ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
October 12, 2001
"This hand, to tyrants ever sworn the foe,
For Freedom only deals the deadly blow;
Then sheathes in calm repose the vengeful blade,
For gentle peace in Freedom's hallowed shade."
- John Q. Adams
1842 Journal Entry
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WORK POLICIES MUST MOVE INTO THE 21ST CENTURY TO INTEGRATE
WORK AND FAMILY, REPORT SAYS
Coping with increasingly long work hours, finding adult and child daycare, missing
that first step and rarely seeing one's spouse, all are issues facing today's American
work force. While the problems of working families enjoyed a brief flurry of attention
during last year's presidential campaign, attention has since dwindled. To put these
issues back on the national agenda, the Sloan Foundation's Work-Family Policy
Network Sept. 14 released a Call to Action and a report focused on changing existing
policies to alleviate these persisting family pressures. The Network calls on the
administration, state and local governments, business and labor to each do its part to
put a concerted approach in place. "Integrating Work and Family Life: A Holistic
Approach," written for the Network by Lotte Bailyn, T Wilson professor of management
and Thomas A. Kochan, George M. Bunker professor of management, MIT's Sloan
School of Management, and Robert Drago, professor of labor studies, Penn State,
suggests ways in which each party can help working families while achieving their own
objectives. The Call to Action begins by stating: "American families need access to a
universal paid leave policy, but the specific forms should be made flexible by building
on what leading firms and union agreements already provide some workers." Also called
for are attempts to "trade reduced hours of work for employees in return for the flexibility
in scheduling that employers need." With joint planning, employers should be able to
support reduced hours when family responsibilities are greatest and workers should be
able and willing to increase their hours when employer and customer needs peak. The
report also focuses on the ways work redesign can better fit the needs of employees and
employers, efforts that are already under way in a variety of organizations. The "need to
accelerate the pace of moving women into top-level positions" in corporations, unions,
and government organizations is another piece of the puzzle, as are attempts to increase
workers' "rights to join a union." At the community level, many attempts are under way to
coordinate childcare and elder care and the report argues that we should foster "greater
investments in their services, and facilitate volunteerism in their programs." The report
concludes with a call for leadership to create "Work-Family Councils and Summits" on
the local, regional and national levels. The need for an integrated approach to work
family problems, already serious, will only become more so. "While work and family
have changed, the public and private policies and practices governing employment
remain mired in the past, modeled on the image of an ideal worker as a male breadwinner,
with a supportive wife at home," the report states. This image is not accurate for the 21st
century. Most workers today, regardless of gender, have family responsibilities and
married workers generally have a working spouse. Juggling children, elderly parents,
household requirements, career, and relationships becomes an intolerable cycle of chaotic
choices. There is no "wife" at home to organize and run the non-work aspects of life.
Employers pay for this mismatch of practice and reality with high costs of turnover,
absenteeism, and lost investments in human resources. Workers face an increasing time
squeeze, financial pressures, and the spillover of stress into every aspect of everyday life.
A number of leading American organizations are already dealing with these problems,
but the approaches are often piecemeal and have not been integrated. Some employers
offer paid family leave, but many Americans who desperately need income supports during
family leave have none available. A few communities are bringing together public and
private sector organizations around child care and related issues, but these community
initiatives are not being brought together at a national level. The authors sum up the
Call to Action by noting: "Addressing these issues is not just good social policy: it is
essential to the economy. Only by redefining out-of-date models of the family and of
employment, and developing strategies that reflect the new definitions, will we benefit
from the talents of the full work force." A copy of the full report is available at
http://lsir.la.psu.edu/workfam/integrate.htm
Contact: A'ndrea Elyse Messer aem1@psu.edu
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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:
GeorgeDoherty@callatherapist.com with your name and mailing address.
Online Brochure can be accessed at: http://www.angelfire.com/biz3/news/cismuw.html
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SUPPORT FOR MENTAL HEALTH STAFF IN THE IMMEDIATE RESPONSE PHASE
In the response phase during and immediately after impact of the disaster, the provision of
certain supports for workers can help mitigate stressors and help workers to remain effective
in their jobs. There are a variety of services such as communications, food, shelter and
supplies that are essential to "keep the organization going". In a large scale disaster mental
health operation, the organization might consider assigning a logistics coordinator to this
function. The following need to be considered.
Assistance With Locating And Checking On Families
When disasters occur during working hours, employees' major concern will be learning information
about the well-being of their families. Worker anxiety can be expected to increase and efficiency
to markedly decrease until this information is obtained. Some anxiety can be mitigated if
workers have disaster plans at home and know that their family members have the skills and the
supplies to take care of themselves. Nonetheless, staff will need information concerning the
status of their families.
