Seeing Trauma, Missing Lives: Reworking Psychological First Aid through Participatory Action Research In Post-Disaster Taiwan

Introduction: Following typhoon-triggered landslide flooding that devastated the Indigenous Fata’an village in southeastern Taiwan in fall 2025, civilian-led relief efforts mobilized rapidly. Interdisciplinary teams of mental health professionals—including social workers, psychologists, and psychiatrists—provided psychological first aid and early support. Guided by dominant disaster mental health frameworks, we—working with the Taiwan National Union of Social Workers (TNUSW)—initially aimed to identify survivors with probable post-traumatic stress disorder (PTSD) and refer them to formal care. However, through our field engagement, we encountered a growing mismatch between standardized conceptualizations of trauma and survivors’ lived experiences. This disjuncture prompted us to critically examine how trauma is recognized, constructed, and addressed in post-disaster Indigenous communities in rural Taiwan.

Methods: This participatory action research (PAR) is grounded in our frontline intervention and reflexive field inquiry across two sites: (1) home visits to residents identified as potentially traumatized and (2) psychiatric outreach encounters involving brief screening and diagnostic interviews. Our data sources include the first author’s reconstructed field chronology, case records maintained by the TNUSW (approximately 1,200 households visited and 150 referrals processed), photographs, and our field notes. Through iterative cycles of action and reflection, we analyzed these materials thematically to examine how Taiwan’s public health system, social work organizations, psychiatric services, and volunteer networks interpreted and responded to distress in situ.

Results:

1. Identifying Trauma: From Screening to Situated Assessment
   We found that standardized screening tools produced uniformly elevated scores in the acute aftermath, limiting their ability to differentiate levels of need. In practice, we and other frontline workers relied on contextual judgment—drawing on daily functioning, embodied symptoms, and narrative accounts—to identify cases warranting referral.
2. Governing Trauma: Fragmented Assemblages of Care
   We observed that mental health response operated as a loosely coordinated assemblage across sectors. Despite expanded coverage, service access and continuity varied across communities. The absence of shared documentation and referral mechanisms meant that survivors were repeatedly assessed across systems without receiving sustained, coordinated care, raising concerns about equitable access to meaningful support.
3. Relocating Trauma: Beyond the Disaster Event
   Through our fieldwork, we came to understand that distress often reflected the reactivation of prior adversities—such as loss and interpersonal violence—or the exacerbation of pre-existing conditions, rather than disaster exposure alone. These cases were frequently under-identified within event-focused screening approaches.

Conclusions and Implications: Our findings suggest that post-disaster mental health response functioned as a rapidly assembled yet fragmented system. Standardized screening tools proved limited in distinguishing need, while gaps in coordination across sectors constrained continuity of care. Rather than appearing as a fixed clinical category, trauma emerged in our work as situational, relational, and shaped by prior life conditions. From a participatory perspective, our experience highlights the importance of grounding assessment and intervention in survivors’ lived realities, strengthening coordination across service systems, and critically reflecting on how professional frameworks shape whose needs are recognized and addressed. These shifts are essential for developing more responsive and contextually grounded disaster mental health practices.