ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
August 17, 2001
"Some are born great, some achieve greatness, and some hire public relations writers."
- Daniel J. Boorstin
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Learn the latest in emotional intelligence in the workplace
http://www.eiconsortium.org
Through this site, the Emotional Intelligence (EI) Consortium seeks
to advance high-quality EI research and practice in organizational
settings. The site offers free chapters of new books, information on
EI measurement tools, a list of references on the subject matter, as
well as links to purchase specific EI books. Visitors can check out
the consortium's latest research and also browse it "wish list" of
future research. Additionally, the site provides a list of programs
the consortium has identified as having raised the level of social
and emotional competence for adults in the workplace.
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6th National Conference on Advancing School-based Mental Health Programs
"Expanding the Continuum of Care to Promote Mental Health"
September 20-22, 2001, The Hilton Portland Hotel in Portland, OR
Contact: Sylvia Huntley, Center for School Mental Health Assistance,
University of Maryland School of Medicine, 1-888-706-0980 Email:
shuntley@umaryland.edu
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The Red Cross Disaster Mental Health Services-I (DMHS-I) course will
be offered in Casper, WY on Friday-Saturday, September 14-15, 2001.
If you want to take this course as a Disaster Mental Health
Professional, please send an email for further details on how to
register to: larlion@callatherapist.com The enrollment is limited to 20
participants. APA has approved this course for 12 CEUs. Other
mental health professions have also approved it for continuing
education.
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CRITICAL INCIDENT STRESS WORKSHOP sponsored by The University of Wyoming Counseling Center
and The Rocky Mountain Region Disaster Mental Health Institute will be held in Laramie, WY
on November 16, 17, 2001. There will be two workshops. One will be in Basic Critical Incident
Stress Management (CISM) on 11/16-11/17 and will be a certification course taught by
International Critical Incident Stress Foundation (ICISF) certified trainers. The Advanced
Issues in Critical Incident Stress Debriefing will be taught by U.S. Navy Psychologist
CDR Bryce Lefever, PhD, ABPP. Enrollment in both workshops is limited. There is an early bird
registration period. If you wish to receive a printed brochure, please email:
larlion@callatherapist.com with your name and mailing address.
Online Brochure can be accessed at: https://www.angelfire.com/biz3/news/cismuw.html
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HEAVIEST RAINS IN A CENTURY KILL HUNDREDS
More than 230 people were killed in Pakistan just over a week ago after the
heaviest rains for 100 years caused flash floods in Punjab and North West
Frontier Province. One village was completely washed away in the worst
affected district of Mansehra in North West Frontier Province. More than
170 people died in Manshera while the streets of the capital Islamabad and
Rawalpindi were awash. Naheed Maalik of the Pakistan Red Crescent reports:
The rain started at six in the morning, quite normal for Islamabad this time
of the year. It had been drizzling on and off during the week and through
the night, with relentless humid heat during the daytime. So the harder the
rain fell, the more the hopes grew for a comparatively cooler summer
ahead. The problem was, the rain did not stop falling. Soon half the city
was suffering a power cut - a fairly typical reaction to rain in Pakistan. But
now, the commuters started getting stuck in traffic jams caused by flooded
roads. That's when the realization hit: this was not a normal monsoon shower.
More at: http://www.ifrc.org/Docs/News/01/073001/
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THE CONCEPT OF DISASTER MENTAL HEALTH
Anyone who sees a disaster cannot remain untouched by it. Loss and trauma directly affect
many people in disasters. There are also many others who are emotionally impacted by simply
being a part of the affected community. Seeing massive destruction and other terrible sights
evoke deep strong feelings. Residents of communities stricken by disaster often report
feelings of grief, sadness, anxiety, and anger even if they themselves are not victims.
These strong reactions may confuse them because they, themselves, were spared personal loss.
It is important to remember that everyone who sees a disaster is, in some sense, a victim.
