After almost any large scale disaster, you’ll hear reports that rescue workers, supplies and counsellors are being sent to the area – as if mental health professionals were as vital as food and shelter.
Time has an excellent interview with psychologist Scott Lilienfeld on how our ideas about ‘post-disaster counselling’ are rapidly moving away from the ‘everyone needs to talk’ cliché due to a better understanding of mental health and resilience in the face of tragedy.
Although everyone might be shaken up after a disaster, the vast majority – between about 70% and 80% – will not have mental health problems and will not need the help of psychologists or psychiatrists.
It was initially thought that legions of counsellors were needed to work with everyone affected by the devastation to give sessions of ‘critical incident stress debriefings’ – where people are asked to describe everything that happened to them and vent their emotions – supposedly to help prevent problems developing in the long term.
Instead, studies suggested that this was at best useless and instead probably made mental disorders more likely – probably because it raises or extends the level of stress in already very stressed people.
Perhaps unsurprisingly, most disaster victims are not that interested in exploring their emotions but want to get to a safe place, find out how there friends and family are, and solve immediate practical problems. This in itself tends to make people feel better.
Consequently, new strategies involve only working with people who specifically ask for help and – instead of getting people to ‘vent’ – the focus is on reducing emotional arousal, assuring physical safety and putting people in contact with loved ones.
This strategy is often known as psychological first aid and was specifically designed to avoid the debriefing approach.
Time interviewee Lilienfeld has been key in challenging the idea that ‘everyone needs counselling’ after tragic events and has been a leader in making our disaster response a lot more effective. Highly recommended.
Link to Time interview on post-disaster counselling.