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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT August 30, 2002 "The greatest test of courage is to bear defeat without losing heart." - R.G. Ingersoll
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Basic and Advanced Critical Incident Stress Management Workshops
November 22-23, 2002
Casper, WY
Co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd Snowy Range A.S.I.S.T. CISM Team"Religious Aspects of Domestic Violence" November 24, 2002
Casper, WY
co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd The Governor's Domestic Violence Elimination (DoVE) CouncilFifth Annual Innovations in Disaster Psychology Conference
"Psychosocial Reactions to Terrorist Attacks"
Sept. 29-Oct 1
Location: Radisson Hotel
Rapid City, South Dakota
4th World Congress on Stress
September 12-15, 2002
Edinburgh, Scotland
UNITED KINGDOM
Contact: Northern Networking Ltd
1 Tennant Avenue
College Milton South
East Kilbride, Glasgow G74 5NA
Scotland, UK
Tel: 44 (0) 1355 244966
Fax: 44 (0) 1355 249959
E-mail:
stress@
glasconf.demon.co.ukTENTH ANNUAL
SANTA FE SYMPOSIA
nine different weekend symposia
on a variety of mental
health topics.
October 11-27, 2002
Faculty includes:
Institute for Meditation &
Psychotherapy: Bill O'Hanlon,
Donald Meichenbaum,
Peter Tanguay and others.
For more information
and a brochure, contact:
New England
Educational Institute
92 Elm Street APA502
Pittsfield, MA 01202
Tel: (413) 499-1489
Fax (413) 499-6584
E-mail: educate@neei.org; Web: www.neei.org27th Congress of the World Federation
for Mental Health
Melbourne, AUSTRALIA
February 21-26, 2003
Contact:
ICMS Pty Ltd (Congress Secretariat)
84 Queensbridge Street
Southbank VIC 3006, Australia
Tel: 61 3 9682 0244
Fax: 61 3 9682 0288
E-mail: wfmh2003@icms.com.au89th International Conference:
Stress and Depression
October 20, 2002
Milan, ITALY
Contact:
Istituto di Psicologia
Clinica Rocca-Stendoro
Corso Concordia 14
Milan 20129, Italy
Tel/Fax: 39-02-782627
E-mail: ist.roccastendoro@libero.itSeventh World Congress
on Stress, Trauma & Coping,
"Crisis Intervention in Baltimore, MD
a Changing World"
February 12-16, 2003
Call For Papers:
http://www.icisf.org/cfp.pdf Deadline: September 3, 2002
Proposal Form:
http://www.icisf.org/ presentation%20proposal%20form.doc
ILLNESSES HINDER LOW-INCOME FAMILIES' ECONOMIC SECURITY
In a study of 254 low-income families in three U.S. cities, 52 percent report concurrent physical and mental health problems in both the primary caregiver and at least one of the children in the household. In addition, the separation of welfare assistance, Medicaid and health insurance programs has created major challenges for recipients to obtain and keep a lasting job--a key goal of welfare reform, researchers say. Linda Burton, professor of human development and family studies and sociology at Penn State, says that the health problems of parents and children appear to be integrally linked, and that solutions developed by policymakers should address both economic and health issues of families. Burton and several colleagues presented their analysis -- part of a larger study of 2,400 families by experts at eight universities -- earlier this month at an American Sociological Association meeting. For the full story, visit: http://www.psu.edu/ur/2002/welfarereform.html
PROGRAM TO COMMEMORATE SEPT. 11 ANNIVERSARY, REMEMBER ALUMNI
Penn State officials have planned an University-wide observance of the one-year anniversary of Sept. 11, including a remembrance of the 10 known Penn State alumni who lost their lives in the terrorist attacks on New York and Washington and the hijacked airline crash in Shanksville, Pa. The solemn interfaith ceremony, organized by a committee of Penn State students, faculty, staff and local officials, will begin at noon on Wednesday, Sept. 11, in Eisenhower Auditorium on the University Park campus. Doors will open at 11:30 a.m. For the full story, visit: http://www.psu.edu/ur/sept11/
As One-Year Anniversary of 9/11 Attacks Approaches, Federal and State Programs Continue Assisting Individuals, Families and Businesses
Nearly one year after the World Trade Center attack, Federal Emergency Management Agency (FEMA), U.S. Small Business Administration (SBA) and New York State Emergency Management Office (SEMO) disaster assistance for New York area households and businesses has exceeded $673.6 million. For mor, visit: http://www.fema.gov/diz01/d139/n143.shtm
