Disasters test civil administrations’ and health services’ capacity to act in a flexible but well-coordinated manner because each disaster is unique and poses unusual challenges. The health services required differ markedly according to the nature of the disaster and the geographical spread of those affected. Epidemiology has shown that services need to be equipped to deal with major depressive disorder and grief, not just posttraumatic stress disorder, and not only for victims of the disaster itself but also the emergency service workers. The challenge is for specialist advisers to respect and understand the existing health care and support networks of those affected while also recognizing their limitations. In the initial aftermath of these events, a great deal of effort goes into the development of early support systems but the longer term needs of these populations are often underestimated. These services need to be structured, taking into account the pre-existing psychiatric morbidity within the community. Disasters are an opportunity for improving services for patients with posttraumatic psychopathology in general but can later be utilized for improving services for victims of more common traumas in modern society, such as accidents and interpersonal violence. 1. Introduction Disasters, by their nature, are events that are unanticipated when and where they occur and are situations in which the protective mechanisms of a civil society are particularly likely to fail. Globally, there is an average of at least one disaster every day, the frequency of disasters is rising with climate change, as are the numbers of people involved with increasing population densities but, overall, the proportionate mortality caused by natural disasters has fallen. Conversely, the morbidity caused by people’s exposure to trauma is rising and a substantial portion of the health effects lies in the psychosocial and mental ill health domains, and this is placing a rising burden on services that are often very stretched already [1]. In response, an approach is required that is built of public health interventions for groups of people. Practical and community support are critical in the immediate aftermath of events though rarely should mental health professionals provide that care. In addition a population-based approach enables primary and secondary preventative intervention to be offered and it facilitates evidence-based practice. This paper uses the term psychosocial care to describe these population-based interventions and to differentiate them from the mental healthcare
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