Even persons who experience a disaster "second hand" through exposure to media coverage can
be affected. This includes children whose parents might lose track of how much disaster
material their children may be seeing and/or hearing.
DISASTERS AND TRAUMA
There are two types of trauma that can occur in most disasters: individual and collective.
Individual Trauma can be defined as "a blow to the psyche that breaks through one's
defenses so suddenly and with such brutal force that one cannot react to it effectively."
Individual trauma manifests itself in the stress and grief reactions that are experienced by
individual survivors.
Collective Trauma can be defined as "a blow to the basic tissues of social life that
damages the bonds attaching people together and impairs the prevailing sense of community."
Collective trauma severs the social ties that survivors have with each other and with their
local community. These could be ties that might provide important psychological support in
times of stress. Disasters disrupt nearly all the activities of daily living as well as the
connections they entail. People may relocate to temporary housing away from neighbors, and
other social support systems such as church, clinics, childcare, or recreation programs.
Work can be disrupted or lost due to business failure, lack of transportation, loss of tools,
or a worker's inability to concentrate due to the stress resulting from the disaster.
Children may lose friends and school relationships as a result of the relocation. Fatigue
and irritability can increase family conflict and undermine family relationships and ties.
For mental health professionals who are trained to work with individuals, collective trauma
may often be less "visible". People will find it difficult, if not impossible, to heal from
the effects of individual trauma while the community around them remains in shreds and there
is no existing community setting.
People generally pull together and function during and after a disaster. However, their
effectiveness is diminished. There are many types of stressors that affect disaster survivors.
In the early "heroic" and "honeymoon" stages, there is a lot of energy, optimism, and
altruism. However, while ther is often a high level of activity, there is also a low level
of efficiency. As the implications and the meaning of losses become more real, grief
reactions intensify. Fatigue sets in. Frustrations and disillusionment accumulate and more
stress symptoms may appear. Diminished cognitive functioning (short-term memory, confusion,
difficulty setting priorities and making decisions, etc.) may occur due to fatigue and stress.
This can impair survivors' abilities to make sound decisions and take necessary steps
toward recovery and reconstruction.
Disaster stress and grief reactions are normal responses to an abnormal situation. Most
disaster survivors are normal persons. They function reasonably well with the stresses and
responsibilities of everyday life. However, with the added stress of disaster, many people
will exhibit signs of emotional and psychological strain. Reactions include post-traumatic
stress and grief responses. These are normal reactions to an extraordinary and abnormal
situation. They are to be expected considering the circumstances. These reactions can be
experienced by survivors, community residents, and disaster workers alike. They are usually
transient in nature and rarely imply a serious mental disturbance or mental illness. Contrary
to myth, neither post-traumatic stress disorder nor pathological grief reactions are rampant
following disasters.
The post-traumatic stress process is a dynamic one. It is a process in which the survivor
attempts to integrate a traumatic event into his/her self-structure. This process is natural
and adaptive. It should not be labeled pathological (i.e., a "disorder") unless it is
prolonged, blocked, exceeds a tolerable quality, or interferes with regular functioning to
a significant extent.
Grief reactions are also a normal part of disaster recovery. Individuals may lose loved ones,
homes, and treasured possessions. They may also lose hopes, dreams, and their assumptions
about life and its meaning. Grief responses to such losses are common. They are not pathological
(warranting therapy or counseling) unless the grief is an intensification, a prolongation,
or an inhibition of normal grief.
Equilibrium usually re-establishes itself with the relief from stress, the ability to talk
about the experience and the passage of time. Public information about normal reactions,
education about ways to handle them, and early attention to symptoms that are problematic
can speed recovery and prevent long-term problems.
