ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
October 5, 2001
"The only thing we have to fear is fear itself." - Franklin D. Roosevelt
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HERSHEY TEAM PROVIDES EMERGENCY WORKER SUPPORT
A team comprised mostly of Penn State Milton S. Hershey Medical Center employees has been
called into service to provide peer-driven emotional and psychological support for emergency
and recovery personnel who have been working at the crash site of United Airlines Flight 93. The
Boeing 757 crashed in Somerset County, Pa., on September 11 during a terrorist hijacking. All
44 people on board were killed. Lee Groff, coordinator of Penn State Hershey's Critical Incident
Stress Management Team, said the request for its services came through a representative of the
Pennsylvania Emergency Management Agency. The terrorist-related events "have been traumatic
for virtually every American," said Groff. "But for emergency workers at the disaster sites, many of
them volunteer firefighters, the sense of devastation and loss is intensified. When these people are
finished with the vital work of removing wreckage and recovering bodies, they need to talk to
someone about what they've seen and how it affects them. That's our job." For the full story, visit
http://www.hmc.psu.edu/news/pr/2001/Sept/team.htm.
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CRITICAL INCIDENT STRESS WORKSHOPS - Laramie, WY - November 16-17, 2001
https://www.angelfire.com/biz3/news/cismuw.html
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COPING, RESILIENCY, AND RECOVERY IN THE WAKE OF TERRORIST ATTACKS
On September 11, 2001, tragedy struck New York, Washington, D.C. and Pennsylvania as well
as the whole country. Immediate, short-term and long-range effects on victims, victims' families,
responders and the general public can be expected to vary in intensity and emotional responses.
How we face the tasks before us and how we respond - personally, as communities, as a nation,
and world-wide - may very well determine the viability of the American vision and way of life
for the remainder of the 21st century and beyond.
The United States is no stranger to adversity, tragedy, war and disaster. We have dealt with it
before. Each generation has been tested and challenged - and each generation has risen to
the occasion.
Our national unity was tested in a bloody Civil War that forever changed the future and the
character of the country. In 1941 we were stunned by an attack by the Empire of Japan on our
own soil. This led to our entrance into World War II. That event changed forever the world view
of this country and our involvement in world affairs. We became a leader in the world with all
of its attendant rewards and responsibilities.
In the 1950's, the long Cold War began with its threat of nuclear annihilation and resulting
stresses and trauma in a society intent on survival, defense and the defeat of communism. The
Korean War was fought to a stalemate not resolved to this day. Many grieved the losses of loved
ones in uniform.
When John F. Kennedy became president in 1960, he represented a dramatic change in the
leadership and direction of this country. He offered a vision and hope for a bright and prosperous
future. He challenged us to move in new directions and provided impetus for the manned space
program. The nation endured severe stress and real and perceived threat to our security and
well-being during the Cuban Missile Crisis. Brinksmanship and a firm, strong resolve and message
helped avert a possible direct threat to American cities.
On November 22, 1963 in Dallas, Texas, President John F. Kennedy was assassinated. This
event shocked the nation and the world. In the days following this event the country felt vulnerable,
grief-stricken and angry. Shaken to the core, we grieved for our loss and had our future changed
forever. The leader who had challenged a generation to act had fallen. However, the ideals that
he held out for the country have endured; the goals he set and the vision for the America he
described have not been lost. The resolve of a generation was far stronger and had greater
impact than the assassin's bullets. The inspiration of Kennedy's challenges to a generation has
resulted in improved civil rights for all, many positive social changes, better opportunities for
education for all citizens, more research and development in all the sciences and medicine,
accomplishment of the goal of putting a man on the moon and returning him safely, and
continuing positive international relations and development in other countries with assistance
from numerous Peace Corps Volunteers.
During the 1960's the U.S. struggled with the issues surrounding the Viet Nam War and the ongoing
mounting casualties. Civil Rights leader Martin Luther King was assassinated. Presidential
candidate Robert F. Kennedy was assassinated. Riots in our cities tore at the very fabric and
core of American values and life. Civil Rights and anti-Viet Nam War rallies and marches
proliferated nationwide. Confusion, anger, grief, decreased morale, loss of a sense of direction,
challenged traditional values, and cultural change all impacted a reeling society.
