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Natural disasters: health and mental health considerations.

The recent occurrence of the tsunami in southwest Asia heightened awareness of the devastating impact of natural disasters on human lives. What makes a natural disaster so devastating? The suddenness and magnitude of the occurrence renders the areas affected by natural disasters unable to respond effectively to the emergency because the devastation exceeds the capacity of the area's resources. By definition, a natural disaster is an ecological phenomenon that occurs suddenly and is of sufficient magnitude to require external assistance (World Health Organization, 1980). Noji (2000) identified the overall objectives of a public health response to disaster management as the following:

1. Assess the needs of disaster-affected populations;

2. Match available resources to those needs;

3. Prevent further adverse health affects; implement disease control strategies for well-defined problems;

4. Evaluate the effectiveness of disaster relief programs, and improve contingency plans for various types of future disasters. (p. 21)

An effective public health response to natural disasters includes individual and community interventions that incorporate clinical, research, and community organization skills.

Practitioners and authors have identified disaster response as a natural practice area for social workers given the crisis intervention and clinical orientation of the profession (Newhill & Sites, 2000). Much of the professional social work literature on natural disasters emphasizes the clinical aspect of social work intervention (Cohen & Ahearn, 1980; Kreuger & Stretch, 2003; Newhill & Sites; Puig & Glynn, 2003; Shah, 1985; Spitzer & Neely, 1992). Although social workers typically respond to disaster relief through clinical interventions, research and community responses also are needed to manage the disaster. A four-step approach to social work intervention incorporating research, administrative, community organization, and clinical practice elements provides a more complete approach to disaster relief efforts.

Implementation of research protocols is a critical first step in responding to a disaster. Research intervention is important initially and at the end of the disaster relief effort to assess outcomes and the effectiveness of the response. As an initial intervention, Noji (2000) proposed that in the management of disaster relief workers connect data collection and analysis to disaster relief decision-making processes. Field surveillance data collection is important to reducing adverse health and mental health conditions and to rendering more effective the overall decision-making process related to the disaster response. Rapid disaster damage assessment techniques can be used to assess damage, define the nature and extent of the health and mental health problems, identify population groups at heightened risk, identify immediate health and mental health needs, assess resource needs, locate resources to meet identified needs, and assess the effect of the response to the disaster (Toole & Tailhades, 1991; World Health Organization, 1999).

A sound management and community response is critical to the disaster relief effort. These responses should include an effective disaster plan and a system of communication including information about who is responsible for what and how to communicate if power lines and phone lines are damaged (Milsten, 2000). Coordination among provider networks and a developed response for how to gain access to resources are critical also.

The management and community response must address the three phases of a disaster and what responses, services, and resources will be needed at each phase. The first phase--prewarning disaster preparation--emphasizes preparing for the disaster, which includes developing, reviewing, and revising disaster plans. Communities with predeveloped disaster plans will be better prepared to respond to the disaster as it occurs. Unfortunately, this phase is often absent in sudden disaster experiences. The next phase--natural disaster event--focuses on dealing with the event as it occurs and providing resources and support as needed. The last phase--recuperative effort--focuses on reconstructing the community, healing, and repairing damages (Flynn & Norwood, 2004; Salinas, Salinas, & Kurata, 1998; Tanaka et al., 1998).

Research indicates that quick assessment of needs, identification and procurement of resources, and speedy and effective disaster response can lead to more lives saved. Safer's (1986) research on the 1980 earthquake in Italy indicates that 25 percent to 50 percent of the people who lost their lives could have been saved if life-saving first aid had been administered sooner. For significant reductions in mortality, search and rescue responses must occur within the first two days after the disaster (Noji, 2000; Safer). Emergency medical services must be provided quickly. Schultz and colleagues (1996) identified that the greatest need for medical services occurs 24 hours after a disaster. They also pointed out that the majority of injured people obtain medical care at emergency rooms for the first three to five days after an emergency. Although search and rescue missions and medical care should be provided shortly after the disaster, it is often challenging to bring supplies and extra health care personnel into the disaster areas because of the destruction of roads and bridges, power outages, and hazardous conditions such as unclean air, hazardous material leakages, fires, and increased risks of the spread of infections. A well-planned management and community response can increase the amount of aid in these situations.

