Any effective global response to the Tsunami Disaster needs to be well thought out and coordinated. While the media is reporting the need for immediate mental health interventions, a rush to help may not be the most appropriate action to take in the immediate aftermath of this disaster. At this stage, it is too early to begin a "mental health" response. People are in shock, grieving and in the first stages of recovery. These are normal responses to traumatic experiences. Not trauma in itself. The needs right now are still the basics of food, water, medical care and shelter. Even at a later stage, it will not be appropriate for scores of mental health professionals from other countries to descend on these areas to provide care. There are language and cultural issues to be considered, as well as the experience and credentials of those volunteering in a trauma response. Finally, these efforts are often organized hastily and provide short-term interventions that can be inappropriate and leave people without support for their long-term needs. This was clearly one of the lessons from past global disasters.

Our immediate recommendation is to encourage people to give donations now, and over the long haul, to appropriate international and UN aid organizations, particularly those that will be involved with supporting national and local mental health efforts on the ground. Efforts, conducted by those with appropriate expertise, should be focused on doing short and long-term needs assessment in each of the affected areas, and further actions should be coordinated through local, established mental health organizations. We would encourage people to advocate to governments, health ministries and other intervening agencies to ensure that local, long-term mental health interventions are included and funded as a part of all emergency response plans. The media should also be encouraged and educated to provide sensitive, and informed coverage of events from an appropriate psychosocial perspective. Probably the most effective assistance from the global community will be supporting psychosocial training initiatives focused on a family and community based orientation for trauma-affected populations.

We are aware that despite the above recommendations, numerous groups are planning to send teams of people to various locations to do needs assessment and provide counseling. It would be best if these efforts could be coordinated rather than separate and potentially disruptive, competitive interventions, and should be managed through official organizations that are already on the ground.

Finally, we should be focusing attention on the psychological needs of the aid workers, journalists and all others involved in the post-disaster relief efforts. We should be ensuring that the aid organizations and news services have systems and resources in place to support these workers. The burnout and emotional toll is already evident in reports coming out of these affected areas.

We are monitoring the ongoing mental health responses being developed by WHO and UNICEF, two of the main international bodies already working in the Tsunami countries. WHO Department of Mental Health and Substance Abuse (MHS) has sent people to various locations to do rapid assessments of mental health needs, make plans for mental health assistance, provide advice and guidance on mental health programmes to Ministries of Health or to the WHO country office, and to provide assistance in coordination of various agencies offering mental health or psychosocial services. For the long-term support projects, WHO will soon be organizing coordination meetings to plan immediate, mid-term and long-term mental health responses to this disaster.

Here are basic recommendations from WHO:

•  mental health concerns should complement humanitarian work in the first days of the aftermath and not unduly burden relief operations.

•  It may not be helpful to have large numbers of people arrive on site in the Tsunami impacted areas. There will be a need for specialists to address specific concerns, but the impacted countries are in the best position to determine who is needed at which times.

•  Coordination of the detailed aid response should occur at the country level. To ensure a coordinated effort, people should first contact the country-offices of WHO, UNICEF, and the country's Red Cross/Red Crescent Society.

•  Basic social and mental health interventions should be implemented before more specialized interventions are considered. The Sphere standard for social and mental health, which was developed for these kinds of situations, should provide guidance on what the minimum response should be in middle and low-income countries. The Sphere Handbook, the most influential book in international humanitarian aid is available on line at:

•  In the acute relief phase, it is advisable to conduct few social/medical actions so there will be little interference with responses to vital needs such as food, shelter and control of communicable diseases.

•  Specific mental health activities should be initiated during week three/four, once life-saving operations are already underway.

Please continue to check this site for updated information. ITSP is available for media interviews, technical assistance, expert advice and information.

Educational Resources:

Guidelines for International Training in Mental Health and Psychosocial Interventions for Trauma Exposed Populations in Clinical and Community Settings
[PDF file]

Mental Health in Emergencies: Mental and Social Aspects of Health Populations Exposed to Extreme Stressors [PDF file]

For Information, Contact:

Jack Saul, Ph.D., Director
International Trauma Studies Program
New York University
155 Avenue of the Americas 4th Floor
New York, New York 10013
Tel. 212.691.6499 Fax 212.807.1809

These international aid organizations are accepting
donations for support of the survivors of the Tsunami Disaster
World Health Organization (WHO)


UN World Food Programme

International Federation of Red Cross & Red Crescent Societies

International Rescue Committee

Medecins Sans Frontieres (MSF)

Oxfam America Asian Earthquake

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