In the summer of 1966 in Austin, Texas, Charles Wittman went up into the Texas Tower on the
campus of the University of Texas. He killed or wounded staff and tourists on his way to the top.
Once there, with his arsenal of weapons and ammunition, he methodically began to pick off
people on the campus and in town. He killed or wounded more that 40 people before being
killed himself by 2 police officers and a civilian volunteer. This whole drama was viewed on
live television throughout Texas and the country. It was the first time such an event had ever
been seen live by so many people and was the worst "terrorist" event to occur in this country
to that date. It shook the country and demonstrated the vulnerability of innocent people to such
acts.
During the early 1970's the country experienced the first significant fuel crisis. This awakened
the country to the realities of oil sources and the control exerted by groups outside the U.S.
such as OPEC. At Kent State University, the tragedy of students being shot by National
Guardsmen shocked the nation. Photos and video of the events traumatized many vicariously,
many of whom remain with residual problems to this day.
Also in the 1970s our government system was challenged internally by the Watergate scandal
and break-in. It resulted in the first resignation of a sitting president in the country's history. In
1979 the country endured the frustratingly long and drawn out daily drama of the Iranian
Hostage Crisis. In many respects it paralyzed significant parts of the country. Its resolution
partially depended on the election of a new president. While long, frustrating and drawn-out,
the crisis resolved peacefully.
In the 1990s the country fought the Gulf War. In early 1993, New York reeled following a
terrorist bombing of the World Trade Center. There were six casualties, repairs were made
and New York recovered. A domestic terrorist, Timothy McVeigh, bombed the Murrah Federal
Building in Oklahoma City in 1995. This was the worst act of terrorism in U.S. history to that date.
There have been other traumatic events that have shaken our consciousness in recent years.
Columbine stands out, but there have been other violent events in our nation's schools in
other parts of the country. Each of these events above resulted in direct and vicarious
trauma in many individuals, communities and the nation. Each one has had significant
long-range effects on the country. While each was followed by a period of grief and mourning
and shock, each has also generated some positive and constructive changes. In all cases, the
communities and the country as a whole have been very resilient and have recovered
psychologically, emotionally and physically.
RESILIENCE AND RECOVERY
Resilience is the capacity of an individual, group, community, organization, or a nation to
withstand loss or damage and to recover from the impact of an emergency, critical incident,
or disaster. Vulnerability can be viewed as a measure of the susceptibility to suffer loss or
damage. The higher the resilience, the less likely the damage will be and the faster and
more effective will be the recovery. Conversely, the higher the vulnerability, the more
exposed is the community, group, individual or nation to loss and damage.
Developing and using a resilience and vulnerability profile is an integral element in effectively
planning the management of consequences to a community or country following an emergency,
critical incident or disaster. Such a profile helps identify the strengths of particular areas,
communities or groups in terms of resources, skills, networks and community agencies available.
These strengths and local capabilities can be used and further developed to help minimize
the negative consequences of an emergency, critical incident or disaster by supporting recovery
activities.
When preparing to intervene, it is critical to assess which phase (heroic, honeymoon,
disillusionment, recovery) the individual, community, or country is currently in. This will help
in designing a general intervention. The approach will be different for each phase. This is an
example of community psychology at its best.
In the recent terrorist aftermath from the WTC in New York, the Pentagon and the plane crash
in Pennsylvania, these phases will be increasingly difficult to characterize. At this point, observing
from a distance, it appears that the heroic phase is concluding. With aid coming from around
the country and the world, and measures ( economic and legislative) being enacted by Congress,
the affected areas appear to be entering a honeymoon phase. Plans for recovery and the
future are being discussed. The country as a whole is making plans for a changed way of life.
While still uncertain about the future (immediate and long-term) the country is beginning to
debate rational and effective responses and recovery efforts. These will require close scrutiny,
observation, and continued re-evaluation.
WHAT CAN MENTAL HEALTH PROFESSIONALS EXPECT?
The responses of communities and individuals around the country will vary over the next
6 months to a year. Some will prove to be more resilient than others in recovering and getting
on with life. Cultural differences and different economic levels will be variables that will affect
recovery. Morale will be affected by both the real and perceived directions, actions, and goals
voiced, outlined and acted upon by community and national leaders.
