Disaster Mental Health Risk Reduction : Appraising Disaster Mental Health Research as If Risk Mattered

The globally increasing frequency, intensity, and complexity of extreme climatic events and disasters poses significant challenges for the future health and wellbeing of affected populations around the world [1,2]. Mental health problems in the general population, which still too often go un-attended or untreated in many countries [3], are known to be further elevated among those exposed to extreme climatic events and disasters [4,5]. 

In view of the onslaught and rapid succession of such events, affected communities and existing supports are increasingly stretched in their ability and capacity to cope with such events, thus posing urgent questions about how people and support systems can best be enabled to adequately deal with and operate in this changing and challenging reality [6]. 

Current approaches to addressing the mental health consequences of extreme climatic events and disasters typically involve so-called Mental Health and Psychosocial Support (MHPSS) systems which are informed by guidelines and commonly mobilized during disaster response and recovery phases. These MHPSS systems can involve varied local and external actors who provide supports, ranging from basic emergency support to meet immediate practical and psychosocial needs to advanced psychological treatment, within supportive conditions that globally differ dramatically across geographies, and which can be severely affected by the disaster as well. 

The anticipated increase in mental health and psychosocial problems arising from more frequent and cumulative exposure to extreme events and its interplay with  demographic, social, economic, and political context-based vulnerabilities, poses several key questions regarding the adequacy of our current MHPSS approaches. These questions foremost concern our understanding of the changing nature and prevalence of mental health  impacts that are likely to arise in future, the key strategies needed to more effectively prevent or address these impacts, the associated increases in MHPSS capacity requirements, as well as the traditionally reactive role of MHPSS which is usually limited to addressing mental
health impacts after disasters have occurred.

Disaster risk reduction (DRR), as espoused in the Sendai Framework for Disaster Risk Reduction 2015–2030, is a relatively new paradigm which has profoundly shaped the way that contemporary societies deal with disasters through disaster-related policy and practice [7]. DRR moves beyond the traditional approach to managing disaster events and consequences, towards proactive concerted approaches that seek to better understand, reduce, and manage disaster risks. As such, DRR adopts an all-hazard approach, and goes beyond the prevailing event orientation. DRR has found its expression in the health domain within Health Emergency and Disaster Risk Management (Health EDRM) [8].

Yet, until recently, the intersection of DRR and MHPSS has received relatively little systematic attention [9]. Despite a growing recognition of the importance of mental health in global disaster policy (such as the UNDRR Sendai and WHO Health EDRM Frameworks), the intersections of our current approaches to disaster risk reduction and efforts to address mental health and psychosocial aspects in disaster and emergency contexts are still relatively poorly understood. As such, it is pivotal that we deepen our understanding of this intersection and develop the practical and scientific knowledge required to advance this field in the future.