Tackling community trauma after disasters

Estimates suggest more than half of adults felt anxious or worried directly after the 2019–20 Australian Black Summer bushfires.
 
That is backed up by a new Australian Institute of Health and Welfare report on the disaster’s short-term health impacts.
 
Since the Federal Government’s introduction of additional Medicare-subsidised mental health items in mid-January, claims by bushfire-affected people through their GP and other healthcare providers increased from 148 services in the week ending 26 January to 510 in the week ending 15 March.
 
Service access peaked in June, and have averaged to 498 per week up to 11 October.
 
But concerns remain. As Australia enters another bushfire season, experts say the full impact on mental health will be seen in the months and years to follow.
 
Dr Penny Burns, Deputy Chair of the RACGP Specific Interests Disaster Management network, says this has certainly been the experience of her GP colleagues in Christchurch, New Zealand.
 
‘They had the earthquake in 2011 and when there’s a significant tremor, they still get people coming in because that triggers them,’ she told newsGP.
 
‘After you’ve been through a bushfire, that can trigger people; even the smell of smoke from burning off.
 
‘The GPs in those environments are the first stop for patients. As GPs in the community, you are more aware of when people are likely to be triggered and more able to be aware that they might need extra support.’
 
That, of course, includes children.
 
Unfortunately, however, Dr Burns, who is also a member of the RACGP Specific Interests Child and Young Person’s Health network, says the youngest can sometimes be overlooked, particularly if parents and health professionals do not know the signs.
 
‘When you have a distressed family that’s been affected by a big natural disaster, parents will be distressed and the children, even if they don’t know much about the disaster, will pick up on that distress that the parents are displaying,’ she said.
 
‘So it’s really, really important that we don’t forget that a quiet child sitting in the corner just playing by themselves is not necessarily a child that’s got good wellbeing, and is not necessarily a child that is not distressed.
 
‘For some children it will be getting quiet and becoming very good, while other children might act out more. But it’s about a change in behaviour.’
 
As with adults, Dr Burns says research has shown signs of poor mental health and wellbeing may not appear right away.
 
‘Following some bushfires earlier in Canberra, there was a study done that showed that in the first six months children were “very good”, behaved well and did the right thing. Then, following that, children started to act up,’ she said.
 
‘That was because the children had sort of been in a shock state, if you like, following that event.’
 
The challenges have been two-fold this year, with the coronavirus pandemic adding to the trauma and recovery period.
 
‘One of the things we know in terms of recovery from [a disaster] is that routine and community, and coming together is really important,’ Dr Burns said.
 
‘COVID ... stopped that happening because we were told to stay away from people, to isolate, to stay on our own. So that was an ongoing event for these children.’


Dr Penny Burns, Deputy Chair of the RACGP Specific Interests Disaster Management network, says it is important for GPs to take note of any behaviour changes in children that may be a sign of distress. 

To help GPs respond to the needs of their communities, Emerging Minds has launched a short course, Supporting Children & Families in General Practice After a Natural Disaster or Community Trauma.
 
It offers practical guides and tips for providing support in the immediate aftermath, and the short-term and long-term following a natural disaster or community trauma.
 
Dr Burns, who was involved in its development, says the course also helps GPs navigate appropriate responses for different age groups and stages of childhood.
 
‘Very young babies can be affected, older children and adolescents, and the effects and considerations are different,’ she explained.
 
‘It talks about what a child needs to recover, things like routine and feeling safe with their family around them. It also goes through … how to explain and talk to children in their language about what that means to them and how parents can actually deal with it.’
 
The course is deliberately focused on children and families, based on the idea proposed by the late British psychoanalyst John Bowlby that those who wish to help children also need to help the parents.
 
‘It will give GPs a strong understanding of what the effects are over the longer term for these children, and how to support parents who are the key person in their child’s emotional wellbeing in actually being able to facilitate that really safe slow recovery,’ Dr Burns said.
 
‘And most children will recover. Following bushfires and COVID, all the evidence supports that the majority of people with some mild assistance will recover, and it’s only a small number that will need ongoing referral to psychologists and psychiatrists.
 
‘But, again, GPs needs to be able to identify that and that’s what this talks about as well – what are the red flags? When do we get worried? And who do we refer to for ongoing support?’
 
By helping to ensure children’s wellbeing is maintained during these events is essentially preventive medicine, which Dr Burns says is the strength of the GP.
 
‘This is about prevention, and about developing skills for future events as well because this won’t be the last event they’ll go through,’ she said.
 
‘And if parents and children can develop really good strategies for this event, then they’re already ahead of the game.’
 
Supporting Children & Families in General Practice After a Natural Disaster or Community Trauma is an RACGP-accredited activity and will attract two CPD points. It is estimated to take approximately one hour, though participants can complete the course at their own pace.
 
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