Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT January 24, 2003 "Research is formalized curiosity. It is poking and prying with a purpose." - Zora Neale Hurston
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
COMING SOON:
Rocky Mountain Region
Disaster Mental Health Institute -
SPRING WORKSHOP SERIES
March 22 - Religious Aspects of
Domestic Violence
- Pat Bradley
April 23, 24, 25 -
Crisis Counseling, Trauma, and Response:
A Multi-level Approach
- Marguerite McCormack
May 3 - Recognizing and Responding to Suicide Risk
- Jon Richard, PsyD
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers
ammp@optushome.com.au Conference Website:
http://www.acisa.org.au/ conference2003/VIII European Conference
on
Traumatic Stress (ECOTS)
May 22 - 25 2003
Location: Berlin
GERMANY
Contact:
Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail:
trauma-conference@kfb-berlin.de
27th Congress of the
World Federation for
Mental Health
February 21-26, 2003
Melbourne, AUSTRALIA
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.au
Annual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 12 - 14, 2003
Location: Orlando, Florida
USA
Contact: lhakel@siop.bgsu.edu
4th International Symposium on Bilingualism
April 30 - May 3, 2003
Location: Tempe, Arizona, USA
Contact:
4th International Symposium on Bilingualism
Arizona State University
PO Box 870211
Tempe, AZ 85287-0211, USA
Email: isb4@asu.edu
CANBERRA, Australia - Australian Bush Fire Destroys Homes
Hundreds of people began sifting through the charred remains of their homes in Australia's capital on Sunday, after the worst wildfires in the city's history swept through suburbs, killing four people and forcing thousands to evacuate. Nearly 400 houses were destroyed, officials said. ``I have been to a lot of bush fire scenes in Australia ... but this is by far the worst,'' Prime Minister John Howard said Sunday. Hospitals treated about 250 people for burns and the effects of smoke from the fires, which swept into Canberra on Saturday. Many were residents who battled flames with garden hoses and buckets filled from swimming pools. A number of them reported no fire crews in their burning neighborhoods. ``We saw a few fire trucks coming down the street. But I think they must have thought, 'That one's a lost cause' and carried on to another house,'' said Phil Bates, a carpenter. Fire crews admitted they were overwhelmed by the magnitude of the flames, but John Stanhope, Chief Minister of the Australian Capital Territory, defended emergency services against charges they were ill-prepared. ``This was an event of such enormity, of such force and such devastating power that it simply ran over the top of us,'' he said. Police said a 61-year old man died of smoke inhalation while trying to save his house, and an 83-year-old woman died in her home. A 37-year-old woman was found dead at her burned-out home along with an unidentified body. Winds eased Sunday, and firefighters said blazes were under control. Workers bulldozed fire breaks around much of the city. Scorched pine plantations formed a landscape of blackened and skeletal trees.. A mist of fine ash blew through the streets and thick smoke hung over the city of about 320,000 people, surrounded by drought-hit farmland and tinder-dry forests. More than 20 percent of the city was without power Sunday morning. Conditions were forecast to worsen Monday and Tuesday with temperatures and wind speeds picking up. No rain was forecast for the week. Extra police patrolled the city after reports of looting and suspicions of arson, said Canberra police chief John Murray. One man was arrested and charged with stealing. Most of the fires were sparked a week ago by lightning in a nearby national park. Strong, dry Outback winds and soaring temperatures in Canberra's outer suburbs triggered Saturday's havoc. Howard interrupted his summer vacation to tour the fire-scorched suburbs, where residents described the speed of the fires. ``We just got a few precious things out and the family dog and within two minutes the house was just gone,'' Tony Walter told Howard. ``It just exploded.'' Damages were expected to run into hundreds of millions of dollars. Besides homes, the fires consumed medical centers, schools and thousands of acres of pine forests, said chief minister Stanhope. Many firefighters lost their homes and possessions while fighting blazes elsewhere, he said. The Stromlo Observatory, a historic telescope and science center on a hill outside the city, was also destroyed. People who lost their homes will be given $5,800 to buy emergency supplies and clothing, and the city will seek alternative housing. More than 1,000 people were still in evacuation centers Sunday and people were warned not to return to their homes because of the danger of more fires and explosions caused by gas leaks. The city also faced a looming environmental crisis: Its main sewage plant was damaged in the fire and was expected to overflow into a local river in about a day if it was not fixed. Australia is in the grip of a yearlong drought that has left much of the countryside parched and vulnerable to fire. Once fires start, they roar through dry undergrowth and into oil-filled eucalyptus trees, creating infernos that are all but impossible to put out.
