Mental Health Disaster Relief Not Always Clear Cut In the coming months hundreds upon hundreds of mental health professionals will flood Haiti, eager to tend to the psychologically wounded victims of the earthquake. But the role of a mental health professional in the aftermath of a major disaster like Haiti's isn't always well-defined.
NPR logo

Mental Health Disaster Relief Not Always Clear Cut

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Mental Health Disaster Relief Not Always Clear Cut

Mental Health Disaster Relief Not Always Clear Cut

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


The earthquake did more than shatter homes and bodies. Haitians are also struggling emotionally and the emotional wounds are no less serious for being invisible. Alix Spiegel has this story about the role of mental health professionals.

ALIX SPIEGEL: They came after Oklahoma City and flooded Sri Lanka in the wake of the South Asian tsunami. They came in droves to New York after 9/11. And according to Richard Mollica, a professor at Harvard who spent his life researching mental health responses to natural and man-made disasters, mental health professionals will soon come to Haiti as well.

RICHARD MOLLICA: There's going to be many, many, many, many hundreds and hundreds of organizations - big, little and small doing mental health work in Haiti. And they all have their own agenda and their own donors and their own goals.

SPIEGEL: There is no doubt, Mollica says, that all come with the best of intentions. But, he says, the work of a mental health professional in the aftermath of a major disaster isn't always clear.

MOLLICA: Mental health has had a hard time figuring out how to fit in with the medical response.

SPIEGEL: Apparently, while mending a broken leg is pretty straight forward process, mending a broken heart is much more fraught. In fact, according to Sandro Galea, former director of the Center for Global Health, organized mental health responses to major disasters are really relatively new.

SANDRO GALEA: The big shift in the field came after the Vietnam War.

SPIEGEL: Is he - it was only after Vietnam that American psychiatry came up with a formal definition of Post Traumatic Stress Disorder. But once PTSD was firmly established, the mental health community actively embraced it.

GALEA: Scientific and the therapeutic community really coalesced around providing services for people who are experiencing traumatic events.

SPIEGEL: But unfortunately, though they was a clear definition, initially, mental health professionals didn't have clarity at all about what should be done to prevent PTSD. One big idea though, that did became popular through the '80s and '90s, was this idea that professionals should encourage victims to talk in a very, very detailed way about what has happened to them, within days of a traumatic event. Richard Mollica says people just assumed that this would help.

MOLLICA: At the time of the tragedy, sharing that story with people and going through it point-by-point, would sort of discharge any emotional upset that you might stir up, and that might come back to haunt you six months from now.

SPIEGEL: And so, after Okalahoma City, and 9/11, and Katrina, mental health professionals rushed in to help. But in 2007, according to Sandro Galea, two big research reviews came to a very clear conclusion about this practice, known as debriefing.

GALEA: The body of evidence suggests that it actually might harm people and that people who actually do undergo debriefing probably do worse in the long term and in the short term.

SPIEGEL: This doesn't mean to both Galea and Mollica that it's always harmful to discuss your experience. It's just that those kinds of discussions are probably better left till months later, when there is time to teach people who have been traumatized how to master or counter their feelings. So these days, says Mollica, the new approach of the mental health community is something called psychological first aid.

MOLLICA: It's kind of the bible now of how to approach survivors, psychologically, in the acute phase.

SPIEGEL: The funny thing about psychological first aid is that there's really very little that's particularly psychological about it. Mollica says it's mostly very practical, basic social work.

MOLLICA: You can't find your son. Well, this is who you need to talk to at the Red Cross to find your son. You don't have enough of water for tonight. This is who you need to work with, you know, to get water for yourself.

SPIEGEL: Alix Spiegel, NPR News, Washington.

Copyright © 2010 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.