Individuals
Therapists can expect an increase in certain types of presenting problems. These will include,
but not necessarily limited to: somatic complaints, depression, grief reactions, feelings of
hoplessness and helplessness, generalized and specific anxiety, phobic reactions, trauma
reactions, school phobias, fear of flying and travel, fear of elevators and other closed spaces,
fear of strangers, increase in divorce rates, family problems, spousal and child abuse, intrusive
thoughts and ruminations related to anxiety and fears, difficulties concentrating and making
decisions, absenteeism, difficulties making plans, sleep problems, nightmares, disturbing dreams,
difficulties relaxing, etc.
These and other related presenting problems can be expected to manifest in children as well
as in adults. Some adults who have had direct relationships or exposure to the actual events
may be at risk for feelings of survival guilt. Some veterans and others who have experienced
post-traumatic stress from other previous events may re-experience symptoms.
Under most conditions with clients presenting, most developed therapeutic approaches will
generally be sufficient with the caveat that this ongoing crisis will continue to generate certain
feelings and responses. Individual adjustment and adaptation are a couple of the general
goals in these cases. Another helpful approach is the use of support groups guided and/or
facilitated by avaliable mental health professionals. Ongoing discussions of feelings, current
events and actions would be a useful approach. If symptoms persist and/or become more
severe or present as severe, further and more intensive therapeutic approaches are indicated.
Communities
Contact on a regular ongoing basis with various community groups, formal and informal, by
mental health professionals can help in the assessment of community morale, recovery and
other responses as well as opportunities to promote morale, recovery, etc. by helping identify
positive, constructive community actions and goals and suggesting other positive actions and
activities. This is a time for mental health professionals to use their skills, knowledge and abilities
to become active participants in their communities at many different levels other than the
consulting room, workshops, and speeches.
While there are wide variations in the types of losses individuals, groups and communities
may suffer, the following are the most common types of potential losses and damages:
* SAFETY - threats of death or injury.
* HOME/SHELTER - threats to safe, appropriate accommodation.
* HEALTH/WELL-BEING - threats to short or long-term well-being in terms of physical health
and psychological and emotional well-being.
* FOOD - threats to an adequate supply of food and to a supply that is uncontaminated.
* CONTAMINATED WATER - threats to an adequate supply of water and to a supply that is
uncontaminated.
* SEWAGE/WASTE DISPOSAL - threats to a continued safe disposal of waste and an avoidance
of environmental health risks.
* SOCIAL LINKS - threats to the networks and links which sustain daily community life, which
provide a sense of order and meaning and which allow access to support and services.
* INFORMATION - threats to sources or outlets of information about existing or emergency
management services.
* ACCESS - threats to transport systems and utilities as well as to physical infrastructure such
as roads and bridges.
* INCOME/ECONOMIC OPPORTUNITY - threats to the capacity to earn a livelihood through
the loss of employment, loss of customers, or the loss of assets.
It is important to prioritize needs and the following is one possible way:
1. SUSTAINING LIFE (including people on life support machines).
* Essential medical facilities, medical equipment, "hospital in the home", medicines
2. SUSTAINING PHYSICAL WELL-BEING
* Accommodation, food and water, clothing, etc.
3. SUSTAINING MENTAL WELL-BEING
* Personal and psychological support and information.
4. REDUCING SOCIAL ISOLATION
* Access to support networks as well as information and resources.
5. REDUCING PHYSICAL ISOLATION
* Access to support networks as well as information and resources.
6. SUPPORTING EMERGENCY STAFF
* Supporting staff whose job is to provide urgent, critical support to others.
7. SUPPORTING PEOPLE WHO HAVE FEW RESOURCES
* Access to financial supplementation and resource supplementation.
8. ASSISTING PEOPLE WHO HAVE RESOURCES ADEQUATE TO MANAGE THEIR OWN
RECOVERY
* Access to assistance.
Some Issues
In terms of individual, group and community issues which support resilience and help to
reduce vulnerability, there are some relevant broad principles to consider:
1. We are aware from the experience of many events that the affected community(s) will expect
to contribute to their own recovery. If denied an opportunity, they may establish their own
structures and processes to achieve that end. It is paramount, therefore, to support community
involvement. Successful management of the consequences is not possible without community
commitment and involvement.
