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A framework for mental health and psychosocial support in radiological and nuclear emergencies

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EXECUTIVE SUMMARY

The health impact of radiological and nuclear emergencies can last for decades.
Lessons learned from past radiological and nuclear accidents have demonstrated that the mental health and psychosocial consequences can outweigh the direct physical health impacts of radiation exposure. International radiation emergency preparedness and response standards outline provisions for mitigating these effects. Yet, practical guidance for addressing the mental health and psychosocial aspects of radiation emergencies remains scarce.

A Framework for Mental Health and Psychosocial Support in Radiological and Nuclear Emergencies was developed to fill this gap while building upon existing World Health Organization (WHO) and InterAgency Standing Committee (IASC) guidelines for providing mental health and psychosocial support (MHPSS) in emergency settings.

This framework aims to promote integration between the MHPSS and radiation protection fields. It is intended for officials and specialists involved in radiation emergency planning and risk management as well as MHPSS experts working in health emergencies.

Individual and community mental health and psychosocial well-being can be impacted considerably during and after radiation emergencies due to a number of factors. In particular, fear and uncertainty about radiation risks may be common.

In addition, emergency protective actions designed to protect human lives (such as iodine thyroid blocking, radiation monitoring and decontamination, sheltering in place and evacuation), could have repercussions on the physical or mental health of the affected people. Furthermore, people may link various somatic illnesses with exposure to radiation and thereby overwhelm unprepared health systems.

In addition to environmental and socioeconomic impacts, radiation emergencies are characterized by multiple factors, including health risk uncertainty and social stigma towards affected people (including the workers of the affected nuclear facility). These factors are sometimes coupled with inconsistent media coverage and misconceptions which can exacerbate people’s distress. Substance abuse, domestic violence, depression, anxiety, post-traumatic stress disorder and other psychosocial outcomes become more likely after such emergencies.

Estimates indicate that at least one in five people affected by an emergency or a disaster will experience a mental health condition, with certain groups particularly at risk. In the case of radiation emergencies, these groups may include:

■ people directly affected;

■ children from affected areas and parents concerned about the long-term impact on their children’s health;

■ pregnant women and lactating mothers from affected areas;

■ people with underlying health concerns;

■ people with low literacy levels and difficulty in following risk communications;

■ first responders, clean-up workers and other responders working in stressful conditions;

■ people living in residential facilities and institutions;

■ evacuees and members of hosting communities;

■ people with pre-existing mental health and psychosocial concerns;

■ the workers of the nuclear facility and their families.

Care should be taken to consider the unique needs of each of these groups.

A number of actions discussed in this framework can be implemented to support the mental health and psychosocial well-being of affected people and communities across the emergency cycle.

These actions are guided by several crosscutting considerations of MHPSS planning and implementation, which are discussed in the document.