US & World

Mental Health Disaster Relief Not Always Clear Cut

In the coming months hundreds upon hundreds of mental health professionals will flood Haiti, eager to tend to the psychologically wounded victims of the earthquake. But the role of a mental health professional in the aftermath of a major disaster like Haiti's isn't always well-defined.

The emails started coming several days after the earthquake.

Charitable organizations based in Haiti had been taking stock and discovered that, in addition to everything else that was desperately needed, their staffs were emotionally shaken — they needed someone to help.

So they began reaching out to people like Amber Gray. Gray is a psychotherapist based in New Mexico, and she says the message she got was clear. "You know, we need counseling, somebody to come in and provide support."

So, Gray made travel plans. And as she readied herself and packed her bags, more emails came — this time from other mental health professionals, therapists like Gray who were devastated by the images they saw on television and wanted to go help the people of Haiti directly. "Probably twenty a day, specifically on mental health," Gray says.

The Mental Health Response In The Wake Of Disaster

In the coming months hundreds upon hundreds of mental health professionals from organizations large and small will flood the country of Haiti, eager to tend to the psychologically wounded victims of the earthquake. But the work of a mental health professional in the aftermath of a major disaster like Haiti's isn't always clear.

"Mental health has had a hard time figuring out how to fit in with the medical response," says Richard Mollica, Director of the Harvard Program in Refugee Trauma, who has spent the last thirty years researching mental health responses to natural and man-made disasters. Everyone comes with the best intentions, Mollica says, but while mending a broken leg is a straight forward process, mending a broken heart is much more fraught.

According to Sandro Galea, former director of the Center for Global Health, it's only relatively recently that mental health professionals have started to show up en mass in the wake of a major disaster. "The big shift came after the Vietnam war," he says.

When soldiers came home from Vietnam clearly shaken by their experiences in battle, American psychiatry finally sat down and came up with a formal definition of Post Traumatic Stress Disorder (PTSD), this idea that experiencing a traumatic event will emotionally devastate some portion of the people exposed to the trauma.

And once that definition was firmly established, Galea says, the mental health community became activated. In fact in the decades since Vietnam, trauma has become an extremely popular area of study and work. "The scientific and therapeutic community really coalesced around providing services for people who are experiencing traumatic events," he says.

Unfortunately, though they had a clear definition, initially the mental health community didn't have much clarity at all about what should be done to either prevent or relieve PTSD. And so there has been a tremendous amount of experimentation, not all of it equally successful.

Debriefing Tragedy

One big idea that became popular through the 1980's and 90's, was "debriefing." Therapists were taught that within days, or even hours, of a traumatic event, professionals should arrive on the scene and encourage victims of a trauma to talk in a very detailed way about what had happened to them. Carefully people were walked through each minute of the horror and asked to describe how they felt about it.

"I think it was a pretty common sense idea that if you're in a tragic overwhelming, life experience, that, at the time of the tragedy, sharing that story with people and going through it point by point by point... would sort of discharge any emotional upset that you might stir up," says Mollica. Therapists reasoned that, after doing this, the trauma would not, "come back to haunt you six months from now," he says.

And so, after Okalahoma City, after 9.11, and, to a certain extent, even after Katrina, mental health professionals rushed in to help. They sat with victims coaching them through these very painful sessions.

But Galea says that over the years research on this practice started to trickle in. Finally, in 1997, two big research studies reviewed all the evidence and came to a clear conclusion about debriefing. "The body of evidence suggests that it actually might harm people and that people who actually do undergo debriefing probably do worse in the long term and in the short term," he says.

Galea and Mollica agree that this doesn't mean it's always harmful to discuss your experience. The problem, they say, is that in the immediate aftermath of a trauma, people are so emotionally volatile that it's difficult for them to control their emotions after they are aroused in this way. Mental health professionals, then, shouldn't push them to talk. Discussions like that are better left until months later, when there's time to teach people who have been traumatized how to master or counter their feelings.

The New Idea

These days, the new approach of the mental health community is something called "psychological first aid," Mollica says.

"It's kind of the bible, now, of how to approach survivors now in the acute phase," he says.

The funny thing about "psychological first aid" though, is that there's very little that's particularly "psychological" about it. Mollica says it's mostly very practical, basic social work.

"You can't find your son? Well, this is who you need to talk to at the Red Cross to find your son. You don't have enough water for tonight? This is who you need to talk to to get water for yourself."

By clearing a path for people in this way, Mollica believes therapists reduce the stress on victims, which ultimately helps them avoid more serious psychological repercussions down the road.

And there will doubtless be serious psychological repercussions down the road for many of the adults and children now living open and exposed in the ruins of Haiti.

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