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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT September 6, 2002 "You have to have a dream so you can get up in the morning." - Billy Wilder
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Basic and Advanced Critical Incident Stress Management Workshops
November 22-23, 2002
Holiday Inn
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
Holiday Inn
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
PENN STATE RESPONDS QUICKLY TO PARKING DECK COLLAPSE IN STATE COLLEGE
The collapse late yesterday (Sept. 3) of a two-story parking structure at a privately-operated State College apartment building, the Pepper Mill Condominiums, home to many Penn State students, resulted in no injuries. Among the many emergency personnel responding to the incident at 710 South Atherton Street shortly before 6 p.m. were several University teams, including Penn State Police, the Penn State Hazardous Material (HAZMAT) crew, a Life Lion helicopter crew from the University's College of Medicine in Hershey, and experts in structural engineering from the University's College of Engineering. While a number of cars were damaged or destroyed in the sudden collapse and traffic was temporarily rerouted around the area, rescue workers were able to determine that no one was trapped in the wreckage by this morning.
FOR SOME, QUALITY OF CARE MORE IMPORTANT THAN DOCTOR'S ETHNICITY
Among Puerto Rican women living in the United States, empathy and mutual respect are more important when choosing a doctor than the doctor's ethnicity, according to Penn State experts. "Only one-fifth of all Latino patients who see a Latino physician are influenced in their choice by the physician's ethnic background and only 40 percent are influenced by the ability of the physician to speak Spanish," says R.S. Oropesa, associate professor of sociology and demography. "Latino patients are attracted most by a doctor's cultural sensitivity, regardless of whether that doctor is Latino or non-Latino." Oropesa worked with Nancy S. Landale, professor of sociology and demography, and doctoral student Tanya S. Kenkre to survey 1,219 Puerto Rican women. The team presented its findings last week at an American Sociological Association meeting. For the full story by Paul Blaum, visit http://www.psu.edu/ur/2002/pricanwomen.html
TREATMENT OF ANXIETY DISORDERS WITH COMORBID DEPRESSION - Understanding anxiety with depression.
A number of studies have found that anxiety disorders commonly precede the onset of depression and that childhood anxiety disorders are often antecedents of adolescent or adult anxiety disorders or depression. Thus, identifying high-risk individuals in childhood and successfully treating childhood anxiety disorders may prevent the development of later anxiety disorders and subsequent depression. CBT for childhood anxiety disorders has been empirically supported, and treatment gains appear to be relatively well maintained over the course of at least several years. For children with severe anxiety or for those who do not respond to cognitive behavioral approaches, SSRIs or other anxiolytics may be indicated.
PSYCHIATRIC DISORDERS COMMON AMONG HCV-INFECTED VETERANS
Psychiatric disorders and problems with drug or alcohol use are more common among military veterans who are infected with hepatitis C virus (HCV) than among veterans who are not, according to a report published in the August issue of Gastroenterology.
REMEMBER HURRICANE FLOYD? This September marks the third anniversary of Hurricane Floyd that brought record-level flooding on the Neuse River and overwhelmed the City of Kinston, NC. On September 5, FEMA and the State of North Carolina will commemorate the progress made in reducing flood risks throughout the state and to stress the continued need for flood insurance.
FEMA Funds Authorized For Commissary Ridge Fire
A wildfire near Kemmerer, Wyoming is the latest to qualify for federal fire management assistance funds from the Federal Emergency Management Agency (FEMA). For more, go to: http://www.fema.gov/regions/viii/2002/r8_12.shtm
Tornado Rips Through Northwestern Wisconsin
The Red Cross is delivering disaster relief to northwestern Wisconsin where a Monday afternoon tornado destroyed downtown Ladysmith and injured dozens of residents.
Relief Community Provides Aid to India Flood Victims
The American Red Cross is working with the Indian Red Crescent Society and the International Federation of Red Cross and Red Crescent Societies (Federation) to provide relief to thousands of flood victims in India.
NEWS ARTICLES ONLINE KANSAS CITY - Water Department Asks For Street Closure To Protect Water Supply.
http://story.news.yahoo.com/news?tmpl=story&u=/ibsys/20020829/lo_kmbc/1305732TUCSON - City staging major drill in bioterror.
http://story.news.yahoo.com/news?tmpl=story&u=/azstar/20020830/lo_azstar/city_staging_major_drill_in_bioterrorDETROIT - Moroccan, Algerian men charged in terror investigation to appear in U.S. court.
http://story.news.yahoo.com/news?tmpl=story&u=/ap/20020830/ap_wo_en_po/us_attacks_investigation_1USA - Islamic cell 'had Disneyland and Las Vegas as targets'.
http://www.portal.telegraph.co.uk/news/main.jhtml?xml=/news/2002/08/30/walq30.xml&sSheet=/news/2002/08/30/ixnewstop.html
International ISRAEL - Israel 'smashes' Hamas Terror cell.
http://news.bbc.co.uk/1/hi/world/middle_east/2207888.stmBRITAIN - Airport Security stepped up for 11 September.
http://www.news.scotsman.com/topics.cfm?id=965582002&tid=1PANKISI GORGE - Georgia Troops Look For Kidnapped Businessman.
http://www.guardian.co.uk/worldlatest/story/0,1280,-1981714,00.htmlPAKISTAN - Bhutto Says Pakistan Government Has Terror Links.
