Psychiatrists’ role in disaster situations: A narrative review of empirical evidence

Abstract

Disaster exposure is widespread, and a significant portion of those who experience severe impacts may develop mental health distress and clinical conditions. Psychiatrists may play crucial roles in multidisciplinary emergency response teams supporting both survivors and other responders. However, no previous study has yet explored the evidence discussing and supporting these roles. We aimed to synthesize available evidence featuring the roles of psychiatrists in disaster response in order to guide future research, training and public policy. We conducted a narrative review applying a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-guided search of four databases: MEDLINE, Embase, PsycINFO and the Cochrane Library, using a strategy combining disaster-related terms with those related to psychiatric and psychological crisis interventions. We included in this review original quantitative, qualitative and mixed-methods studies reporting interventions during or after disasters in which psychiatrists played an active role. After removing duplicates, 2318 titles and abstracts were screened, 125 articles underwent full-text review and 14 studies ultimately met the criteria for inclusion. Psychiatrists played a multifaceted and crucial role in diverse disaster settings worldwide, providing direct clinical care, leading and coordinating mental health responses, generating research, building local capacity and offering expert supervision. Psychiatrists have been shown to serve important roles in disaster settings, but more research is needed to better understand their specific contributions and plan their most appropriate integration as essential and unique members of multidisciplinary response teams.

Keywords

Disasters mental health psychiatry public health community mental health services

Introduction

Both natural (e.g. earthquakes and floods) and man-made (e.g. armed conflict, industrial accidents) disasters have profound and enduring effects on individuals’ and communities’ mental health. The World Health Organization (WHO) estimates that up to 13% of people affected by disasters develop a mild or moderate mental disorder, while 5% experience severe forms (WHO, 2019). Mental health conditions such as depression, anxiety, insomnia, acute stress disorders and post-traumatic stress disorder (PTSD) are common among disaster-affected populations. These burdens are likely to grow with the increasing frequency and severity of disasters driven by climate change and socio-political instability (Goldmann and Galea, 2014). Therefore, a systematic approach to prevention, early detection and triage, and appropriate acute and long-term interventions are critical (North and Pfefferbaum, 2013).

Disaster psychiatry is a specialized field of psychiatry concerned with preventing and responding to the mental health consequences of disasters, supporting the psychosocial well-being of affected populations and responders alike (Christodoulou, 2024). Psychiatrists are critically positioned to play various important roles throughout the disaster management cycle – preparedness, response, recovery and mitigation (Ramalho et al., 2024). These roles are not confined to diagnosing and treating individuals in communities affected by disasters, or supporting other mental health, health and social workers in ensuring care for people with pre-existing and newly emerging conditions. They are also needed to advise policymakers and contribute to the restoration of community life and any other needed ongoing support. Despite the potential crucial role of psychiatrists, much of the literature on this topic is based on expert opinion and conceptual frameworks rather than empirical evidence. At the same time, the role of psychiatrists in disaster management remains poorly defined and inconsistently implemented across regions and types of disasters. This ambiguity contributes to the underutilization of psychiatric expertise during critical phases of intervention and delays in the deployment of mental health resources. There is a need for consensus on the core competencies, ethical challenges and cultural considerations relevant to psychiatric contributions in disaster preparedness and response.

The present narrative review aims to address this gap. The review aimed to examine evidence and experience, as recorded in the literature, of the role and impact of the work of psychiatrists before, during and in the aftermath of humanitarian disasters. Specifically, we aimed to evaluate literature that could offer the basis for evidence-based recommendations to enhance psychiatrists’ contributions to disaster-related interventions. This review also aims to serve as an initial step toward addressing the growing need for clear protocols and guidelines due to the ever-increasing prominence of disasters and their mental health impact.

