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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT December 13, 2002 "If you are not failing now and again, it's a sign you're playing it safe." - Woody Allen There will be no MENTAL HEALTH MOMENT over the holiday season. Publication will resume on January 10, 2003. There will be a brief Holiday issue next week. SEASONS GREETINGS TO ALL.
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The Right Response in the
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VIOLENCE PERVADES MOVIE MARKETING, EVEN TO YOUNG VIEWERS
The vast majority of movie previews on video rentals feature scenes of violence, regardless of the rentals' MPAA ratings. Sexually suggestive scenes are also common, and are most likely to appear on previews for PG-13 and R-rated movies, according to a Penn State study. "Our data revealed that 75.7 percent of movie previews contained at least one scene of aggression, with an average of more than two scenes per minute, and 45.8 percent contained one or more scenes featuring guns, with an average rate of two scenes per minute," says Mary Beth Oliver, co-director of the Media Effects Laboratory at Penn State. The study also reported that materials intended for a younger audience featured a preponderance of violence, with two-thirds of previews for G/PG and PG-13 rated films containing at least one scene of aggression. Oliver and Sriram Kalyanaraman, a former Penn State doctoral student, published their findings in the Journal of Broadcasting & Electronic Media. For the full story by Paul Blaum, visit http://www.psu.edu/ur/2002/movieviolence..html
Australian Fires Blacken 250,000 Acres
SYDNEY, Australia - Firefighters took advantage of favorable weather on Saturday to build defenses against wildfires raging across Sydney's northern fringe, but strong winds were expected to return Sunday and fan the flames again. About 80 fires are burning across New South Wales state in eastern Australia, but the most dangerous are around the outskirts of Sydney, a city of 4 million people. Three separate blazes burning Friday joined overnight into a 15-mile-long front. The fires have burned more than 250,000 acres across the state since Wednesday and destroyed about 40 homes, almost all in the rural outskirts of Sydney. A smoky haze hung over most of the city. ``We really do have a huge area of fire up there,'' said John Winter, a spokesman for the New South Wales Rural Fire Service. Winter said firefighters were lighting controlled fires, known as backburning, in underbrush and grasslands around and ahead of fire fronts to reduce the amount of natural fuel available. He said fire crews had gained control of blazes in the southwest and west of Sydney but warned the danger was far from over. ``Obviously we remain concerned because even with the milder conditions today the fires still will spread,'' Winter said. Winds had eased and swung around Saturday, pushing many fires back onto areas already burned. Fire crews had been expecting at least two days of favorable weather. But forecasts from the Bureau of Meteorology Saturday afternoon said weather would deteriorate Sunday, with temperatures soaring to 95 degrees Fahrenheit.. The humidity was forecast to drop and winds blowing east from the ocean were to strengthen and swing northwest. ``This will cause us to review all of our strategies,'' said Rural Fire Service chief Phil Koperberg. In the Blue Mountains, 55 miles west of the city, 40 fire crews and six aircraft on Saturday had contained the worst blaze in the area near the village of Blackheath. Some major roads in and around Sydney remained closed Saturday. More than 4,500 mostly volunteer firefighters, including hundreds of reinforcements flooding in from neighboring states, are battling the fires. Each Southern Hemisphere summer, temperatures often top 100 degrees Fahrenheit and hot winds from the arid interior fan firestorms along the continent's heavily populated coastal fringe. A drought affecting almost 90 percent of Australia has made this year's bush fire season one of the worst in decades. Arsonists have also been blamed for lighting some of the blazes.
