Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT January 16, 2004 "How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic
with the striving and tolerant of the weak and strong. Because someday in your life you will have been all of these." - George Washington Carver
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CRISES IN RURAL AMERICA
Crisis Interventions And
Critical Incident Stress Management:
Current Status and Future Directions
April 21-24, 2004
Casper, Wyoming
CALL FOR PAPERS
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
Society of Australasian Social Psychologists
33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
Contact: SASP@auckland.ac.nz
Deadline for submissions: 1 February 2004WFPHA 10th International Congress on
Public Health: Sustaining Public Health
in a Changing World: Vision to Action
April 19-22, 2004
Location: Brighton, ENGLAND
Contact: Allen K. Jones, PhD
Secretary General World Federation of
Public Health Associations
Email: stacey.succop@apha.orgXIV. IFTA World Family Therapy Congress
March 24 - 27, 2004
Location: Istanbul, TURKEY
14th Biennial Meeting of the Society
for Research in Human Development
(formerly the Southwestern Society for
Research in Human Development -- SWSRHD)
April 1 - 3, 2004
Location: Park City, Utah, USA
7th European Conference on Psychological Assessment
April 1 - 4, 2004
Location: Malaga, SPAIN
Contact: Antonio Godoy
Facultad de Psicologia
Universidad de Malaga
29071 Malaga.( SPAIN)
Tel. (34) 952 13 25 32
Fax (34) 95213 11 00
Email: godoy@uma.esAnnual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 2 - 4, 2004 Location: Chicago, Illinois, USA
Email: lhakel@siop.bgsu.edu
Federal/Commonwealth Disaster Aid For Puerto Rico Surpasses $42 Million
The Federal Emergency Management Agency (FEMA) and the Commonwealth of Puerto Rico have disbursed $42,270,654 dollars under the Individual and Household Program (IHP) to applicants who suffered damages resulting from the rains, flooding and landslides which occurred on November 10-23,2003. To date, some 44,155 residents have filed for disaster assistance in the twenty -one disaster declared municipalities. For the full story, go to: http://www.fema.gov/news/newsrelease.fema?id=10128
FEMA Winter Storm Watch Information and Fact Sheets: http://www.fema.gov/storm/winter.shtm
FEMA Community Planning Fellowship Information: http://www.fema.gov/fima/planning.shtm
Disaster Aid Tops $4.4 Million For Washington Residents
The Federal Emergency Management Agency (FEMA), the U.S. Small Business Administration (SBA) and the Washington Division of Emergency Management (EMD) have announced that over $4.4 million has been distributed to individuals, families and businesses who suffered losses as a result of the floods between October 15 and 23.
Residents and businesses located in Chelan, Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Mason, Okanogan, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom counties who suffered damage from the October storms were eligible for aid. The deadline for individual assistance was Jan. 6, 2004. Proposals from governments and private nonprofit organizations are still being reviewed. For the full story, go to: http://www.fema.gov/news/newsrelease.fema?id=10269
Recent progress in Afghanistan raises stakes for success, says outgoing UN envoy
The successful conclusion of Afghanistan's recent constitutional Loya Jirga promises great hope, but the country faces many onerous challenges if it is to capitalize on that accomplishment, the outgoing senior United Nations envoy to Afghanistan told the Security Council. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9461&Cr=afghanistan&Cr1=
UNICEF pledges to demobilize 5,000 child soldiers in Afghanistan
The United Nations Children's Fund (UNICEF) and the UN mission to Afghanistan have set a target of demobilizing 5,000 child soldiers this year as part of their joint campaign to reintegrate war-affected youngsters in the country. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9462&Cr=afghanistan&Cr1=
UN-organized forum calls for recommitment to Cairo population summit goals
A United Nations-organized conference of European population and reproductive health experts wound up a three-day meeting with a plea to mobilize the funds needed to achieve the goals of the 1994 Cairo population summit, which called for gender equality and the universal right to education and development. For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9444&Cr=population&Cr1=
Annan calls for action to combat rising Islamaphobia and anti-Semitism
United Nations Secretary-General Kofi Annan today issued a strong call for action to address rising Islamaphobia and anti-Semitism, warning that complacency in the face of intolerance amounts to complicity.
Delivering the inaugural Robert Burns Memorial Lecture at UN Headquarters in New York, Mr. Annan criticized those who remain silent in the face of bigotry, saying “such passivity must not be allowed to masquerade as tolerance.” For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9432&Cr=Islam&Cr1=
UNICEF pledges to focus on child survival and other basic concerns in 2004
The United Nations Children’s Fund (UNICEF) today pledged to focus its efforts next year on helping the young to survive in a world where they are often caught up in war, ravaged by HIV/AIDS, imperilled by exploitation, and under-serviced by society.
