5.6 Delivery considerations
Following a disaster, a wide range of delivery mediums are needed to suit the varied needs and preferences of people as well as the post-disaster environment. These include early childhood and aged care centres, workplaces, mobile delivery, schools, and digital health.
The challenges a region or community faced prior to the disaster can be exacerbated afterwards. Both specialised and non-specialised services need to adapt to the needs of disaster-affected communities, flexingup at time of greater need and engaging proactively using mobile teams, pop-up services, and door-knocking to reach people who are reluctant to seek help.
People’s ability to access services needs ongoing monitoring as conditions on the ground change. Considerations include:
- • blocked transport routes,
- • changed access to media or other communications,
- • damaged or unusable information and communication technology (ICT) infrastructure,
- • disruption to economic activities or education that affects people’s ability to travel to services,
- • financial constraints that limit access to allied health or medical practitioners,
- • the stigma surrounding mental ill-health, and
- • the social and cultural appropriateness of service offerings.
5.6.1 Assessment and screening
Effective assessment and screening are important in mental health care following disasters. For many reasons people’s distress and the impact of trauma can be missed or not dealt with, delaying treatment. Children and adolescents often do not volunteer information on how trauma has impacted them. In small communities in the wake of the disaster, others may hold back, reluctant to seek help and use the scarce resources that are available.
Good practice in assessment and screening that is supported by evidence includes:
- • community upskilling to ensure people are aware of signs of impact in others,
- • providing emotional support and referral with the use of Psychological First Aid,21 and
- • specialised mental health assessment and referral to support, required for people with acute symptoms when mental ill-health does not improve with non-clinical interventions.
Queensland Health notes:
assessments can be offered at any point where it seems warranted, but a formal assessment should be offered if these incapacitating distressed states persist for longer than three months or if incapacitation or dysfunction related to the event appears to develop after this time.22
5.6.2 Use and efficacy of digital service provision
Technology-enabled mental health services such as digital apps, telehealth, and online treatment have emerged as a strong complement to face-to-face assessment and treatment. They bring unique benefits such as confidentiality and 24-hour access. During the 2019-20 Black Summer bushfires and the COVID 19 global pandemic, digital and telehealth services were effectively used in health care, including mental health.23 People made good use of dedicated disaster helplines for telephone and online support as well as assessment and ongoing support.24
Digital services are convenient and reduce pressure on face-to-face services. Good practice digital service provision is incorporated into disaster mental health and wellbeing planning at the local level, ensuring that local primary health care providers are kept informed about and involved in on-line clinical care if the service-user authorises this.
However, technology-enabled solutions should be seen as complementing rather than replacing face-to-face help. Connectivity problems, damaged ICT infrastructure, users’ comfort with the technology, and gaps in local knowledge are limiting factors when services are provided digitally and remotely. Some populations, such as people in rural, remote, and very remote areas, including Aboriginal and Torres Strait Islander People, may not have consistent access to digital tools due to physical infrastructure issues. These are groups disproportionately affected by disasters.
5.6.3 Proactive outreach
At times of disasters, practical assistance and engagement across the community is important to ensure connection, encourage support, and offer assistance when needed.
Proactive outreach can overcome access barriers by meeting people at home or other easy to reach locations. They can offer mental health check-ins in combination with practical help and health checks.
The characteristics of each community and the nature of the disaster determines the most appropriate methods of outreach. These may include home and farm visits (actively listening to concerns expressed around kitchen tables), information sessions, town hall meetings, community barbecues, neighbourhood drop-in centres, workshops and meetings, field days, or creative arts events and workshops.
Proactive outreach is effective when:
- • many services work together to triage and refer people to services, and where people only need to register once,
- • informal support is given priority as well as comprehensive referral options being available for specialised services, and
- • the specific cultural, social, and economic context of service-users is attended to.
5.6.4 Streamlined provision of disaster mental health support and information
Following a disaster people can find it difficult to navigate the services and assistance available at a time and in a manner that is right for them. The differentiation between various services may not be obvious. Support may be provided by local, state and territory, and Australian governments as well as through private or philanthropic grants. The types of support range from specific mental health and wellbeing supports to practical recovery supports – all of which may come with different eligibility requirements. Finding assistance following a disaster can be extra challenging due to the stress caused by the disaster itself, the overwhelming nature of the aftermath workload, and in some cases, a sense of paralysis and isolation.
"You’re dealing with people who are traumatised and it’s very hard for them to say what they need because they’re only looking to the end of their nose. They’re only going to give you their immediate need and… it might be a roof over their heads."25
A single streamlined source of practical mental health and disaster support information would assist communities affected by disaster and enable quicker and more efficient access to mental health support. Such information could be delivered through a portal managed nationally, with strong regional connections. It could include information to educate people about mental health and wellbeing in a disaster context, as well as where to find help.
5.6.5 School and workplace delivery
Providing support at the local workplace and school level is an important strategy to assist community recovery. In schools, education about the disaster and access to psychological support is vital for the recovery of children and young people.26 Psychological First Aid and trauma-informed care training can be valuable for teachers and workplaces. Education programs utilising story telling are proving effective in supporting and educating children following disaster (see Examples from Experience).
Workplaces should also ensure accessible support is available through regular check-ins and that Employee Assistance Programs can cater for disaster-related mental health.27
5.6.6 Tracking mobile populations
Certain population groups which are at risk of experiencing heightened stress and possibly trauma following a major disaster are also ones that are at risk of falling through service provision cracks. These include:
- • Tourists and other non-residents who leave the area, and then cannot access services because eligibility is based on living in the disaster zone.
- • Seasonal workers whose whereabouts and needs are not known to local authorities; or who are not eligible for MBS or postcode-based health assistance; or face language challenges.
- • Those who are experiencing homelessness or are of no fixed address in a disaster-affected area.
- • People who voluntarily live ‘off the grid’ outside mainstream settlements, who may not be known to authorities; may live in dwellings not known to Councils; and who - like people of no fixed address - may not have publicly accessible personal details that are up to date.
- • People who do not return to, or move away from, their disaster affected community or region and may not have access to the same level of funded mental health care as a result of relocation.
- • Aboriginal and Torres Strait Islander People who live on traditional lands in rural and remote Australia and whose lives feature marked inter- and intra-community mobility, with circular movements within a ‘mobility region’, and a high rate of travel to places (including regional centres) within the region for relatively short periods of time.
Disaster health registers can also be helpful for keeping track of mobile populations affected by disasters that lead to population dispersals.
5.6.7 Trauma-informed service provision
Trauma-informed care aims to look beyond the person’s symptoms, changing the question from ‘what is wrong with you?’ to ‘what happened to you?’
It is a delivery approach that acknowledges and recognises the impact of a trauma experience, including its impact on mental health and wellbeing. In a disaster or emergency situation, people are likely to be living with the disaster aftermath for a long period, and several family members may be experiencing undue levels of fear and worry. This means many practitioners (and especially GPs) will need a skill base that equips them to deal with the broad range of traumatic events.
The Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder (PTSD) and Complex PTSD provide general and mental health practitioners, policy makers, industry, and people affected by trauma with access to recommendations reflecting current evidence on how to better respond to the needs and preferences of people living with these conditions.28
Given Aboriginal and Torres Strait Islander People’s lived experiences with intergenerational trauma, it is important that culturally safe services and trauma-informed service provision for Aboriginal and Torres Strait Islander People and communities and available, including a culturally trained and resourced workforce.