Disaster Medicine and Mental Health: Who, How, When for International and National Disasters

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Dr. Hobfoll and colleagues, the authors of the “Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence,” highlight several areas of intervention. Based on a review of the literature on early preventive and therapeutic mass trauma intervention, the authors conclude that to date no evidence–based consensus has been reached. Neither do they expect adequate representation of randomized controlled trials of interventions to be conducted in the foreseeable future, if ever. Accordingly, no specific intervention model can be recommended. Additionally, the heterogeneity of disasters and their aftermath defy specific guidelines, and the authors emphasize the need for flexibility of interventions and adaptation to specific circumstances. The authors draw attention to some central elements or principles of intervention ranging from prevention to support and therapeutic interventions. They characterize the scientific basis for these approaches as “evidence–informed. The five intervention principles are to promote 1) sense of safety, 2) calming, 3) sense of self– and collective efficacy, 4) connectedness, and 5) hope. Under these five headings the authors provide much empirical support, some of which is extrapolated from related fields of research, in an attempt to gain consensus from researchers and practitioners. When more highly specialized forms of intervention are proposed, the authors are careful to stress that needed assessments should be made and indications should be present. In our opinion, the authors have chosen a wise approach with a good chance of achieving consensus in a field which has been plagued by controversy. However, there may already be a move towards more concerted action. One recent example is on the issue of Psychiatry 70(4) Winter 2007 337