Chapter 12 - Lessons Learned from the Spitak Earthquake and Other Catastrophic Disasters

Summary

This chapter summarizes the organizational and clinical lessons learned in implementing and conducting a post-disaster recovery program. It underscores the importance of a hierarchical approach with a centralized chain of command. This approach can facilitate recovery by mitigating adversities and removing roadblocks to community recovery. Supporting and empowering affected local governments and civil society, however incremental, plays a central role in extending assistance to underprivileged sectors. Likewise, working with the school hierarchy provides the necessary support to implement a school-based psychological intervention. Working with international donors and relief organizations should be a centralized “demand-driven” process rather than an “all aid is welcome” approach. Care for those with serious medical conditions, the displaced elderly, the homeless, and orphans should take priority over non-urgent mental health needs.

Before engaging with survivors, preparation of therapists for the hardships of fieldwork and providing support, supervision, and respite during fieldwork can minimize disabling reactions, e.g., vicarious traumatization and burn-out. Empowering mental health providers to take proper actions based on local socio-cultural norms rather than mechanically applying foreign knowledge can significantly improve the outcome of interventions. Most victims experience a combination of symptoms from different diagnostic categories, not only PTSD and depression but also grief reactions, substance abuse, and anxiety. Additionally, survivors have to contend with multiple adversities (e.g., loss of housing and jobs, financial problems) that will compound their psychological reactions. Effective therapists are flexible and adjust treatment according to the most pressing psychosocial needs of the survivors.