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Feature Article

When the smoke clears. Supporting communities after a disaster

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

Abstract

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.

The magnitude and extent of the 2019-2020 bushfire season have affected multiple states and communities across Australia, with growing concern that this marks a significant turning point in climate change-enhanced bushfire risk and extreme climatic events. The prolonged nature of the crisis saw large numbers of volunteer firefighters and communities exposed to extended periods of risk, adversity, loss and tragedy. Over 2400 homes were destroyed, with the destruction of vast tracts of rural infrastructure, livestock and native animals. The bushfires resulted in the tragic deaths of 34 individuals, including volunteer firefighters working to protect homes and communities. 

In the wake of the disaster, the Prime Minister announced a A$76 million funding package for the provision of mental health support and access to trauma-informed specialist services that can be immediately provided to firefighters, emergency personnel, and individuals and communities affected by the bushfires. The prioritisation of mental health as the disaster was unfolding highlights the extent to which concerns for mental health has risen to prominence in disaster response planning. 

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It is important that any mental health interventions are guided by the evidence around disaster management and intervention. There has been considerable controversy over how to appropriately meet mental health needs in the immediate aftermath of a natural disaster. A new provision under the Prime Minister’s funding announcement provides direct access to psychologists, social workers and occupational therapists, removing previous requirements for a primary care mental health plan.1 This is intended to improve access to direct care in rural regions funding telemental health, but may raise the possibility of fragmented and nonintegrated care. This article outlines some of the key issues and clinical conditions that are important to consider across the postdisaster recovery period. It remains a fundamental contention that the GP should remain at the centre of physical and mental health care.

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