How Can We Help Survivors of Natural and Man-Made Disasters?

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Here in my adopted city of Vancouver, people are still reeling from the recent killing of 11 people by a man who intentionally drove his SUV into a crowded Filipino street festival. Among the victims were a 5-year-old girl and both of her parents. Several other people remain hospitalized with serious injuries.

In the wake of any sort of disaster, whether natural (e.g., earthquakes, tsunamis) or man-made (e.g., car attacks, school shootings), the lives of survivors may be profoundly altered. Loved ones may have died and homes may have been destroyed; physical injuries may be severe and lead to permanent disability; and the psychological impact can be severe and long-lasting.

However, as a general rule, we are far more resilient than is commonly thought, and most people have a surprising capacity to heal and recover with the passing of time and the availability of adequate social support.

In this post, I briefly summarize what we know about the impact of disasters, whether natural or man-made. I then discuss what we can do to support the social and psychological well-being of survivors of both types of events. Just to clarify: in this post, I am talking about acute or short-lived disasters, events that start and end within a very short time. In war zones and refugee settlements, the settings in which I have done my work, disasters may be ongoing and pose a far greater threat to mental health and psychosocial well-being.

How are people affected by disasters?

There’s no simple answer to this question, because so many factors influence how people will be affected. However, there are some consistent patterns:

1. People tend to be more severely affected by man-made atrocities than by natural disasters. Human beings understand that natural disasters occur—earthquakes are a natural phenomenon, as are tsunamis, tornadoes, etc. They are often terribly destructive, but they are not the intentional result of someone wishing to cause extreme harm.

Man-made disasters, in contrast, are not “natural” in any sense. They are the result of someone intentionally causing widespread death and destruction. This adds an additional element to the experience of survivors: an altered sense of the world as a fair or safe place, and a confrontation with the darkest aspects of human beings—the capacity for causing wanton, intentional harm to other people.

2. Those at greatest risk of enduring psychological harm are those most directly affected. This includes people who have experienced physical injuries, especially if these result in ongoing disability, and those who have lost family members, their homes, and/or their livelihoods. Witnesses may also be severely affected, especially if they have witnessed gruesome injuries and death. As many as 25 to 30 percent of directly impacted survivors may develop enduring or chronic PTSD.

However, the farther removed people are from the disaster, the less likely they are to be psychologically impacted in any lasting way. Witnessing a disaster on the TV news or on social media may be distressing, but it is unlikely to cause lasting trauma. Despite alarming media concerns about widespread trauma beyond the immediate circle of affected communities, this seems to be uncommon.

3. In the immediate aftermath of any disaster, symptoms of psychological distress are normal and common reactions, not signs of any disorder. They don’t mean that someone will develop PTSD or any other psychiatric disorder. For the great majority of people, symptoms of trauma, anxiety, or depression will abate within a few weeks, provided they have the support of family and friends and the communities to which they belong (e.g., religious communities, schools, neighborhood organizations).

Less than a third of survivors are likely to develop enduring symptoms of post-traumatic stress disorder (PTSD), depression, or anxiety. As noted earlier, those most at risk of developing persistent distress are those most directly exposed and whose lives are most directly affected. In addition, people with pre-existing psychological difficulties may be at elevated risk of becoming traumatized by a disaster.

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4. A common mistake is to assume that enduring psychological distress is primarily the result of the disaster itself. In fact, persistent distress also stems from all the changes and challenges caused by the disaster.

In the aftermath of any disaster, people must cope with the loss of loved ones, with physical disabilities, with the loss of their homes and livelihoods, with economic hardship, and with the experience of being displaced if they cannot return to their homes. These ongoing stressors contribute powerfully to the distress we see among disaster survivors. This underscores the vital importance of providing material and social support to disaster survivors, not just during the initial aftermath of the event, but in ongoing ways until they have adjusted to their post-disaster lives.

What can we do to help disaster survivors recover and rebuild their lives?

Figuring out how to be helpful means understanding the needs of different types of disaster survivors at different points in time.

1. In the immediate aftermath of a disaster, the priority should be reestablishing physical safety, reconnecting family members separated by the event, providing information about where to get help (e.g., medical assistance, housing support, legal aid), and mobilizing social support networks—family, friends, community leaders, social service organizations. This is not a time for the provision of professional mental health services, but for mobilizing and strengthening natural social support networks.

A common approach used in this phase is called Psychological First Aid, which entails all of the activities I’ve just mentioned, along with training people to listen supportively, while never pushing them to talk about their experience of the disaster they have just survived. This is not an occasion for something called Critical Incident Stress Debriefing, or CISD, an intervention originally developed for first-line intervenors (police, emergency medical staff, firefighters) that was once widely popular but has since been shown to complicate rather than facilitate psychological recovery.

This first phase is where community organizations and religious rituals can play an important role in helping survivors make sense of and grieve the losses they have experienced. A supportive public recognition of the losses people have experienced can be psychologically helpful, as can a public commitment to ensuring that people are safe following the disaster.

2. After a few weeks, most people will start to recover and gradually return to their pre-disaster level of functioning. However, a substantial minority of people will continue to experience symptoms of PTSD, depression, and/or anxiety. Here, community-based psychosocial interventions such as the Skills for Psychological Recovery (SPR) program can be highly useful. SPR, which helps people develop a variety of post-disaster coping skills, can be implemented by trained community members and employed in community settings that lack the potential stigma of mental health clinics.

Trauma-focused cognitive behavioral therapy (TF-CBT) may also be helpful at this stage, though there is some debate about whether it is best provided in this second phase or after additional time has passed and some individuals continue to experience symptoms of PTSD or other disorders. Other non-professional resources, such as yoga, mindfulness classes, and physical exercise, may help people re-regulate their emotional state and find greater calm.

3. After a month or two, people who are still struggling with severe distress may benefit from professional mental health support. There are several empirically supported therapies that can help people overcome disaster-related trauma, depression, and anxiety. The biggest barriers are likely to be the social stigma attached to seeking psychotherapy and the lack of culturally-sensitive mental health services in or near disaster-affected communities.

Local governments can fund outreach services and mobile clinics, thereby expanding the reach of mental health professionals and trained para-professionals to those areas where they are most needed. And grounding any mental health support in a solid understanding of local beliefs related to suffering and recovery can enhance the extent to which services are utilized and beneficial.

4. Activism can be a powerful antidote to the feelings of powerlessness that disasters can create. For example, survivors of various school shootings, such as the Parkland school shooting, have gone on to become highly visible advocates of gun control legislation. Survivors of environmental disasters such as the Love Canal disaster have gone on to advocate for greater environmental protections and the pursuit of compensation from companies whose knowing pollution of local water and land has caused widespread illness and death.

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