Feature Article

When the smoke clears. Supporting communities after a disaster



© Martin Von Stoll, Stoll Photography blackhead beach, hallidays point nsw
© Martin Von Stoll, Stoll Photography blackhead beach, hallidays point nsw


There is an increased risk of short- and long-term mental health impairment following a disaster, such as the recent Australian bushfires. Timely and effective reconstruction and practical assistance have a key role in supporting mental health. GPs also have a central role in monitoring and providing long-term care for patients who have been exposed to bushfire trauma.

Key Points

  • Psychological distress is common after a disaster and does not always suggest a mental disorder or require treatment.
  • Community mental health is best supported by practical reconstruction initiatives and support for individuals to return to pre-bushfire levels of personal and financial resources.
  • Psychological First Aid provides a framework to combine practical and psychologically informed responses after a natural disaster.
  • People with acute or pre-existing mental health conditions should be identified and provided with timely access to specialist care.
  • People most severely exposed to critical incidents, those who have lost a family member or close friend, and those who have had their home or livelihood destroyed have a higher risk for developing mental health impairment.
  • Conditions with increased frequency after a disaster include post-traumatic stress disorder (PTSD), depression, prolonged grief reactions and adjustment disorder, as well as harmful behavioural responses such as heavy drinking, family conflict and intimate partner violence.
  • The real mental health burden is likely to emerge over the medium- and longer-term when many emergency services and additional resources have moved on.
  • Trauma-focused psychological interventions are recommended as the first-line treatment for PTSD. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may be helpful if other treatments are not available.
  • Children exposed to bushfire risk or living with a parent with post-traumatic mental health difficulties are at risk of PTSD and heightened internalising and externalising disorders.
  • Physical health comorbidities need to be actively monitored.