Guam Slammed By Supertyphoon; Island Crippled
The Pacific island of Guam is reeling in the face of Supertyphoon Pongsana. Packing sustained winds of 150 mph with gusts topping out near 200 mph, Pongsana passed directly over the U.S territory Sunday leaving the island without power and water. President Bush signed a major disaster declaration only hours after the supertyphoon ravaged the island. No deaths have been reported, but wide spread damage occurred including knocked down walls at the islands only hospital. For further information, go to: http://www.fema.gov/diz02/hq02_245.shtm
FEMA Grant to N.Y. Helps Children's Mental Health
FEMA approves funding for NY and Sesame Workshop to develop materials to help hundreds of thousands of children handle mental health issues resulting from the World Trade Center attack. For further information, go to: http://www.fema.gov/diz01/d1391n182.shtm
BANGLADESH - Death toll mounts to 20 in Bangladesh bomb blasts http://sg.news.yahoo.com/021207/1/35hsy.html
BANGLADESH - Bangladesh on nationwide alert following bombs http://www.rte.ie/news/2002/1208/bangladesh.html
RUSSIA - GEORGIA ANNOUNCES COMMENCEMENT OF A LARGE-SCALE ANTI-TERRORIST OPERATION IN TBILISI http://www.infocentre.ru/eng_user/index.cfm?page=0&date=2002-12-08&startrow=1&msg_id=53141
IRAN - Iran says no fear of any possible U.S. attack - denies giving permission for airspace use against IRAQ http://www.alertnet.org/thenews/newsdesk/B374854
DISASTER MENTAL HEALTH OUTREACH SERVICES
Published research and reports of disaster mental health programs have underscored the importance of active outreach to affected populations. The need for active outreach services after a disaster is premised on the following:
* Most people do not see themselves as needing mental health services following a disaster, and do not seek out such services. Therefore, mental health staff must actively find and interact with survivors in community sites where they are living, working, and reconstructing their lives.* Everyone who sees a disaster is affected by it. This includes people who are exposed through media coverage. As a result, mental health education must be provided to the community at large following disasters.
TYPES OF OUTREACH ACTIVITIES
Outreach can be categorized on two levels: microlevel outreach to individuals or small groups, and macrolevel outreach to the community at large.
Microlevel Outreach
Some disaster mental health outreach activities occur on a "micro" or individual level. These involve a face-to-face, telephone, or written interaction between mental health workers and specific individuals or small groups. Casefinding, letter writing, and door-to-door visits to survivors are some examples. The major goal of microlevel outreach is to find and make contact with survivors, assess their problems and needs, provide education about resources and coping strategies, and link them with needed assistance.
Cohen and Ahearn (1980) list the following as microlevel outreach objectives for to individual survivors:
* Providing education and information about resources available to help reorganize their lives.Outreach to individuals may identify survivors who need mental health intervention. In such situations, outreach is a precursor to individual treatment.* Helping with identification of ambivalent feelings, acknowledging needs, asking for help, and accepting support.
* Helping with prioritizing needs, obtaining resources, and increasing individual capacity to cope with specific priorities identified.
* Providing opportunities to become engaged and affiliated.
* Providing a structured method of perceiving specific problems, self-observations, behavior, and powerful emotions through help in understanding, defining, and ordering events in the larger world.
Outreach to individuals can be an effective, beneficial intervention in and of itself. Often, mental health workers in disaster recovery programs are discouraged by the fact that large numbers of "clients" do not materialize. They interpret this as meaning that their outreach activities have not been successful. In fact, outreach has a far larger objective than "advertising" services and bringing people in the clinic door for treatment. The educational aspect of outreach can promote and enhance healthy adaptation and coping. By providing survivors with anticipatory guidance about normal stress and grief reactions, stress management strategies, and information about resources, such outreach may actually prevent a survivor from needing mental health treatment.
Preventive outreach strategies may reduce survivors' anxiety and diminish the number of people in need of clinical treatment. However, disaster mental health workers should be cautious not to "normalize" disaster stress reactions to the point of stigmatizing people who do feel the need to seek mental health assistance. The goal is to reassure survivors about the normalcy of common reactions. At the same time, educational interventions must help people to feel comfortable in seeking assistance if their reactions seem intense, go on for too long, or interfere with interpersonal relationships, work, or school.
Macrolevel Outreach
On a broader level, mental health workers reach out through organizations or the community at large. An example is public education through the electronic or print media. Other macrolevel outreach approaches include environmental or social action interventions aimed at organizational, community, or societal target points. Examples include consultation, training, or advocacy. Such activities aim to influence policies, procedures, legislation, organization of services, environmental factors, or community attitudes and behavior that may impede the emotional recovery of disaster survivors. Community organization is another macrolevel form of outreach. It seeks to bring together community residents to deal with specific problems of recovery. It can increase a sense of environmental mastery and help to establish or repair social bonds and support networks among affected citizens.
