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I was recently quoted by ABC news on the psycho-physiological risks of disasters on non-psychiatric chronic illnesses in Chile and the importance of relief aid in reducing the risks of depression and post traumatic stress disorder (PTSD) in the aftermath of the Haitian earthquake. Yet despite the occasional media attention on the impact of these tragedies on the local population of Haiti and Chile, the psychological well-being of emergency health responders themselves continues to be ignored in the media and the larger public health debate on the outcome of these devastating earthquakes.
Indeed, disasters require that we respond not only to those who require immediate psychosocial help amongst the local effected population, but also to the psychological well-being of first responders involved in providing aid, relief, and medical care. Higher rates of depression, substance abuse, suicide, divorce and other psychosocial sequilae have been well documented amongst first responders to disasters.
Unfortunately, the cataclysms in Haiti and Chile have shown us that, despite the aforementioned evidence, the necessary contingency planning which is needed to address the psychosocial impact of dealing with mass mortality and morbidity by first responders continues to be woefully deficient. This oversight is particularly stark amongst the smaller international nongovernmental organizations (NGOs).
One strategy to address this shortcoming would involve adequate training and education that would foster workplace resilience in a mass-casualty theater. Institutional structural changes are needed to address and sustain group wellness and operational function by identifying the at-risk individual within the first responders and intervene or provide adequate venues whereby these caretakers can seek the needed psychosocial help on the theaters of operation or soon after repatriation.
Making matters worse, the absence of any form of screening for aid workers and volunteers have led to the occasional deployment of psychologically fragile individuals as first responders. These "disaster tourists" actually hamper aid and impact the overall moral of the professionals engaged in saving lives. In Haiti, for example, a first-responder psychiatrist from George Washington University described the case of a mildly demented elderly man "who chases disasters" and was deployed by an NGO with a group of professional trauma physicians. Far from being helpful, this individual's erratic behavior and wavering levels of cognition distracted from effective relief work and taxed the time of physicians deployed to help the local population.
What this episodes and other similar occurrences in the past several months indicate is the notable lack of effective structures that address psychosocial readiness, screening, and the general staff-focused psychological contingency planning by NGOs that are involved in disaster relief. This is a testament to the need for a more concerted effort at self-regulation and a unified code of disaster operations and conduct by the cornucopia of poorly regulated international NGOs that have emerged in the past decade.