“Each of these issues alone poses heartbreaking challenges for hundreds of millions of children,” UNICEF Executive Director Carol Bellamy said. “Together, they represent a global imperative to do more for children in 2004.” For the Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9350&Cr=children&Cr1=
A Rational Approach to Antipsychotic Pharmacotherapy
In order to maximize their therapeutic impact, the advantages and disadvantages of typical and atypical antipsychotic agents must be weighed so that the optimal therapeutic/risk benefit ratio is achieved. For the article, go to: http://www.medscape.com/viewprogram/2675
UK Launches New Antidepressant-Suicide Probe
Britain's medicines' agency announced on Tuesday a new study to find out if people taking antidepressant drugs are at increased risk of suicide. For the article, go to: http://www.medscape.com/viewarticle/466754
Diagnosis and Treatment of Depression in the Elderly Medicare Population: Predictors, Disparities, and Trends
Because of its high prevalence and its substantial effect, depression is a major contributor to the burden of illness in the older population. J Am Geriatr Soc 51(12) 2003 For the article, go to: http://www.medscape.com/viewarticle/465926?mpid=23098
THE MEDICAL MINUTE: RETHINKING THE ANNUAL PHYSICAL
Maybe you made a New Year's resolution to get more exercise, and you want to be sure you're fit enough to do it. Or perhaps you've been having a little ache you can't quite get rid of and wonder if the doctor can figure it out. So you make an appointment for a physical, right? Maybe not. According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, prevention is an important goal of modern medicine, but the Centers for Disease Control found that 64 million office visits were for routine annual exams in 2000. These and the associated routine tests may cost up to $7 billion a year with little return on investment. While many health-related areas have good evidence of benefit from annual exams, others do not. Read the full story at http://live.psu.edu/story/5150
A MOST PRECIOUS GIFT
Americans are a giving people. We donate money, food, time and more to charitable, community and religious organizations, and even to victims of foreign disasters. But according to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, only one in five eligible Americans gives the gift that is so dear that someone needs it every few seconds -- the gift of blood. January is National Blood Donor Volunteer month, and this year the need for new donors is critical. Donations are down compared to past years. Read the full story at http://live.psu.edu/story/5247
RURAL CRISIS INTERVENTION
Mental health services before, during and following disasters, critical incidents, crises, and terrorist activities are becoming an integral part of disaster, crisis and critical incident preparedness, mitigation, response, and follow-up (Provenzo & Fradd, 1995; Gist & Lubin, 1999). Disaster Mental Health Services (DMHS) is a relatively new field which has expanded significantly within the past 15 years (since Hurricane Andrew). Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) have been around since the early 1980s (Mitchell & Everly, 1993).
A review of the current literature reveals a number of published studies and articles that deal with a broad cross-section of topics on crisis intervention and related areas (CISM, Trauma, Disaster) in rural environments. These include CISM services in rural settings (Seebold, 2003); Telehealth services (Dimmick, Burgiss, Robbins, Black, Jarnagin & Anders, 2003); stress in rural areas (Cowen, 2001); suicide intervention (Aoun & Johnson, 2001); rural elderly (Neese, Abraham & Buckwalter, 1999;Snustad, Thompson-Heisterman, Neese & Abraham, 1993); responses in rural communities following natural disasters (Sundet & Mermelstein, 1996); community action for abusive men (Hanson & Whitman, 1995); litigation in rural practice (Bushy & Rauh, 1993); rural crisis intervention teams (Silver & Goldstein, 1992); childhood depression (Cecchini, 1998); rural psychiatry in hospital emergency rooms (Morris, 1997); intervention with at-risk adolescents (Rose-Gold, 1991); Guidance in small schools (Dinkmeyer, 1990); cultural aspects (Paulsen, 1988a; Paulsen, 1988b); responses of rural ministers to natural disasters (Echterling, Bradfield, Wylie, 1988); the farm crisis (Mermelstein, 1987; Thompson & McCubbin, 1987; Hargrove, 1986); rural sexual abuse prevention (Johnson, 1987); short term interventions with families and children following tornadoes (McRee, Corder, Deitz, Silverstein, et al., 1985-1986); disasters in small communities (Farberow, 1985); crisis intervention in rural schools (Wise & Smead, 1985; Harper, 1984; Beare, 1981); rural psychiatric training (Bassuk & Cote, 1983); use of paraprofessionals in rural populations (Shybut, 1982; Marshall, 1971); working with rural families (Anderson, 1976); and approaches to drug prevention and treatment in rural areas (Bourne, 1974). A literature search revealed a total of 37 articles published on these topics since 1974. While this is probably not inclusive of all work done on crisis intervention in rural areas, it does suggest a lack of dissemination of such information to mental health and related professionals.
