Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT October 3, 2003 "The tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in a democracy." - Montesquieu
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CRITICAL INCIDENT STRESS MANAGEMENT
Rocky Mountain Region
Disaster Mental Health Institute
Dates & Locations:
Laramie, WY: November 12-15, 2003
Casper, WY: November 19-22, 2003
Contact: George W. Doherty
Laramie, WY 82073
IV Mexican Congress of Social Psychology
November 5 - 7, 2003
Location: Tlaxcala, MEXICO
Contact: Manuel Gonzalez, President of SOMEPSO
(Mexican Society of Social Psychology)
Phonr: +52 55 5804 4790, Fax: 5804 4789
International Conference on Creativity and
Imagination in Education and Methods of Mastery
November 17-20 2003
Location: Moscow, RUSSIA
Contact: Vladimir Spiridonov
Vygotsky Institute of Psychology
The Russian State University for the Humanities
Miousskaya Square 6, 125267
Moscow , Russia
Phone: +7-095-250-61-47, 7-095-250-66-32
Middle East/North Africa Regional
Conference of Psychology
December 13 - 16, 2003
Location: Dubai, United Arab Emirates
Contact: Dr. Raymond H. Hamden
MENA RCP, PO Box 11806
Dubai, United Arab Emirates
Phone: +971-4- 331-4777
Society for Judgment and
Decision Making Annual Meeting
November 10 - 11 2003
Location: Vancouver, CANADA
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
Volunteers Critical To Recovery Effort
Volunteers from around the country have come to the aid of those affected by Hurricane Isabel. They serve in a variety of roles - staffing recovery warehouses, answering telephones and perhaps the most visible, cooking and serving meals. Theirs is an important role in helping disaster victims on the road to recovery. For full story, go to: http://www.fema.gov/news/newsrelease.fema?id=5350
Urban Search and Rescue Teams Now WMD Ready
Search and rescue teams in 28 cities now have the equipment and training to respond to chemical, biological or nuclear attacks as the government takes steps to prepare for potential terrorist strikes. For full story, go to: http://www.fema.gov/press/ap/ap100203.shtm
Department of Homeland Security Announces Recipients of Joint Interoperable Communications Grants
17 Communities Across the U.S. Will Receive Funds to Develop Demonstration Projects. The Department of Homeland Security (DHS) announced today the 17 communities that will receive a portion of $79.6 million in funds to help communities develop interoperable communications systems. The grant recipients will receive funds as part of a joint program between DHS and the Department of Justice (DOJ) to develop demonstration projects that will use equipment and technology to increase interoperability among the fire service, law enforcement, and emergency medical service communities. For full story, go to: http://www.dhs.gov/dhspublic/display?content=1736
UNICEF hails entry of 1 million Afghan girls to school
More than 1 million girls in Afghanistan have entered schools since the fall of the Taliban, which banned their attendance, in “a testament to the courage and wisdom of the Afghan people, and the generosity of the international community,” the United Nations children’s agency said today. For full story, go to: http://www.un.org/apps/news/story.asp?NewsID=8430&Cr=afghan&Cr1=
UNICEF launches emergency hepatitis B vaccination campaign in Peru
The United Nations Children’s Fund (UNICEF) has launched an emergency vaccination campaign against hepatitis B for two ethnic groups in a remote region of the Peruvian Amazon, whose existence could be threatened by a prolonged outbreak of the disease. For full story, go to: http://www.un.org/apps/news/story.asp?NewsID=8342&Cr=Peru&Cr1=
UNICEF voices ‘grave concern’ at child trafficking in Afghanistan
The United Nations Children’s Fund (UNICEF) today expressed “grave concern” over the reported abduction and trafficking to neighbouring countries of Afghan children, some as young as four, and called on the government to use “the full weight of the law” against those found responsible. For full story, go to: http://www.un.org/apps/news/story.asp?NewsID=8355&Cr=trafficking&Cr1=
Mental Illness and Informed Consent: Seeking an Empirically Derived Understanding of Voluntarism
Informed consent is a practice of legal and ethical significance for persons living with mental illness. Curr Opin Psychiatry 16(5) 2003 For article, go to: http://www.medscape.com/viewarticle/460483
Survey Finds Millions of Previously Unrecognized Drug Abusers in U.S.
