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Central Asia Regional Health Security Workshop George C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany. Mental Health in Disasters. Geoffrey J. Oravec, MD, MPH, MALD Capt, USAF, MC Center for Disaster and Humanitarian Assistance Medicine

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Central Asia Regional Health Security WorkshopGeorge C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany

Mental Health in Disasters

Geoffrey J. Oravec, MD, MPH, MALD

Capt, USAF, MC

Center for Disaster and Humanitarian Assistance Medicine

19 April 2012


What is a disaster?

Why is mental health important?

Affected populations


What is a Disaster?

  • A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources. - UN 1992

  • A situation or event which overwhelms capacity, necessitating a request to a national or international level for external assistance. Meets at least one of the following criteria:

    • 10 or more people killed

    • 100 or more people affected

    • Declaration of state of emergency

    • Call for international aid

      • Center for Research on the Epidemiology of Disasters

What is a disaster
What is a Disaster?

Vulnerable Population



Disaster Risk



Disaster trends
Disaster Trends




Types of disasters
Types of Disasters

  • Psychological Problems:

  • greater number

  • longer duration

  • more complex

Why mental health is important
Why Mental Health is Important

  • Mental health is the leading cause of disability in the world

  • Major economic and social costs

  • Increasing demands on the health system following disaster

  • Decreased resources following disaster

  • Decreased ability to respond, recover and rebuild

Causes of stress reactions
Causes of Stress Reactions

  • Violence

    • Experiencing or witnessing destruction, death, injury, illness, disability, killing, torture, atrocities

  • Loss

    • Family and friends

    • Physical capacity

    • Self: Identity, independence, confidence, role in family

    • Security: safety, education, job, finances

    • Home and social institutions/support

    • A future

  • Threat of Violence or Loss

Reactions to danger
Reactions to Danger

  • Physical

    • Fight or flight, ↑ heart rate, ↑ breathing, ↑ blood pressure, muscle tension, trembling

  • Emotional

    • Fear, anxiety, aggression, strong emotions, hopeless, helpless, alert

  • Psychological

    • Confusion, difficulty concentrating, numbness, disbelief

  • Behavioral

    • Restless, acting without a plan, inaction, non-adherence to recommendations, over-dedication

Following disaster
Following Disaster

• Physical

  • ↓sleep, ↑startle response, hyper-arousal, tension, fatigue, irritability, aches and pains, nausea, change in appetite, change in libido, low energy

  • Emotional

    • grief, anxiety, guilt, anger, numbness, helplessness, hopelessness, shame, decreased interest, decreased pleasure, depressed mood

  • Psychological

    • nightmares, poor concentration, unwanted memories, re-experiencing of disaster, confusion, disorientation, indecisiveness

  • Behavioral

    • withdrawal, isolation, avoidance, numbing behavior (drugs/alcohol), distrust, conflict, irritability, social and occupational problems, decreased intimacy

  • Following disaster2
    Following Disaster

    • Problematic:

      • Duration is too long

      • Social or occupational functioning impaired

    Following disaster3
    Following Disaster

    • Distress (normal reaction)

    • Behavior Change (normal or problematic)

    • Disorder (problematic, specific symptoms, illness)



    • Smoking

    • Alcohol

    • Over dedication

    • Sense of vulnerability

    • Insomnia

    • Irritability, distraction

    • PTSD

    • Depression

    • Complex Grief

    Center for the Study of Traumatic Stress

    Affected groups
    Affected Groups

    • Victims

    • Responders

    • Population at Large


    • Ensure basic needs are met (food, water, shelter)

    • Re-establish social structures and support services

    • Promote community mobilization, cohesion, participation, psychosocial programs

    • Avoid critical incident stress debriefings

    • Employ Psychological First Aid (PFA)

      • Expert-consensus based approach

      • Not only for professionals

      • Look, Listen and Link

    • Medical treatment for disorders

    Psychological first aid core principles
    Psychological First Aid Core Principles

    • Safety

    • Calming

    • Connectedness

    • Self-Efficacy

    • Hope/Optimism


    • Primary traumatic stress

    • Vicarious traumatic stress

    • Compassion fatigue

    • Burnout

    • Withdrawal, isolation, lack of support

    • Mental disorders

    How to prevent responders from becoming victims
    How to Prevent Responders from Becoming Victims

    • Selection

    • Training

    • Resiliency

    • Clearly defined role

    • Organizational support

    • Adequate work/rest cycle

    • Diet and exercise

    • Connection to other workers, social support

    • Opportunity to talk


    • Good Risk Communication

      • Clear message

      • Early information

      • Credible Sources

      • What the public should do / not do

      • Dispel rumors

    • Social support for those who need it

    • Return to normalcy

    Psychological timeline

    Honeymoon(Community Cohesion)


    A New Beginning






    (Coming to Terms) Working Through Grief


    Trigger Events and Anniversary Reactions


    1 to 3 Days -------------------TIME-------------------------------1 to 3 Years


    Psychological Timeline