2. It is useful to set out community issues in these terms because it places them in a management
and operational framework. Issues of resilience, vulnerability and need are expressed in terms
in which they can be operationalized and dealt with in a practical way.
3.These issues are a broad characterization of the types of assistance and support that individuals
and groups may require after a significant emergency or disaster. They are a way of thinking
about service provision in management and operational terms rather than simply in terms of
the particular assistance measure.
Filling Needs:
The following are some of the major needs that should be addressed:
Information
* Information and advice about assistance measures and how to access them, including eligibility
conditions and application procedures.
* The normal biopsychosocial reactions which can be expected and how they can deal and cope
with these reactions in themselves, members of their family and their community.
* How to make sense of the event in terms of its cause and fitting it into their "view" of the world.
Resources
* Financial assistance where eligible to help restore losses. This may include, where appropriate,
grants, loans, and insurance.
* Physical goods such as temporary accommodation, essential household items, temporary public
transport, tools, etc.
Management Capacity
* Time and opportunity - e.g. to undertake recovery activities.
* Physical capacity - e.g. which may include the support of other people, machinery, or other
support where there is a particular need.
* Access to services - e.g. through establishing support systems, locating service centers close
to affected areas or access in terms of translator, interpreter, or other language and media
services.
* Expertise - e.g. access to specialist services such as tradesmen, financial counselors, and other
professional services.
Support
* Personal support - e.g. outreach services, personal advisors and counselors, specialist support
services, advocates and gatekeepers.
* Community support - e.g. community development officers, etc.
Involvement
* Consultation in developing and implementing assistance and recovery programs.
* Encouragement in making a contribution to policy and program development.
* Engagement in monitoring and auditing the progress of recovery.
RECOVERY AND RETURNING TO EQUILIBRIUM
All survivors of disasters suffer loss. They suffer loss of safety and security, loss of property, loss
of community. loss of status, loss of beauty, loss of health, or loss of a loved one. Following a
disaster, all individuals begin a natural and normal recovery process through mourning and
grief.
Assessing Resilience
A number of factors support individuals, families and communities and help to minimize the
consequences of disasters in terms of supporting sustaining recovery activities. Some of them
are the reverse of vulnerability such as access and adequate resources. Identifying and assessing
those positive factors possessed or shared by individuals, families, groups, communities and
agencies which support resilience gives emergency planners and managers the opportunity to
further develop resilience to increase the "disaster resistance" of the population.
Some of the elements supporting resilience include:
1. Shared community values, aspirations and goals
* including a shared and positive sense of the future, a commitment to the community as a
whole and agreement of community goals as well as a shared culture.
2. Established social infrastructure
* such as information channels, social networks and community organizations such as sporting
and social clubs.
3. Positive social and economic trends
* such as a stable or growing population, a healthy economic base.
4. Sustainability of social and economic life
* which embraces a capacity for the community to weather disruption.
5. Partnerships
* Partnerships bewteen agencies, between community groups and between commercial
enterprises, or any combination of these may bring innovation, sharing of experience,
knowledge, resources, and common goals. This applies particularly where the partners
play a dominant role in the social and economic life of the town such as towns dominated
by a particular industry or economic activity.
6. Communities of interest
* Where a group may exist over a wide area and be otherwise socially diverse but they share
a common area of interest, skill or expertise. This includes communities bound together by
faith and religious commitment as well as less formal groups such as business or commercial
associations or sporting or recreational clubs.
7. Established networks
* Clear, agreed and stable links between people and groups facilitate the exchange of
information as well as the sharing of resources and the commitment of skills, time and
effort to planning and preparedness.
8. Resources and skills
* The resources and skills available locally may be directly relevant to emergency management
planning, preparedness and for community support when an emergency or disaster occurs.
These can be identified by the type of resource or skill, its amount, the cost to use it, its
availability, and by its location. Where useful resources or skills do not exist they may be
developed or promoted as part of preparedness activities.
WHERE DO WE GO FROM HERE?
People in crisis are extremely vulnerable. They are open to hurt as much as to help. The goal
of crisis counseling should be to protect them from further harm, while providing them with
immediate assistance in managing themselves and the situation. Crisis counselors provide brief,
clear, and gentle directions and support to distressed victims. As soon as possible, they help the
victims take on responsibility for their own care. It is important to provide frequent reassurance
and guidance when the situation is most threatening. The most important thing is to offer
assistance to help the individual gain a sense of control of self and situation, and not to do
everything for the victim.