A redesigned survey of who uses and abuses drugs in the United States has found millions of "missed" users and addicts, with an estimated 22 million Americans abusing alcohol or drug. For article, go to: http://www.medscape.com/viewarticle/461045?mpid=18508
THE MEDICAL MINUTE: FLU SHOT OR NOT?
Fall begins flu season. Even though influenza does not typically arrive on the east coast until December, now is the time to prepare. That usually means a shot, but this year something new is available -- a nasal spray vaccine for the flu that has been approved by the FDA. The spray is different than traditional flu vaccine because it contains living flu viruses that have been treated so they cannot develop into the disease. The virus lives in the nose and throat of the vaccinated person for a while as the person's immune system develops resistance to it. The traditional shot has dead virus. Currently the spray is recommended only for healthy, non-pregnant people between 5 and 50 years of age, for whom tests have shown it to be about as effective as shots. Read the full story at: http://live.psu.edu/story/4200
THE MEDICAL MINUTE: GET BACK TO SCHOOL...SAFELY
As the carefree days of summer give way to the hectic back-to-school season, parents and caregivers should take time out to teach and review important safety guidelines with children. In the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, the Pediatric Trauma Prevention program at Penn State Children's Hospital offers a few guidelines to help parents and caregivers keep kids safe on their way to and from school, including tips on school bus safety and walking and riding bikes to school. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=3927
TYPES OF MENTAL HEALTH PROBLEMS FOLLOWING DISASTERS
The following are the more severe and, therefore, relatively uncommon responses among victims of a major disaster. The criterion is relatively simple: When the behavior indicates the victim is no longer able to function appropriately in the situation, he/she should be referred for professional assistance.1. Psychosomatic - vomiting, diarrhea, insomnia, loss of appetite, headaches, allergies, ulcers, bladder problems, extreme tiredness and weakness, rashes. These are some of the physical symptoms commonly associated with or directly resulting from emotional stress.When the conclusion is reached that the person should seek consultation with a professional, encourage the person to avail him/herself of such services and offer assistance, if needed, in locating competent help. It may be helpful to enlist the assistance of family and friends in persuading the person to accept treatment. Sometimes a physician or clergyman is most useful. It is best to work closely with a professional and to develop free and open relationships with them which will facilitate assistance with severe emotional problems.
2. Loss - bereavement (loss of loved ones); separation from loved ones (especially children); loss of limbs due to trauma; loss of familiar objects, possessions, lifestyle, memories; loss of independence; loss of home or farmlands, livelihood, etc.
3. Social stresses - divorce, delinquency, alcoholism reactivated, family discord. These reactions may not appear immediately due to the priority of pressures of coping with physical problems of adjustment to the disaster. As these problems are overcome or postponed, the emotional aftermath of stress may surface in various forms of interpersonal and socially negative behavior.
4. Sequelae of physical trauma - broken bones, burns, pain toxicity, changes in body image caused by disfigurement and invalidism, loss of memory. Sudden and unexpected physical damage to the body also very often leads to what is known as somatopsychic disturbances, that is, emotional distress resulting from physical injury.
5. Psychological - nightmares, unreasonable anticipation of another disaster, difficulty concentrating, severe depression, extended dazed feeling, nervousness, crying spells, hopeless feelings, irritability. More formal classifications are:A. Depression - severe sadness, feels hopeless, can't get out of bed, won't eat, cries, is apathetic, unable to engage in usual activities, sleep disturbance, feelings of helplessness, unshakable feelings of worthlessness and inadequacy, withdrawal from others, does not respond to others;
B. Disorientation - Confused and doesn't know where he/she is, what's happening, what time it is, unaware of surroundings, memory loss, dazed;
C. Hysteria - uncontrollable crying and upset, screaming, can't be left unattended, agitated, may show paralysis or numbness of parts of the body;
D. Psychosis - complete personality change, irrational thinking and highly unusual behavior, may report sensations for which there is no cause, and may have delusions of grandeur or persecution.