If workers do not have information about the well-being of their families, the organization
should make every effort to help them obtain information. All agencies with disaster
responsibilities should have a pre-established plan for how employees will check on their
families if a disaster occurs during working hours. Tranchina (1991) suggests that each
employee should have on file a regularly updated list of family members, addresses, phone
numbers, and usual whereabouts during given hours of the day. Employees are strongly encouraged
to establish a plan with their family members by which the family will make every effort to
contact the workplace to report on family well-being. This is especially important in those
situations where employee roles are essential and they may not immediately be able to leave the
workplace.
If conditions allow, staff may be released to go home and take care of their families prior to
reporting for duty for disaster response. In the situation where staff cannot be released
(on an inpatient unit, for example), there are several options. When additional staff report
for duty, staff can be released to check on families. Staff in less critical roles (clerical
staff, for example) may be assigned to family locator functions, and may go into the community
to check on families, conditions permitting. If phones are working, one line can be dedicated
to family search activities.
Debriefing of Mental Health Staff
It is essential that disaster mental health workers begin to process their own emotions about
the disaster prior to attempting to help survivors. It is strongly recommended that a debriefing
or other group discussion of workers' own reactions be conducted for workers prior to deployment.
Using a Team Approach
Whenever possible, mental health personnel should be assigned to work in teams of two. If there
are not enough mental health workers to allow this arrangement, staff can often work in a team
assignment with public health nurses, Red Cross workers, or other human service type disaster
responders. This helps ensure a system by which staff can serve as a check and balance for
each other in assessing needs, making decisions, setting priorities, etc. in the chaotic
disaster environment. It also provides staff with a "buddy system" for monitoring each other's
stress level and providing support and encouragement.
Briefing
Provide workers with as much information as possible about what they will find at the disaster
site. This may involve a quick briefing before sending workers into the field, or a briefing
for new staff as they arrive at the scene. This forewarning can help personnel gear up
emotionally for what they may find.
Work Related Supplies
Pens, paper, data collection forms, name tags, educational brochures on disaster stress reactions
and stress management, and any other necessary supplies should be sent with workers to the
worksite.
Official Identification
Official identification cards that are recognized by law enforcement will be necessary to enter
the disaster site. In addition, name tags will be important once staff get to their assigned
worksite. Most disaster survivors do not see themselves as needing mental health services,
and may shy away from talking to staff who have name tags saying "psychologist" or "psychiatrist".
Experience has shown that titles like "crisi worker", "crisis services", or "health services" are
less intimidating to survivors.
Access to Disaster Site
In addition to appropriate identification, workers will need information about safe routes to
the work location, hazards to avoid, etc. Sometimes, transportation and/or an escort may be
necessary.
Food and Shelter
If mental health staff are unable to live at home during their disaster assignment, either
because of distance or because of hazardous travel conditions, it will be necessary to provide
them with shelter. It is preferable that staff have lodging in an area separate from disaster
survivors in order to give staff a break from the demands of the disaster when they are off
duty. Shelter may be available in local hotels or motels, depending on the severity of damage
in the disaster zone. Even in urban areas with many facilities, however, available rooms fill
fast with the influx of disaster workers as well as survivors and other groups needing temporary
housing. Hotel accommodations may need to be made outside the impact area, and workers may need
to commute to and from their field assignment.
For mutual aid mental health workers who may have come from outside the local jurisdiction,
the mental health agency will probably have to provide some assistance in making hotel
accommodations. At the very least, a list of local hotels and motels will be helpful to mutual
aid personnel in making their own reservations. There are logistical and psychological advantages
for a given mutual aid team to house all of its members at the same hotel, if room availability
permits. Defusings, debriefins, and practical aspects of team coordination are made significantly
easier.
If hotel or motel housing is unavailable, personnel may need to sleep in churches, community
centers, or official shelters. In some situations, housing may be akin to "camping out".
Personnel should be knowledgeable of these conditions and should take personal supplies,
clothing, tents and sleeping bags. In South Carolina following Hurricane Hugo in 1989, mental
health staff at times slept in buildings without windows or electricity. The state Department
of Mental Health provided public safety officers to ensure the security of workers. Security
will need to be considered and planned for when conditions are primitive.
Food for workers may be available through local restaurants and grocery stores. Sometimes,
workers may need to eat at mass feeding sites or mobile canteens set up by the Red Cross,
Salvation Army, or other groups. If workers will be depending solely on these sources for
their meals, the mental health agency should inform the organization providing the meals
to ensure that this arrangement is acceptable and that there will be adequate food for
workers. Workers should take some food and water with them into the disaster area as backup.
Communications
Staff should have a mechanism for communicating through the mental health chain of command.
They should be able to reach their supervisor, and to transmit through the supervisor to the
Emergency Operations Center (EOC) pertinent information about conditions or needs in the field.
The field based workers are often the "eyes and ears" not only for the mental health agency,
but for other responding agencies as well. Workers may come across a previously unknown hazard
or need which should be communicated to the EOC.