Paulsen (1988) discussed the economic crisis affecting rural America in terms of its impact on the individual and his or her community. She outlined three themes: (1) rural communities are in a state of chronic crisis, (2) rural individuals are members of a distinctly unique culture, and (3) the rural crisis warrants a unique response from mental health professionals. All three of these provide insights into rural crises and all three deserve further study.
Harper (1984) discussed crisis intervention and management techniques in rural or remote areas, focusing on rural Alaska and suggested guidelines for successful interventions which highlighted the importance of understanding cultural differences. These are important considerations in most rural areas in the United States as rural areas tend to follow cultural traditions more than urban areas in general.
Telephone crisis lines are one method that has been used in both rural and urban areas. Shybut (1978) found that underutilization, especially by males and by the elderly of both sexes, was the initial problem on a crisis intervention telephone service used in a rural area. Telecounseling and other forms of counseling, including online counseling on the internet are areas that present potential for covering large geographic areas common in the rural west.
Rural Families and Children
Rural families and children in rural areas encounter situations different from their urban counterparts. Cowen (2001) described the sociodemographic and stress characteristics of rural parents who accessed crisis child care services and determined if the utilization of these services would reduce the reported incidence of child maltreatment. 127 sets of parents (aged 17-62) completed a basic sociodemograpbic questionnaire and the Parenting Stress Inventory (PSI). Child maltreatment reporting statistics were used to determine if there was a significant decrease in the reported incidence of child maltreatment. The demographic data suggested economic disadvantage. The data indicated that parents perceived external stressors, those outside of the parent-child relationship, as the major contributor to their current life crisis. Comparison of child maltreatment rates between rural communities that did and did not receive crisis child care preventive interventions indicated that the programs were effective in preventing child maltreatment. The findings of this study provide support for the ecological model of child maltreatment which posits that availability of social support for families who experience high stress or crisis can decrease the incidence of child maltreatment.
Various types of crisis intervention are often used in rural environments. Anderson (1976) presents a variation of short-term family crisis treatment adapted to the specific needs of rural families in northern New Hampshire. Crisis was defined as a significant loss, and treatment consisted of 5-6 sessions which incorporated contract setting and homework assignments. She suggests that crisis intervention may be the treatment of choice in a rural setting.
Farm Crisis
Over the past 20 years, there has been a crisis in many farming communities as the face of agriculture in the country has changed. Many family farms were lost or sold with attendant stressors on those involved. Hargrove (1986) examined the myth of rural communities uniting under stress and suggests clinical and community activities for mental health workers during farm crises. He maintained that a model for understanding human response to natural disasters is useful for understanding response to such crises. He offers recommendations at the community level and suggests that the clinical/advocate model developed by G. B. Melton (1983; see also PA, Vol 61:9256) provides a useful perspective from which to operate.
Treament approaches to such crises vary. For example, Jurich & Russell (1987) evaluated 15 farm families who underwent therapy at the Kansas State University Family Center, using a model of family adaptation to stress developed by H. I. McCubbin et al (see record 1981-30250-001). Major interventions included reframing, mobilizing resources, and utilizing less indirect means of intervention. Ss showed a greater increase in well-being at three months than did a general sample of clients. However, stress levels were not lowered as much as the general sample and life satisfaction was lower at follow-up than the general population. Thompson & McCubbin (1987) outline some resource materials available to help educators, counselors, and others to support rural familes in crises and to facilitate decision making, long-range planning, and problem solving. Counseling programs, workshops, publications, support groups for coping with for stress, and computerized decision aids are reviewed.
In another approach, Paulsen (1988) asserts that rural crises create new numbers of rural individuals who are in need of assistance as they cope with the stress of economic dislocation and the overwhelming difficulties that occur after the loss of a farm or business. She discusses individual, family, and community treatment aspects within the thematic context of a culture in crisis. An urban-based regional family service agency, Farmers Helping Farmers, is presented as an example of a systems response to the rural crisis. The proposed treatment involves a multilevel community response that includes self-help support groups, instruction of adaptive coping skills, and sharing information in rural communities. Mental health professionals are challenged to further their understanding of rural crises and to adopt more flexible treatment strategies to encompass a multilevel systems response.
