Table 3

The strategic, seven-step model of community care

StepActionNature of actionPurposeTimescale
1Strategic planning, mitigation and preparationComprehensive multiagency planning, preparation, training and rehearsal of the full range of service responses are required in advance of events.Preparedness, prevention, risk communication and mitigation before events occur to prepare services and staff, and reduce risks of distress and mental disorder through developing the resilience of all natures of communityBefore events and continuing afterwards
2Public prevention programmes to develop communitiesWhenever possible, prevention services intended to develop the psychosocial resilience of communities, families and workplaces are planned and delivered in advance.
3Universal and selective psychosocial interventionsFamilies, peers and communities are supported in providing programmes of response to people’s psychosocial needs in the aftermath based on the principles underpinning psychological first aid (PFA).24 25Universal interventions are offered to everyone affected.
Selective interventions are offered to people who, on the basis of the risk factors they face, appear to be at greater risk of persisting distress and/or mental disorders.
Immediately after events begin and continuing thereafter
4Community support and developmentInterventions include activities intended to sustain communities, restore their cohesion and develop their abilities to deliver social support through, for example, leadership, and restoring activities in schools and communities.
Families and communities should be provided with routes by which they can draw the attention of health and social care services to people in need.
Delivering public welfare, social and public mental healthcare paradigms of response to meet groups and communities’ psychosocial needs as soon as events occur and restore their agency
5Monitoring and signposting for people in need to welfare, health and social care servicesServices are established to initiate mental health assessments and monitoring to identify, after the immediate aftermath of events, unmet needs of people whose distress is sustained by secondary stressors and people who need personal assessments in case they have emerging or recurrent mental disorders.23Personal health assessment to identify people with unmet needs:
  • whose distress is sustained by secondary stressors;

  • who require continuing monitoring;

  • who need referral for personalised services and provision of indicated psychosocial interventions or mental healthcare, as appropriate.

After 4–6 weeks and continuing into the medium and longer terms
6Augmented primary health and social carePrimary health and social care services are augmented in the aftermath and medium term after disasters to provide assessment, monitoring and intervention services for people who do not recover from immediate and short-term distress or develop problems later.Delivering personalised psychosocial, health and social care paradigms of assessment and interventions for people who need or may need primary mental healthcare or specialist mental healthcareMedium and longer terms (ie, from 4 weeks)
7Specialist mental healthcareHealthcare strategists should ensure there are routes that are negotiated with and promulgated to primary healthcare, social care and education services for people who require specialist mental healthcare to be referred with minimum delay.Medium and long terms
  • Reproduced with the permission of the copyright holders, WilliamsR and Kemp V.