Methods

Five reviewers (R.K., R.d.F., R.R., V.P.-S. and S.N.) conducted this narrative review, which was informed by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations for reporting data (Page et al., 2021). The less rigid, more semi-systematic approach of a narrative review allowed us to be more inclusive. Consistent with the aims of a narrative review, we did not conduct a formal qualitative appraisal of the included studies, as would typically be expected in a systematic review. We searched four databases: MEDLINE, Embase, PsycINFO and the Cochrane Library, from inception until 30 September 2024. The search strategy combined free text terms and explored MESH headings for the topics of disaster/crisis and psychiatric/psychological help combined as following: (disaster OR emergency) AND ( ‘psychological first aid’ or ‘mental health first aid’ or ‘psychological crisis intervention’ or ‘mental health crisis intervention’ or ‘psychiatr* first aid’ or ‘psychiatr* crisis intervention’). This search strategy was first developed in MEDLINE and then adapted for use in the other databases. Following the search, all identified citations were collected and uploaded into Covidence, and duplicates were removed. A pilot test helped reach consensus among the five reviewers on inclusion and exclusion criteria. Then, titles and abstracts were screened for inclusion against the criteria by the reviewers (R.K., R.d.F., R.R., V.P.-S. and S.N.) acting independently. Potentially relevant sources were retrieved in full. The full texts of selected citations were assessed in detail against the inclusion and exclusion criteria by the same five independent reviewers. Disagreements between reviewers were resolved through discussion until consensus was reached. Formal measures of inter-rater agreement (e.g. kappa statistics) were not calculated. Instead, consistency in study selection and data extraction was ensured through iterative discussion among the authors. We included original research studies, covering quantitative, qualitative and mixed-methods studies published in English. Articles were included if they discussed the provision of mental health care during or after natural (e.g. earthquakes, hurricanes and floods) or man-made (e.g. wars and industrial accidents) disasters, where psychiatrists had an active role at any part of the intervention. For the purposes of this review, an active role was defined as a direct and identifiable involvement of psychiatrists in any stage of the intervention, including planning, implementation, delivery, coordination or evaluation. Studies in which psychiatrists were mentioned only marginally or as part of a general multidisciplinary team without a clearly described role were not considered eligible. We excluded opinion pieces or editorials, literature reviews, conference abstracts and non-peer-reviewed literature, as well as articles not published in English.

Data extraction and analysis

Data were extracted from papers included in the review by the five reviewers acting independently. They used a data extraction tool developed for the review and modified and revised as necessary by consensus among reviewers during the process. The data extracted included specific details about the study, such as country, participants and study methods, and key findings relevant to the focus of the review. Any disagreements that arose between the reviewers during data extraction were resolved through discussion. If appropriate, authors of papers were contacted to request missing or additional data when required. The extracted data were analyzed using thematic analysis, following the six steps recommended by Braun and Clarke (2006). Following data extraction, the authors familiarized themselves with the data and met to discuss a preliminary set of themes based on conceptual similarities in the reported roles and activities. These preliminary themes were subsequently refined through iterative discussions until a final thematic framework was reached by consensus. The outcome of the analysis and the identified themes are presented below in narrative form.

Results

After eliminating duplicates, the titles and abstracts of 2,105 studies were screened. Following this, 125 articles were included for a fulltext screening, which resulted in 14 studies included in this review (see Figure 1). These articles reported studies conducted in diverse geographical settings, including Japan (n = 2), the United States of America (n = 3), South Korea (n = 2) and one study each from the following countries: China, Dominican Republic, Israel, Malaysia, and Philippines. Natural disasters were the main focus of most included articles (n = 4), followed by the COVID-19 pandemic (n = 4), terrorist attacks (n = 3) and transportation-related disasters (n = 3). Most studies aimed to examine mental health outcomes following these disasters, while some aimed to evaluate the effectiveness of various intervention models to address psychological distress in affected populations. Most included studies used a range of observational and interventional designs, including follow-up cohort studies. Intervention types varied from telephonic support and crisis helplines to structured psychological first aid training programs, stepped care models and early outreach mental health initiatives in disaster zones (see Table 1).

Figure 1.

Flow diagram of the study selection process.

Table 1.

Expanded description of the studies.

