There has been a lot of talk among mental health professionals about the psychological consequences of the devastating earthquake that struck Port Au Prince, Haiti, two weeks ago, and just what should be done right now. The answer, it turns out, is not what you might expect.
Check out the National Center for PTSD’s “psychological first aid” suggestions. Their list is comprised of primarily educational measures. Notably, nowhere on the list of things to do in the first weeks following a disaster is psychotherapy as we traditionally think of it. Indeed, nowhere on the list is anything that needs to be done by mental health professionals. The suggestions are pretty much good common sense: seek emotional support from friends, family, religious and other community groups; maintain as predictable a routine as possible for your kids; and although you should stay informed, stay away from sensationalized media coverage. If people are acting anxious, that’s because they are distressed — and that’s normal following a disaster. For most people this distress will decrease when basic needs are satisfied and some measure of stability is reestablished.
This is not to say that mental health professionals should not volunteer their time to help in this crisis. They might work in Haitian communities to educate people about normal reactions, or even organize events to help raise money to rebuild hospitals and schools. An effective mental health professional’s expertise in immediate post-disaster contexts is limited to education. Sending American psychologists to Haiti to do mental health work is not worth the money, given that (1) this type of education can be done by people already there and (2) the resources they would take up in terms of their housing and sanitation would be a net draw on relief efforts.
Why can’t mental health professionals come up with something better than reassuring us to follow our common support mechanisms in immediate post-trauma contexts? Well, two answers: (1) We actually do have the beginnings of what to do in the immediate aftermath of trauma in recent pharmacotherapy research (e.g., previous blog entry), but it’s still pretty uncharted territory. In Haiti applying this research would be impractical in any case as hospitals were destroyed, let alone medications not being available. (2) Attempts to do “emergency psychotherapy” — like critical incident debriefing, which was big in the 1990s and used following 9/11 — have shown to actually over-sensitize people to trauma, resulting in higher rates of trauma-related problems later on. So, as we know that most people exposed to a trauma recover, and indeed, natural disasters result in some of lowest rates of PTSD relative to other types of trauma, our best bet at this point is to educate, and leave people to marshall their own psychological and community resources.
So, support relief efforts in Haiti — but let’s not send the shrinks just yet. They will be needed later on, when it becomes clear who is in the minority that suffers long-term distress. And let’s hope that the urge on the part of mental health professionals to do something hasn’t passed by then, as that’s exactly when it will be needed.