Registration Deadline for WTC Aid Nears
Individuals, families and small businesses affected by the Sept. 11 attack on the World Trade Center have two weeks remaining to register for federal mortgage and rental assistance(MRA) grants and low-interest loans. More than 11,000 people have already registered for FEMA's MRA program. For further information, go to: http://www.fema.gov/diz01/d1391n190.shtm
THE MEDICAL MINUTE: 'TIS THE SEASON FOR COLDS
The latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical, reminds everyone to feed a cold and starve a fever or is the other way around? Theories on treatments for colds and other respiratory infections have been offered since Hippocrates noted that colds were more frequent in the winter. Everyone has his or her own favorite remedy and stores abound in medications for every symptom. It helps to understand what causes colds to fully appreciate how to deal with them. First, colds and flu are not the same. The flu (or influenza) causes higher fever, severe aches and fatigue, often severe sore throat and hacking cough. The flu hits quickly but colds are more gradual. The average adult gets two to four colds a year; children get six to eight. Two hundred strains of cold viruses can infect the nose and throat. Although bacteria can infect the respiratory tract they are very different. For the full Medical Minute, visit http://www.psu.edu/ur/2003/medicalminute019.html
USA - CDC Says Smallpox Plan Ready to Go
http://www.reuters.com/newsArticle.jhtml?type=topNews&storyID=2066832USA - Officials in 11 states to receive shipments of smallpox vaccine http://www.boston.com/dailyglobe2/018/nation/Officials_in_11_states _to_receive_shipments_of_smallpox_vaccine+.shtml
ALASKA - Samples confirm Norovirus outbreak plagues Ketchikan
http://www.adn.com/alaska/story/2469976p-2517165c.htmlIRAQ - UN inspectors uncover proof of Saddam's nuclear bomb plans "These are not old documents. They are new and they relate to on-going work taking place in Iraq to develop nuclear weapons" http://www.dailytelegraph.co.uk/news/main.jhtml?xml=/news/2003/01/19/wirq19.xml&sSheet=/news/2003/01/19/ixnewstop.html
IRAQ - War nears as Iraqi nuclear bomb papers are found
http://www.scotlandonsunday.com/uk.cfm?id=71912003TRINIDAD - Cruise ships pull out of Trinidad over UK terror warning http://www.sun-sentinel.com/news/local/caribbean/search/sfl-117trinidad,0,6682703.story?coll=sfla-news-caribbean
MENTAL HEALTH INTERVENTIONS IN DISASTER SHELTERS
Mental health services function at three levels in meeting the psychosocial health needs of survivors and workers in shelters: Population, Environment, and Individual.
The first and second levels involve "macro" level interventions, or interventions with systems. The third level involves "micro" level interventions, or interventions with individuals. Most mental health staff are more experienced in interventions at the micro level. While all mental health interventions ultimately focus on the needs of the survivors, the mental health worker must be acutely aware of the interrelationship between the forces of the postdisaster systems. These include the disaster recovery programs and the authoritative structures that implement them (Cohen, 1986). These systems have a powerful effect upon the well-being of the survivors. Mental health workers can have an important role in influencing programs to make services as responsive to needs of disaster survivors as possible. He/she can also help programs to understand the mental health implications of programmatic and administrative decisions (Cohen, 1986). For example, in a large urban shelter after the Loma Prieta earthquake, a tentative decision was made to house men in a separate facility from women and children. This meant that intact families would be separated. When the tentative decision was communicated to shelter residents, the agitation and anger in the shelter rose dramatically. Mental health helped shelter management understand the importance of keeping families together, and the decision was reversed. This example illustrates that systems-level interventions in the shelter can be as important as individual interventions.
Interventions With The Population
There are two shelter populations that mental health staff will be concerned with: residents and staff (professional and volunteer).
