Disaster Check Points for Psychiatrists

Several factors can influence psychiatric risks after disasters. The nature of the disaster can contribute at both individual and community levels. Small-scale or localized disasters (eg, aviation disaster, mass shooting) may be time-limited; others (such the aftermath of a hurricane, an epidemic, or ongoing terrorism)-may persist over a longer period. A history of psychiatric disorder or trauma potentially increases risks. The prevalence of major depressive disorder, PTSD, and substance abuse is increased in communities that have experienced traumatic events. The most commonly reported symptoms after a disaster are sleeplessness, anxiety, depression, and constant, overwhelming bereavement.

People experience a spectrum of reactions as a result of traumas, which may include loss of family members, friends, pets, home, work; direct or indirect injuries that may be physical or psychiatric; displacement because of evacuation or inability to evacuate; feelings stemming from the actual event; frustrations from response and recovery efforts; and overall chaos. See reference 23 here.

For many patients, stress may not be directly related to disaster itself but rather to post-disaster chaos. stress reactions may result in physical symptoms, such as nausea, GI distress, sweating, shivering, faintness, dizziness, muscle tremors, weakness, elevated blood pressure, elevated heart and respiration rates, uncoordinated movements, feeling overwhelmed, extreme fatigue, exhaustion, headache, and narrowed visual field.

Emotional reactions include numbness, anxiety, fear, rapidly shifting emotions, guilt, survivor guilt, exhilaration, survivor joy, anger, sadness, helplessness, feelings of detachment, feeling unreal, disorientation, feeling out of control, denial, constriction of feelings, strong identification with victims. Diagnoses may include MDD, anxiety disorders, PTSD, and substance abuse.

There should be an awareness of the differing expressions of grief among various cultural groups. Effective assessment of and intervention for psychiatric needs require an awareness of cultural strengths and confines (see reference 16 here.). Past individual and community trauma history among cultural groups should also be appreciated. Language barriers require the use of translators. Other cultural factors include perception and receptiveness toward mental health as well as variations in help-seeking behavior.

Children and the elderly also have special needs after a disaster. Children’s reactions to and distress following disasters may be atypical relative to those of adults. Sudden arrests of developmental progress; loss of developmental achievements; and changes in sleep, appetite, family and peer relationships, and academic performance can all suggest psychiatric distress. In addition, children’s distress may reflect parental distress. Any post-disaster psychiatric intervention ideally includes what remains of the pre-disaster family unit.

Many become more isolated and have significant medical comorbidity as well as other disabilities. Cognitive processing is often slowed, and as a result, the elderly have difficulty in understanding and navigating post-disaster health and human services. There are numerous other special populations; they include first responders, individuals with disabilities, and rural versus urban populations because the respective populations may have varying degrees of social support and identity. Psychiatrists need to appreciate strengths, resiliencies, and challenges that influence the effects of disasters on these highly vulnerable populations

Psychiatrists continue to play significant roles for individuals who present with post-disaster psychiatric symptoms. Psychiatrists provide much needed interventions, including trauma counseling, cognitive-behavioral therapy, and psychopharmacological management. Licensure and credentialing represent an important medicolegal challenge for psychiatrists who do disaster work. Know the requirements of the state where you will be doing the volunteer work. The American Psychiatric Association can provide information regarding licensure in disasters.

Psychiatrists must not self-deploy to disasters. This will only add to the chaos because the strained health care systems and infrastructure are likely to be unable to handle excessive volunteers. Psychiatrists may need to provide documentation of their training when they volunteer. It is prudent to have copies of your license and credentialing information. It is also advisable to contact your malpractice insurance provider regarding coverage while doing volunteer work. Despite the chaotic nature of disaster psychiatric work, it is important for psychiatrists to maintain confidentiality. Some patients might worry about being stigmatized because they sought psychiatric care. Although efforts to maintain confidentiality should be made, the exchange of information with disaster response agencies will help individuals who need post-disaster services. Obtain the patient’s permission to exchange such information.

One of the most challenging issues of post-disaster psychiatry is self-care of disaster responders. Psychiatrists are exposed to significant secondary traumatization when they provide care to those affected by the disaster. They hear stories of loss that evoke feelings of sadness and helplessness. Moreover, psychiatrists and their families may be direct victims of disasters and experience extreme disruptions in their lives. Yet, they continue to care for others affected by disasters.

For more on this topic, see Disaster Psychiatry: What Psychiatrists Need to Know, on which this slideshow is based.