DISPATCH FROM THE WORLD SUMMIT: POVERTY AND ENVIRONMENT LINKED
The following dispatch comes from Adam Kapp, a psychology major from West Chester and one of 14 Penn State Schreyer Honors College students who are in Johannesburg, South Africa, attending the United Nations-sponsored World Summit on Sustainable Development as part of an international academic experience led by Amy Glasmeier, professor of geography: Currently, we've been here for seven days, and we still have a few days left. Over the last two days, we've all had a chance to participate in excursions with the Environmental Justice Network, visiting sites and learning about the connections between poverty and environmental degradation. My trip took us to a township where a now-defunct mining operation has created massive, unpredictable sinkholes as well as underground fires that spew toxic chemicals into the air within sight of a hospital and in the path of children going to and returning from school. There are many serious issues to be addressed by the United Nations at this summit, and striking a balance between the three emphases here--people, planet, and prosperity--will be a Herculean task for the U.N. delegates. However, surrounded by the natural beauty of the South African landscape, I have hope that the representatives may yet realize that it is the very life of the planet that is at stake. For the full dispatch, visit: http://www.psu.edu/ur/dispatch/southafrica
A listing of the top ten natural disasters affecting the United States as ranked by FEMA relief costs. http://www.fema.gov/library/df_8.shtm
Hurricane Andrew - Ten Years Later
Ten years ago, Hurricane Andrew swept through Florida before moving on to Louisiana, severely impacting hundreds of thousands of people along the way. Hurricane Andrew still remains the most costly natural disaster in U.S. history with more than $30 billion in damages. Hurricane Andrew is also only one of three Category 5 hurricanes to ever come ashore in this country. In addition to Hurricane Andrew, 10 years ago this week Hurricane Iniki, slammed Kuaui, Hawaii, and Typhoon Omar hit the island of Guam making the last week in August 1992, one of the most disaster impacted weeks in our nation’s history. For further information, visit: http://www.fema.gov/hurricaneandrew.shtml
A hurricane is a tropical storm with winds that have reached a constant speed of 74 miles per hour or more. Hurricane winds blow in a large spiral around a relative calm center known as the "eye." The "eye" is generally 20 to 30 miles wide, and the storm may extend outward 400 miles. As a hurricane approaches, the skies will begin to darken and winds will grow in strength. As a hurricane nears land, it can bring torrential rains, high winds, and storm surges. A single hurricane can last for more than 2 weeks over open waters and can run a path across the entire length of the eastern seaboard. August and September are peak months during the hurricane season that lasts from June 1 through November 30. For more, visit: http://www.fema.gov/hurricanes/whatis.shtm
NEWS ARTICLES ONLINE WASHINGTON - U.S. Plan to Restrict Foreign Planes http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020829/ap_on_go_ca_st_pe/flight_ban_1
CDC says they're prepared to handle bioterrorism. http://www.cnn.com/2002/HEALTH/08/28/bioterrorism.cdc.ap/index.html
NEW YORK - 2 men thought dead since 9/11 found alive. http://www.sunspot.net/news/custom/attack/bal-te.missing28aug28.story?coll=bal%2Dhome%2Dheadlines
WASHINGTON - Airline Passengers Will No Longer Be Asked Security Questions. http://ap.tbo.com/ap/breaking/MGAKOYRXF5D.html
International PAKISTAN - Pakistan warns of terror threat around 9/11 http://www.sunspot.net/news/custom/attack/bal-pakistan911-28.story?coll=bal%2Dhome%2Dheadlines
IRAN - Iran arrests "100 terrorists, 50 spies," says intelligence minister. http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020827/ap_wo_en_po/iran_arrests_2
GERMANY - German Foreign Ministry creates anti-terror department. http://www.irna.com/en/head/020828200844.ehe.shtml
MENTAL HEALTH ROLES IN THE EMERGENCY OPERATIONS CENTER
Part 1