Finally, clinical services are needed in all phases of the disaster. Flynn and Norwood (2004) pointed out that the psychological responses of most people to a disaster include fear, anger, and distress. They identified a typology of people affected by disaster and suggested that members of each category may require services and interventions specific to their experience and exposure to the disaster. The first category includes the primary victims and survivors or the people who experienced the event or the loss directly. They may have lost a loved one, lost property, or experienced an injury, for example. The second category involves secondary victims or the people who witnessed the event but experienced no personal losses. An example of an individual in this category is a rescue worker at the scene. Secondary victims may also be community members who did not experience personal loss but must deal with damage that occurred to their community--destroyed buildings, interruption of services, and so forth. The third category is made up of tertiary victims or people affected indirectly through television or media contact. It is important to be mindful that everyone who experiences a disaster is affected by it. Psychological reaction is to be expected; however, the nature, duration, and magnitude of the responses can vary. Typically, assignment of blame is less with survivors of natural disasters, and the experience affects more people and communities. However, people who lived through a natural disaster may encounter severe effects (Norris et al., 2002). An effective clinical response requires a strong assessment and varying treatment approaches depending on the person's category, history of prior pathology, coping responses, and risk and resilience factors (Flynn & Norwood, 2004; Norris et al.). Cohen and Ahearn (1980) made the point that successful mental health services provision requires a thorough knowledge of the disaster and its consequences, knowledge of the disaster victims and their reactions, and knowledge of interventions that can be used with disaster victims.

As the world becomes more sensitized to natural disasters and develops more effective responses to the devastation, there are multiple ways in which social workers can intervene in these situations. Broadening professional contributions to include research, administrative, community organization, and clinical interventions, the disaster response can have more impact. Communities that develop a strong disaster plan, conduct rapid assessments, procure resources, and provide assistance in coping with the aftermath will have a more effective approach to deal with disasters.

Turning to the journal, this issue features articles that challenge the social work profession to re-examine roles and approaches to health and mental health treatment. Suggestions are provided for approaching issues and problems in different ways.

Kahng and Mowbray's fascinating study examines the relationships among psychiatric consumers' psychological characteristics, self esteem, and behaviors. Their informative study indicates that consumers' psychological characteristics played critical roles in the formation of self-attitudes. Based on their research, the authors advise social workers that interventions targeted at self-esteem should be based on consumer psychological characteristics and behavioral problems.

Vourlekis, Ell, and Padgett present an evidence-based assessment protocol for a prevention intervention in cancer care. Part of the Screening, Adherence, Follow-up (SAFe) case management program, the protocol focused on the assessment of general health and functional status, social support, and emotional distress among women with breast cancer. Their research provides a model for evidence-based approaches to practice.

Examining an intervention aimed at communication of end-of-life care decision making, Gutheil and Heyman found that it is possible to affect communication about end-of-life care in advance of the dying process. Their findings have important implications for work with older adults and their health care proxies.

Boutin-Foster and colleagues present an assessment tool designed to identify patients in need of comprehensive social work evaluation. The tool was developed to identify people with complicated discharge planning needs early in the hospitalization process. Social workers responsible for discharge planning may find this tool helpful.

Hollingsworth offers a compelling examination of prenatal gender selection from an ethics perspective. Using the NASW Code of Ethics, the author identifies ethical considerations that confront social workers working in this area.

Concerned with the issue of health promotion and aging, Marshall and Altpeter identify a framework for health promotion. Using this framework, they detail ways in which social workers can promote positive health among older adults.

Ka'opua, Gotay, Hannum, and Bunghanoy's research offers insight into elderly Asian/Pacific Islander wives adaptation to their husband's prostrate cancer. Content and grounded theory methods were used to gain an understanding of the wives' experiences in coping with significant changes in the couple situation. Implications for social work practice are discussed.

Mizrahi and Berger examine social work hospital leadership from a longitudinal perspective. Using a qualitative approach, the authors examined administrators' responses to changes that occurred in the hospital setting and how these changes have affected the delivery of social work services.

