When one of the largest earthquakes ever recorded left an estimated quarter of a million people dead across Indonesia, Sri Lanka, India and Thailand on Boxing Day 2004, aid agencies quickly arrived to look after the wellbeing of battered and traumatised survivors. A major part of the emergency response was mental health, but the World Health Organisation (WHO) promptly did something it has never done before or since.
A type of psychological therapy, called “psychological debriefing”, is often used to encourage people to supposedly “process” the intense emotions by talking through them in stages. It was intended to prevent later mental health problems by helping people resolve difficult emotions early on. However, for the 2004 earthquake crisis, WHO recommended that it shouldn’t be used, as studies had shown that people given post-disaster psychological debriefing were subsequently more likely to suffer mental health problems than people who had had no treatment at all.
Yet, in spite of this advice, the therapy was extensively used. The reluctance to do things differently was tied up with some of the least-appreciated facts about our reactions to disaster. In our society, we are so focused on the trauma of an event that we forget only a minority of people – rarely more than 30% in well-conducted studies and often considerably less – will develop psychological difficulties as a result of their experiences, and the single most common outcome is recovery without the need of professional help. Of course most people will be shaken up, distressed and bereaved at the time of disaster, but these are natural reactions and not in themselves disorders.
On an emotional level, psychologists can feel drawn to “do something” to help people who are suffering. Although this is an admirable human motivation, being aware of what works is a professional responsibility. Sometimes the motivations may not be so admirable, as the idea that rescuers can arrive in disaster areas and prevent mental illness in a single meeting often serves the needs of relief workers and their image more than disaster-affected communities. It would be great if single-session treatments worked, but considering the dangers of past attempts, our goal should be to promote high-quality mental health services, based on solid research, in partnership with the community.