"THE SECOND DISASTER"
The process of obtaining temporary housing, replacing belongings, getting permits to rebuild,
applying for government assistance, seeking insurance reimbursement, and acquiring help from
private or voluntary agencies is often fraught with rules, red tape, hassles, delays, and
disappointment. People must often establish ties to bureaucracies to get aid they can get
nowhere else. However, the organizational style of the aid-giving bureaucracies is often too
impersonal for victims in the emotion-charged aftermath of the disaster. To complicte things
still further, disasters and their special circumstances often foul up the bureaucratic
procedures even of organizations established to handle disasters. Families are forced to
deal with organizations that seem or are impersonal, inefficient, and inept.
Many individuals may be unable to obtain benefits for which they are eligible in a timely
manner from the agencies involved. Individuals who felt competent and effective before the
disaster may suddenly experience a serious erosion of self-esteem and confidence. Feelings
of helplessness and anger are common. In response, mental health professionals may assist
individuals by reassuring them that this "second disaster" is a common phenomenon. They can
reassure them that most people have difficulty finding their way through the bureaucracy.
Simply hearing the phrase "the second disaster" often brings a wave of relief to survivors,
possibly with some welcomed laughter.
MENTAL HEALTH SERVICES
Unfortunately, many people equate the phrase "mental health services" with being "crazy".
Offering mental health assistance to a disaster survivor might seem to be adding insult
to injury -- "First I have lost everything and now you think I'm mentally unstable." Most
disaster survivors are overwhelmed by the time-consuming activities of putting the concrete
aspects of their lives back together. Counseling or support groups may seem esoteric in the
face of such pragmatic pressures. Some very effective mental health assistance can be
provided while the worker is helping survivors with concrete tasks. For example, a mental
health worker can use skilled but unobtrusive interviewing techniques to help a survivor
in sorting out demands and setting priorities while they are sifting through rubble together.
People may be too busy cleaning up their homes or with other concrete demands to seek out
services and programs that might help them. Initially, they are relieved to be alive and
well. They often underestimate the financial impact and implication of their losses. They
also tend to overestimate their available resources. The bottom-line impact of losses is
often not evident for many months, or, occasionally, for years.
The heroism, altruism and optimism exhibited in the early stages of disaster might make it
seem like "others are so much worse off than I am." For most people, there is a strong need
to feel self-reliant and in control. Some people equate government relief programs as welfare.
For others, especially recent immigrants who may have fled their countries of origin due to
war or oppression, government is not to be trusted. Pride may be an issue for some people.
They may feel ashamed that help is needed, or may not want help from "outsiders". Tact and
sensitivity to these issues are important.
Most survivors of disaster are people who are temporarily disrupted by a severe stress.
However, they can function capably under normal circumstances. A lot of the mental health
work initially will be to give concrete types of help. Mental health professionals can
assist survivors with problem-solving and decision making. They can help them to identify
specific concerns, set priorities, explore alternatives, seek out resources, and choose a
plan of action. Mental health staff must inform themselves about resources available to
survivors, including local organizations and agencies in addition to specialized disaster
relief resources. Mental health professionals may help directly with some problems, such
as providing information, filling out forms, helping with cleanup, locating health care
or child care, finding transportation. They may also make referrals to specific resources,
such as assistance with loans, housing, employment, permits, etc.
Less frequently, individuals may experience more serious psychological responses such as
severe depression, disorientation, immobilization, or an exacerbation of prior mental
disturbance. These situations will likely require referral for more intensive psychological
counseling. The role of the disaster mental health professional is not to provide treatment
for severely disturbed individuals directly. Their role is to recognize their needs and
help link them with an appropriate treatment resource.
COMMUNITIES
The demographics and characteristics of the affected communities must be considered when
designing a disaster mental health program. Urban, suburban and rural areas have different
needs, resources, traditions and values about giving and receiving help. It is essential
that programs consider the ethnic and cultural groups in the community, and provide services
that are culturally relevant and in the languages of the people. Disaster recovery services
are best accepted and utilized if they are integrated into existing, trusted community
agencies and resources. In addition, programs are most effective if workers indigenous to
the community and to its various ethnic and cultural groups are integrally involved in
service delivery.
