Disasters and Mental Health
Disasters and Mental Health by Juan Jose Lopez-Ibor pdf
It is almost impossible to find an acceptable definition of what a disaster is. Nevertheless, a definition is unavoidable if we want to be able to face disasters and their consequences. Quarantelli states that, if the experts do not reach an agreement whether a disaster is a physical event or a social construct, the field will have serious intellectual problems, and that defining what a disaster is does not mean becoming involved in a futile academic exercise.
On the contrary, it means delving into what are the significant characteristics of the phenomenon, the conditions that lead to it and its consequences. On the other hand, a definition is also needed to guide the interventions following a natural event, for instance, when a government declares a region devastated by a flooding as a “catastrophe area”. Furthermore, a definition is needed for understanding, because any concrete disaster poses the question of its meaning.
A danger is an event or a natural characteristic that implies a risk for human beings, i.e., it is the agent that, at a certain moment, produces individual or collective harm. A danger is therefore something potential. A risk is the degree of exposure to the danger, it is therefore something probable. A reef shown on a nautical map is a danger; but it is a risk only for those who sail in waters nearby. A disaster is the consequence of a danger, the actualisation of the risk.
The mental health consequences of disasters have been the subject of a rapidly growing research literature in the last few decades. Moreover, they have aroused an increasing public interest, due to the dramatic impact and the wide media coverage of many recent disastrous events—from earthquakes to hurricanes, from technological disasters to terrorist attacks and war bombings.
The World Psychiatric Association has had for a long time a great interest and commitment in this area, especially through the work of the Section on Military and Disaster Psychiatry and the Program on Disasters and Mental Health. Several sessions on this topic have taken place in past World Congresses of Psychiatry, and other scientific meetings organized by the Association have dealt exclusively with disaster psychiatry.
Several research and practical issues remain open in this area. Among them, those of the boundary between “normal” and “pathological” responses to disasters; of the early predictors of subsequent significant mental disorders; of the range of psychological and psychosocial problems that mental health services should be prepared to address; of the efficacy of the psychological interventions which are currently available; of the nature and weight of risk and protective factors in the general population; of the feasibility, effectiveness and cost-effectiveness of the preventive programs which have been proposed at the international and national level.
Moreover, wherever disasters strike, policy and service organization issues that plague the mental health field worldwide receive even more prominence: the detection and management of mental health problems are assigned less priority than care for physical problems; trained personnel is lacking; community resources for mental health care are poor; a vast proportion of people in need hesitate to ask for or accept mental health care.
However, it is clear that the field is progressing rapidly from the scientific viewpoint (with a refinement of early diagnostic concepts and treatment strategies, and a deeper understanding of resilience factors at the individual and community level) and that in a (slowly) growing number of countries concrete steps have been taken concerning training of personnel, education of the population, and the development of a network of services prepared to deal with psychological emergencies.
This volume aims to portray this evolutionary phase, by providing an overview of current knowledge and controversies about the mental health consequences of disasters and their management, and by offering a selection of first-hand accounts of experiences in several regions of the world. We were impressed by the liveliness of some of the reports, and particularly touched by some of the chapters dealing with the mental health consequences of armed conflicts, especially on children and adolescents.
The authors of these chapters have accepted our advice to be as objective as possible in their descriptions. However, despite the intentions of the authors and the editors, some traces of their unavoidable emotional involvement may have been left in their chapters.
Neither the research overview nor the selection of experiences presented in this volume should be seen as being comprehensive.
We hope, however, that the book will throw more light on the issue of mental health consequences of disasters, stimulate acquisition of more knowledge through research, enhance our sensitivity, and contribute to a more effective prevention and management of the behavioural effects of disasters. Disasters have been happening since time immemorial and will continue to happen. We must be prepared to face them and deal with their consequences.