Parker-Oliver provides a poignant account of life with an asthmatic child. Her account provides a real-life glance into the everyday challenges of coping with the illness while trying to create a normal and responsive home environment for the child.

Finally, Gorin provides insight into the national election. Social workers are urged to continue to advocate for services, legislation,

and programs that can benefit our client population groups.

The articles in this issue bring to the forefront important considerations for the profession. We hope that these articles stimulate readers to examine how these concepts may be applied in health and mental health care work settings.


Cohen, R. E., & Ahearn, F. L. (1980). Handbook for mental health care of disaster victims. Baltimore: Johns Hopkins Press.

Flynn, B. W., & Norwood, A. E. (2004). Defining normal psychological reactions to disaster. Psychiatric Annals, 34, 597-603.

Kreuger, L., & Stretch, J. (2003). Identifying and helping long-term child and adolescent disaster victims: Model and method. Journal of Social Service Research, 30(2), 93-108.

Milsten, A. M. (2000). Hospital responses to acute-onset disasters: A review. Prehospital and Disaster Medicine, 15(1), 32-53.

Newhill, C. E., & Sites, E.W. (2000). Identifying human remains following an air disaster: The role of social Work. Social Work in Health Care, 31(4), 85-105.

Noji, E. K. (2000). The public health consequences of disasters. Prehospital and Disaster Medicine, 15(4), 21-31.

Norris, F. H., Friedman, M. J., Watson, P.J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001. Psychiatry, 65, 207-260.

Puig, M. E., & Glynn, J. B. (2003). Disaster responders: A cross-cultural approach to recovery and relief work. Journal of Social Service Research, 30(2), 55-66.

Safer, P. (1986). Resuscitation potential in mass disasters. Prehospital Disaster Medicine, 2, 34.

Salinas, C., Salinas, C., & Kurata, J. (1998). The effect of the Northridge earthquake on the pattern of emergency department care. American Journal of Emergency Medicine, 16(3), 254-256.

Schultz, C. H., Koenig, K. L., & Noji, E. K. (1996). A medical disaster response to reduce immediate mortality after an earthquake. New England Journal of Medicine, 34, 438-444.

Shah, G. (1985). Social work in disaster. Indian Journal of Social Work, 45, 463-476.

Spitzer, W., & Neely, K. (1992). Critical incident stress: The role of hospital based social work in developing a statewide intervention system for first responders delivering emergency services. Social Work in Health Care, 18(1), 39-58.

Tanaka, H., Iwai, A., & Oda, J., Kuwagata, Y., Matsuoka, T., Shimazu, T., & Yoshioka, T. (1998). Overview of evacuation and transport of patients following the 1995 Hanshin--Awaji earthquake, Journal of Emergency, Medicine, 16, 439-444.

Toole, M.J., & Tailhades, M. (1991). Disasters. What are the needs? How can they be assessed? Tropical Doctor, 219(Suppl.), 18-23.

World Health Organization, (1980). Emergency care in natural disasters: Views of an international seminar. World Health Organization Chronicle, 34, 96-100.

World Health Organization. (1999). Rapid health assessment protocols. Geneva: Author.


The NASW Press expects authors to adhere to ethical standards for scholarship as articulated in the NASW Code of Ethics and Writings for the NASW Press: Information for Authors. These standards include actions such as

* taking responsibility and credit only for work they have actually performed

* honestly acknowledging the work of others * submitting only original work to journals

* fully documenting their own and others' related work.

If possible breaches of ethical standards have been identified at the review or publication process, the NASW Press may notify the author and bring the ethics issue to the attention of the appropriate professional body or other authority. Peer review confidentiality will not apply where there is evidence of plagiarism.

As reviewed and revised by NASW National Committee on Inquiry (NCOI), May 30, 1997

Approved by NASW Board of Directors, September 1997

Colleen M. Galambos, DSW, is director, School of Social Work, University of Missouri-Columbia, 730 Clark Hall, Columbia, MO 65211; e-mail:
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Title Annotation:EDITORIAL
Author:Galambos, Colleen M.
Publication:Health and Social Work
Geographic Code:1USA
Date:May 1, 2005
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