Preparing Scotland: responding to the psychosocial and mental health needs of people affected by emergencies

3 Core Principles

People who are thrown together in the aftermath of emergencies frequently respond with great fortitude and resilience. Statutory responders should recognise this and should actively promote the fullest participation of local, affected populations.

There is a broad range of ways in which people react psychosocially when they are involved in an emergency. Distress following an emergency is very common but, in most cases, transient and not associated with lasting dysfunction or mental disorder. The majority of people are unlikely to require access to specialist mental health care.

Effective social support plays a vital role in people's recovery following emergencies. There is evidence that supportive social networks can help people to cope with traumatic events and can protect against the development of stress-related mental illness.

Often the disruption in people's lives that follows an emergency can have as big an impact as the emergency itself. Some people may require assistance and support due to this over an extended period of time.

Arrangements should recognise that people who are affected by emergencies may be able to function well for some time after the event(s) but may develop psychosocial problems or mental disorders later, and sometimes much later. Arrangements should also recognise that a small minority of people may require mental health care over extended periods.

Despite the general resilience of people affected by emergencies, a minority may require screening, surveillance and clinical assessment. These will be people who continue to show high levels of distress or who have been identified as being in an "at risk" group.

People who become psychologically unwell following traumatic experiences may develop a number of disorders. These include alcohol and substance misuse, anxiety disorders and phobias, adjustment disorder depression, or post-traumatic stress disorder. Children may show their distress in other ways, for example, separation anxiety or behavioural problems.

Some people, families and communities may experience more adverse effects and may require longer-term, psychosocial support and mental health care.

A comprehensive response to psychosocial and mental health care needs requires a multi-agency approach. This includes coordinating services from social care and health care providers, emergency responders and non-governmental organisations.

As with other aspects of caring for people and managing the recovery following an emergency, the best outcomes are likely to be achieved by working in partnership with the affected people and communities, and by facilitating a high level of self-determination by those affected.

A stepped care model should be used that begins by attending to basic needs (such as safety, security, food, shelter, acute medical problems); it should then proceed through responses made by people, families and communities to non-specialised support services; and lastly to specialist mental health care services.

The stepped model of care should be based on the principles that underpin Psychological First Aid ( PFA). Specific formal interventions such as single session individual psychological debriefing should not be provided as these have not been shown to be effective, and may cause harm for some participants.

Psychological First Aid

There are a number of components of effective psychological first aid, listed below. The components should be modified to match the needs of each individual. A child, for example, will require a different explanation of trauma reactions than an adult. There is no particular order to follow, as this will depend on the people affected and on the emergency.

Key components of effective Psychological First Aid

• provide immediate care for physical needs
• protect from further threat and distress
• provide comfort and consolation for people in distress
• provide practical help and support for real-world-based tasks ( e.g. arranging funerals, information gathering)
• provide information on coping and accessing additional support
• facilitate reunion with loved ones where possible and/or connection with social supports
• provide education about normal responses to trauma exposure including two essential elements
  • recognising the range of reactions
  • respecting and validating the normality of the post-trauma reaction

The likelihood of a person developing more serious psychosocial problems or mental disorders will depend on many factors including the intensity and duration of their exposure to emergency-related stressors, certain prior experiences, and the availability, or otherwise, of social support. The stepped care model should be applied in ways that include a clear pathway for accessing specialist services for those people who are thought to be at particular risk.

Early psychological reactions to emergencies can be difficult to distinguish from the symptoms of disorders that may develop later. Responders and staff in health, social and welfare services should be provided with basic education and training about psychological responses to emergencies across the age range. This will help to avoid inaccurate estimates of the prevalence of disorders.

The specific needs of children who are affected by emergencies should be addressed and support and advice should be provided for parents and/or carers. Education services have an important role in restoring and normalising community life for children and their families; they should be included in emergency planning.

People with chronic (long-term health conditions), with physical and mental disabilities (including severe mental disorder), or who are elderly may need additional support following emergencies. Community resources should play an important role in restoring and normalising community life for these people and their families.

Plans should include specific provisions for the psychosocial care of the staff of responder organisations linking with occupational and other relevant arrangements.

Attempts should be made to identify and follow up non-professional responders (that is, civilians who have assisted in the emergency response) as they may have had increased exposure to potentially traumatic experiences without having access to the organisational support of professional emergency service responders.

Some groups of people may be at risk of discrimination or violence in the aftermath of emergencies and may need extra help to stay safe.

Responders should work with community leaders to identify the needs of those people who are affected, taking into account cultural factors, such as language, faith and belief, and other needs. Some sections of the faith communities have established emergency plans and, where possible, their specific requirements should be integrated into the contingency planning infrastructure and arrangements.

The model of care should be capable of being evaluated. By working with appropriate partner organisations, standards for research, evaluation and information-gathering should be developed and planned before emergencies occur. The object of research should be to identify and improve best practice for people who are affected by future emergencies.

The following timeline outlines the development and delivery of psychosocial and mental health care at each stage of an emergency. The time intervals are approximate and are intended to offer an indicative framework for planning, training, and service preparation.