3.1 Key components of care
‘Components of care’ refer to the main service types required in an integrated approach to mental health and wellbeing before, during, and after disasters. The widely accepted four-component model of care developed by the United Nations Inter-Agency Standing Committee (IASC) Reference Group on Mental Health and Psychosocial Support in Emergency Settings has been adapted, with the addition of psychosocial prevention and preparedness as a fifth component. Australia’s vast distances, and the multi-level nature of its mental health governance make this fifth component particularly relevant in an Australian Framework.
Figure 3 The IASC Intervention pyramid for mental health and psychosocial support in emergencies (adapted)
In considering components of care in a disaster it is important to note that:
- • Psychosocial support including emotional and coping support and reassurance, self-help resources, peer support, and community development are the foundational service types.
- • Services become more focused, specialised, and costly towards the tip of the pyramid.
- • A person’s individual mental health response – and the type of support needed – will depend on the impact of the disaster event, their social networks, natural supports, and individual circumstances.
- • A service response is needed at all levels from the outset, but immediately following a disaster, it is likely that people will be mainly occupied with assistance at the pyramid’s base.
- • During their recovery process, people need to be able to step up or down their supports as needed, or they may need supports at several levels simultaneously.
- • The role of mental health workers varies. At the preparedness and practical relief stages, they collaborate with others to provide advice, training, and advocacy, as well as emotional support and reassurance. At the pyramid’s tip, they are the main providers and offer a specialised service response.
3.1.1 Prevention and preparedness
Evidence indicates dedicated psychological prevention and preparedness strategies can lessen the toll of major disasters on people’s mental health and wellbeing. For individuals and families this means equipping them with the ability to appropriately adjust response strategies through psychological preparedness activities that enable a better understanding of the impact of disaster and the potential psychological responses they may experience.
At a community and a systems level the following actions have been shown to strengthen individual and community resilience:
- • Community education to prepare people for disasters and share information about coping strategies.
- • Local and regional planning for mental health responses to disasters including the needs of people with disabilities and existing mental health illnesses.
- • Mapping help-seeking journeys post-disaster to provide insights that optimise service access and linkages.
- • Establishing training and support systems for emergency services workers,7 health care providers, local government and community service workers.
- • Including community services and volunteer groups in multiagency disaster drills and exercises.
- • Actively engaging young people as leaders in local psychosocial risk planning.
- • Building mental health literacy among priority sections of the population with specific needs.
Psychological preparedness is particularly important in communities which are at risk of disaster due to social and environmental factors.8 In Australia for example, droughts affect everyone but create more immediate and intense challenges for rural communities which experience water stress, and stock and financial losses.
The afore mentioned measures can build cooperation between services and increase everyone’s knowledge of the local mental health and wellbeing ecosystem. Training and community education will also strengthen the community’s ability to support people experiencing violence or trauma prior to a disaster.
3.1.2 Practical support and advocacy
Practical support and advocacy following a disaster ensures people’s basic needs are met and safety is maintained. It includes a range of disaster relief services, such as disaster evacuation and recovery centres, housing, food, and urgent financial support. Such services are the first point of contact for emotional and mental health support. Providing smooth and efficient practical support is an important part of a mental health response.
The manner in which such services are designed and delivered to meet the needs of individuals, especially in priority groups, is critical. Careful consideration should be given to how people with disability will access services (including virtual services) following a disaster, how children and young people will be supported, and how to best communicate with people whose digital access is limited or who communicate best in a language other than English.
Mental health worker involvement is critical in planning and participating in disaster relief services. The IASC identifies advocacy for ‘safe, dignified, culturally and socially appropriate assistance’ as a key responsibility for mental health-trained staff. Such staff can:
- • highlight the social context of service provision,
- • advocate for and assist to establish child-friendly spaces in evacuation and recovery centres,
- • ensure people receive a caring, empathetic connection in a time of crisis,
- • identify ways to overcome barriers to help-seeking; and
- • share the principles of trauma-informed care with those providing disaster relief.
Emotional support, reassurance, and early intervention should be provided at this level, rather than formal comprehensive debriefing or interviewing, which evidence indicates is not beneficial and should be avoided.9 Emergency services workers need the skills to assist people in coping with stresses they are likely to feel following a disaster – as advocated in the IASC’s 10-step stress reduction protocol.10
3.1.3 Support targeting communities and families
Community and family support focuses on rebuilding and strengthening relationships, and using the resources of people’s immediate peer and community networks to help people recover together. The aim is to assist people to navigate and access formal support, build resilience, reconnect, and encourage each other’s recovery efforts. Research shows that often people find help through volunteers, family or friends, and encounters with people they trust who have had similar experiences and ‘get it’.11
Evidence-informed considerations are:
- • Building the capacity of existing community organisations and informal groups can be more effective than establishing new services. The former are well-placed to deal with the downstream impacts of disaster such as drug and alcohol issues and family violence, and are likely to have expertise in providing tailored help to different parts of the population.
- • Topping up existing grants to local organisations makes planning, training, infrastructure changes, and the employment of recovery workers happen faster, and is more likely to build long-term capability.
- • Where a community grants program is offered, a community co-design and decision-making process has been found to minimise community division, maximise inclusion, and streamline administration.
- • Liaison with existing organisations also serves to keep government agencies connected to community needs as they change over time after the disaster event.
3.1.4 Focused non-specialised support
Focused non-specialised services utilise trained and supervised workers to provide support to individuals and families. Focused non-specialised services work to enhance collective as well as individual resilience in a disaster setting, as research indicates both are critical to buffering the mental health impacts of disaster.12
In Australia, General Practitioners and primary health care providers play a critical role in providing this type of support, and are a gateway to more specialised mental health support providers. Mental healthcare practitioners who are experienced at working with survivors of other trauma, such as motor vehicle accidents and violence, are also an important community resource for this component of care.
The emotional support, reassurance, and early intervention provided through Psychological First Aid is an important distress response. It is highly valuable in addressing coping and short-medium term needs, while also preventing the escalation of psychological states to the point where longer term and clinical impacts occur.
Services such as counselling and psychotherapy also provide a mixture of emotional support and practical assistance in non-confronting community environments. Services suited to children and young people include family-centred interventions and play therapy, school interventions, cognitive behavioural therapy, and use of therapeutic animals. Access to traditional and contemporary healing practices should be an option for Aboriginal and Torres Strait Islander People.
Peer or Lived Experience workers can also be a valuable component of psychosocial support as they offer a unique style of support based on the sharing of personal lived experience.
3.1.5 Specialised services
Specialist clinical support involves targeted, specialist mental health care, delivered by mental health professionals to a small section of the population for whom mental health challenges have become persistent or acute.
These may include people with:
- • Emergency-induced mental ill-health: depression and anxiety disorders, (including acute stress disorder and post-traumatic stress disorder), substance misuse, and sustained personality changes.
- • Emergency-induced social problems: for example family separation; disruption of social networks; destruction of community structures, resources, and trust; and family violence.
- • People with pre-existing mental ill-health, especially if the continuity of care provided by usual services and supports is disrupted.13
It is important to note the need for specialised mental health support can emerge many months or years following a disaster, emphasising the need for long-term funding horizons.