CHARACTERISTICS OF SUCCESSFUL OUTREACH
Early Intervention and Visibility
Often disaster survivors see their experiences as intensely personal. They believe that their ordeal is something that cannot be understood by someone who did not share the experience. By arriving as early as possible in the disaster, mental health workers see, hear, and often feel very similar things to the survivors. A willingness by the mental health workers to engage in whatever needs to be done (helping with cleanup, for example) contributes to the early establishment of trust and credibility in the eyes of survivors.
Borrowing from Freud, Lindy and Grace (1986) describe a survivor network boundary that forms following a disaster. This perimeter seeks to safeguard traumatized members from harm and to promote psychic healing. They refer to this barrier as the trauma membrane. Whereas the membrane includes early permeability to people willing to help, it soon becomes tightly sealed. Outsiders are allowed in only under certain circumstances. The concept of the trauma membrane further reinforces the importance of early mental health involvement in response activities. Acceptance must be attained before the membrane closes to "outsiders".
Deploying Appropriate Staff
Outreach staff have to be comfortable working in community-based, nonclinical roles. They must be able to adapt to changing situations, make independent decisions, and work without close supervision (Peuler, 1988). They need to be action-oriented and willing to do whatever needs to be done. Staff should be comfortable with being outside and in the elements.
Workers must be comfortable and adept in striking up conversations with people they have not met previously, and have not come to them seeking help. It is helpful if workers live in the community. This way, they will have common knowledge, concerns, and topics of conversation. Personality is important. Workers must enjoy people and not appear lacking in confidence. They must project interest and empathy.
It is helpful if workers wear comfortable clothes that blend into the community. In a farming area, for example, boots and jeans might be the appropriate attire. Clothing should be appropriate to the weather, to the hazards, and to the job to be done.
There are some advantages for outreach workers to be older. They have more life experience to draw on, especially if they come from the community that was affected by the disaster. Secondly, they are more frequently perceived as nonthreatening (DeWolfe, 1992). However, age and gender should be appropriate to the group being served.
Workers should be comfortable and effective in making public presentations. They will often be called on to give impromptu talks about the emotional impact of disasters. They should have a thorough awareness of community resources, and must be knowledgeable about phases of disaster recovery. They should be culturally sensitive and appropriate in their interventions. It is also important for them to have a thorough understanding of the stress inherent in disaster work. They must also possess the knowledge and skills necessary to recognize and manage that stress for themselves and with other workers.
Persnnel who generally function well in outreach roles include crisis workers, psychiatric emergency staff, case managers, mental health nurses, social workers, and trained paraprofessionals.
Indigenous Workers
Professionals and paraprofessionals from within local community groups can be particularly effective as outreach workers. Indigenous personnel are especially useful in providing services to distinct ethnic and cultural groups. A thorough knowledge of the cultures, cultural values, and cultural practices is essential to providing appropriate interventions. Additionally, when mental health workers have been unable to penetrate the trauma membrane, indigenous workers from within the membrane often can be identified and trained to do outreach and education.
paraprofessionals recruited and trained from within the local population can often accomplish social support functions that outside workers cannot. They are often more successful at establishing a peer relationship and understanding the survivors' style of life (Reiff and Riessman, 1965). These peer counselors can play the role of a "friendly neighbor" who listens and provides emotional support for people who would shun mental health because of the associated stigma (Riessman, 1967; Solomon, 1986). Additionally, workers from the area will likely have an easier "in" with the community. With a rural population, for example, a person familiar with farming, ranching, animals, orchards, gardening, farm equipment, and the price of hay and manure will have some common topics with which to begin a conversation (DeWolfe, 1992).
Trained indigenous staff are often uniquely able to develop effective case-finding strategies. They can recognize survivors' emotional and social needs, identify resources acceptable to the population, and make effective referrals. Local workers can adeptly use their status as a peer to transmit norms about help-seeking (Solomon, 1985). In other words, survivors perceive that seeking help is acceptable and sanctioned by his/her own group members. Workers indigenous to particular community groups can provide services within the context of the values, norms, systems, and politics of their community group.