Study, country (authors)	Role of psychiatrists	Expanded description
Typhoon Haiyan, Philippines (Weintraub et al., 2016)	Diagnosed and treated severe mental disorders; trained local health workers	Psychiatrists within Médecins Sans Frontières’ (MSF) teams addressed severe mental disorders, including psychotic symptoms, often unrelated to the disaster. They prescribed psychotropic medications, managed complex cases and collaborated with local authorities to build capacity through training, ensuring sustainable mental health care in the post-disaster setting.
2004 Tsunami, Penang, Malaysia (Krishnaswamy et al., 2012)	Led early mental health response and training of local personnel	A team that included psychiatrists promptly mobilized after the tsunami, training healthcare workers, teachers and volunteers in crisis intervention. These trained volunteers assessed and treated individuals showing psychological distress.
World Trade Center Disaster, USA (Boscarino and Adams, 2008)	Helped design research, analyze data and recommend future studies	Psychiatrists contributed to creating a robust methodology to assess psychological trauma effects in World Trade Center (WTC) survivors. They analyzed mental health outcomes, identified intervention gaps and provided recommendations for improving research and mental health care for future trauma-exposed populations.
Mount Unzen-Fugen Eruption, Japan (Araki et al., 1998)	Assessed distress and provided crisis intervention and medication	Psychiatrists conducted assessments of evacuees displaced for years using the General Health Questionnaire (GHQ-30) tool. They provided direct mental health support, including crisis interventions and medication management, addressing ongoing psychological distress caused by prolonged evacuation.
COVID-19 Pandemic, USA (Gray et al., 2021)	Developed and delivered a proactive mental health PPE model for frontline workers	Psychiatrists designed a multi-tiered mental health support program for hospital staff, emphasizing preventive care. They provided crisis intervention, psychological first aid and clinical support to workers under stress, continuously adapting the program to meet evolving pandemic challenges.
Sewol Ferry Disaster, South Korea (Oh et al., 2019)	Designed and evaluated mental health interventions for affected students	Psychiatrists played a key role in planning and evaluating mental health services provided to Danwon High School students impacted by the ferry disaster, focusing on volunteer involvement and addressing post-disaster psychiatric symptoms through structured interventions.
School Bus–Train Collision, USA (Tuckman, 1973)	Conducted immediate psychological intervention and coordinated hospital and family support	Psychiatrists worked alongside social workers to interview students, families and medical staff after the accident. Their goal was to offer early psychological intervention, identify students at risk for prolonged trauma and ensure ongoing mental health support through a coordinated, visible presence.
Oklahoma City Bombing (Tucker et al., 2014)	Coordinated crisis hotlines, responder debriefings and long-term care planning	Psychiatrists and administrators collaborated with various agencies to provide immediate and long-term mental health services, including crisis hotlines, training, community support and research to understand and address the psychological impact of terrorism on victims and responders.
Suicide Bombing Survivors, Israel (Schreiber et al., 2007)	Led structured intervention (PIMSMA) and longitudinal symptom assessments	Psychiatrists implemented a structured intervention in an emergency department for survivors of suicide bombings. They conducted follow-up assessments up to 2 years post-injury, evaluating PTSD, depression, anxiety and sleep quality to gauge the intervention’s effectiveness on medium-term mental health outcomes.
COVID-19 Helpline, Dominican Republic (Sosa Lovera et al., 2022)	Designed and supervised a nationwide psychological helpline	Psychiatrists guided a team of psychologists providing psychological first aid and crisis intervention via phone to individuals experiencing pandemic-related distress. They oversaw service delivery, referral processes for complex cases and evaluation of outcomes, reaching nearly 500 users with reported improvements.
Stepped Care for Healthcare Workers Spain (Mediavilla et al., 2023)	Supported the delivery of a stepped care intervention for distress	Psychiatrists and psychologists trained and supervised staff delivering a stepped care program involving guided self-help and individualized therapy for healthcare workers. The program significantly reduced anxiety and depression symptoms compared to usual care during the COVID-19 crisis.
Teachers Post-Sewol Disaster, South Korea (Lee et al., 2017)	Assessed, diagnosed and counseled grieving teachers	Volunteer psychiatrists provided mental health assessments, crisis counseling and brief supportive therapy to teachers suffering from acute stress and grief within 3 months of the Sewol ferry disaster, offering referrals for ongoing care when necessary.
Psychological First Aid Training, Japan (Semlitz et al., 2013)	Supported the training of NGO and welfare staff post-triple disaster	Psychiatrists collaborated with organizations to provide locally adapted Psychological First Aid training after the 2011 disaster, improving trainees’ knowledge and confidence in supporting survivors.
PFA Training, China (Wang et al., 2024)	Supervised culturally adapted Psychological First Aid program	A psychiatrist provided clinical supervision for a WHO-based PFA training for frontline workers. The program was culturally tailored, well-received and strengthened local mental health emergency response capacity.

Themes regarding the role of psychiatrists in disaster settings

As per the inclusion criteria, all included studies discussed psychiatrists playing a role in the reported interventions. These roles were varied and multifaceted, and are summarized in the themes identified and described below (see also Table 2 for a list of studies informing each theme).

Table 2.

