Improve mental health services to deal with trauma

What you need to know:

  • The truth is that in situations of mass trauma, it is unlikely that all, or even a majority, of the survivors will suffer lasting psychological damage of any kind.
  • Commonly, depression, substance use and anxiety disorders are more important outcomes of trauma exposure. This is because interventions targeting them have a greater chance of success, and have more far-reaching implications than interventions targeting PTSD alone.
  • It is understandable that in a cynical society that does not pay any heed to health, let alone mental health, practitioners would go out of their way to demonstrate their relevance and attract the attention of policy makers and purse-holders wherever they may be.

In the aftermath of every disaster, those of us in the mental health field have been guilty of an egregious malfeasance.

We often come out and appear to agree with the public perception that all those that came out of the disaster are scarred and somehow wounded, and that they all need some psychological intervention to make them whole again. The profusion of all sorts of organisations and individuals involved in some sort of “counseling” or other has not helped matters either.

It is understandable that in a cynical society that does not pay any heed to health, let alone mental health, practitioners would go out of their way to demonstrate their relevance and attract the attention of policy makers and purse-holders wherever they may be.

However, when this search for “increased investment” begins to be harmful, it becomes the responsibility of ethical professionals to call it out and put a stop to it. There are other more useful ways of demonstrating relevance without increasing the potential for harm to survivors of disasters.

The truth is that in situations of mass trauma, it is unlikely that all, or even a majority, of the survivors will suffer lasting psychological damage of any kind.

In fact, most disaster survivors describe feeling stronger and better able to deal with life’s challenges a few weeks after the event. In other words, the saying that “what does not kill you makes you stronger” is often proven right among most disaster survivors.

Research has shown that a small proportion of disaster survivors may develop post-trauma psychiatric syndromes. Several factors are associated with this, but the most important include proximity to the event, previous mental health status and the amount of loss suffered.

IMPORTANT OUTCOMES OF TRAUMA

While most responders are concerned about the syndrome known as posttraumatic stress disorder (PTSD), researchers in the field do not think it is the most important, or even the most prevalent outcome of trauma exposure.

Commonly, depression, substance use and anxiety disorders are more important outcomes of trauma exposure. This is because interventions targeting them have a greater chance of success, and have more far-reaching implications than interventions targeting PTSD alone.

A more interesting fact, that is often not given enough attention, is that none of these disorders is a unique outcome of a mass disaster.

Studies have shown that the vast majority of citizens in a low or middle-income country have experienced a potentially traumatic event in their lifetime. However, in the only population studies available from Africa, we have found that the proportion of the population living with PTSD is less than four per cent.

This, while significant, must be contrasted with the finding that over a quarter of these populations have a different mental illness, often depression, substance use or anxiety disorders.

The suggestion here is that attempting to address mental health only in the context of mass disasters misses the mark by a long mile. Taking concrete measures to improve provision of mental health services to the entire population will reduce the risk of post-trauma mental disorders, and increase chances of recovery for those more severely affected in mass disasters.

The most effective mental health intervention in the wake of a disaster is, therefore, to make provisions for mental health services to be available to all citizens regardless of disaster exposure.

Prof Lukoye is associate professor of psychiatry and dean, Moi University’s school of medicine; [email protected]