In times of serious emergencies and disasters organizational coordination and communication are required beyond that needed in more routine situations. The Emergency Operations Center (EOC) facilitates this ommunication. The EOC is usually under the jurisdiction of the local gevernment. The jurisdiction's emergency management office is responsible for its maintenance and operation. If the disaster needs escalate beyond the capacity of local resources, the governor may be requested to declare a state level of emergency. At this point, state resources are made available to the local jurisdiction. In such a situation, a state EOC may be activated. An EOC is activated, operated, and closed according to a preplanned set of policies and procedures (Herman, 1982).
The EOC is usually a predesignated site or facility. It is equipped and supplied prior to the need for its operation. It is located away from the disaster scene, usually in or near gevernmental offices in order to have access to needed records and resources. Many older EOCs are located underground with construction designed to protect the facility from radioactive as well as natural and technological hazards. However, there is no longer a perceived need for this. Most newer EOCs are built above ground. EOCs are usually designed to be self-sufficient for a reasonable period of time with provisions for electricity, water, sewage disposal, ventilation, and security. Food storage, preparation, and serving facilities are desirable, as well as a bunk room or cots for tired personnel. The EOC may have different rooms and areas for different functions.
Ideally, each organization or agency has a clearly designated worksite with communication equipment and status boards for recording information pertinent to the organization's area of responsibility. For example, social service/shelter operations will maintain a status board listing sites of open shelters and numbers of occupants and staff.
The EOC is different from a command post in two respects. First, the EOC is not usually at the site of the event or incident. A command post is a facility at the scene of an emergency or disaster where site operations are directed. There may be multiple sites of impact and multiple command posts. Each command post has direct communications with the EOC. Second, the EOC facilitates overall, system-wide coordination of response among many disaster organizations. It does not focus on detailed operations at specific sites.
EOC Functions
Functions of the EOC include information management, situation assessment, and resource allocation. These functions include:
1. Providing a common location of operation for individuals having top management responsibilities during the response and early recovery phase; providing centralized direction and control.2. Ensuring clear delegation of responsibility and authority and establishing a clear chain of command.
3. Serving as the single point for collection, evaluation, display, and dissemination of information; ensuring that decision makers in the EOC and in the field have adequate and accurate information.
4. Coordinating personnel, supplies, and equipment on a priority basis.
5. Providing communication and direction to external response agencies.
6. Assessing the need for additional assistance such as mutual aid or requests to the governor for state and/or federal assistance.
7. Ensuring that affected populations are evacuated and sheltered.
8. Monitoring the situation and relaying warnings to local officials and the public.
9. Providing accurate public information and rumor control.
Incident Command System in the EOC
In order to be able to carry out their diverse responsibilities and activities, EOCs must have a system in place. The strategy most commonly used is the Incident Command System (ICS). ICS is an on-scene emergency response system developed by the fire service and is being increasingly integrated into other emergency organizations and private industry. It provides for basic direction and control, including decision making and coordination among multiple agencies (Drabek and Hoetmer, 1991). it provides a chain of command which adapts to emergency events both large and small. Additionally, it provides a common management terminology during times of stress (Russell, 1991).