Role Playing As A Training Tool With Workers
Along with empathy comes the process of offering help. This is not a simple process, because it requires sensitivity to feelings, understanding of values, awareness of cultural and ethnic aspects, and avoidance of damage to pride. Again, the basic procedure is to imagine oneself in the role of the victim. How would you want to be treated? What characteristics of the worker would be most helpful? (e.g. sympathetic, understanding, supportive, ready to listen, warm, competent, informed, personally interested, etc.). What sort of helping behaviors would operate as a "turn off" most quickly and cause resentment toward the person and his/her agency (e.g. impatient, pitying, bossy, cold, condescending, oversolicitous, non-listening, etc.)?
Role-playing is one method of learning. It asks the participants to imagine themselves in an assigned role and to "play the part" for a while. It gives all of those involved an experience which is not too far afield from the actual situation. Many people are anxious or uncomfortable in the role-playing situation, feeling exposed and awkward. Trainers can be of most help by establishing a sense of trust and mutuality and by stressing that it is a learning situation for everyone. Critiques are non-hoatile and non-derogatory. If mistakes are to be made, this is the time to make them because all can profit from them.
Many trainees will already have first-hand knowledge of the problems faced by disaster victims. Role playing various kinds of helping situations will allow the workers to see and to try out various styles and methods. Divide the group into small subgroups and practice using some of the following situations:1. You are at the Evacuation CenterGroups - Therapy And Community
Hundreds of people have had to leave their homes and are being given food and temporary shelter by the Red Cross. You circulate through them and talk at length with one family of five - a father, mother, and three small children. You learn they have lost their house and are wondering what to do next. Keep in mind the steps for effective helping:A. Rapport can be established through the art of listening. Encourage the family to do the talking, and ask questions in order to obtain information about their most pressing concerns. Listen nonjudgmentally, empathetically, and alertly. Establish trust through your interest and concern.2. You Are At The "One-stop Center".
B. Problem focusing - ask about the current difficulties and other difficulties. Arrive at the most immediate problems to be attended to and establish priorities. Repeat back and summarize information to be sure all understand and agree.
C. Evaluate - review the problems, the capabilities, and the resources in your mind as you explore. Can this be handled without additional help? Does it require professional assistance?
D. Resources - learn what personal resources the family has, e.g., other family, relatives, neighbors, friends, and finances. Also determine what governmental agencies and nongovernmental relief agencies may be most helpful and in what order they should be visited. Help the family to understand and overcome red tape, if possible. Be willing to play the advocate role and be alert to possible ways in which you can diminish frustrations.
You have been asked by a Family Services official to help an elderly woman of 65 who has lost her house and all her possessions in a devastating tornado. She was sitting dazed amidst the wreckage and was finally persuaded to come to the center to get help. She has been alone in her house for years with help from Social Security and a daughter who lives in a small town 30 miles away. She has always been independent, but now seems overwhelmed, almost "out ot it", by the catastrophe.A. Listening Can you get her to talk? What was most important among the things she lost? Understand the victim's grief over lost objects and the consequent obliteration of memories. For many, these losses are as important as the loss of loved ones because they represent ties to life and symbolize a continuity with the past.3. You Are Interviewing A Couple In Their Temporary Mobile Home Supplied By FEMA
B. Focus What will be the most important, the most immediate, problem? Medication? Finances? Eyeglasses? Shelter? Focus on the one that is both immediate and most likely to be solved easily.
C. Evaluate Can the woman recover? Will she be able to live alone again? What strengths remain? How does she evaluate her problems? Does she see them realistically? Can she regain her former independence?
D. Resources Can the daughter help? Is the woman willing to live with her? Does she get along with others?
E. Plan When practical, try to present choices. Agree with the woman on what to do first. Make sure she understands. Determine what else you can do and what the ensuing steps will be. Set a time, date, and place for the next contact.
There are two children. Plans for rebuilding are progressing. An additional concern is the youngest child, a 3-year-old girl. She seems to have become unruly and "whiney". The neighbors' children tease a lot, but the girl continues to play with them. The mother doesn't feel happy about having to live in such cramped quarters with an unhappy child for another year. The child has been having frequent nightmares.A. Listen There may be many other problems and difficulties this young couple is having. They may still be having nightmares of the evening of the disaster which devastated their home.4. You Are Visiting The Mother Of A 6-year-old Boy.
