A framework for mental health care response after disasters

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1. It is estimated that 11-38% of individuals experience stress-related or adjustment disorders after community disasters.  

Study Rundown: It has been reported that up to 38% of distressed individuals presenting for evaluation after disaster have stress-related and adjustment disorders. While evidence-based treatments and interventions for individuals with distress after disaster events have been previously described in the literature, there is a growing need to establish a practical and implementable framework that can be instituted into standard disaster emergency response protocols. This systematic review proposes a framework to guide the health care responder in all the aspects of mental health care including case identification, triage to appropriate care, and appropriate intervention. The proposed framework emphasizes the importance of psychiatric assessment including diagnosis as part of the case identification process. While this review is one of the first to address mental health responses to disaster trauma exposure, a large proportion of reviewed studies are not particularly rigorous in terms of methodology, which is largely due to the challenges of conducting such research in disaster settings. Future research is merited to further integrate assessment and referral into existing services and to evaluate the effectiveness of those interventions.

Click to read the study, published today in JAMA

Relevant Reading: Natural and manmade disasters and mental health

In-Depth [systematic review]: A literature search of peer-reviewed English-language literature dealing with mental health interventions and services was conducted from September 2012 to February 2013 yielding a total of 222 unique US based articles stratified by type (original research vs. reviews vs. reports), focus (general disaster response vs. specific disaster service programs), and type of disaster (natural vs. human-caused). Of note, September 11^th was the focal disaster event in the majority of included studies. Between 11-38% of people experience stress-related or adjustment disorders after disasters and 40% had pre-existing psychiatric disorders. This study developed a systematic response flow diagram for mental health responders, including 1) case identification through mental health assessment, differentiating psychopathology i.e. disaster related PTSD, major depression, bereavement, anxiety, suicidal/homicidal ideation psychosis,  from normal emotional distress; 2) triaging to appropriate type and level of care; and 3) delivery of appropriately targeted interventions.

By Elizabeth Park and Rif Rahman

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