Mental health staff must first assess the shelter population in order to plan appropriate care for various groups. They must anticipate possible mental health problems affecting the population and identify mental health staffing needs in the shelter. It is important that staff avoid committing to individual situations until a general assessment is done and priorities can be established for mental health activities.
Knowledge of the mental health status of the community from which the shelter population is drawn is essential in assessment. If mental health workers are not familiar with the community where they are assigned, the team leader should obtain a briefing from shelter personnel or key informants in the community. Staff should have knowledge of the socioeconomic status and ethnic and cultural groups in the community. Health issues, the presence of any significant stressors, and the prevalence of any mental health problems in the community should be learned. Staff should know about any prior history of disasters or traumatic events in the community.
The impact of the disaster on the community and on particular neighborhoods or groups should be explored. Staff should have knowledge of the number of dead and injured and of the damages that have occurred. They should also be aware of trauma occurring as a result of the threat of death, frightening evacuations, exposure to dead and injured, or other traumatic circumstances. Children, the frail elderly, and people with pre-existing stress or health problems may be at risk for mental health problems. Groups found most at-risk include those who:
1. have lost loved ones;2. have lost homes;
3. have been injured or whose loved ones have been injured;
4. have homes with major damage;
5. have lost jobs;
6. have been exposed to traumatic sights, sounds, or experiences.
Some assessment of the population can be done by surveying the registration file. This will provide information on the number and ages of children, the number and ages of elderly, and persons with health problems. The pre-disaster addresses of survivors will tell a worker whether residents of the shelter are from areas severely impacted by the disaster.
Mental health staff should also interview the shelter manager to learn whether the disaster has personally affected shelter staff and volunteers. Sometimes, disaster workers plunge themselves into their work without acknowledging the physical and emotional implications of their own losses. While this may be functional in the short-run, it will eventually take a toll on the worker. These workers should be recognized as at-risk for delayed reactions.
The mental health cordinator can obtain valuable information about the shelter population by observing conditions during a tour of the shelter. Important information can be obtained by asking the shelter manager and nurse for a report on shelter mental health conditions. Mental health staff should ask about their general impressions, mood and stress levels of residents and staff, specific problems, individuals or families needing assessment, and any specific concerns they may have. This should be done at the beginning of mental health's involvement in the shelter, and at the end of each shift. The report should then be passed on to incoming Red Cross and mental health staff.
It is important for mental health staff to recognize that being dislocated from one's home and belongings and being sheltered in a mass care facility is extremely disorienting and stressful. Survivors are often heroic in displaying courage and optimism. However, they are also usually very stressed by the disaster and the shelter environment.
If there are many children in the shelter, mental health should provide child specialists among their staff. Parents in the shelter will be tremendously stressed, and may not be as alert or capable as usual in meeting the needs of their children. Mental health can provide support and guidance to parents. Additionally, mental health can work with the Red Cross to ensure that childcare is available to provide both children and parents with some respite. The Church of the Brethren and other voluntary groups often provide childcare in shelters in times of disasters. With some support and consultation, shelter residents can provide group childcare themselves.
Because of the lack of privacy in shelters, children may occasionally be exposed to witnessing adults engaging in sexual behavior. Also, when children are unsupervised, they may be vulnerable to sexual abuse or exploitation. Mental health should keep these circumstances in mind when observing and intervening with the shelter population. In circumstances where there is concern about child abuse or neglect, mental health staff are required to report any instances of abuse that they observe or seriously suspect. Red Cross staff may need consultation about local reporting procedures.
Based on an assessment of the shelter population, mental health staff can implement actions to meet mental health needs of the population as a whole. Such "macro" level interventions might include:
1. Arranging staffing and other resources to meet the needs of special populations in the shelter: children, elderly, specific ethnic groups.Interventions With The Environment2. Acquainting staff and residents with mental health resources in or near the affected area.
3. Providing debriefing and support groups to shelter residents, including age-appropriate therapeutic activities for children.
4. Providing handouts and posters about normal disaster stress reactions and helpful stress management strategies for children and adults.
5. Providing in-service training and consultation to shelter staff about mental health issues pertinent to the shelter. A topic might include identifying and meeting the needs of special populations. The phases of emotional reactions of survivors and workers during and after the disaster can be helpful. Practical suggestions for communicating with disaster survivors might be needed. How to handle difficult situations such as intimidating or intoxicated residents, and establishing clear rules and structure to help contain the population may be important. When to refer to mental health and clear protocol for when to call law enforcement is essential.