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020830/ts_nm/attack_anniversary_bhutto_dc_2SWEDEN - Swedish Security Police Flies in Terror Experts.
http://story.news.yahoo.com/news?tmpl=story&u=/nm/20020830/wl_nm/airlines_ryanair_hijack_dc_2IRAQ - U.S. detects largest Iraqi military buildup around Baghdad since Desert Storm
http://www.signonsandiego.com/news/world/20020830-1512-us-iraq.htmlUnited Kingdom - Hijack arrest drama on Stansted flight.
http://www.thescotsman.co.uk/index.cfm?id=965572002
MENTAL HEALTH ROLES IN THE EMERGENCY OPERATIONS CENTER
Part 2
Mental health staff should be concerned with two levels in addressing the needs of EOC staff: (1) the individuals and (2) the environment.
Individual Interventions
The mental health role when working with individuals in the EOC is that of an observer and advisor. The mental health representative can be particularly helpful when the effectiveness of other staff members has become diminished due to fatigue and stress. Common signs to look for include cognitive difficulties such as confusion, memory problems, difficulty making calculations or setting priorities, and difficulty making decisions. People may become moody, irritable, or lose their temper. Some individuals may esperience physical symptoms such as headaches, back pain, and tense muscles. All of these are common human reactions in the abnormal situation of a disaster. Mental health workers need to assess these reactions in the context of the situation.
Myers and Zunin (1992) suggest that perhaps the most effective style of mental health intervention in an environment like the EOC is that of informally "roaming" through the worksite. This involves circulating through the work units and break areas, chatting with people, providing brief interventions, giving ad hoc stress management education, assessing the environment for stressors, and occasionally making an "appointment" to see a person individually during a break. This has been called the "over-cup-of-coffee" style of intervention, in which stress management staff simply interact in a "therapeutic" manner with personnel. It has also been referred to as MHBWA (Mental Health By Walking Around) It has been demonstrated repeatedly that emergency-oriented staff respond best to an informal structure when engaging in interactions with stress management or mental health staff.
If a worker's stress is interfering with his/her functioning or is impeding the work of the group, a short break may be helpful in returning the individual to a higher level of functioning. Fifteen to 30 minutes in a room away from the stimuli of the work environment, with some food, beverages and perhaps some brief stress reduction activities, is often all that is needed. The mental health worker should suggest a break to the worker, and accompany the worker on his/her break if the worker does not object. THis should be coordinated with the eOC manager so that coverage of the individual's functions can occur. Coverage for short breaks can be carried out by individuals with similar EOC functions (for example, one law enforcement representative covering for another). In cases where urgent decisions must be made, the break can always be interrupted.
Individual mental health interventions in such settings should be brief in nature. They are intended to return the individual to their role in the EOC. Ideally, a separate room should be available for an individual intervention. If this is not available, a brief walk outdoors or in a corridor may be used. Interventions should focus on the immediate situation and may include the following (adapted from Santa Barbara CISD Policies and Procedures, 1991):
1. ASK what is happening with the individual now. What is the worst part of the situation for them? What will help right now?There may be occasions when an EOC worker may be so fatigued or so distressed by the situation that a decision should be made to release the individual to go home. If the person is highly upset, the mental health worker will want to be sure that the person has safe transport home, and that someone be with them at home (Mitchell and Bray, 1990).2. LISTEN AND REASSURE the individual that the feelings are normal under the circumstances. Offer supportive comments. Try to provide for the worker's stated needs.
3. INFORM the worker that the purpose of the break is to get them back to work as soon as possible,
4. SUGGEST STRESS MANAGEMENT strategies that might seem appropriate, such as deep breathing, progressive relaxation, gentle muscle stretching exercises, or "self-talk". Diversionary activities such as playing cards or reading a magazine for a short while may help. Food and beverage should be suggested if the worker has not eaten for awhile.
5. LET THE WORKER REST. After chatting with the worker, the mental health worker should allow him/her some "breathing space" for 15 to 20 minutes. When checking back on the worker, mental health and the worker probably can determine whether the worker is ready and able to return to his/her work station.