Suicide in Rural Areas
Suicide can occur as a response to increased perceived stress and can also be a response to a severe loss. Treatments for suicidal ideation in rural areas is very limited. Dimmick, Burgiss & Robbins (2003) assessed the impact of a suicide intervention program from a consumer perspective. Self-administered questionnaires were distributed to consumers who had been referred to a suicide intervention counsellor in the two year period of the program in rural southwest Western Australia. 35 patients completed and returned the questionnaire. Three-quarters of respondents were positive about their experience with the service, with half of the respondents no longer having thoughts of suicide and only 20% of all respondents reporting having attempted deliberate self-harm post-counselling. Reported suicidal ideation and attempted self-harm were much higher in the dissatisfied group. Dissatisfaction of respondents stemmed from the history of their treatment and "the hassle created by the many systems for them to access care". However, the overall outcome of this study is that, from the consumers perspective, a high intensity approach to suicide intervention resolved or improved the presenting problem and their ability to deal with it.
Elderly In Rural Areas
As America ages and the impending impact of the Baby Boom generation is only a few years away, it is important to look seriously at how rural elderly do in our society. Snustad, Thompson-Heisterman & Neese (1993) explored the special challenges confronting a multi-disciplinary team attempting mental health outreach to rural elders. Outreach services offer an approach to increasing the equity and accessibility of mental health services to this at-risk vulnerable population. The services that are provided and the principles that guide these services are discussed and illustrated by case studies. Services include (1) multidisciplinary assessment and intervention, (2) integrating community services, (3) assuring access, (4) counseling, (5) caregiver support, (6) family counseling, (7) psychiatric diagnosis and treatment, (8) crisis intervention, and (9) advocacy. Although the program is designed to be appropriate for epidemiology demography, topography, social and cultural environment, and economic and resource infrastructure of the rural southeast, these services and principles can be readily extended to other geographic areas.
Hospitalization for various problems in rural areas can be problematic when large geographic areas are involved, when there is a lack of professionals in rural areas and when other resources including the close availability of hospitals is not existent. Neese, Abraham, & Buckwalter, (1999) developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by 152 rural elders (mean age 78 yrs) participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Ss completed the Mini-Mental Health State Examination and psychiatric diagnoses were classified according to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.
Developing approaches that fit in rural communities and take into account the specific demographics of rural environments will continue to be critical in providing adequate care for rural elderly.
Disasters In Rural Areas
Disasters occur everywhere. Preparation for their aftermath is more often accomplished in areas which are prone to certain types of disaster (e.g. hurricanes, floods, tornadoes). Planning for these in rural environments has improved over the years and responses by disaster agencies (e.g. FEMA) have helped. However, there are other forms of disaster and critical incidents that can and do occur in rural areas as well as urban ones (e.g. critical incidents such as shootings, vehicle accidents, house fires, acts of terrorism, hazmat spills, wildfires, hostage situations, spousal and child abuse, and others). Resources for the aftermath of these are not as readily available nor as extensive as in more urban environments. Farberow (1985) discusses the mental health component of disaster relief, which was incorporated in Public Law 93-288 in the 1970's and mandated the National Institute of Mental Health to provide counseling services and training materials. Studies have shown that small rural communities require a different kind of attention because of their unique characteristics: pride in independence, rejection of the unfamiliar, a tendency to take problems to family rather than professionals, a larger number of persons living well below the poverty line, and less acceptance of mental illness. The impact of disasters occurs in several major phases: pre-impact (knowledge of legislation, resources, services), immediate postimpact (information, coordination, crisis intervention techniques), and recovery (ongoing needs assessment). Farberow suggests that those able to cope better have been found to be older and to have strong and stable relationships with a past reserve of emotional experience. Special attention is needed for children involved in disasters, especially if they lose a family member, and for staff in the immediate postimpact phase when burnout is common.
Sundet & Mermelstein (1996) examined why some survived the Great Flood of 1993 in the midwest and others did not and the relationship of those outcomes to classic crisis intervention theory. Qualitative case investigations were conducted from 8 severely impacted river towns in Missouri. Graduate social work students began on-site data gathering approximately seven weeks after the flood's initial strike in the state. Outcomes for each community were classified as danger or opportunity crisis resolutions. Results indicate specific, pre-disaster community characteristics were associated with post-disaster survival or failure. Among demographic variables, only the poverty rate appeared to have a strong association with outcome. Contrary to expectations, a vibrant economy was not a predictor of community survival. Communication skills were invaluable aids in survival.