Roles of psychiatrists in disaster mental health response.

Role	Description	Examples from studies
Direct Clinical Care and Crisis Intervention	Psychiatrists provided direct care including assessments, crisis counseling, medication management and referrals in disaster zones.	Sewol Ferry (Oh et al., 2019) – On-site triage and grief support. Hurricane Sandy (Weintraub et al., 2016) – Medication continuity and emergency mental health care in shelters.
Leadership and Coordination	Led or co-led mental health response teams, developed clinical pathways and integrated services across sectors.	2004 Tsunami in Malaysia (Krishnaswamy et al., 2012) – Coordinated training, triage and follow-up. Disaster system integration (Gray et al., 2021) – National leadership in emergency mental health planning. Korea national response (Lee et al., 2017) – Psychiatrist-led coordination of early interventions.
Research and Evidence Generation	Involved in designing, implementing and analyzing studies on disaster mental health outcomes to inform best practices.	9/11 (Boscarino and Adams, 2008) – Longitudinal PTSD studies with clinical recommendations. Disaster response models (Schreiber et al., 2007) – Development of triage tools and surge planning frameworks.
Capacity Building and Training	Trained and supervised local health workers, expanding mental health care capacity during and after disasters.	Malaysia tsunami (Krishnaswamy et al., 2012) – Training over 1000 workers in psychological first aid. COVID-19 in China (Wang et al., 2024) – Remote training modules and frontline staff support. Haiti earthquake (Semlitz et al., 2013) – Supervised community mental health workers.
Advisory and Supervisory Roles	Provided clinical governance, case supervision and ethical oversight to ensure quality and safe practice.	COVID-19 response (Wang et al., 2024) – National protocol development and remote clinical oversight. (Semlitz et al., 2013) – Ongoing supervision and quality assurance for non-specialist providers.

Direct clinical care and crisis intervention

Several included articles described psychiatrists as providing frontline mental health care in disaster-affected settings. This included performing psychological assessments, delivering brief interventions, managing psychiatric medications, offering crisis counseling and facilitating referrals to long-term services. For example, after the Sewol Ferry disaster in South Korea, psychiatrists were rapidly deployed to support disaster survivors by providing on-site mental health triage and brief crisis interventions, particularly in the context of infectious disease outbreaks and mass trauma (Lee et al., 2017; Oh et al., 2019). Some studies noted the adaptability of psychiatrists in disaster settings, serving as a critical first line of psychological support, particularly in resource-limited or overwhelmed health systems, often working in non-traditional roles or remotely when access to physical locations was limited (Weintraub et al., 2016).

Leadership and coordination of mental health response

Psychiatrists also took on leadership roles in organizing and coordinating the mental health aspects of disaster responses. This included setting clinical care pathways, integrating services across sectors and mobilizing multi-agency collaborations, ensuring a systematic and scalable mental health response, particularly during large-scale crises. For example, after the 2004 tsunami in Malaysia, a psychiatrist-led team designed and implemented a system for training frontline responders, triaging survivors and ensuring follow-up care across multiple agencies and regions (Krishnaswamy et al., 2012). In other cases, psychiatrists acted as coordinators of national disaster response frameworks, helping to embed mental health into emergency preparedness and response (Gray et al., 2021).

Research and evidence generation

The included literature also reported psychiatrists playing a key role in conducting disaster-related mental health research, which contributed to improved intervention strategies, policy development and future preparedness planning. As an example, following the 9/11 attacks, psychiatrists helped design longitudinal studies assessing the mental health impacts on first responders and civilians, leading to evidence-based recommendations on PTSD interventions and monitoring (Boscarino and Adams, 2008). Similarly, Schreiber et al. (2007) highlighted the involvement of psychiatrists in developing evidence-based models for mental health triage and surge capacity planning in disasters.

Capacity building and training

Within the included studies, psychiatrists were also often involved in training local healthcare providers, emergency responders and community workers, thus strengthening the local mental health infrastructure and ensuring the sustainability of interventions. As one study reported, in the aftermath of a tsunami in Malaysia, psychiatrists led training workshops for primary care providers and community health workers, focusing on psychological first aid (PFA), recognition of common psychiatric symptoms and basic counseling skills (Krishnaswamy et al., 2012). Semlitz et al. (2013) and Wang et al. (2024) reported on initiatives where psychiatrists not only trained local providers but also established supervision and mentoring frameworks to support them post-deployment, ensuring a long-term mental health response beyond the immediate crisis phase.

