Douglas Paton, School of Psychology, Massey University, Palmerston North, New Zealand. Phone +64 6 350-4118 Fax +64 6 350-5673 Email: D.Paton@massey.ac.nz
John Raftery, ASTSS & Dept of Public Health,University of Adelaide, P O Box 2184, Kent Town, South Australia 5071, Australia. Email: email@example.com
In this issue, a broad range of issues are canvassed. We are only too aware of the incidence of sexual abuse within the Australisian region. In addition to the devastating effects that such abuse can have on the person and their family, it can also exercise an insidious influence on those professionals who assist abuse survivors. Lyndall Steed and Robyn Downing examine this issue and discuss how providing therapeutic services for survivors of sexual abuse and assault can result in vicarious traumatisation in psychologists and counsellors.
Flooding disasters in New Zealand, New South Wales, Bangladesh and China have, over recent months, attracted world-wide media attention. In this edition, Adam Munro describes how reduction (mitigation) planning in flood prone areas can contain problems and prevent hazard activity reaching truly disastrous proportions. Even effective mitigation, however, does not guarantee that other consequences of hazard activity are similarly contained. Economic, community and psychological effects may persist long after the primary threat from the hazard has dissipated, even when hazard activity has been successfully contained or managed. These problems are likely to become even more pronounced and prolonged if events escalate, both physically and temporally. Consequently, attention must be paid to, for example, understanding the nature of these longer term sequelae, how they change over time, and their management implications. The long-term effects of disaster on those affected is discussed by Anne Eyre in her article.
Anne describes how impact can extend well beyond the period of disaster impact and the role of self help groups in assisting adaptation and promoting future resilience. An interesting issue concerns how support groups can assist the development of regulatory and legal recommendations designed to support those affected and ensure, as far as possible, that the socio-legal procedures stimulated by disaster do not add to the distress faced by survivors and that past experience can be channelled towards future preparation for disasters.
The issue of preparation is also central to David Johnston and Kelly Benton's description of community perceptions of risk from volcanic hazards. They argue that strategies for communicating hazard and mitigation information must be framed by these perceptions. The mitigation strategies describes by Adam Munro also reflects this process of community consultation and the need for it to be a continuous and evolutionary activity. While this forethought is given due consideration in developed countries like New Zealand, this is not always possible, for resource, political or practical reasons, in many areas within the developing world. Even where plans are in place, disaster can strike with little or no warning, limiting response effectiveness, delaying recovery and introducing the possibility that the needs of survivors may differ from those anticipated.
Such was the case in Papua New Guinea when a tsunami struck its eastern seaboard. The lack of warning and the speed with which this event occurred would have negated or significantly reduced any preparations that had been in place. The tsunami struck an indigenous population ill-prepared and ill-resourced to respond. The need for outside assistance for those affected prompted a large international response. Increasing acknowledgement that such events create not only physical but also social and psychological problems for the inhabitants of affected areas means that humanitarian aid increasingly incorporates a mental health component.
Throughout this century organised humanitarian response to disasters, whether natural or person-made, has been a characteristic of the response and recovery phase. The Red Cross, and its equivalents in other countries, is an example of an organisation which has been on the ground during and after major events like wars and natural disasters. More recently the interventions provided by these agencies have incorporated a psychological component. The post 1980 emergence of PTSD as a diagnostic category provided a rationale for these interventions - early intervention and education would reduce the likelihood of long term psychological damage from the exposure to a major stressor.
As the global village shrinks even further the potential for rapid deployment of psychological intervention has been further enhanced. Improved communication technology and media coverage means that information on the plight of those in disaster-affected areas reaches the outside world almost immediately. Additionally, the same communications technology hastens the process of mobilising the humanitarian relief effort, resulting in 'pre-packaged' aid programs and interventions being used, irrespective of the altruistic intentions underlying their provision, with possibly only limited or no opportunity to ensure their appropriateness for survivors.
Response to disaster thus increasingly embraces not only medical and physical aid but also psychological and psychiatric assistance. This model, one designed to provide comprehensive coverage of community needs, is consistent with moves to develop and implement comprehensive, integrated emergency management. However, the process of realising the benefits that accrue from implementing this philosophy are complex and involve more than the ad hoc provision of established practices and procedures simultaneously. This issue will be particularly challenging when integrating a mental health component to deal with survivors from diverse cultures, and to manage dynamic problems at psychological, social and community levels.
Procedures such as CISD and CISM now exist in systematic, readily deployable formats, and there are now even more precise and focused interventions, such as EMDR treatment, which are being exported in the aftermath of traumatic events and major disasters. Not surprisingly these developments are not without controversy as issues about cultural appropriateness, the theoretical bases for intervention, and the training of personnel that deliver these interventions are raised. Because these interventions cross cultural and political boundaries there is the further issue of cultural hegemony.
Recently, several serious critiques about the efficacy of such interventions in the cultures within which they were developed have been debated within the academic literature. The existence of concerns regarding the efficacy if these interventions, on home ground, raises questions regarding the value of these interventions in other cultures. Differences in, for example, cultural beliefs and practices, cultural and religious support systems, grieving processes and rituals, and the manner in which the latent construct 'traumatic stress' is represented in other cultures raise problems in regard to the design and delivery of support and therapeutic services in other cultures. We have known for some time that inappropriate intervention, or intervention that is inconsistent with the needs of a community (e.g., response-generated demands) can exacerbate rather than ameliorate the stress and disruption experienced by disaster-affected communities. If this can happen on 'home ground', it is even more likely when intervention is being administered in other countries. Nor should this issue be seen as being relevant only when providing humanitarian assistance overseas. Increasing cultural heterogeneity within Australasia makes it an issue of domestic concern.
In the absence of community-based involvement and planning, such as that described by Johnston and Benton and by Munro, we are unlikely to have any objective appreciation of community needs. Intervention that fails to meet actual community needs is more likely to fuel 'response generated demands'. When disasters strike overseas', understanding community needs becomes even more important. Steed and Downing's discussion of vicarious traumatisation is also relevant here. Working in disaster-ravaged areas can threaten therapists' safety and control and, when working overseas, expose them to cultures and cultural practices that may heighten their vulnerability to vicarious traumatisation. Not only can questions of the cross-cultural validity of therapeutic interventions be raised, but their provision in hazardous and culturally diverse contexts may also threaten the psychological integrity of the therapist and lessen their effectiveness in both disaster and domestic contexts.
Consequently, it is timely to devote an edition of the journal to the issue of humanitarian aid provision. Contributions are invited from readers. It is expected that contributors will go beyond a description of examples of programs and individual experiences to present evaluation and critique of such interventions.
Humanitarian Aid following disasters: Problems, issues and directions
Guest Editor: John Raftery
This special edition will appear as Volume 3 Part 2 (August 1999). Authors wishing to submit papers to this special edition should send their manuscripts to John Raftery by 31st March 1999.
Notes for contributors can be found in the appropriate section of the Journal.