Inoperable phone lines may hamper communications. Even if regular telephones are functioning,
field staff can benefit from the convenience and security of having cellular phones, although
some rural areas do not have this service. Portable FAX machines and their phones, as well as
a laptop computer with modem can also be useful. If such equipment is not available, however,
a cooperative agreement with amateur radio groups to serve as a communication link may be
necessary. Staff should not expect to communicate via police or other emergency radio
frequencies, as these will be bust with emergency transmissions. sometimes, communication may
need to be via messenger or runner.
Supervision
A clear chain of command should exist for workers in the field. They should know who their
supervisor is, and if the supervisor is not always in the immediate area, how to communicate
with him/her. They should be instructed about what types of information should be communicated
to the supervisor.
In some situations, workers will be assigned to a site that is under the management or command
of another organization. A common example is a Red Cross shelter. In such situations, workers
are expected to follow the rule and regulations of the host organization, and to follow any
criteria or guidelines that might exist in a memorandum of understanding between that
organization and mental health. Logistical issues such as levels of staffing and schedules
of mental health workers at the site will need to be worked out between the mental health
supervisor and the site manager. All supervision related to mental health issues, clinical
practices, policies and procedures, etc. is the responsibility of the mental health agency
supervisor.
The following suggestions may be helpful to supervisors in dealing with disaster related
stress among mental health workers.
1. Remember that early identification and intervention with stress reactions is the key to
preventing worker burnout. Review stress symptoms with workers before they go into the field.
Provide handouts for workers regarding stress management and self-care.
2. Assess workers' appearance and level of functioning regularly. It is not uncommon for
workers to deny their own level of stress and fatigue. For example, workers may say they
are doing "fine", but may be exhibiting multiple stress symptoms and appear very fatigued.
3. Try to rotate workers among low-stress, moderate-stress and high-stress tasks. Limit
workers' time in high-stress assignments (such as working with families identifying the
deceased at the morgue) to an hour or so at a time, if possible. Provide breaks and
personal support to staff in such positions.
4. Ask workers to take breaks if effectiveness is diminishing; order them to do so if necessary.
Point out that the worker's ability to function is diminishing due to fatigue, and that they
are needed functioning at full potential to help with the operation. Allow the worker to
return to work if he/she rests and functioning improves.
5. On breaks, try to provide workers with the following:
* bathroom facilities
* a place to sit or lie down away from the scene; and quiet time alone
* food and beverages
* an opportunity to talk with co-workers, if they wish.
ORGANIZATIONAL SUPPORT FOR MENTAL HEALTH STAFF IN THE
LONG TERM RECOVERY PHASE
For mental health personnel who work in the long term recovery program, there are several
supports that can make the work more rewarding and effective.
In the long term recovery phase, as in the immediate response phase, utilization of a team
approach can help to miyigate the stressful effects of working in isolation. Whatever the
size of the long term effort, the mental health agency should make every effort to design
the program so that there is a team of staff participating. This is far preferable to
having a "one person operation" or having individuals from various agencies or offices assigned
to work in isolation. Having a team of workers to meet with, both formally and informally, can
help to prevent erosion of morale.
Perhaps most importanly, the team structure provides workers with a system of peers who truly
understand the nature and goals of the work. To the population as a whole, and to mental health
staff not familiar with the process of disaster recovery, once debris is removed and rebuilding
begins, it is assumed that emotional recovery has taken place. There may be little understanding
of the need for mental health support over the many months to follow. Disaster mental health
workers not functioning as part of a team effort often feel isolated and unappreciated.
A team format for services also provides staff with both formal and informal forums for
supervision and peer consultation on difficult cases or challenging community situations.
In-service Training and Consultation
Provision of in-service training regularly can give workers knowledge and skills specific
to long term recovery issues. The disaster mental health worker should remain current in
his or her knowledge of programs, services, and resources available to disaster survivors.
Periodic updates by representatives of key recovery agencies, such as FEMA and the Red Cross,
are useful. Certain topics can be anticipated, such as planning for the anniversary of the
disaster. Other training needs unique to the particular disaster and community may be
identified as the programs proceed.
Consultation from local or outside experts in disaster recovery can help staff in identifying
and overcoming problems or barriers to effective service delivery. In addition, in-service
training and consultation provide rewards for staff that have tangible positive effects on
morale.
Stress Management Activities During Long Term Recovery Work
The stress of long term mental health disaster work is often less discernible than the intense
and obvious stress immediately post-impact. Training on long term stresses of disaster work
and stress management strategies is important. Regular sessions set aside for staff to discuss
the psychological and emotional impact of the work can be helpful in identifying and mitigating
work-related stressors and in providing staff with peer support. Such meetings can be run in a
peer-support group format or can be facilitated by an outside consultant.
Staff may need peer and supervisory reminders that there is "life outside disaster". The
importance of good nutrition, rest, exercise, recreation, and participation in usual family
and social activities should be underlined.
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REFERENCES
Tranchina, M.W. (1991). Locating employees' family members during disasters. Fire Chief,
October: 56-57.
To search for books on disasters and disaster mental health topics and purchase them online,
go to the following url:
http://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: http://www.angelfire.com/biz3/news
