Two months have passed since 112 people were killed when their plane plunged into the sea off Dalian of northeastern China's Liaoning Province on May 7.

"The air disaster itself was over in a matter of days. But in terms of mental pain for the families of victims, it may just be beginning," said Wang Xiangdong, professor of psychiatry at the Institute of Mental Health, Peking University.

Wang was in Dalian attending the 4th Asia Pacific Psychopharmacology Workshop, when the air disaster occurred.

Wang joined two colleagues, Ma Hong and Lu Qiuyun, in rescue work just 24 hours after they were asked by the Janssen Pharmaceutical (Xi'an) Ltd, a joint-venture in China. Three employees of the company, who were flying to Dalian ahead of the same workshop, were among the dead in the crash.

"The relatives and colleagues of the three victims were shaken by the event, but they showed different levels of psychological problems such as emotional numbness, resentment, shame, anxiety, tension and hopelessness," Wang said.

"Some of them didn't eat and drink and had difficulty falling asleep at night."

It turned out the professors had to offer counselling to more than 30 members of staff of the company and the three victims' families two days after the disaster.

The staff said the counselling helped them come to terms with their grief.

Within a few days relatives of victims calmed and became stoic in the face of their adversity. They flew three beautiful kites that carried words and grief for their loved ones to Heaven.

"Mum will read my letter, and she will no longer feel lonely there," an 11-year-old boy said while pointing to the sky.

"It was a pity that we were only invited by the company so we could not help more people," Ma Hong said.

They failed to get approval from local authorities to get in touch with more relatives of the victims. They were told there were no precedents or regulations to allow mental health experts to become involved in disaster relief work.

In the end, they were allowed to give a two-hour training lecture to clinicians of a local psychiatric hospital prior to their return flight to Beijing taking off, according to Ma.

But the media showed great enthusiasm in this "new" type of disaster relief work.

"I was surprised, encouraged and moved when I found reporters, both national and local, closely following us and trying to understand the whole meaning of what we were doing," Ma said.

"It was not our first involvement in disaster relief work, but it definitely was the first time that we felt the public concern. Perhaps this will help to arouse public awareness in promoting mental health rescue work in disaster relief efforts," she added.

Just a beginning

Experts in psychiatry admitted that post-disaster psychiatric intervention in China was only just beginning, though many of them have conducted a great deal of research on it.

"Post-disaster psychiatric intervention is only a 'baby' in China," said Wang.

According to official statistics, about 200 million Chinese people are affected by man-made and natural disasters, such as earthquakes, floods, hurricanes, tornadoes and wildfires every year.

But just 300 from 15,000 psychiatric practitioners in China have received professional training in post-disaster psychiatric intervention.

"But that is not an excuse for us to ignore its importance," Wang added.

"Faced with the possibility of losing children, parents, homes, possessions and even communities, each person involved risks behavioural and emotional readjustment problems.

"Without early psychiatric intervention or none at all, it often takes longer for people to recover from trauma; some of them just cannot recover."

He said 'help' was a better description if people viewed the word 'intervention' as too academic.

"As well as medical treatment and financial compensation, people's hearts and feelings should also be looked after."

Government support

Wang and some other professors began their work in post-disaster psychiatric intervention in 1994, when a fire in a cinema killed 323 people, 288 of them children, in Karamay in northwestern China's Xinjiang Ugyur Autonomous Region.

"Rescue workers found themselves in a fluster when they wanted to comfort families of victims and the local government appeared powerless when facing grief-stricken crowds, so they called Beijing for help," recalled Lu Qiuyun, who went to Karamay with Ma Hong at the invitation of the Ministry of Public Health as the first team of mental health experts.

Lu still remembers the raspy screams of a woman who lost her elder son in the fire.

"She refused to eat, drink or sleep. She just walked on and on in the room, crying and screaming," Lu said.

Lu noticed that the younger son of the woman was holding a glass of water and watching his mum carefully all along.

Lu told the woman: "Look at your younger son, he is growing and getting to know how to take care of his mother."

The woman gradually calmed down after hearing these words.

Lu also gave her some medicine that would help her to fall asleep.

Equally unforgettable for Lu was the happy face of the younger son behind the door during Lu's second visit to the family. "My mum is getting better!" the little boy exclaimed.

The month-long intervention in Karamay went smoothly with the support of the local government, said Ma Hong.

But the professors' voluntary help were refused by the local government in Luoyang of Central China's Henan Province, where 309 people died in a fire during a party on December 25, 2000.

They were only allowed to talk to some rescue workers whom they also found in need of help.

"Those workers took charge of sterilizing the bodies and placing them in the morgue. Later they reported the sight of deep rouge lips reminded them of the deaths," Ma said.

"We still need official access to get involved in disaster relief work," said Wang, who is working out a plan for placing psychiatric support into China's disaster relief system.

"A detailed plan can be expected within a few years."

Methods and rules

Being authoritative psychiatrists, Wang, Ma and Lu still feel they are treading on thin ice when involved in rescue work.

"In every disaster, every one of the people involved is unique," said Wang.

"We cannot just follow the guidance of books when offering treatment. Sometimes we need more flexibility to act according to circumstances."

As well as many successful cases of individual intervention, critical incident stress debriefing is another useful method and it is proved successful in developed countries.

It is a kind of group intervention in which all the members are able to discuss what has happened, each from his or her own perspective.

Hearing each other's perspectives enables people to get a better mental and emotional understanding of an entire event. More importantly, they learn what to expect of their reactions, according to Lu.

"One principle is to normalize people in distress," Lu added. "They are generally healthy people who are having normal responses to an abnormal situation."

Two national training courses on post-disaster psychiatric intervention for local psychiatric clinicians were held in April last year and this June.

"For rescue workers, health care workers, journalists and volunteers who may come into contact with traumatized survivors, basic knowledge of traumatic stress is needed," Wang said.

"It will help to be more sensitive to a disaster victim's need to feel cared for and respected."