A keynote in two parts: The intersection of emergency management and disaster mental health, and a vision of disaster mental health that emerges from its challenges

This commentary, derived from the opening keynote address at the PreAct conference, presents two complementary perspectives on providing mental health services in the acute aftermath of disaster. An emergency management perspective emphasizes the imperative that mental health services be embedded into disaster response frameworks before crises occur; otherwise, they risk being excluded from operational response. It also warns that uncoordinated or ill-prepared responders may hinder rather than help incident management, underscoring the need for discipline, focus, and integration. From the psychiatric perspective, the challenges include working within the limited evidence base for interventions beyond Psychological First Aid, requiring humility, flexibility, and clinical judgment. Another central point is that communities that routinely address the mental health impact of daily traumas not only become more resilient to disaster but also experience less stigma and suspicion toward psychiatric care when services are mobilized post-crisis. Together, these perspectives highlight the importance of preparation, integration, and community investment for effective disaster mental health response.