Advisory and supervisory roles

In addition to direct and leadership roles, psychiatrists often provided clinical governance, acting as expert advisors or supervisors to ensure care remained clinically sound, as well as intervention fidelity and ethical standards, particularly in often chaotic or resource-scarce disaster environments. Wang et al. (2024) and Semlitz et al. (2013) described how psychiatrists oversaw clinical activities of non-specialist responders, offering case consultations, guiding triage decisions and supervising psychological interventions in disaster zones.

Discussion

In a world where disasters are common, but the mental health workforce is insufficient, psychiatrists are particularly in short supply, and their training and deployment are long and resource-intensive, making it essential to understand their specific roles to plan and fund effective and efficient responses. The present narrative review was set to explore the literature discussing the role of psychiatrists in disasters, paying attention to studies providing evidence-based discussions of these roles. Across the 14 included studies, which covered studies focused on a wide range of disaster contexts (e.g., earthquakes, tsunamis, and the COVID-19 pandemic), psychiatrists were consistently portrayed as versatile and essential contributors. Their roles spanned from leadership and coordination (e.g. guiding national or local response teams) and expert advisory and clinical governance, to direct care (e.g. assessments, medication, crisis intervention), capacity building through training and supervision, and research and evidence generation. The identified roles were presented as independent themes in the results section, but they should not be regarded as mutually exclusive. In practice, psychiatrists in disaster settings may assume multiple roles, often simultaneously, for example, providing clinical care while also supporting coordination of mental health services or contributing to training activities. Moreover, these findings underline the multi-dimensional role of psychiatrists in disaster response and recovery, emphasizing the need for their integration into future disaster preparedness and response frameworks across the areas of preparation, immediate crisis intervention, ongoing mental health support and long-term rehabilitation. Overall, while psychiatrists contributed significantly to addressing the mental health needs of disaster-affected populations, the findings also show considerable opportunities for further development and integration of psychiatric expertise into disaster management frameworks.

Mental Health and Psychosocial Support (MHPSS) has become increasingly prominent in contemporary disaster and emergency response frameworks (Inter-Agency Standing Committee [IASC], 2007), reflecting a growing recognition of mental health as a core component of humanitarian action. At the same time, long-standing practices such as crisis debriefing have come under scrutiny due to limited evidence of benefit and concerns about potential harm, prompting a shift toward more evidence-informed and context-sensitive interventions. Within this evolving landscape, the present review provides evidence-based reports of psychiatrists playing important roles in disaster settings. As reported by previous authors, psychiatrists can help ensure continuity of care for individuals with pre-existing mental illnesses, including those residing in mental health facilities, who are particularly vulnerable during disasters. Their clinical expertise can help maintain treatment regimens and manage acute exacerbations, as well as safeguard the rights and well-being of these populations. Moreover, psychiatrists can foster collaborative, community-centered responses by working with diverse partners – such as people with lived experience of mental health conditions and their families, local community members, religious and community leaders, traditional healers and marginalized groups – to promote culturally grounded, ethically sound and sustainable MHPSS practices.

Psychiatrists are uniquely positioned to provide specialized clinical care in disaster contexts, offering diagnosis, treatment and continuity of care for both newly emerging and pre-existing mental health conditions (Neria et al., 2008; North and Pfefferbaum, 2013). Yet, the literature reviewed suggests that psychiatrists’ services remain underutilized or insufficiently incorporated in many disaster settings. This underrepresentation has been noted previously, with calls for enhanced mental health integration into disaster preparedness and response plans (IASC, 2007; WHO, 2013). One promising area for expansion is the formal inclusion of psychiatrists in interdisciplinary disaster response teams. The reviewed studies showed psychiatrists playing roles in telephonic and remote interventions, approaches that proved vital during the COVID-19 pandemic when in-person services were constrained (Pfefferbaum and North, 2020). These modalities not only extend the reach of psychiatric care but also demonstrate the potential for innovative service delivery models in disaster scenarios. However, greater investment in training and infrastructure is needed to scale such interventions and ensure their accessibility and sustainability, especially in low-resource settings (Galea et al., 2020).