Whenever possible, it is important to help the victim identify and focus on the problem, or the
most important problem if there are several. This helps the individual gain a sense of perspective
and to prioritize their recovery efforts. They need to be told what is happening and why to help
reduce the sense of surprise or feeling that they are being lied to.
Provide Information Sessions
Information sessions presented jointly with the organizations involved are intended for the whole
community. They consist of providing general information and dealing briefly with the current
difficulties, the reactions that may be shown by the victims, services available, and the problems
typically associated with returning to normal life. The activities suggested for information sessions
are all optional. None are mandatory, neither for the disaster victims nor for the members of
their families or witnesses of the event.
During these information sessions, the following messages are among those given with regard to
physical and emotional reactions:
* the physical and emotional sympotms are part of a stress reaction and are considered normal;
* these symptoms occur in most people in a situation of stress, threat or loss. They are primitive
reactions of the mind and body, and their purpose is to help the individual survive;
* stress syndromes, although normal, can, however, present health risks if they persist, since they
rob people of energy and make them vulnerable to illness. In some cases, they can even have
reppercussions on a person's whole life;
* there are many ways of dealing with stress reactions, such as surrounding oneself with people
one feels good with and with whom it is easy to talk about what one is experiencing, doing
vigorous physical exercise, or using relaxation techniques.
* the most effective way of relieving stress reaction syndrome is verbalization sessions on the event.
Provide Verbalization Sessions
Verbalization sessions on the event are a simple but effective method of assisting the population
and responders to cope with and carry on with normal life. A verbalization session on the event
usually permits the alleviation of acute stress reactions in order to reduce or prevent delayed
stress reactions.
This method is a rational way of dealing with stress reactions. The intervention model focuses
on 3 specific objectives:
* to help people express their feelings;
* to assist them in understanding their emotional reactions and their behavior;
* to promote a return to a state of equilibrium in each individual.
Specialized literature in this area suggests that this type of intervention gives very good
results if it takes place quickly after the disaster or tragedy, that is, 24 to 72 hours
following the event. The optimal intervention should take place as soon as possible after the
appearance of symptoms (the concept of immediacy) and as close as possible to the site of the
disaster or the evacuation site of the disaster victims (concept of proximity). It should bring
together similar groups (concept of community) and create a climate that carries a clear message:
what they are experiencing is normal; it can be healed and they will be able to resume their
activities (concept of expectancy).
Groups should be homogenous and have a maximum of 12 participants. The atmosphere should
be positive, supportive and understanding. The reactions of each participant are shared and
accepted. The basic rule is that no one criticizes another person.
Verbalization sessions on the event should be led by competent mental health professionals
who are knowledgeable about this type of intervention and who have received the necessary
training.
Provide Follow-up, Referral to Mental Health Resources, Counseling
Each organization should have some means of monitoring individuals' recovery from traumatic
events or incidents. This may take place as a routine follow-up meeting (group or individual)
with the debriefing facilitator. a meeting between supervisor and employee, or a routine medical
check with the employee health nurse or physician. The purpose of the follow-up is to allow the
worker further opportunity to talk about feelings about the incident. It is also to assess with the
individual whether the symptoms are diminishing. A good time to do a routine follow-up is
about a month to 6 weeks following the event.
If workers still have difficulties with stress symptoms at that time, a routine referral to a
mental health counselor should be suggested. The organization should have a pre-established
plan for referrals to counselors who are knowledgeable or specialize in working with emergency
service personnel. Many EAP plans cover this.
Provide Post-disaster Counseling for Individuals or Groups
Counseling should be offered to individuals who were unable to attend a verbalization session
or debriefing. Counseling can also be offered to people who feel a need for individual help or
for longer term help in a group.
Finally, crisis presents an opportunity for change and re-evaluation. This can be a positive and
constructive development.
A pre-disaster collaborative relationship can make training available for emergency workers in
the mental health aspects of their work. This can help them to anticipate and effectively deal
with their own mental health needs and those of victims. Such pre-disaster planning between
mental health and emergency services also paves the way for effective collaboration during
and after a disaster. ****
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Book Search: 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
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
