As I write this downtown Ottawa is still in
lockdown following several shootings. Like many people in Ottawa I feel shocked
that this is happening in my town and angry that someone is trying to kill my
neighbours. Trying to work out what is happening and whether it is safe for me
to travel across the city, I was also struck by the numerous tweets offering
psychological support. This made me think, as a psychiatrist, what should be
the response of the mental health community to shocking disasters such as these.
Having been in Sri Lanka just after the 2005 tsunami and in New Zealand during
and after the Christchurch earthquake I have had some experience of what makes
an effective response.
The most important thing to say is that
most people will find their own ways to cope with this and most people, even
those with direct exposure to the events of today, will not become mentally ill
or develop post-traumatic stress disorder. Feeling anxious, sad and not
sleeping after a disaster is a normal response to an abnormal situation. Paying
attention to a hierarchy of basic needs including making people feel safe,
providing food and drink and adequate timely information so that people can
make meaning of what has happened is helpful.
Also having teams of “counsellors” offering
immediate debriefing to people is unlikely to help and may make things worse by
getting them to relive the trauma.
What is helpful is using existing networks
and services, which means both professional and personal networks. Reinventing
the wheel after a disaster rarely works. In the first week after a disaster
those who are at most risk of more serious psychological distress include those
with existing mental disorders, those intensively involved with the trauma and
those whose symptoms of stress are prolonged. In the longer term the use of
rituals such as memorial services or other spiritual activities can be
extraordinarily helpful (which they were in Sri Lanka) along with a return to
“normal” activities and timetables as soon as possible.
Other communities have experienced and
survived disasters in the past – here are some links to resources which
inform the psychological response:
Psychosocial Support in Disasters – excellent resource from Australia
Coping after a Traumatic Event – link to UK Royal College of Psychiatrists web page and information leaflet
Information sheet provided by the Royal Australian and New Zealand College of Psychiatrists for clinicians providing care to people after the Christchurch
earthquake
World Health
Psychiatric Association and World Health Organisation statement on the role of psychiatrists after disasters