Capacity building emerged as another relevant role-played by psychiatrists in disaster situations, both in preparation and in response to disasters. Psychiatrists have the expertise to train non-specialist health workers and community members in psychological first aid and basic mental health support, thereby amplifying the mental health workforce and MHPSS interventions ready for and during disasters (Van Ommeren et al., 2011). Scaling up these efforts could help overcome the widely evidenced shortage of mental health professionals. Moreover, psychiatrists could play a more proactive role in strengthening health system preparedness by helping to develop culturally sensitive, community-based mental health programs that can be rapidly deployed in the wake of disasters (Patel et al., 2018). At the same time, the COVID-19 pandemic offered a salient example of how psychiatrists can contribute to mental health crisis management within the healthcare workforce (Karaliuniene et al., 2022). Targeted interventions aimed at frontline healthcare workers helped reduce psychological distress and fostered a culture of psychological safety (Greenberg et al., 2020). These efforts highlight the importance of psychiatrists’ involvement in occupational mental health, an area often neglected in disaster planning but critical for maintaining healthcare system resilience.

The review also suggests psychiatrists’ contribution to disaster mental health research. Their involvement in study design and implementation can help ensure that research is clinically relevant and that outcomes can guide effective intervention development. Disaster outcome studies have often lacked sufficient psychiatric input, limiting their scope and the generalizability of findings (Norris et al., 2002). There is a pressing need for psychiatrists to take leadership in advancing methodologically rigorous, longitudinal research that explores not only individual mental health trajectories but also systemic factors influencing recovery (Lowe et al., 2015).

This review on the role of psychiatrists in disaster settings has various limitations. First, the scope of included studies is limited and may be subject to selection bias, as it primarily highlights high-profile disasters, potentially overlooking smaller-scale or undocumented efforts, especially in less accessible regions. Second, the wide variability in study designs, settings and measured outcomes makes it difficult to directly compare findings or draw broad conclusions; many studies are descriptive or observational rather than controlled trials, which limits the strength of evidence. Third, the review spans diverse cultural and resource settings, where the roles and impact of psychiatrists may differ considerably based on local healthcare infrastructure and social factors, which restricts the generalizability of findings. In addition, most studies focus on immediate or short- to medium-term outcomes, with less attention given to the long-term effects of psychiatric interventions or sustained involvement in disaster recovery. The reviewed evidence was also more abundant in natural disasters than in other emergencies like armed conflicts or pandemics, possibly underrepresenting psychiatrists’ roles in those contexts. Fourth, there is a limited amount of rigorous quantitative data evaluating the effectiveness and cost-benefit of psychiatric interventions in disaster settings, which hinders the identification of best practices and the optimization of mental health responses. A further limitation concerns the restriction of the search to English-language publications. This choice may have introduced language bias and potentially led to the exclusion of relevant studies published in other languages, particularly considering the substantial contributions to this field from non-English-speaking regions. Consequently, some key perspectives or findings from the international literature may not have been captured in the present review. Finally, psychiatrists typically work within multidisciplinary teams alongside psychologists, social workers and other professionals, and the specific roles of each of those different team players are often not differentiated when reporting the implemented interventions. Thus, while the present review aimed to capture the specific contributions of psychiatrists, these contributions may be underrepresented. Despite these contributions, a significant gap remains in psychiatrists’ representation in disaster operational planning. In this regard, while psychiatrists often appear as study leads or key contributors, their roles are not consistently described or recognized within disaster response frameworks. This under recognition may reflect broader systemic challenges, including the historical marginalization of mental health in emergency preparedness policies (Saraceno et al., 2007). Addressing this gap requires concerted advocacy and policy work to integrate psychiatric expertise explicitly into disaster leadership, planning committees and resource allocation decisions (WHO, 2019).

Conclusion

Studies reporting mental health interventions in disaster settings suggest that psychiatrists can play an important role, although their involvement appears to be variable and, in some cases, limited or underreported. There is a pressing need to integrate psychiatrists more prominently into planning, policy formulation and leadership roles in disaster response systems to ensure that mental health considerations are adequately addressed from the outset. Future efforts should focus on expanding the roles of psychiatrists in operational planning, capacity building, innovative service delivery and research.

Footnotes

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors disclosed receipt of the following financial sup port for the research, authorship, and/or publication of this article: V.P.-S.’s research fellowship is funded by the National Institutes of Mental Health (NIMH) grant T32MH096724.

Ethics approval and informed consent statements

There were no human participants in this article and informed consent was not required.

ORCID iD

Rodrigo Ramalho

Data availability statement

All data generated or analyzed during this study are included in this published article

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