∙ Both mental and physical health are central components of DRM.

∙ Both mental and physical health require meeting the basic needs of food, water, shelter, safety and security.

∙ Health includes ensuring dignity and respect of individuals, families and communities.

∙ DRM mental health policies and practices should be evidence-based

∙ Determinants of mental health must be considered, including social, economic, safety, security, stability and community concerns.

∙ DRM mental health includes attending to the needs of direct victims/survivors, response/recovery workers and leaders.

∙ Planning should align mental health with the overall healthcare planning and response throughout all phases of disasters in order to systematically ensure it remains a priority for leadership.

∙ There is an expanding evidence base for the importance of attending to mental health concerns during disasters.

∙ Best-practices should include adapting existing guidelines for health interventions and health care delivery during disasters to specific locations, disaster types and cultural contexts.

∙ Training and education of mental health providers, program designers and policy makers should be an ongoing priority.

∙ Mental health surveillance in communities and at health care delivery sites should be an integral part of all efforts.

∙ Monitoring and evaluation should be incorporated into any program. Indicators should be developed to demonstrate the effectiveness of mental health programs.

∙ The mental and physical health systems should be integrated to save money

∙ Individual, family and community mental health DRM programs should build on existing strengths, promote skills, increase resource availability and provide education and emotional support.

∙ These support programs unite actors, sectors, countries and communities to focus on the promotion and protection of health

∙ Plan across all stages of disaster when designing a recovery plan – prevention, preparedness, response, recovery and adaptation.

∙ Recognition of, and support for, the transition from the acute emergency to the longer-term recovery is required.

∙ Mental health DRM should include interventions to support caregivers and disaster responders.

∙ Develop community engagement and assistance programs with the aim of supporting local actions for recovery and strengthening resilience.

∙ Promote skills for individual and group psychological recovery and incorporate them into more general strategies for recovery.

∙ Offer primary care and mental health programs for people to access for post-disaster concerns, with appropriate referral mechanisms in place if needed.

∙ Develop strategies for supporting those affected and their communities.

∙ Mental health DRM must consider vulnerable groups/populations (e.g. culturally and linguistically diverse, disabled persons, women, pregnant women, children, the elderly and the institutionalized).

∙ Recognition of, and support for, social rituals, meaning-making, and community-initiated recovery programs.

∙ Build on local resources whenever possible, and encourage communities to foster their own capabilities.

∙ Prepare for a worsening of existing problems and simultaneously a disruption of usual healthcare services.

∙ Prepare for secondary stressors that further complicate the picture during prolonged disasters or prolonged recovery periods.

∙ Emphasize providing support to caregivers and those that respond to disasters.

∙ Caution providers and responders that psychological first aid can result in adverse outcomes if misunderstood or applied inappropriately.

∙ The principle of “Do No Harm” should be clearly articulated and included in any recovery plan.

∙ Efforts to develop community health resources and ability to respond should be encouraged.

∙ It is difficult to improve/address mental health concerns without first building or rebuilding and then promoting the resilience of affected communities.

∙ Evidence-based principles of support are important to mental health DRM: ensuring safety, fostering interpersonal connections and support, teaching calming techniques, supporting connectedness and communication, promoting hope and positive views for the future.

∙ Identification of the factors that foster community resilience and recovery, as well as developing measures of community psychosocial well-being, can aid in future planning.

∙ Gender, age, ethnicity, religion, minority status, socioeconomic status and other such factors must be considered in mental health DRM.

∙ DRM mental health interventions must address at-risk and vulnerable populations including disaster-response personnel.

∙ DRM mental health planning and response requires regional and geopolitical coordination

∙ Stigma regarding mental health is a global phenomenon that must be recognized, acknowledged and addressed.

∙ Urban/rural area differences must be addressed

∙ Existing and potential capacity and capability for implementation, accountability and sustainability. These include factors such as economics, politics and regional or national stability.

∙ Disasters have effects beyond the local population through movement of refugees or internally displaced people to surrounding communities or more distant regions; as well as movement of resources from other areas into the disaster affected community.

∙ Special considerations are needed for children and adolescents during all stages of a disaster: developmental levels of children and adolescents should be considered; caring for parents will enhance the mental health of their children.

∙ Psychological support for first responders since they are humans who also suffer from stress. They can have a stronger level of stress. SAMSMA first response – many nations are superior in the mental health systems. Incorporated reporting of psycho health for first responders

∙ Mental health preparedness should include consideration of both natural and man-made disasters.

∙ Centralized decision-making in collaboration with local leaders is critical to complex disaster interventions. This process will vary by country, location and culture.

∙ Evacuation planning is central to an all-hazards disaster plan for mental health care. The differential effects of evacuation should be considered for specific populations including women, children, the ill/hospitalized and the elderly

∙ Managing the local response to those evacuated and joining new communities requires planning and a well-developed communication strategy in order to enhance care and minimize discrimination and stigma.

∙ Education, training and simulations are essential to prepare for natural and man-made disasters.

∙ Across geo-political boundaries and regional coordination:

- Promotion of training and education

- Shared strategies on disaster prevention and preparedness

- Collaboration in multinational preparedness, response and recovery

- Shared proposals and initiatives regarding systems development, response plans, policy development and evaluation

- Best-practices

- Research

- Leveraging technology in planning and delivery of services when possible

- Consensus on leadership issues such as grief, stress management and risk/crisis communication. Discussions on how behavioral health can support those charged with leading disaster management efforts throughout all phases.

∙ Effective communications should be timely, accurate and culturally sensitive.

∙ Maintaining, fostering and restoring communications amongst individuals, families, communities and countries is essential.

∙ Maintaining family and community structures and networks enhances mental health

∙ When populations lose community infrastructure and in particular communication capability, stress and negative responses may increase.

∙ Key principles of risk communication are applicable across cultures.

∙ The media (of all types) is an important vehicle for sharing information and promoting mental health and recovery.

∙ Planning for multiple alternative methods of communication is needed since during a disaster usual forms of communication may be disrupted.

∙ Include communication and information strategies when designing a recovery plan, including information centers, hotlines, media releases, web sites and social media.

∙ Include outreach programs for affected groups and individuals utilizing multiple means of communication.

∙ Families should be kept together.

∙ The basic principles of risk communication (e.g. accuracy, clarity, transparency, promptness, directness) are central to sustaining community functions and decreasing anxiety.

∙ Leadership training, cultural competency of disaster responders and care givers, and strategies to send messages to vulnerable populations are needed.