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