Mental health staff in the EOC serve in an advisory role to the EOC director. Thay may make recommendations to the director about individual staff members who may need to take a break or be relieved of duty until they are more rested. However, mental health staff have no authority to order any of these actions. That authority rests with the individual next in command above the affected staff member or with the EOC director.
When disaster personnel are in the "heroic phase" of response, they are often not aware of the effects of stress on their functioning. Specific feedback about their performance may need to be given to convince them that they need to rest. Often, workers may resist the suggestion that they take breaks or that they need time off-duty for rest. Workers may actually need to be ordered to take breaks. This is best accomplished by pointing out that the worker's role is vitally important, and that it is essential for him/her to rest in order to return to functioning at his/her full potential.
Mental health support staff need to circulate throughout the EOC and regularly check with other EOC representatives about the welfare of their field personnel. Department heads should be reminded about the importance of policies concerning breaks, length of shifts, etc. for field personnel. Mental health staff in the EOC need to make sure that linkages betwee field personnel and field mental health staff are in place to provide appropriate mental health support. Mental health support staff should not overlook 911 operators (whether functioning in or near the EOC, oe in another facility).
Environmental Interventions
Mental health staff work with the EOC director and/or other support staff to ensure that, as much as possible, the EOC environment considers the psychosocisl needs of the workers. Consultation might concern the physical environment, staff scheduling, or support and stress management services for EOC personnel.
The EOC is the "nerve center" of disaster operations. By definition, it is hectic and noisy. Situations change rapidly. Workers must adjust continuously to new information and new crises that require their attention. Mental health workers observe the environment and its activities, and advise the EOC director of any suggestions that might reduce the stress level. Consultation might concern EOC layout, with suggestions for noise reduction, traffic flow, groupings of workers, etc. A quiet room or space where workers can get away from the bustle of the EOC on their breaks should be suggested if one is not already designated. A separate room for individual mental health interventions may also be desirable. Adequate lighting, communication devices, supplies, etc. can all help reduce worker frustrations.
Basic needs of food, clothing, and shelter must be accommodated. Regular and healthy meals, snacks, and beverages need to be emphasized. Staff should be encouraged to avoid excessive caffeine and sugar. If staff are "living" in the EOC, arrangements for showers and clean clothing need to be made. Sleeping space should be made as comfortable and quiet as possible.
One major concern for EOC staff is the well-being of their family members. Most disaster plans encourage personnel to do what is necessary to ensure the well-being of their families prior to reporting for disaster duty. This may not always be possible for the high-ranking officials designated to staff the EOC. Sometimes, disaster conditions themselves may prevent personnel from learning the whereabouts and situation of their loved ones. If a mechanism is not in place to try to locate and learn the status of family members, mental health staff should consult with the EOC director about the importance of this function.
An EOC support staff member may be assigned the sole responsibility of locating families, using suggestions of EOC personnel as to individual family members' possible whereabouts, and using whatever communication systems are available.
It's recommended that jurisdictions establish policies urging family members to contact the work site bt phone or by any other feasible means during the emergency. Additionally, the policy should require personnel to complete a chart or form with the likely whereabouts of their loved ones during various times of the day. Tranchina (1991) has noted that these policies can provide some reasonable means for organizations to assist in locating family members of staff during major emergencies or catastrophes. Knowledge of family status can help staff to perform their duties without the added burden of worrying about family members.
One major family concern for EOC representatives is the care of their children for the duration of their work responsibilities. Provision of childcare for EOC and other disaster personnel should be a high priority in order to allow personnel to function with as much peace of mind as possible. For example, the city of Oakland, California, as part of the city Emergency Plan, provides childcare on a 24-hour basis for children of emergency response personnel, including those working in the EOC. Trained childcare workers watch children at a location near the EOC, where personnel can visit their children during breaks and time-off (Renteria, 1992).
Mental health staff provide consultation to the EOC director about stress management interventions and activities for EOC personnel. Advice about scheduling of breaks and time-off can be important. Diversionary activities such as magazines, cards, or games can be provided for use during off-duty time. For example, in a busy EOC during the response to the Loma Prieta earthquake, a masseuse provided needed relief to knotted necks and shoulders.
The healing properties of humor should not be forgotten. Laughter can help break tension. It can provide relief from stress. It is not unusual for disaster jokes and cartoons to surface soon after a disaster. Disaster worksites often become decorated with cartoons that help workers keep some perspective and "lighten up" a bit in the midst of a difficult situation. Humor, however, must be used with some care. People are highly suggestible when under stress. Both workers and survivors can sometimes take things personally and may feel angry or hurt if they feel that they are personally the subject of a joke.