McRee, Corder & Deitz (1985-1986) outline the experiences of a voluntary intervention team that aided in providing mental health services to children in a tornado disaster area. Topics include administrative issues and services provided by the team. They suggest that this information may be helpful in planning and programing for other agencies involved in similar crises interventions in rural communities.
Critical Incidents and Crisis Intervention
Critical incidents are, fortunately, not as common in rural as in urban areas. However, they do occur and do have significant impacts on communities, those directly involved and on responders.
Silver & Goldstein (1992) suggested a model for the classification of crisis intervention and disaster services as being clinic-based, ad hoc, school-oriented, disaster service based, and integrative. An example is presented of an integrative-collaborative model that was developed to cope with situations of suicide, accidental death, or natural disaster when they occur in rural areas and small towns. The Community Crisis Intervention Team (CCIT) was developed with characteristics specific to a collaborative model. The distinctive qualities of the CCIT are identified and discussed within the context of a case study of an intervention in a school setting following an adolescent's suicide.
There is a good amount of literature that discusses the CISM/CISD process in various settings. This information can be used in rural settings as well.
Rural Practice:
The attributes of the rural setting, the emergency psychiatric services, the staff, the patients, and a program to meet these needs are described by Bassuk & Cote (1983). They distributed a questionnaire to directors of the emergency service of each community mental health center in Vermont in 1979. Results suggest that the extensive informal network of crisis care providers gives rural emergency services their unique character.
Hospitals
Psychologists work in many different domains within the rural hospital environment, but their services in the rural hospital emergency room may be the most critical. As Morris (1997) emphasizes, medical emergencies frequently have significant behavioral and psychological components that require psychologists' knowledge-base, assessment, consultation, crisis intervention, and treatment skills to respond fully to the needs of patients and their families. Morris concludes that the psychologist and physician make an especially powerful combination in the rural health care environment.
Hessen (1989) discusses the psychosocial support provided by a psychiatric outpatient clinic at a small rural hospital in Norway in connection with a plane crash that produced 36 casualties. The disaster training of human service workers, psychiatric emergency plans, emotional support, cooperation between health and social services, long-term support functions, use of the media, responsibility for support work, use of experts on psychosocial intervention in crisis work, and work routines for and psychological debriefing of psychiatric personnel were areas found to be of significance in handling the situation.
Schools
Crises in schools take on a number of different aspects at various levels. Critical incidents such as Columbine tend to receive greater attention, especially in the media. However, there are also other areas of group and individual crisis that, if addressed early enough, could possibly help prevent greater crises or incidents later. Rose-Gold (1991) reviewed the literature on drop-out prevention and suggests intervention strategies, procedures, and techniques that may be appropriate for small rural schools. He recommends that (1) counselors should identify drop-out prone children in the primary grades to improve the chances of success of later interventions and (2) counselors in remote areas should establish personal contacts with outside social service agencies and create networks to increase their effectiveness in securing outside assistance. Group, family, crisis, and academic tutoring-counseling combinations are explored. Counselors often find themselves in advocacy roles for potential dropouts and should discuss this issue of advocacy with their administrators to avert the potential development of a conflict.
Dinkmeyer & Carlson (1990) describe a guidance program of a part-time counselor in a small, rural school (Kindergarten through Grade 8). Three key components for a successful guidance programs suggested are (1) program planning and development (establishing a guidance philosophy, formulating goals and objectives, implementing the services and activities, seeking program approval, and a written guidance plan); (2) implementation (in-service training workshops, parental training, parent-education programs, parent-child activities, student tutoring, and crisis intervention); and (3) program maintenance (e.g., professional development activities, networking, mentoring, consultation, community contact, and evaluating the program activities and services).
Ministers
An often neglected area of crisis intervention support involves the roles of rural ministers in crises and disasters. Echterling & Hoschar (1989) contrasted the roles, activities, and stresses of 24 urban and rural ministers in responding to the November 1985 flood in West Virginia and Virginia. Ss completed questionnaires 7-26 months after the flood that assessed the challenges they faced, the special contributions they offered survivors, and the problems they experienced in their disaster work. Urban and rural Ss faced similar challenges, such as helping people to integrate disasters into the theological context of their religious beliefs. However, they often differed in the resources available to them, in the variety of disaster relief roles they took, and in the strategies they pursued in ministering to the needs of their communities.