6. Consulting with Red Cross leadership about stress management for shelter staff and volunteers; providing input regarding staff scheduling, breaks, and supportive services; arranging and providing staff support groups, stress reduction activities, and debriefings throughout the duration of the shelter assignment; providing brief supportive counseling services for individual staff or volunteers who are affected by the disaster or the stress of the job; and providing debriefing groups for workers at the end of their assignment in the shelter.
Mental health staff should work with the shelter manager and nurse to ensure that the shelter environment considers the psychosocial needs of both survivors and workers. Mental health staff may provide consultation or assistance about the following aspects of the shelter environment:
1. Space: Mental health staff can consult with the shelter manager about the layout of the shelter. While conditions may not be ideal, optimal allocation of space seeks to reduce noise and provide as much privacy as possible. Staff should ensure that families remain together. If there is discomfort or actual conflict among groups, they should be housed in separate areas, if possible. Some community space is important to promote social interaction, conversation, and recreation. Quiet space is important for individuals to find respite from the bustle of activity.Mental health personnel should also try to identify a quiet, private area or room that will belong to mental health alone. Here, staff may take fragile, decompensating, or acutely disturbed people who need to be separated from the stimuli of the setting or need some uninterrupted time with a mental health worker.
2. Information: initially, residents will need information about the location and well-being of loved ones. Red Cross Disaster Welfare Inquiry services within the shelter may help them, although this system is not usually functional until several days into the disaster. Anything mental health staff can do to assist people in locating loved ones is helpful. Often, survivors are not thinking clearly under the stress of the situation, and concrete problem-solving suggestions are valuable. Rumors are rampant during the first days of disasters, and staff should remind residents of the importance of waiting for "official" or verified information.
People also need information about the changing disaster situation, e.g., damages in various areas, road closures, projected duration of evacuation. All available methods of communication should be provided to help them: television, radio, newspapers, bulletins, newsletters, maps, and briefings by emergency officials. However, mental health staff should also observe to make sure that too much media intake does not add to the stress of residents. For example, adults may become glued to the television long after they have ceased to obtain new information. Parents may also need to be reminded about the effects of too much graphic television coverage on their children.
Once information on the impact of the disaster is known, residents will need information on resources for recovery. The most immediate need will be for information about temporary housing resources. Posters, brochures, bulletin boards, and visiting resource specialists from various disaster programs can provide shelter residents with the information they need. In a Presidentially declared disaster, most government and voluntary agencies are grouped at a one-stop center called a Disaster Application Center (DAC). Shelter residents will need information about the purpose, location, hours, and resources of the DAC.
Educational materials on common reactions of adults and children to disasters are especially important. Such information wil help to reassure people that most of their reactions are "normal reactions of normal people to an abnormal situation". Education can help to alleviate anxiety and will also provide anticipatory guidance about reactions that may come up in the future. Suggestions about stress management are also useful. Educational materials should help people to recognize when stress reactions exceed "normal" in intensity or duration, and where to seek further support and assistance.
3. Activities: Recreation, exercise, and large-muscle activity, appropriate to age and health, can help to reduce stress and improve the spirit and morale in the shelter. Involvement in meaningful activity can help residents of all ages to re-establish a sense of control and purpose. Involving residents in shelter tasks, such as serving meals, reading to children, or putting together a skit for entertainment, can be helpful. Childcare can provide therapeutic activities for children. It can also help to reduce stress on parents who are pre-occupied with many post-disaster problems and decisions.
Because there may be many individuals in the shelter, the task of identifying those at-risk or in need of mental health intervention may seem formidable. Most individuals do not seek out mental health assistance. it is critical, therefore, that mental health staff actively outreach or "case-find". This can best be accomplished by having mental health staff circulating and "working the floor" of the shelter (MHBWA - Mental Health By Walking Around), touching base with shelter residents and making informal observations and assessments of individuals in need. This method has been called "roaming" (Myers and Zunin, 1992). DeWolfe (1992) has referred to this as the "over a cup of coffee" method of informal intervention. Sitting at a mental health table or in a counseling room WILL NOT provide mental health workers with the contact and exposure necessary to make adequate assessments.