It is an organizational structure which is divided into four sections: operations, planning, logistics, and finance. Planning involves acquiring information about current and future situations. Operations directs activities to reduce the immediate hazard and to maintain and/or restore essential functions. Providing for all support needs such as food, communications, medical supplies, etc. is the responsibility of logistics. Finance tracks all costs. The functions can be performed by separate individuals simultaneously, or one individual can perform two or more functions (Russell, 1991).
EOC Staffing
The characteristics of the community, the size and scope of the emergency, and the phase of the response determines which individuals need to be in the EOC at any point in time. Individuals who are needed in the EOC in the early stages of the emergency might not be the same people needed during later stages. In the early stages, the EOC will likely be operating 24 hours a day. This requires coverage for multiple shifts.
Though the local government has overall responsibility for disaster response, a variety of other public, private, and voluntary agencies may be represented. Groups which are commonly represented include:
1. Elected officials and top appointed officialsEOC representatives may be of two types: those with emergency decision-making responsibilities and those who serve a liaison function with other agencies and jurisdictions. It is vital that EOC representatives responsible for decision-making come from the top levels of management, representing the top person or second-in-command in their organization (Herman, 1982), or have been authorized to make decisions on top management's behalf. Coordination can be hampered when representatives at an EOC lack the full authority to make command and coordination decisions. Unfortunately, those assigned to the EOC often represent middle management levels of their organizations. Mid-level managers often do not have the authority or experience required for emergency decision-making. It is essential that the EOC representative have in-depth knowledge of the capabilities of his/her organization and how its resources can best be activated. Retrospective analyses of emergency operations have shown that each representative must have sufficient rank and authority to make immediate, high-level policy decisions (Auf der Heide, 1989). In a declared emergency, the local emergency ordinance can give mid-level managers the necessary authority.2. Office of Emergency Services personnel
3. Public safety (local and state police, county sheriff, fire, emergency medical services, 911 communications)
4. Public works
5. Public health
6. Mental health
7. Social service/shelter operations (including public social services, American Red Cross, Salvation Army, etc.)
8. Coroner
9. Schools
10. Public utilities
11. Public information officer
12. Amateur radio volunteers
13. Resource procurement personnel
14. Finance personnel
15. Support staff (food, janitorial, clerical, stress-management)
The EOC is likely to have one or more support staff who provide services and supplies that keep the organization running. These staff may provide clerical support, switchboard functions, food and beverages, maintenance and janitorial services, and stress management.
Ideally, each agency represented at the EOC should use a team approach to manage shift coverage and any unexpected leave of absence. Orderly rotation of personnel is essential for decreasing the probability of dangerous errors due to fatigue. Additionally, a team approach acknowledges the value of rest and interdependency as characteristics of successful emergency management.
Shift change procedures should ensure communication and continuity between shifts. New shifts should be briefed on operations of the prior shift. An action log can provide the incoming shift with brief written documentation of decisions and activities of the prior shift.
Mental Health Role in the EOC
Not all jurisdictions' emergency plans call for a mental health representative in the EOC. Most municipal jurisdictions do not have a mental health department. In many county and state jurisdictions, mental health is a division of a larger department, such as Health Services or Human Services. In such cases, emergency plans often call for the department head to be present in the EOC. Mental health, as a subordinate division, is not represented.
It is, however, strongly recommended that emergency management plans include a decision-making representative of mental health in the EOC. Representation legitimizes the importance of mental health's role both in the EOC and in the community-wide recovery efforts. It ensures that mental health resources are used appropriately.
The mental health EOC representative should be an individual who is specifically knowledgeable in the field of disaster mental health. This individual must also have the authority to make key decisions. he/she must have access to the most accurate information available in order to deploy mental health resources most efficiently and effectively. This individual must also be aware of decisions and actions of other agencies with whom mental health must coordinate efforts. He/she must also have information about decisions of other organizations that may affect mental health operations. Examples include such things as road closures that will affect mental health's access to an area, or the opening of additional shelters that will require mental health staffing. In addition, mental health expertise may be important to other key decision makers when there are mental consequences of particular decisions or actions. For example, a decision to provide mass shelter in separate facilities for men and women will violate the basic disaster mental health principle that families are a key source of stability for individuals, and family units should remain intact.
