Hidden Impact: What You Need to Know For The Next Disaster

Hidden Impact: What You Need to Know for the Next Disaster: a Practical Mental Health Guide for Clinicians: A Practical Mental Health Guide for Clinicians, by Frederick J. Stoddard, Jr., Craig L. Katz and Joseph P. Merlino,  Published by Jones and Bartlett Publishers, Boston, 2010, 249 pages

Review originally published in the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry

Most clinicians who have expertise in mental health aspects of disaster developed their skills in this area after they found themselves seeing patients following some tragic event. It is true that well trained clinicians know about acute stress, loss, grief and PTSD since these conditions come up in many forms with many patients. However, the application of their clinical skills in the midst and in the aftermath of disaster is a whole different ballgame. Having co-taught a course in disaster psychiatry for several years at the annual meeting of the  American Psychiatric Association, I heard this story many times as colleagues joined us for the course after experiencing a disaster in their area.

There are many courses seminars, journal articles and books which will inform you in great depth about the essential topics in disaster mental health, many of them written and edited by the editors and contributors of Hidden Impact. The book is originated from the Group for the Advancement of Psychiatry (GAP) where the authors ore members of the Committee on Disasters and Terrorism . GAP has a tradition of identifying important areas of mental health and supporting publications in these areas. In my opinion this book fits the bill as the first book on this subject you should read or if you were only reading one book this is the one to read. It is the book that you will throw in your suitcase if you find yourself traveling to a site to render care in the aftermath of a disaster

In 250 pages this is  as comprehensive a course of study on this subject as I have ever seen in a book this size. It is well written, interesting and quite practical. Each chapter starts with a vignette, which either centers on victims of a disaster or on the caretakers faced with the dilemma of dealing with the aftermath of such an event.  The book is filled with practical information such as a comprehensive check list (and I do mean comprehensive) of  what to take with you if you go into an area to render care.( ie, pack your own power, take local maps, support socks, brimmed hat, iodine for water decontamination etc. There are clinical tables and charts to be sure you don’t miss the basics such as what to expect during the impact phase (first 48 hours) acute phase (1-8 weeks), post acute phase (2 months and beyond). There are many clinical screening tables such as the one for PTSD in children. There is a discussion and review of pharmacology in disaster situations. There are chapters on the use of telepsychiatry, liability, ethics, staff support as well as some of the latest thinking on resiliency. There is also a list of useful resources including websites

You should not be surprised to  find that if you are working in a  disaster situation, you will be interacting with the media as well with community leaders who have the responsibility to make reports to the media . In this regard the topic of risk communication and “how to do it“ is well covered in a succinct chapter. By the way, your clinical skills can also be useful to members of the working press who are often traumatized by working in a disaster environment. This latter clinical issue is discussed in the chapter about  understanding and helping first  responders. It is clear that the we need to apply our knowledge of the psychological impact of disasters not only to the primary victims  but also to the secondary victims who come to the aid of others. That of course includes ourselves. Perhaps one of the most valuable tables offered in the book is a table from SAMHSA (Substance Abuse and Mental Health Services Administration) about  managing and preventing stress, which includes the signs that you may need stress management assistance and ways to help manage your own stress.

As an added bonus the book is approved for AMA PRA Category 1 CME credits with instructions for getting Continuing Medical Education Credits from the Medical Society of The State of New York.

Addendum:  This review would not be complete without mentioning a recent book which should be a companion piece to this one. It is edited also by two of the same authors Fredderick J Stoddard and Craig Katz along with Anand Pandya and includes chapters by Merlino and many others on similar and related topics. It is titled Disaster Psychiatry: Readiness, Evaluation and Treatment. Published by the American Psychiatric Press, 2011.

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