The traditional, office-based approach is of little use in disasters. Very few people will
come to an office or approach a desk or table labeled "mental health". Generally, the goal
is to provide human services for problems accompanied by emotional strain. It is
essential not to use words which might imply emotional problems, such as counseling,
therapy, psychiatric, psychological, neurotic, or psychotic. Mental health staff may identify
themselves as human service workers, crisis counselors, or use other terminology that does
not imply that their focus is on pathology. Workers seem less threatening when they refer
to their services as "assistance", "support", or "talking" rather than labeling themselves
as "mental health counselors".
Mental health professionals need to use an active outreach approach. They must go out to
community sites where survivors are involved in the activities of their daily lives. Such
places include neighborhoods, schools, disaster shelters, Disaster Application Centers (DACs),
meal sites, hospitals, churches, community centers, etc. Survivors will usually be eager
to talk about what happened to them when approached with warmth and genuine interest. Mental
health outreach workers should not hold back from talking with survivors out of fear of
"intruding" or invading their privacy.
INTERVENTIONS
It is important for disaster mental health professionals to recognize the different stages
of disaster and the varying psychological and emotional reactions involved in each stage.
For example, it would be counterproductive to probe for feelings when shock and denial are
shielding the survivor from intense emotions. Once the individual has mobilized internal and
external coping resources, they are better able to deal with their feelings about the
situation. During the "heroic" and "honeymoon" stages, people who have not lost loved ones
may be feeling euphoric, altruistic and optimistic rather than bereaved. During the
"inventory" phase, people are seeking and discussing the facts about the disaster, trying
to piece reality together and understand what has happened. They may be more invested in
discussing their thoughts than talking about feelings. In the "disillusionment" stage.
people will likely be expressing feelings of frustration and anger. It is not usually a
good time to ask if they can find something "good" that has happened to them through their
experience.
Most people are willing and even eager to talk about their experiences in a disaster.
However, it is important to respect the times when an individual may not want to talk
about how things are going. Talking with a person in crisis does not mean always talking
about the crisis. People usually "titrate their dosage" when dealing with pain and sorrow,
and periods of normalcy and respite are also important. Talking about ordinary events and
laughing at humorous points is also healing. If in doubt, ask the person whether they
are in the mood to talk.
SUPPORT SYSTEMS
Disaster relocation and the intense activity involved in disaster recovery can disrupt
people's interactions with their support systems. Encouraging people to make time for
family and friends is important. Emphasizing the importance of "rebuilding relationships"
in addition to rebuilding structures can be a helpful analogy.
The most important group for individuals is the family. Workers should attempt to keep the
family together (in shelters and temporary housing, for example). Family members should be
involved as much as possible in each other's recovery.
For people with limited support systems, disaster groups can be helpful. Support groups
can help to counter isolation. People who have been through the same kind of situation
feel they can truly understand one another. Groups can help to counter the myths of
uniqueness and pathology. People find assurances that they are not alone or "weird" in
their reactions. Groups not only provide emotional support, but survivors can share
concrete information and recovery tips. They can benefit from the guidance of other
experienced survivors. Besides the catharsis of sharing their experiences, they can
identify with others who are recovering. They can then begin to feel hope for
their own situation. Mental health professionals might involve themselves in setting
up self-help support groups for survivors. They may also help facilitate support groups.
Finally, mental health professionals may also involve themselves in community organization
activities. Community organization brings together community members to deal with concrete
issues of concern to them. These issues might include social policy in disaster
reconstruction or disaster preparedness at the neighborhood level. This process can
assist survivors with disaster recovery by not only helping with concrete problems, but
by re-establishing feelings of control, competence, self-confidence, and effectiveness.
Possibly most importan, it can help to re-establish social bonds and support networks
that have been fractured by the disaster.
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To search for books on disasters and disaster mental health topics and purchase them online,
go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