In the EOC, the mental health work station should be situated close to representatives from public health, emergency medical services, social services, the Red Cross, and schools. In some EOCs, these functions work together at the same table or in a room designated specifically for them. Mental health will also need to work with the coroner if there have been deaths, in order to ensure outreach and emotional support to the bereaved and, in some cases, to the coroner's staff. The disaster mental health plan may call for mental health to provide support to first responders in the field (fire, EMS, law enforcement). If so, the mental health EOC representative should work in close coordination with first responder representatives in the EOC to ensure that services are delivered where needed.
The responsibility of the mental health representative is to make decisions about priorities and resource allocation, in coordination with other agencies represented. He/she also serves as advisor to the top official in charge of the EOC (usually the County Administrative Officer or the Office of Emergency Services Director).
The mental health representative in the EOC provides overall direction of the disaster mental health response. His/her responsibilities are executive in nature. They are designed to develop. direct, and maintain a viable organization and to keep that organization coordinated with other agencies, elected officials, and the public. As outlined by Auf der Heide (1989), these responsibilities include:
1. Organizing to meet the needs of the disaster.in all but the smallest jurisdictions, the mental health system will need a disaster services field coordinator who will function outside the EOC. This will most likely be at the mental health administrative office or alternate location. It is the responsibility of this coordinator to manage the deployment of staff and provision of services in the field according to the directives of the EOC representative. This coordinator isresponsible for keeping the EOC representative informed of mental health activities and needs for personnel, supplies, and equipment. The field coordinator also feeds information about conditions in the field back to the EOC.2. Establishing disaster mental health response objectives.
3. Setting priorities for work accomplishments.
4. Approving resource and personnel orders and releases.
5. Approving public information outputs.
6. Coordinating with agencies and public officials.
in very large mental health organizations, the EOC representative and field coordinator may require additional coordinators for planning and logistical functions. A planning coordinator collects data and provides the coordinator and EOC representative with information about the incident. Information includes status of resources, status of situations, and estimates of future needs for the coming days and weeks. The planning coordinator may also conduct planning meetings, prepare alternative strategies, and compile action plans. The planning coordinator collects data for and may prepare grant applications to FEMA for a Disaster Crisis Counseling Grant as authorized by PL 100-707, Section 416.
A logistics coordinator handles the pragmatic aspects of deploying personnel, equipment, and services in the field. This includes providing the services that "keep the organization going", such as communications, food, shelter, security, and debriefing for mental health staff in the field. Additionally, the logistics coordinator ensures adequate facilities, supplies, service equipment, and other resources needed by staff in the field to conduct their business (Auf der Heide, 1989). In very large-scale disasters, military support may be necessary to provide logistical support.
Communication between the EOC and mental health staff in the field may be hampered if phones are inoperable. Cell phones may be valuable in areas with such service. Mental health might also consider establishing a cooperative agreement with amateur radio ("HAM") groups. Many of them routinely provide radio communication for such groups as the Red Cross. With such an agreement, radio operators at the EOC and key mental health locations could provide the needed communication linkage.
Mental Health Support in the EOC
Drabek and Hoetmer (1991) state that "No kitchen generates the kind of heat found in the EOC." The social and psychological context within which life and death decisions are made generates pressure that is immense.
There is an ever-present need to take immediate action to prevent or alleviate human suffering and physical destruction. This pressure is intensified by scrutiny of the media and public officials. The pressures are increased further by the shortage of time: during the disaster, decisions must usually be made quickly if they are to have any effect at all.
The climate of the EOC is also influenced by limited, uncertain, rapidly changing, and often conflicting information. Available information tends to be partial and imperfect.
