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General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and encouraging the active use of social support networks, and self-care strategies. Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether "indicated" interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process.

Debriefing, like trauma counseling, and even grief counseling, has been taken up as an instant solution. Some suggest it is a part of the trauma industry. It may be seen as something to hold onto in the face of disaster or other chaos, because it offers the security of a structure, some sense of control over what to do to help when one wishes to undo what has happened, help others and the self, to make meaning of a horrific or shocking experience. The need to pursue a way of responding suggests that those who would offer help fear being overwhelmed, or do not trust their normal compassionate, protecting, and comforting responses. It would be sad if these spontaneous, caring, and altruistic reactions that so bind human society in times of tragedy were devalued or put aside, for they, ultimately are the beginning of the healing process.

Recent acts of terrorism have emphasised the need for research to further establish not only the nature of the impact of disaster and terrorism on the population, but also further define methods of effective intervention. Those affected, and often overlooked, include children and adolescents, yet, our knowledge of the impact upon the younger members of our community is limited. The literature is evolving, and there are a small number of valuable studies that can inform a response to the mental health needs of this younger population. This article reviews some of the psychological impacts of disaster and terrorism upon children and adolescents, and considers both risk and protective factors. The importance of a developmental approach to children's understanding of disaster, particularly death and the nature of grief and loss are discussed as is the distinction between the phenomenology of bereavement and trauma. Family and community support are highlighted as protective factors, and a number of recent, valuable recommendations for intervention including psychological first aid and cognitive-behavioral therapy are described. Finally, the complex role of the media and the degree that children should be exposed to images of violence and disaster is considered. Disasters, whether they are natural or human-made always will be with us. It is necessary that a public-health approach that not only prepares for such scenarios, but responds by maximising the use of existing systems and agency linkages, is taken.