community of clinicians and researchers/ Within the Department of Veterans Affairs, clinicians who had previously focused their clinical efforts on war-zone veterans with chronic PTSD were suddenly asked to turn their attention to the acute psychological problems of hurricane and earthquake survivors. Allthough many VA professionals had little or no clinical experience with acutely traumatized individuals, they learned quickly and responded by offering services to civilians as well as veterans who had been exposed to these natural disasters. A similar reorientation has been seen among PTSD therapists nationwide as attested by the rapid enrollment of mental health professionals in Red Cross disaster programs mentioned by Jane Morgan.

In short, there has been recent recognition that in addition to food, shelter, and blankets, basic needs following a disaster include attention to acute psychological reactions. This has created a policy shift and demand for services that exceeds, by far, our present scientific knowledge. There has been a rapid rise in availability of acute psychological intervention strategies that, in general, are applications or modifications of the critical incident stress debriefing (CISD) model generally credited to Jeffrey Mitchell. A CISD approach has been utilized widely and most experts endorse some variant of this approach. Confidence in rapid debriefing within the first few days of a traumatic event has also been advocated by militqry mental health experts who, in recent wars have established CISD-type services in battalion aid stations so that front line troops can have rapid access to debriefing services for acute problems such as battle fatigue or combat stress reactions.

VA and non-VA researchers who had previously honed their methodological skills on investigations concerning long-term psychological reactions to trauma such as PTSD began to apply these techniques to the study of acute reactions to natural disasters and industrial accidents. I do not mean to neglect important research accomplished prior to 1989 on catastrophic events such as nuclear reactor accidents at Three Mile Island and Chernobyl, the fire at the Beverly Hills Supper Club, the architectural collapse at the Hyatt Regency Hotel in Kansas City, and the granddaddy of all trauma research, Eric Lindermann's classic paper on the Coconut Grove Fire in Boston in 1944. What I do mean to emphasize, however, is that there has been a rapid increase in research of this nature. It is probably safe to say that no major American disaster since 1989 has escaped the scientific attention of at least one team of trauma researchers. For example, John Freedy and Dean Kilpatrick in their article mention that their team alone has received NIMH funding to study the psychological aftermath of Hurricane Hugo, the Loma Prieta Earthquake, the Sierra Madre Earthquake, the Oakland Hills fire, and Hurricane Andrew. I am sure that the recent Northridge Earthquake has already generated several research proposals.

Despite the proliferation of treatment and research of victims of disasters, there has been virtually no research on the efficacy of CISD and other disaster mental health strategies. As noted in the thoughtful article by Brian Flynn, the scientific body of information needed to inform service planners, administrators and providers is non-existent. "Significant research gaps and inconclusive findings characterize the disaster trauma literature." Clearly, there is a pressing need for treatment outcome research to systematically and comprehensively evaluate CISD and other acute mental health interventions that have been enthusiastically promoted and institutionalized in recent years.

Part of the problem may be that on the one hand most of us believe that these approaches really work. We may be right. On the other hand treating disaster survivors may be more gratifying and reinforcing to clinicians than treating victims of traumatic events that happened months or years ago because disaster survivors are more likely to achieve psychological recovery with or without mental health intervention.

In addition to the need for treatment outcome research, as mentioned above, we need a wider angle lens and a longer attention span when planning mental health disaster relief programs. Diane Myers has argued convincingly that intervention efforts must address the collective as well as the individual trauma suffered by survivors. Programs must explicitly attempt to repair damage to "the basic tissues of social life." Such efforts must focus on social disruption, family stress, loss of home, financial problems, and other demoralizing consequences of a disaster in addition to the psychological impact of the traumatic event per se. She also reminds us that there is a sequence of reactions to a disaster and that "interventions must be appropriate to the phase of the disaster." Such a broader and longer context must also include the unique historical, social, ethnic and cultural characteristics of the community affected by the diaster. An eloquent example of one person's protracted and complicated struggle to reconnect with the pre-disaster threads of her life is Susanna Hoffman's article about her own experiences following the Oakland Hills fire.

To me, it is extremely important and gratifying that we may have developed techniques which not only alleviate the acute suffering of diaster survivors but which also prevent the later development of PTSD. I am concerned, however, that an overemphasis on CISD and other acute interventions may distract us from the need for long-term follow-up. In some cases such follow-up may be necessary for individuals who need more traditional therapy for unresolved disaster-related issues. In other cases, strategically phased booster shots may be needed to promote and complete a recovery process that has stalled following an acute CISD-like intervention that was provided shortly after the disaster. Hopefully, these and other possibilities will be systematically evaluated in the near future.

The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.

All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction.

For more information call the PTSD Information Line at (802) 296-6300 or send email to ncptsd@ncptsd.va.gov. This page was last updated on Thu Jul 20 17:01:08 2006.