Treatment
Treatment for clients in rural areas who experience crises is similar to other treatments used in urban areas. However, resources and support systems often are not as available or extensive. Johnson (1987) describes the introduction of a sexual abuse prevention program in rural midwestern US communities that involved the use of theater and social work interventions. Preventive programs are designed to prevent abuse from happening by improving children's information, power, and resources to prevent abuse. The project included components to address community acceptance, training of teachers, presentation of a play, and classroom follow-up.
Bourne (1974) discussed drug abuse treatment strategies appropriate for small urban and rural communities. Four stages of community response to drug abuse are described: denial, panic, fragmentation of effort, and cohesion. A progression of intervention approaches is suggested (hotline, drug abuse council, drug turn-in project, crisis intervention center, physician back-up, and a formal narcotic treatment program). Drug usage is viewed as symptomatic of broader societal problems, and the possibility of a community's concern for drug abuse being channeled into concern for alcohol and tobacco abuse is suggested.
Other Providers
Shybut (1982) developed a paraprofessional program to (1) create additional mental health personnel and (2) serve as a link for integrating the traditional, centralized mental health system with the community-based, informal, nonprofessional network. The three year project encompassed 22 counties and 20,000 square miles of Nebraska. Emergency medical technicians, law enforcement personnel, and hospital personnel were trained in emergency mental health (crisis intervention and management of behavioral emergencies). Other community members were trained to staff an emergency mental health hotline. A third group was trained to be community caretakers. These individuals were selected on the basis of their interest in helping others and their personal suitability. Some of their training efforts were directed at developing community projects to enhance individual coping skills. These projects included facilitating a self-awareness group, organizing a stress management workshop, forming drug and alcohol abuse education groups, and organizing parent-teacher discussion groups. Interim data support the efficacy of the program implementation model.
Marshall (1971) describes a demonstration project using selected indigenous nurses as an adjunct to mental health programs. 35 nurses were selected from three rural counties in Vermont on the basis of data acquired from official community caretakers (e.g., physicians and clergy). The nurses were paid a token wage ($100/yr), provided with a telephone, and reimbursed for travel and expenses for the 26 wk. of training. Ss were given selected readings, films demonstrating psychopathology, instruction on interview techniques, and consultation on current crises they were confronting in their communities. An 18-mo follow-up indicated the validity of the method for selecting indigenous crisis interveners. Of the 346 abbreviated records obtained, 277 had mental health overtones. 69 Ss were judged potentially suicidal. Data is presented on the 7 types of crisis encountered. Results show that potential suicides utilized the services of the nurses and that the nurses were able to discriminate and successfully deal with the potentially suicidal.
Conclusion
In the current times of crisis nationally and internationally with increased levels of stress, anxiety and concern about terrorism, it is critical that mental health professionals in rural areas become aware of recent research, training and approaches to crisis intervention, traumatology, compassion fatigue, disaster mental health, critical incident stress management, post-traumatic stress and related areas.
In order to continue to grow and to meet identified needs, these areas will require continued development as well as focused research and dissemination, analysis and discussion of information about evidence-based approaches. Research will help identify how these approaches can best be utilized as well as how relevant changes need to be made in practice. Networking and sharing experiences can also help develop resources. Dissemination of such applications to participants from rural areas is critical due to the uniqueness of rural environments and the smaller number of trained professionals who cover vast distances and sometimes many communities.
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Marshall, Carlton D. (May 1971). The indigenous nurse as community crisis intervener. Seminars in Psychiatry, Vol. 3(2), pp. 264-270.
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Mermelstein, Joanne S. (Oct 1987). Criteria of rural mental health Directors in adopting farm crisis programming innovation. Dissertation Abstracts International, Vol 48(4-A), pp. 1013-1014.
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Paulsen, Julie (Sum 1988). A service response to a culture in crisis. Journal of Rural Community Psychology, Vol 9(1), pp. 16-22.
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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
Conflict and Crisis in Rural America
by Larry W. Waterfield
Book Description
This work covers the growing economic and cultural split between rural and urban America. The author addresses the following issues: the "rural-urban wars" over land use, control of water, cheap food policy, trade, the use of chemicals and pesticides, animal rights, the bias in urban-dominated media, corruption in food marketing and distribution, what is happening to the land, and who the largest landowners are. In this book, Waterfield suggests that rural America's share of national wealth is declining and that America is the world's best hope for solving the problems of hunger and rural poverty.
Additional Readings at:
Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
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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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