Past disasters guide us in helping the wounded
Following the Victorian bushfires, the federal and state governments met with health professionals and trauma experts to rapidly develop an evidence-informed framework to bring mental health care to those people affected by the fires. Photo: Jason South
Almost four years on from the Victorian Black Saturday bushfires, two years on from the Queensland floods and having just commemorated the 10-year anniversary of the Canberra fires, there remain significant casualties of these disasters.
Not so much in terms of infrastructure and buildings, homes and jobs (which are still being restored where possible) but in terms of the mental health of those affected by disaster.
Even now as bushfires continue to rage through Gippsland and fires in NSW and Tasmania are still being monitored, it has been brought home to us that Australia is a country that is beholden to nature. We are at the mercy of cyclones, floods, fires and drought.
And, if predictions of climate change are correct, we need to expect more of all these disastrous events. The threats and destruction of the current fires also potentially serve to open up old emotional wounds from these disasters past.
While we may prepare for these eventualities by refraining from building houses so close to the coast and making them more cyclone and fireproof, it is also important to plan for what these events will do for the mental health of Australians, particularly children.
Obviously, the way in which those who lived through the bushfires or floods are affected will vary depending on their experiences - such as where they were, what they were exposed to, what they may have witnessed happening to others, or tragically, whether they lost loved ones. It is important to acknowledge that the impacts of these events are different for everyone.
Although dependent on what was experienced, a proportion of survivors after any disaster will show what is called a ''resistant'' trajectory of recovery.
They report few if any symptoms of mental distress. At the other end of the scale, a small minority will develop persistent, diagnosable mental health conditions such as depression or post-traumatic stress disorder.
Most survivors, however, fall somewhere between the two. They will develop mild to moderate readjustment difficulties.
These are the people who, in the aftermath of disaster recovery, generally fall between the cracks.
They focus on rebuilding, helping others, grieving over loss without seeking any formal mental health assistance.
It is incumbent on response agencies to ensure that these people are offered health interventions, not only for their own wellbeing, but because to fail to do so will cost the health system much more further down the track.
Following the Victorian bushfires, the federal and state governments met with health professionals and trauma experts to rapidly develop an evidence-informed framework to bring mental health care to those people affected by the fires.
This framework was implemented in the wake of the Queensland floods and, sadly, is likely to be used again and again in the future.
The framework identified three levels of response. The first is known as ''psychological first aid'' and is designed for the entire affected population.
Psychological first aid gives those affected by the disaster some simple recovery strategies to help them, their loved ones and others in their community.
It also helps them recognise signs of mental health issues and how to get professional care if required.
This level of advice can be delivered by first responders, in addition to community members.
Level two involves actual intervention by primary care and allied health professionals. The target group here is those who have persisting mild-to-moderate distress that affects their ability to function in everyday life. It can be provided by GPs and other community health workers.
Level three focuses on those who have developed a diagnosable mental health condition as a result of their experience.
While in the minority, these people need specialist care from appropriately trained providers.
It is critical to ensure that services in the affected communities have the capacity and skills to provide the level of care commensurate with the needs of survivors and are consistent with the framework.
These services not only ensure wounds from previous disasters continue to be addressed, but also provide intervention for distressing memories reawakened in this bushfire season and offer early and effective support to those newly affected by the current fires.
Australians are tough. And, yes, for the most part, people experience a normal recovery process after disaster.
But for those of you who do not experience a so-called normal recovery, it is not because you are ''not tough''.
There are many like you and one of the few upsides of disasters such as Black Saturday and the Queensland floods is that we know how and when to help, when to step back and let you manage your own recovery and when to step in when you aren't feeling tough enough to go on.
>> Professor David Forbes is director of the Australian Centre for Posttraumatic Mental Health at the University of Melbourne.