From rescue to recovery: Why mental healthcare needs to be a part of disaster relief
As natural disasters rise, there’s an urgent case to be made for offering psychological first aid to affected people within the first 72 hours
When the mountain cracked open above Ronti Peak in Chamoli, Uttarakhand one February morning in 2021, sending a roaring torrent of rock, ice, and melted snow down the Dhauliganga valley, it wasn’t only hydropower plants that were swept away. Entire families who had survived the deluge soon discovered another kind of emergency—one that lingered long after the debris had settled. “I remember the sound before anything else," says Jyoti Dhaundiyal, 40, a school teacher from the valley. “It was like the earth was screaming. After that, it was all mud, chaos, and silence." For weeks, she couldn’t sleep. “Everyone talked about the rescue, the losses, the bridges," she recalls. “No one asked how our minds were holding up. Even today, when it rains, I can feel my nerves tighten in my head."
India’s cycle of floods, cloudbursts and cyclones has become routine — but the invisible harm that follows is rarely treated with the same urgency as roofs and rations. This year, relief agencies and state officials reported tens of thousands of homes destroyed. By mid-2025, one tally put the number of Indians who lost homes to disasters at more than 160,000. In the northeastern states, official situation reports recorded more than 257,000 people in relief shelters during a single emergency window this summer.
Clinicians and disaster responders now say that it is in the first 72 hours after a catastrophe — ‘the golden window’—that the course of recovery is most often set. Practical, humane interventions during that interval — what global agencies call mental health and psychosocial support (MHPSS) or psychological first aid (PFA) — can reduce suffering, stabilize families and keep acute distress from calcifying into chronic psychiatric disorders. That the theme for this year’s World Mental Health Day, observed annually on 10 October, was ‘Mental Health in Humanitarian Emergencies’ underscores why accessible mental healthcare needs to be made an essential part of emergency response.
“Early recognition of discomfort stops intense feelings from becoming chronic psychological injuries. Establishing safe spaces for people to express their feelings of fear, rage, or sadness before they solidify into silence or retreat is known as ‘healing within the golden window’," says psychologist Kshama Dwivedi, director, Swami Vivekanand Group of Institutes, Bhopal. Restoring human connection and reassuring survivors that they are not alone are the main goals, she adds.
EARLY SIGNS OF TRAUMA
The National Disaster Management Authority (NDMA) updated India’s guidelines on mental health and psychosocial support in 2023, formally folding emotional triage into the architecture of relief. The document urges early assessment, rapid psychosocial support teams and mechanisms for referral — “a ladder of support" from community-level helpers to specialist care.
This year, we witnessed destruction first-hand in Dehradun’s Dharali, recall Anand and Usha Mathur, an elderly couple from Delhi who were visiting relatives in the hill station. “We couldn’t even reach their home, and what we saw still shakes us — a wave of mud, water, and rocks swallowing everything in its path. I lost my wife for a day in the chaos. In the relief camp, everyone was focused on safety, food, and drinking water. We didn’t even think of the psychological impact. But once we returned home, my wife withdrew completely. She didn’t speak for weeks," says Anand.
In the wake of trauma, many survivors describe feeling “numb" or “detached"—a temporary pause that can help them cope with overwhelming shock. When that numbness deepens into disorientation, withdrawal, mutism, flashbacks, or sleep disturbances, it may signal emerging psychological distress, notes Anuvinda Sadananda, consultant psycho-oncologist and mental health professional, Apollo Hospitals, Bengaluru. “Other red flags include irritability, hostility, emotional outbursts, hopelessness, or suicidal thoughts. Routine psychological screening during relief operations is crucial to distinguish normal coping from early signs of trauma that require professional care," she stresses.
LESSONS FROM KERALA
For Neenu Rathin, founder of The Social Town, the 2018 floods in Kerala were a firsthand case study in understanding the importance of psychological support in disaster relief. Recalling how government call centres were quickly overwhelmed in the aftermath of the disaster, she says, “We mobilized people with counselling experience, created new helplines, and shared numbers widely so anyone in distress could reach a trained volunteer." Rotating shifts ensured someone was always available to listen—a model later revived in the state during the pandemic to support frontline health workers.
This model adopted by Kerala stood out for its empathy. Remembering the difficult days, Rathin says, “It was Onam. The government organized feasts, distributed clothes, even set up games and libraries. Camps became hopeful, communal spaces." This example echoes psychologist Dwivedi’s belief that effective recovery, following a disaster, begins within the community. “When official teams leave, continuity lies with those who stay—local leaders, teachers, and volunteers trained in basic psychosocial support. Shared meals, community storytelling, and group conversations can often do more to rebuild resilience than any single intervention."
Going back to Kerala, a community-based study conducted across Pathanamthitta, Alleppey, and Kottayam districts in 2024 and published in the Indian Journal of Psychiatry in April that year, found that nearly half of the survivors of the devastating floods showed symptoms of post-traumatic stress disorder (PTSD). About 49.7 percent of 600 adults screened positive for PTSD three months after the floods, the study claims. While more than 90 percent of respondents took shelter in relief camps, the researchers noted that structured psychological support was “minimal and uncoordinated."
Rathin who is only too familiar with the scene on-ground rues, “There just aren’t enough psychologists on the ground, and network issues often make helplines unreliable." In comparison to Kerala, PTSD rates after floods in Uttarakhand in 2013 were 67.7 percent and 60 percent in Kashmir in 2014. While the figures may be more than a decade old, they point to a persistent national blind spot: India’s disaster response continues to rebuild infrastructure faster than minds. It’s high time things changed.
HELP ON THE GROUND
An effective early psychological response must be multilayered, coordinated, and rooted in the community. As mental health expert Anuvinda Sadananda explains, the first few days are crucial for restoring a sense of safety and connection.
Who needs to be involved? Mental-health professionals including psychologists, psychiatric social workers and counsellors, trained community volunteers and frontline health workers, local government and NGO representatives.
Training essentials: First responders need to be trained in psychological first aid (PFA), crisis communication and active listening, recognizing red flags for trauma or suicide risk and delivering culturally sensitive and ethical care.
Core interventions by first responders need to:
- Secure safety and basic needs of victims.
2. Offer emotional grounding and reassurance.
3. Reconnect survivors with family, community, or faith networks.
4. Identify high-risk groups — children, elderly, widows, those with prior mental illness.
5. Set up referral and follow-up pathways for professional care.
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
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