B. Focus Which is the main problem - rebuilding the house, the youngest child, or the continuing nightmares? Which can you possibly help with?
C. Evaluation How serious are the problems? Is professional help needed for anyone? For whom?
D. Resources Professional mental health agency for therapy? Advocacy for insurance, low interest loans? Moving the mobile home to another area? What agencies will be needed? What resources does the family have to help itself? Are they close, warm, involved?
E. Plan Mutual agreement on what to do first and how.
The mother is puzzled by the boy's behavior in school and at home. He is reluctant to play, has to be coaxed, and follows her around all the time. She feels he no longer cares for school, something he had always enjoyed before. You agree to talk to the teacher to see what you can learn about the boy's behavior in school. You learn that in school he now has become a behavior problem. He doesn't mind and is difficult to control. What can you do to help the teacher, the mother, and the child?
5. You Have Been Asked To Be Available At The Temporary Morgue.
Many of the victims who come in to identify dead members of the family seem to be having difficulty adjusting to their sudden loss. The thought was that having someone there from mental health might be helpful. Are you able or willing? Can you handle the circumstances surrounding death? Can you:A. Help the survivor face the reality of the loss?6. A neighbor has remarked that a woman across the street seems to be having difficulties because her eyeglasses were crushed during the disaster.
B. Help the survivor feel free to express grief (e.g., to cry, reminisce, to feel the "normal misery" of the mourning)?
C. Offer support and comfort?
D. Help in making arrangements for movement or burial?
E. Arrange for additional support as long as needed?A. How do you approach the woman?7. The disaster occurred nearly 8 months earlier.
B. What resources can you offer?
C. Are eyeglasses the only problem, or are there more? How do you find out?
A young father is frustrated in his efforts to fill out income tax forms. He needs advice. A friend told him you might be able to help.
8. You are handling telephone inquiries of all sorts.
A call comes from a middle-aged woman who wants to know the telephone number of welfare services. She seems upset. You think she needs more than a telephone number, since you know the phone lines to welfare services have been jammed all day.A. What can you offer your caller?There are opportunities for uncovering strengths in disasters which go unnoticed or unrecognized. They can provide a positive focus for discussions with clients. Some of these are:
B. What are the limits on what should be offered?
C. How can you find out the best way to be of help?
Tapping Strengths In The Individual And The Community1. Recovery as a new purpose for life.
2. Experiencing the helpfulness and mutual aid of others.
3. Rebuilding to make desired improvements.
4. Sharing of severe stress leading to stronger relationships with significant others.
5. Opportunity for community leadership to emerge and reaffirm itself.
6. Opportunity to develop new strengths, new abilities to cope. How can workers capitalize on these?
Special problems may suggest the formation of therapy groups (under professional leadership). Children's fears and anxieties are often helped when played out or discussed in groups, giving the child a chance to see he/she is not alone. Parents may find that a group situation is the best place to discuss their children's problems, and, in the process, to bring up their own.
Meetings of the affected population are helpful when factual information can be disseminated. Later, group participation in the decisions about rebuilding and reclamation is helpful in restoring and maintaining community spirit. Opportunities for recreational events, block parties, disaster anniversary ceremonies, etc. should be taken advantage of, if possible. Schools, social clubs, neighborhood councils, church groups, etc. may serve as facilitators in such activities.
Governmental And Non-governmental Disaster Relief Agencies can also be of assistance and you should have a working knowledge of which ones are currently available with referral numbers and contacts.
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:
This follow-up book to Ursano et al.'s earlier title Individual and Community Responses to Trauma and Disaster expands the focus on terrorism. There is widespread belief among professionals that terrorism (and torture) produce the highest and most diffuse rates of psychiatric sequelae of all types of disaster. This book's international experts assess the lessons learned from the most recent atrocities. They look at prevention, individual and organizational intervention, the effect of leadership, and the effects of technological disasters and bioterrorism/contamination.
Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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