A survey of registration forms may suggest individuals with mental health problems or at-risk for stress-related problems. Additionally, regular checks with the nursing station may help mental health in identifying individuals with physical complaints that may be stress-related. Shelter volunteers and residents themselves can be used as key informants to help mental health staff to identify persons in need. Mental health staff can ask such questions as "How do you see the stress level in the shelter?" and "Are there any specific situations, individuals, or families you are concerned about?"
The priority for intervention should be individuals with acute mental health needs. These may include individuals who have a history of psychiatric illness and may be decompensating because they have stopped taking medication. There may be people with drug or alcohol problems who may go into withdrawal. There will likely be individuals who are experiencing acute stress or grief reactions related to the disaster. These individuals may be moved to a counseling room or detoxification room, if one has been set up. Psychiatric evaluation and medication may be provided if available and appropriate. Transport to a psychiatric emergency or detoxification unit may be arranged if necessary and available. In most situations, medication should be avoided for individuals experiencing acute grief or stress reactions. The exception is if medication is deemed absolutely necessary to obtain some sleep or short-term relief. Individual counseling and attention will usually help to stabilize the client. If so, the individual can probably remain in the shelter environment. Regular checks should be made of these individuals for the duration of their stay in the shelter. Regular checks will provide for assessment, support, assistance with problem-solving, and reinforcement of coping strengths.
Support groups can serve some useful functions in a shelter. Survivors who attend such groups find reassurance that their problems are not unique. They can also give and receive practical advice on the problems facing them. Mental health staff can provide group education about stress reactions, stress management, and resources. Groups provide a place to refer people who could benefit from some regular contact with mental health. Additionally, they allow mental health staff to provide time-efficient, regular follow-up.
The environment of the shelter will affect the nature of the interventions. Because of the noise and activity level in large shelters, mental health staff do not have the luxury of a controlled, clinical environment for making client observations. Additionally, the environment is not usually conducive to a private, uninterrupted conversation. Mental health staff need to become adept at making brief assessments and interventions, sometimes in as little as five to ten minutes. Despite mental health's attempts to follow-up with any given individual, people often leave the shelter with little notice as their situation changes. An experienced Red Cross worker once advised mental health staff accustomed to a practice of regular visits with clients: "Never assume you will see an individual again. Treat each interaction as though it's the only one you may have with them. Make it count." Although this is a large order to carry out under adverse circumstances, it is not at all impossible. Following below are some guidelines for mental health interventions with individuals in shelters.
Observation
When circulating in the shelter, mental health workers are wise to follow their instincts about individuals who may be distressed. Body language and facial expression may say much about what is going on for specific individuals, and can help the mental health worker decide whom to select for interaction.
Active Listening
While sensitive, active listening is important, the shelter environment will make it difficult. Time pressures will usually not allow for passive responding by the mental health worker. Shelter residents are often in the denial or honeymoon phase of reactions, and may feel happy just to be alive. They may see others who seem much worse off than themselves. They are likely to be reviewing the events mentally and trying to piece facts together to inventory their losses. General questions such as "How are you doing?" will likely elicit vague answers such as "Fine". Additionally, people in the early phase of disaster response may not yet be ready to talk about their feelings. They may be uncomfortable or irritated with questions that probe for feelings they are not ready to experience.
Structured Conversation
Most survivors respond positively to active interest and concern. Gentle structuring of the conversation and alert, active listening by the mental health worker can assist him/her to assess and provide a therapeutic interaction with an individual in a limited period. In their article on "Debriefing and Grief: Easing the Pain", Myers, Zunin, and Zunin (1990) suggest the following format for a brief therapeutic conversation:
First, gather facts. Ask specific questions about the individuals' losses, exposure to trauma, death of loved ones or pets, injury to self or loved ones, health status, prior stressors, coping skills, and support system. It is often helpful to ask survivors what they know about themselves under stress: How are they usually affected by stress? What positive things do they do to cope? What ways of coping do they use that are not so helpful?Because mental health services in disasters are non-traditional and usually non-clinical in nature, mental health needs to pay close attention to issues of privacy and confidentiality. Shelter residents are, for the most part, not "clients". They have not formally or informally agreed to enter a psychotherapeutic relationship.Next, inquire about thoughts. The mental health worker can explore three areas if time allows. First thoughts: "What was the first thought you remember after the impact?" Current thoughts: "What thoughts have you been having since you've been in the shelter?" Repetitive thoughts: "Is there a thought that you just can't get out of your mind?"
