In recent years, increasing attention has been paid to the development of plans to deliver appropriate psychosocial care to those affected by disasters and other major incidents. General hospitals are central to any response and liaison psychiatry services are well placed to play a leading role in the development of appropriate plans. In this chapter the evidence regarding the psychosocial management of disasters will be reviewed and current guidance described.

Several studies have considered the prevalence of mental health difficulties following major incidents and disasters. Whalley & Brewin (2007) performed a systematic review of individuals affected by disasters and reported a 30–40% prevalence of PTSD at 2 years. This review and other research confirms that a significant proportion of those affected by disasters do go on to develop a psychiatric disorder and that a larger number will experience immediate distress.

Early interventions

Considerable work has been undertaken to develop interventions that may prevent longer-term post-traumatic difficulties. There is very little data containing research to support the effectiveness of any specific early intervention, but they remain popular and are advocated by many people.

Early interventions have emerged from a variety of historical approaches. In the First and Second World Wars the proximity, immediacy and expectancy model was widely used for soldiers with acute combat stress (Kardiner & Spiegel, 1947). In this approach, soldiers were taken away from the front line but kept close to the battle zone (proximity), treated as soon as possible (immediacy) and with a strong expectation of returning to duty (expectancy). A key objective was the operational one of returning soldiers to front-line duties, and an Israeli study has shown that soldiers with combat stress reactions treated in this way fared better than those who were not (Solomon & Benbenishty, 1988). In the Second World War, General Marshall (1944), chief historian of the US army, advocated 7-hour debriefings on the battle field as soon as possible. These were led by a commander and involved soldiers describing their experiences, allowing them to express grief and emotions. The debriefings were described as ‘spiritually purging’ and ‘morale building’ and aimed to facilitate the development of an internal verbal representation of what had happened and a sense of control.