Mental health is a low priority in resource-poor settings and among vulnerable populations fighting for survival after disasters. The psychosocial situation in the conflict setting is more complicated than for victims of natural disasters because their baseline mental health status is unknown.

Psychosocial evaluations from Indian disasters during the past 10 years were collated and analyzed for important mental health predictors. Social issues of food security, equity of safe water provision, and about distribution of disaster relief and aid also were evaluated.

Children were the most vulnerable group in India. Post-traumatic stress disorder (PTSD) usually was a transient response to disasters, and lasted for an average of 90 days. Residual sadness was the only persisting PTSD symptom (84%). Underlying depression was the most important predictor for residual PTSD. Interventions facilitated through natural groups (language and ethnic groups) were easier to facilitate and yielded better results. While spiritual healing workshops had a definite role, relief being provided along religious lines was more controversial. Of 98% whose homes had been destroyed, 89% had their homes relocated/rebuilt within 24 months, and 51% had resumed their previous occupation. However, only 30% recovered economically after natural disasters. The healthcare providers, funders, and relief agencies were hesitant in their response in the setting of complex emergencies, as they are unsafe work environments, at the personal and political level. Mental health interventions were more complex and outcomes less predictable in the conflict setting as compared to natural disasters.

Systematic mental health surveillance post-disaster must be included in the general post-disaster assessment. There is a need for supportive education, training of mental health workers, and development of region specific social and psychological questionnaire for validated use in India.