If ther are indications that the person is thinking of suicide, it is essential to evaluate this possibility. Existence and lethality of a plan, availability of method, and previous suicidal history should be explored. Appropriate steps must be taken if a person is assessed to be a danger to self or others. These steps may include not leaving the person alone, having the individual turn over the weapon of means, and transporting the individual to a psychiatric facility for safety and treatment. Involuntary treatment may be necessary if the person is a serious risk but is not willing to obtain treatment voluntarily. State law will govern who can legally apply a hold for involuntary treatment.
Thoughts about what you need to do next: "What are the most important things for you to do today and tomorrow?" These questions will give the mental health worker a picture of the frame of mind of the survivor. They will also let the worker know how organized the person's thought processes are concerning setting priorities and problem- solving. Most people experience confusion and disorientation in the immediate post- disaster stage. They may need very concrete assistance in deciding a course of action in the face of all that confronts them. The mental health worker can help the person in listing necessary tasks, then setting priorities on the list. Alternatives and resources can be explored, and a plan of action decided upon.
Third, acknowledge feelings if they arise, but don't probe. Most people spontaneously begin talking about feelings as they share their thoughts. People may be experiencing confusion, fear, anxiety, anger, frustration, guilt, and grief. They may also be relieved to be alive, touched by the kindness of others, altruistic, and highly optimistic about recovery. Responses shouls acknowledge or validate feelings, but not seek to deepen or intensify survivors' emotional states. It may be clear that some people are in a level of denial about the impact of the disaster. However, it is important to remember that denial is a functional way for people to deal with the implications of the situation at a pace they can handle. Denial usually does not require intervention unless the individual is seriously out of touch with reality, or unless the denial is detrimental to the survivor, e.g., the person is turning away resources that he/she obviously needs.
Fourth, support and reassure. Usually, people's reactions are normal and common. However, most people need reassurance. This is the time to reinforce positive coping strengths and to provide suggestions or reminders about taking care of themselves, including using their support systems. A brochure on normal stress reactions in disasters and stress management suggestions can be helpful at this point.
Provide comfort. In the face of the overwhelming grief associated with disasters, gestures of comfort are a natural and meaningful form of communication. Most disaster mental health workers report using touch much more frequently in disasters than in their ordinary practice. A hug, a pat on the shoulder, a warm beverage to drink, or help in making up a cot may fill the gap when it seems there is nothing to say. Mental health staff need not fear a brief and appropriate show of emotion on their own part. Shared tears are often reported by survivors as a significant communication of empathy and caring. However, workers must be awarte of their own feelings of powerlessness in the face of overwhelming destruction and loss. They must be careful that their attempts at providing comfort do not reflect more about how the worker is feeling than being truly helpful for the survivor.
Last, consider follow-up. Because of the sheer number of people the mental health worker will have contact with, follow-up with all individuals will not be possible. However, for those in need of further assistance, a plan for intervention and follow-up should be established. This may include referring the individual to disaster recovery resources or to community mental health services. If both the individual and the worker will be in the shelter for a few more days, the worker may make plans to see the individual daily, if needed and if time allows. Maintaining contact means a lot to survivors who are struggling to put their lives back together. it may be helpful for mental health staff to keep a log of identified individuals who appear fragile. The log can facilitate follow-up among shifts of workers. In the case of individuals who would benefit from follow-up, the mental health worker should obtain information about how the person can be contacted in the future. People often move multiple times following the loss of a home. Therefore, mental health staff should obtain the name and phone number of a friend or relative who can serve as a message center.
