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This chapter describes the interface of mental health and disaster. The burden of mental illness for families, communities, and nations is substantial, and the mental illness that follows extreme traumatic events is part of this global burden. Accurate and real-time health surveillance information on the population rates of mental health and illness and the barriers to care are needed to address the mental and behavioral health-care needs of disaster populations. The chapter discusses the range of psychological and behavioral responses to disaster, from subsyndromal symptoms of distress, to initial behavior, distress and health risk behaviors, to the development of specific psychiatric disorders. Cognitive-behavioral psychotherapeutic interventions for children and adults with complex grief are under investigation. The chapter focuses on the complexity of modeling psychopathology after disaster-posttraumatic stress disorder (PTSD). The conceptualization of postdisaster pathology and PTSD requires a broader view across domains of suffering, altered functional capacity, and disability.
This chapter challenges the conventions of psychological debriefing as an intervention that is only applicable in the earliest period post disaster. As psychological debriefing has become more widely accepted, its original highly specific workplace focus has been broadened. The usual application of debriefing to the immediate post-disaster period may reflect its military and emergency services origins. The chapter proposes that it is useful to disentangle the underlying conceptual assumptions involved in psychological debriefing in order to inform an expanded use of the psychological principles that debriefing must be utilized to be effective. Psychological debriefing emphasizes supporting natural processes of recovery and removing barriers to resolution of the emotional impact of life-threatening events. Research on psychological debriefing procedures is often difficult to implement because of the intense and compelling level of need when one is responding to catastrophic situations.
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