Social Network Analysis
Social network analysis examines the interrelationships of individuals and groups in a community concerning exchange of resources, information, social obligations, economic resources, and kinship ties. A thorough community needs and resource assessment should be done, using social network analysis. This will identify problem areas and vulnerable, high-risk groups. It can also lead to a directory of available and appropriate services (Mathews and Fawcet, 1979).
For example, social network analysis may show that a neighborhood or social group attends church frequently. In suc a case, mental health staff could use the clergy, church social groups, and church bulletins for distributing information about common reactions to disaster and about mental health resources.
Community Caretakers and Neighborhood Leaders
In every community, there are informal leaders and "caretakers" who provide support, assistance, or material goods to the community. They are often in jobs or positions of social interchange that allow them to see a great deal of what goes on among community residents. These individuals may include hairdressers, bartenders, merchants, mail delivery persons, utility repair persons, contractors, etc. These important individuals can serve as "key informants" to mental health staff, identifying people in need and areas of community concern. Additionally, they are major sources of information and referral for the individuals in their social network. Providing information about formal resources to informal caregivers has been found to increase the number of referrals these individuals make to social service agencies (Leutz, 1976).
Mental health staff can enhance the effectiveness of informal caregivers and community leaders. Training and consultation from community leaders can enhance their knowledge and skills in providing support to their own community. It is useful to provide them with consultation on the disaster-related psychological and health problems they may see in the community, as well as information about mental health and disaster resources. Mental health staff can also give information about back-up services for problems that are beyond the helping capacity of the informal support system (Cohen and Sokolovsky, 1979).
Recognizing Phases of Recovery and Using Phase-appropriate Outreach Methods
Certain interventions will not work well during the early "heroic" and "honeymoon" phases, when people are generally feeling energetic and optimistic. To ask people to talk about their feelings if they are still denying the implications of their loss is probably ill-timed. A more phase-sensitive approach would be to help them with their immediate, practical concerns. People will likely be more open to talking about their thoughts and feelings a little later in the "disillusionment" phase. Then, much of the protective "numbness" has worn off. People are anxious, sad, tired, irritable, frustrated, and discouraged. A thorough understanding of the phases of disaster, as well as focused attention to the phase that individual survivors are experiencing, is essential to successful outreach.
Ethnic, Cultural and Linguistic Appropriateness
Services need to be provided in a manner relevant to the ethnicity, culture, and languages of the people. Literacy in English and in the language of origin must be considered. Specific outreach approaches must be tailored to people who do not read (public meetings, radio programs in native languages, etc.). Different ethnic groups have varying beliefs about asking for help, about whom they see as helpers, whether they trust government programs, etc. Ideally, mental health outreach staff should be indigenous to the ethnic group they are working with. At minimum, they shopuld be well-trained in cultural values, practices, and beliefs of the froup they are serving. They must work through trusted community groups and individuals.
Identifying and Overcomin Barriers
Mental health workers need to identify barriers to reaching the community. For example, distance, transportation, bureaucratic procedures, or cultural insensitivities may get in the way of mental health programs reaching the people, and may be in the way of people seeking services. A technique that has been useful in many mental health disaster recovery projects is to have staff brainstorm at the beginning of their project about what barriers might interfere with carrying out the project objectives. Staff then also brainstorm about specific ways to overcome or eliminate the anticipated barriers. By doing this at the front end of the project, staff can eliminate some obvious barriers immediately. It also helps to establish a "can do" attitude among staff. While obstacles will occur from time to time, the project staff will find ways to modify their approach so that the program can succeed.
Using Interventions Perceived as Nonthreatening and Nonstigmatizing
Mental health information, education, consultation, and even clinical interventions are usually well-received when presented as "normal" events that are familiar and nonthreatening to the community. Community meetings, presentations, training, discussion groups, written materials such as brochures, and information in the media are examples.