Follow-up may also include recommending alternate accommodations to the shelter manager and nurse when the stress of congregate living may be significantly detrimental to the mental health of a survivor. in such cases, the Red Cross can attempt to find alternate temporary housing.
the point may arise in which a disaster survivor is divulging information that is highly personal or sensitive in nature. At this point, the worker should discuss confidentiality with the person. The role of the mental health crisis counselor in disasters is not defined as providing psychotherapy. In fact, most of the literature on disaster crisis counseling emphasizes the difference between crisis counseling and psychotherapy. The FEMA Handbook for Grant Applications for Crisis Counseling specifies that prolonged psychotherapy measures are inappropriate for this program, and defines the services as "preventive care techniques" (1988). For these reasons, the mental health staff member should inform the survivor that there are limits to confidentiality. If the crisis counselor were subpoenaed to testify in court, he/she could likely not claim client/therapist privilege to uphold confidentiality. If the survivor wishes to discuss issues which should be protected by confidentiality, a referral to a clinician for psychotherapy should be provided by the crisis counselor. Consultation about this issue can be obtained by contacting the Center for Mental Health Services at 301-443-4735.
Follow-up services will need to be arranged if additional counseling for the shelter resident is indicated. The follow-up may be with the mental health worker involved or with another mental health provider. In the case where the mental health provider is a volunteer from the private practice community, a policy should be in place governing self-referral to private practice following the disaster. Many agencies use a review process by the mental health director or peer review committee before a paid or volunteer therapist can refer a client to their own private practice.
Mental health staff should be sure to set up a charting system for people receiving psychiatric evaluation, medications, or intervention of more than a brief nature. Additionally, accurate records should be kept of the numbers of people seen, problems they were experiencing, and types of interventions. Staff should keep accurate records of their time and expenses on the disaster job. These records are essential for obtaining mental health crisis counseling funds from the Federal Government in the event of a presidentially declared disaster.
As the shelter operation comes to a close, mental health staff should pay attention to the mental health needs of the workers disengaging from disaster work. They may provide debriefing for Red Cross personnel at the end of the tour of duty, if Red Cross does not have their own trained disaster mental health volunteers. Mental health staff should arrange debriefing for their own workers using an experienced disaster mental health debriefer who was not a part of the operation.
Following the shelter operation, mental health should make sure that their staff and volunteers are recognized for their contribution to the disaster effort. Workers who stayed behind at the office or clinic to "mind the store" should not be overlooked.
SUMMARY
Disaster survivors who seek refuge in a mass care shelter have usually endured both trauma and loss. They may have been evacuated from a hazard area. in many cases, they have suffered the damage or loss of their home. The shelter environment itself can be stressful for both survivors and staff. It is a setting to which mental health staff can contribute valuable knowledge and skills. This article has provided mental health staff with a brief orientation to the functions of a Red Cross shelter. It has discussedthe shelter as a mental health worksite. Administrative issues for mental health staff have been presented. Suggestions have been made for appropriate mental health interventions with the shelter population, the environment, and individuals.
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REFERENCES Cohen, R.E. (1986). Crisis counseling principles and services. 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.
DeWolfe, D. (1992). Final report: Regular services grant, Western Washington Floods. State of Washington Mental Health Division.
Federal Emergency Management Agency. (1988). Crisis counseling programs: A handbook for grant applicants. Disaster Assistance Programs No. 9. Washington, DC.
Myers, D. and Zunin, L.M. (1992). Stress management program description. Federal Emergency Management Agency, Disaster Field Office 955, Hurricane Andrew. Miami, Florida.
Myers, D., Zunin, H.S., and Zunin, L.M. (1990). Debriefing and grief: Easing the pain. Today's Supervisor, 6(12): 14-15.
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
Individual and Community Responses to Trauma and Disaster : The Structure of Human Chaos
by Robert J. Ursano (Editor), et al
Book Description
Coping with disaster is an overwhelming and often baffling task for survivors, rescue workers, and clinicians. This volume looks in depth at how people experience trauma and suggests practical strategies for treatment. The authors examine issues ranging from the biological basis of posttraumatic stress reaction to the psychosocial and fictional construction of terror, and disasters ranging from random acts of violence to war. From Chernobyl to Desert Storm, from Kentucky floods to Norwegian avalanches, the authors explore the effects of trauma on adults and children. They find certain commonalities in human response to disasters of all kinds, and hold that by understanding these partially predictable patterns of reaction, mastery of chaos, and finally recovery can occur. Based on their comprehensive analysis, they suggest disaster intervention strategies that emphasize recognition of the psychological effects of trauma, as well as preparedness and prevention.
Additional Readings at: Click here and Enter the terms September 11 and Psychology in the search engine
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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.
**********************************************************************
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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