Review of Community Recovery Initiatives SSPA Research Workshop 2 June 2011

Request A briefing paper for the Wellbeing and Resilience Intersectoral Task Group and Healthy Christchurch Evidence about how to enhance individual and community wellbeing following a disaster, in particular –How to support community resilience building –How to provide psychosocial support for individuals who need it.

Integrated and holistic recovery

Methods The international journal literature was systematically searched using MEDLINE, because this search engine allows selection restricted to reviews of the literature, and the Cochrane Database of Systematic Reviews. An internet search was also undertaken. Search terms used included: “disaster, recovery, effective, successful, community, initiatives, prevent*, post traumatic stress, survey”.

Definitions Recovery is the coordinated efforts and processes to effect the immediate, medium, and long term holistic regeneration of a community following a disaster Resilience is the community’s ability to withstand the damage caused by emergencies and disasters; it is a function of the various factors that allow a community to respond to and recover from emergencies Psychosocial resilience is the capacity of individuals, families, communities, systems and institutions to anticipate, withstand, and/or judiciously engage with catastrophic events and/or experiences, actively making meaning out of adversity, with the goal of maintaining ‘normal’ function without fundamentally losing their identity

EmotionalCognitiveSocialPhysical Shock and numbness Fear and anxiety Helplessness Hopelessness Fear of recurrence Guilt Anger Anhedonia Impaired memory and concentration Confusion or disorientation Intrusive thoughts Dissociation or denial Reduced confidence Hypervigilance Regression Withdrawal Irritability Interpersonal conflict Avoidance Insomnia Hyperarousal Headaches Somatic complaints Reduced appetite Reduced energy Anticipated immediate reactions (UK Department of Health Emergency Preparedness Division 2009)

Evidence-based principles for recovery Promote a sense of safety Promote calming Promote a sense of self- and collective efficacy Promote connectedness Promote hope (Hobfoll et al 2009)

It is important to attend to the basic needs of the population first, because the stresses associated with restoring housing and patterns of life can have as much impact on psychological wellbeing as the disaster itself. (NATO 2008; Hutton 2001)

The ability of people to cope and adjust to disaster events is often not so much a function of disaster trauma as it is the capacity of people to access tangible assistance and support. Timely financial and material resources can not only mitigate the impacts of loss and disruption, but allows people to regain a sense of routine and normalcy in their daily lives (Hutton 2001)

Recovery can be facilitated by helping families and neighbourhoods to come together as soon as possible to re- establish social networks and communal life, provide opportunities for people to identify and vocalize common needs and priorities, and establish links with government and other institutions (Hutton 2001).

Because disaster may widen the gap between the rich and the poor, it is vital that agencies pay attention to issues of social protection and economic recovery. Advocacy and engagement are vital tools. (Cosgrave 2008)

Providing psychological support Most people recover from the stress associated with a disaster without medical or psychological assistance Some people experience a severe response. Severe responses to stress include post traumatic stress disorder (PTSD) The occurrence of secondary stressors (such as lengthy displacement from homes) may increase the risk of people developing severe responses

There is no evidence that psychological debriefing is a useful treatment for the prevention of PTSD (Rose et al 2009). No psychological intervention can be recommended for routine use following traumatic events. Psychological interventions may have an adverse effect on some individuals (Roberts et al 2009).

Formal debriefing or screening of everyone affected should not occur, but helpers should be aware of the importance of identifying individuals with significant difficulties. Individual trauma-focussed cognitive behavioural therapy is effective for the treatment of acute traumatic stress symptoms (The European Network for Traumatic Stress 2008).

Successful initiatives Practical help given in an empathetic manner, emotional support and initial reassurance of distressed individuals Information provisions (e.g. regarding tracing family members, accessing temporary housing, food, social benefits, health services, legal advice, and psychological help) Material assistance (e.g. providing housing, food, financial benefits, rebuilding infrastructure) Employment (e.g. retraining to increase employability and independence) Organizing memorial events and building monuments in conjunction with those directly affected Facilitating mutual support and special interest groups Providing psychosocial care interventions to the affected populations