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REFERENCES Cohen, C.I. and Sokolovsky, J. (1979). Clinical use of network analysis for psychiatric and aged populations. Community Mental Health Journal, 15(3): 203-213.
Cohen, R.E. and Ahearn, F.L. (1980). Handbook for mental health care of disaster victims. Baltimore: The Johns Hopkins University Press.
DeWolfe, D. (1992). A guide to door-to-door outreach. Final Report: Regular Services Grant, Western Washington Floods. State of Washington Mental Health Division.
Leutz, W.N. (1976). The informal caregiver: A link between the health care system and local residents. American Journal of Orthopsychiatry, 46: 678-688.
Lindy, J.D. and Grace, M. (1986). The recovery environment: Continuing stressor versus a healing psychological space. In Sowder, B.J. and Lystad, M. (Eds.), Disasters and mental health: Contemporary perspectives and innovations in services to disaster victims. Washington, DC: American Psychiatric Press, Inc.
Mathews, R.M. and Fawcet, S.B. (1979). Community information systems: Analysis of an agency referral program. Journal of Community Psychology, 7: 281-289.
Peuler, J. (1988). Community outreach after emergencies. In Lystad, M. (Ed.), Mental health response to mass emergencies: Theory and practice. New York: Brunner/Mazel, Inc.
Reiff, R. and Riessman, F. (1965). The indigenous paraprofessional. Community Mental Health Journal. Monograph No. 1.
Riessman, F. (1967). A neighborhood-based mental health approach. In Cowen, E.L., Gardner, E.A., and Zax, M. (Eds.), Emergent approaches to mental health problems. New York: Appleton- Century-Crofts.
Solomon, S.D. (1985). Enhancing social support for disaster victims. in Sowder, B.J. (Ed.), Disasters and mental health: Contemporary perspectives. Rockville, MD: National Institute of Mental Health.
Solomon, S.D. (1986). Mobilizing social support networks in times of disaster. In Figley, C.R. (Ed.), Trauma and its wake, Volume II: Traumatic stress theory, research, and intervention. New York: Brunner/Mazel.
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
RECOMMENDED READING
Emotional Recovery After Natural Disasters: How to Get Back to Normal Life (An Idyll Arbor Personal Health Book)
by Ilana Singer
Book Description
During the first two to four weeks after any disaster, workers rush to fix collapsed bridges and freeways, utility crews replace broken poles, gas lines and power lines while water crews repair water supplies and sewers. The Red Cross, Federal Emergency Management Agency (FEMA) and Salvation Army set up shelters and food lines, all working to repair the infrastructure and establish order from chaos. But engineers can't fix people, nor can retrofitted buildings heal the trauma that survivors of natural disasters experience. Disaster survivors need more than simple advice from a grief counselor. They need a mental mechanism to cope with their emotional trauma. If you are a disaster victim, this book provides you with that mental mechanism. If you have a relative or friend who has been in a natural disaster, this book will help you understand what the person is going through and how you can help with the healing process.
Coping and moving beyond the emotional trauma works best when you use the right "tactics," tactics that are found in this book. The six tactics tell you what to do to build the mechanism you need. They offer a solution, not a diagnosis. They belong to a unified psychotherapy, not an eclectic collection of mental health exercises that merely try to make you think differently.
These tactics differ from traditional counseling in three profound ways. First, they help put you in charge of you. You become the expert on your needs and your solutions. Second, unlike traditional counseling theories, these do not rely on a "talking cure." They disprove the notion that to recover and avoid posttraumatic stress disorder, you must relive your horror by repeatedly talking about what you saw, heard and felt. (In fact, this is one of the worst things that you can do.) Third, they refute the counseling and medical notion that you will go through predictable stages of grief recovery before getting over your ordeal.
A human behavior model, not a medical disease model, underpins these six tactics. The human behavior model holds that emotional reactions result from ordinary human characteristics, not pathogens, and that our emotional reaction system is unique and differs from that of any other person. There is no formula to follow. Rather, you can learn to neutralize your emotional upset even during catastrophic circumstances, a position confirmed by three decades of field research at the Center for Counter-Conditioning TherapyŽ.
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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
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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