Pamphlets and/or video/audio tapes on stress reduction exercises should be provided. Mental health staff can help by teaching these techniques to personnel on or off-duty. Stress management "mini-breaks" can be conducted on-site during lulls in activity or during staff meetings or briefings. In 5-10 minute sessions, mental health staff can give brief talks on sources of stress, coping strategies, and stress management techniques (Myers and Zunin, 1992). They can then lead personnel through a few stress management activities, such as deep breathing or stretching tense muscles.
Mental health should also plan or provide stress management interventions for personnel after a shift in the EOC, after the EOC is deactivated, or after an individual's role in the EOC has ended. Ideally, the policies regarding these activities should be in place before the EOC is activated. Interventions and activities may include a shift-end defusing (mini-debriefing), a demobilization meeting for all personnel when the EOC is deactivated, a formal debriefing, a critique, and formal recognition of EOC staff's contribution to the disaster response.
A demobilization meeting can be provided for personnel when the EOC is shut down. Such a meeting is short in duration, about 30 minutes, and serves as a "transition" from the operation back into the world. Usually, information is given about stress and the typical signs and symptoms that people experience (Mitchell and Bray, 1990). Mental health staff emphasize stress management techniques such as eating well, getting rest and exercise, avoiding abuse of alcohol or drugs, and returning to a routine (Hartsough and Myers, 1985). Handouts on stress and its management should be given out. The person in charge, in this case the EOC director, should make closing comments, and thank personnel for their work (Ventura CISD policies and procedures, 1990; Mitchell and Bray, 1990). The meeting provides an opportunity for ventilation of feelings, but usually people are anxious to go home, and no one should be required to talk.
If the work has been highly stressful or traumatic for EOC personnel, a formal debriefing should be arranged for all EOC personnel who wish to attend. A debriefing is a meeting, led by a mental health facilitator with special training in the technique, which provides an organized approach to the management of stress responses in emergency services (Mitchell, 1983). The mental health staff member who has been working in the EOC will probably have become an "insider" to the EOC team. Debriefers should not have been participants in the situation they are debriefing. An outside facilitator should be used, and the EOC mental health personnel may attend the debriefing as "debriefees".
Different from a debriefing, but often equally important, is a critique of the operation. While a debriefing focuses on the psychological and emotional responses of workers, a critique is a meeting for analyzing and evaluating the effectiveness of the operation and recommending changes in policy and procedures for the future. Calling a critique is the responsibility of the EOC director. Mental health may suggest and encourage a critique, and may provide a facilitator. A critique can assure that the input of all participants is heard, and can be helpful in bringing closure to the operation. A critique and debriefing should not be combined in the same meeting, as agendas are quite different (Hartsough and Myers, 1985).
Following a disaster operation, formal recognition of the workers' participation can be very meaningful. Individuals in the EOC have usually worked long hours under grueling circumstances, and a letter in the individual's personnel file or a certificate of appreciation will be much appreciated. Following the Loma Prieta earthquake of 1989 and the Eastbay firestorm of 1991, several agencies chose to give lapel pins to their employees in recognition of their service. Staff wore them proudly, and they were appreciated much more than a certificate would have been (Renteria, 1992). EOC support staff and staff outside the EOC who "minded the store" while EOC staff were away from their regular jobs should also be included in the recognition. In situations where not all personnel are recognized, or where some agencies provide recognition and others do not, there can be feelings of disappointment and even dissent among personnel.
Summary
Because the field of disaster mental health is highly specialized, mental health jurisdictions should have disaster plans that are thoroughly integrated with the comprehensive emergency management plan of their jurisdiction. It is advisable that in a disaster of any magnitude a mental health representative with decision-making authority should be present in the EOC. Mental health staff also play a vital role in providing stress-management functions for EOC personnel during and following EOC operations. ************************************************************************************************
REFERENCES Hartsough, D.M. and Myers, D.G. (1985). Disaster work and mental health: Prevention and control of stress among workers. Rockville, MD: National Institute of Mental Health.
Mitchell, J.T. (1983). "When disaster strikes...The critical incident stress debriefing process." Journal of Emergency Medical Services, 8:36-39.
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.
Myers, D. and Zunin, L. (1992). Hurricane Andrew stress management program description. Miami, FL: Federal Emergency Management Agency, Disaster Field Office 955.
Renteria, H. (1989, 1992). City of Oakland Office of Emergency Services.
Santa Barbara County, California. (1991). Operational and training guide for the critical incident stress management program. Santa Barbara County Office of Emergency Services, Emergency Medical Services, and Mental Health Department. Santa Barbara, CA.
Ventura County, California. (1990). Operational and training guide for the critical incident stress management program. Ventura County Emergency Medical Services and Office of Emergency Services. Ventura, 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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