Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT April 13, 2001
"One of life's greatest rules...you cannot hold a torch to light another's path without brightening your own." Unknown **********************************************************************************************
World Health Day 2001: "Mental Health: Stop Exclusion - Dare to Care"This year's slogan for World Health Day is "Mental Health: Stop Exclusion -Dare to Care." On April 7, World Health Day, a mental health awareness campaign was launched aimed at changing worldwide public opinion on issues related to mental health and stimulating debate over ways to improve the situation in this area. As part of this celebration of World Health Day, PAHO's Publications Program will offer, with a special discounted price, a series of publications related to the theme of mental health and disasters. For more information, please go to the following address: http://www.paho.org/English/DBI/MDS/promo-whd2001.htm
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AMPHIBIAN MORTALITY LINKED TO GLOBAL CLIMATE CHANGE
For the first time, researchers have identified a direct link between global climate change and local factors that cause the death of amphibian eggs in the wild, according to a paper to be published in the April 5 issue of the journal Nature. Scientists have been trying to determine why amphibian populations worldwide have been declining at alarming rates since the late 1970s, but their research has pointed to a confusing variety of causes. Now, Joseph Kiesecker, professor of biology at Penn State, reports the research team he leads has shown that global warming causes changes in rainfall patterns, causing stress in moisture-sensitive amphibians, leaving them susceptible to a variety of pathogens. The specific stresses and specific resulting causes of death depend on the specific conditions in the animals' local habitat. Kiesecker's team found a direct link between the Southern Oscillation Index, which tracks temperature fluctuations including the El Niņo warming cycles in the South Pacific, and the amount of rain or snow in Oregon's Cascade Mountains. For more on this story by Barbara Kennedy, go to http://www.science.psu.edu/alert/Kiesecker3-2001.htm
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Interventions Following A Disaster: Debriefings and Information Sessions
Debriefings
A debriefing is an organized approach to the management of stress responses following a traumatic or critical incident. It is a specific, focused intervention to assist workers in dealing with the intense emotions that are common at such a time. It also assists workers by teaching them about normal stress responses, specific skills for coping with stress, and how to provide support for each other.
A debriefing involves a one-to-one or group meeting between the worker(s) and a trained facilitator. Group meetings are recommended, as they provide the added dimension of peer support.
A debriefing is not a critique. A critique is a meeting in which the incident is discussed, evaluated, and analyzed with regard to procedures, performance, and what could have been improved upon. A critique is a valid and important meeting. It can help workers to sort out facts, get questions answered, and plan for what to do in the future. A debriefing has a different focus: that of dealing with the emotional aspects of the experience.
It will not work to combine a critique and a debriefing in the same meeting. The goals and focus of the two meetings are entirely different. If an attempt is made to combine them, personnel may be much more comfortable analyzing logistics of the operation than dealing with the feelings involved, and the critique is all that occurs.
The basic ground rules for conducting a debriefing are outlined below.
Who Should Attend
Everyone who participated in the incident should attend, unless the group is too big. In that case, it can be split into smaller groups. Multidisciplinary groups with police, firefighters, paramedics and EMTs, emergency room nurses, etc, are good. They bring together the whole team. Command officers and line staff should participate in the same debriefing. The media should be excluded if they wish only to observe. If they were part of the traumatic incident, they should participate in the debriefing as a participant and observe confidentiality like all other participants.
Mandatory vs Optional Debriefings
Opinions vary as to whether debriefings should be made mandatory. Many departments are moving in the direction of making debriefings routine and mandatory after any critical incident. This policy gives personnel the message that:
1. the organization is concerned for workers' well-being, and
2. the debriefing is a natural and routine procedure, with no stigma attached.
When debriefings are not mandatory, personnel who might benefit may not attend for fear of being labeled "weak".
Who Conducts the Debriefing
The debriefing should be conducted by an experienced mental health facilitator. A professional facilitator is recommended because the emotions expressed in a debriefing may overwhelm an untrained facilitator. The facilitator should be skilled in group dynamics and communications, use a crisis intervention approach, have a good knowledge of stress response syndromes and interventions, and be well-versed in operational procedures of emergency service organizations.
When a Debriefing Should Be Held
The best time to hold a debriefing is about 24 to 48 hours after the incident. Prior to that time, workers may still be emotionally "numb", either from the shock of the incident or because their feelings are still being suppressed. Workers are also in the process of intellectually restructuring the incident, often trying to figure out if they operated "by the books". At the 24-48 hour period, emotions are often surfacing in an intense form. This is a good time to deal with them. Effectiveness diminishes with the passage of time between the event and the debriefing. Every effort should be made to conduct the debriefing within 6 weeks of the event. However, successful debriefings have been conducted a year or more following a traumatic incident.
How Long Should a Debriefing Take
Usually 2 to 4 hours should be allowed for a debriefing. In some situations, it may take longer. It is usually wise to block out a morning or afternoon to devote to the debriefing.
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 symptoms 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 repercussions 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.
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 THREE 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.
The 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 between 24 and 72 hours following the event. At least 24 hours should be allowed to elapse before such a session, since the normal mechanisms of denial and avoidance are predominant immediately after the disaster, whereas after 24 hours, cognitive activity decreases to give way to feelings and emotions. Studies have shown the importance of holding these sessions promptly, because the longer one waits to carry out post-disaster intervention, the less effective is the intervention. Therefore it is important that it take place within 72 hours.
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 (the concept of proximity). It should bring together similar groups (the 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 (the concept of expectancy).
The make-up of the groups should be homogeneous and reflect the characteristics of the participants - men, women, the elderly, adolescents, responders, etc. - in order to facilitate discussion.
Groups should be restricted to a maximum of 12 participants, or fewer if there is too great an emotional charge. 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.
The 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.
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For further information and to order Disaster Mental Health and other Mental Health publications online for *free* through NIMH and CMHS, go to the following:
NIMH Publications:
http://www.nimh.nih.gov/publist/puborder.cfm
CMHS Publications: http://www.mentalhealth.org/publications/publications.cfm?SubjectArea=Disaster
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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
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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.
**********************************************************************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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