Priorities for action may shift rapidly as new information is presented. The principle priorities for emergency management are to minimize loss of life, personal injury, and property damage. The actions that support these priorities, however, may change during the course of the event. For example, a levee may fail during a river flood, endangering a different part of town. A previously safe shelter may become damaged in earthquake aftershocks, requiring the opening of a new shelter and the movement of evacuees.
Additionally, the EOC climate embodies the stress that arises from overlapping lines of authority and responsibility. Inter-organizational relationships in disaster necessitate resource sharing and collaborative dependence. If authority or responsibility is unclear, performance may be slow when time pressures are great and response demands are high. The potential for conflict and frustration is high both in the EOC and in the field.
Drabek and Hoetmer (1991) further describe some of the unique stresses that affect emergency personnel in the EOC. Staff literally cannot move around much. They are often confined to a table or work station and its communication devices. They receive information about the entire scope of the disaster, no matter where it occurs. Therefore, they are acutely aware of the extent of loss and suffering. They have no direct contact with disaster victims and cannot look an individual in the face and feel personally responsible for providing help.
Essentially, the EOC climate is high-pressured and emotionally charged. The level of stress must be managed if reasonable and effective decisions are to be made quickly. Training, planning, and regular exercises or drills can prepare staff to function in such an environment. Additionally, a pre-planned stress management component provided by experienced disaster mental health workers in the EOC can help personnel to manage stress so that it does not interfere with functioning.
Stress Management
In addition to the executive role of mental health in the EOC, mental health representatives may provide a support function to EOC staff through the provision of stress management interventions. Such support may be in observing, advising, and intervening with disaster-related stress among the EOC personnel.
If the EOC isn't too hectic, the decision-making representative may wera two hats and may provide this support. However, in disasters of large size or long duration, the decision-making representative will be too busy managing the mental health response to the disaster to provide stress management services in the EOC. It is recommended, therefore, that a mental health staff member(s) skilled in stress management be assigned as support staff to the EOC. It is preferable that these individuals have had training and experience in disaster mental health.
The role of mental health support staff must be understood by other staff in the EOC. It is ideal that the staff member be introduced and his/her role explained by the top official in charge of the EOC. It would be helpful for the mental health representative to write the script for the EOC director. This will help ensure that the role is accurately and appropriately defined. It communicates that the role is seen as important and that it has the sanction of the person in charge.
Managers who have EOC responsibilities in disasters should have pre-disaster training regarding disaster worker stress management. THey should be aware of the common stressors affecting managers of disasters and to the stress reactions they are likely to experience. Stress management and coping strategies which are effective in such settings can be taught. Policies and procedures need to be established pre-disaster to help mitigate stressors and to help personnel manage their own stress and fatigue. For example, the recommended policy for rest periods is one break every two to four hours. It is recommended that shifts be no longer than 12 hours in duration followed by 12 hours of time off. If possible, a full 24-hour day off should be scheduled after each seven-to-ten day shift of work. These policies should be explained as proven standards that enable personnel to function at a higher level of effectiveness for a longer period, Coverin these policies and procedures in pre-disaster training can instill them as a normal part of the EOC routine. It can also prevent personnel from feeling unfairly singled out when a break is suggested during EOC operations (Mitchell and Bray, 1990).
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REFERENCES Auf der Heide, E. (1989). Disaster response: Principles of preparation and coordination. St Louis, MO: C.V. Mosby Co.
Drabek, T.E. and Hoetmer, G.J. (Eds.)(1991). Emergency management: Principles and practice for local government. Washington, DC: International City Management Association.
Herman, R.E. (1982). Disaster planning for local government. New York: Universe Books.
Mitchell, J.T. and Bray, G. (1990). Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood Cliffs, NJ: Prentice-Hall, Inc.
Russell, P. (1991). Hospital emergency incident command system. County of Orange Health Care Agency, CA.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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