ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
September 28, 2001
"The most important thing in communication is to hear what isn't being said."
- Peter F. Drucker
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For information about counseling available for terrorism victims,
families, GO TO the FEMA Newsroom site at:
http://www.fema.gov/nwz01/nwz01_121.htm
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Focus on Tolerance
http://www.tolerance.org
A project of the Southern Poverty Law Center, this Web site is
dedicated to exposing intolerance and equipping visitors with tools
to combat it. The site is designed to reach out to parents, children,
teachers and activists. Parents can read a list of 101 ways to
incorporate tolerance into their lives to affect their children. Kids
can explore "Planet Tolerance". Teachers can read lesson plans and
find an online classroom pen pal to help the kids learn about people
with different backgrounds. Visit the site to learn how to make a
difference, be alerted to the latest incidents of intolerance and
"soul-search" to learn about hidden biases.
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October 12-16: Third Pan-Asia-Pacific Conference on Mental Health,
Beijing, China. Contact: The Third Pan-Asia-Pacific Conference on
Mental Health, No. 5, Ankang Hutong, Deshengmen Wai, Beijing 100088,
China; 86-10-82085465; fax: 86-10-62012742; email:
PAPCMH2001@psycn.com or adrdlzj@public3.bta.net.cn
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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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STRESS MANAGEMENT AND SUPPORT
FOR DISASTER MENTAL HEALTH PROFESSIONALS
Effects of Disaster on Mental Health Professionals
In order to understand the effects of disasters on mental health professionals who intervene, it
is helpful to look at two of the key concepts of disaster mental health.
First of all, no one who sees a disaster is untouched by it. This includes the workers. The
intensity of the emotional climate of the disaster demands that the worker continually confronts
and manages all kinds of painful expressions of emotion (Cohen and Ahearn, 1980). The subtlety
and the intensity of workers' reactions come through in Erikson's (1977) reaction to the Buffalo
Creek, West Virginia flood when he entered the community a year later:
I felt for a moment as though I were in the company of people so wounded in spirit that they
almost constituted a different culture...the sense of being in the presence of deep and numbing
pain remained an important part of the emotional climate in which this study was done. I was
driving down Buffalo Creek late that night when the storm that had been threatening all day
finally broke with mountain vengeance. I pulled over to the side of the road near one of the
several trailer camps on the creek and stayed there as half the lights in the camp flashed on,
children began to cry, and small groups of men trudged out into the darkness to begin a wet
vigil over the stream. Something of the mood of that camp reached across the creek to where I
was parked, and I had to fight off a compelling urge to drive away, to escape. I had been in
the hollow for only twelve hours (Erikson, 1977).
Disaster workers are normal persons who generally function quite well under the responsibilities
and stresses of their jobs. However, exposure to traumatic stimuli and the demands of disaster
work can cause workers to show signs of emotional and psychological strain. These reactions
are normal ubder the extraordinary and abnormal situation of the disaster. Disaster
stress and grief reactions among workers are usually transitory in nature. Relief from the
stressors and the passage of time usually lead to the re-establishment of equilibrium. Education
of workers about normal stress reactions and the importance of stress management on the job
can help workers to anticipate and manage their own reactions to the disaster.
What To Do When A Mental Health Professional Suffers Losses
There are times when mental health staff have sustained direct losses themselves from the
disaster. There have been many ibstances in which directly affected staff have heroically
participated in mental health response activities without letting coworkers or supervisors
know of their own losses. While this may be part of an altruism that occurs after impact, it
may put the worker at real risk if personal, family, and financial needs are not being attended
to. Every mental health agency should find out which of its workers have been directly affected
in order to support the worker and to make appropriate work assignments. The organization can
support its own workers by providing formalized debriefing, crisis counseling services, and
support groups for those directly impacted staff.
A question usually comes up about whether directly impacted mental health professionals can
and should be involved in the mental health disaster response. The answer is "It depends".
Initially, the impacted staff may need time off from work to attend to their own affairs.
On returning to work, these workers may suffer from post-disaster stress reactions such as
poor concentration and fatigue that could negatively influence their work performance. "Light
duty" assignments during periods of heavy personal stress can be helpful, if they can be
arranged. Sometimes, "business as usual" with staff performing their regular functions and
workload, can provide a routine that offers structure and comfort.
Typically, impacted staff will feel a desire to be part of the mental health response. Such
a work assignment should be carefully evaluated with the worker to learn how disaster work
may affect them on a personal level, and how his or her personal situation may affect his/her
disaster work. An important factor will be the worker's ability to separate his/her own
coping styles from those of other survivors, and not to impose, consciously or unconsciously,
his/her own values and methods of coping upon others. The ability to empathize with survivors
may be enhanced by the worker's own losses. However, the worker must be able to maintain
perspective and avoid the hazards of over-identification with survivors. Taking too much
control in a desire to help, playing down others' crises, or avoiding listening to intense
feelings because it is too painful for the worker can be other pitfalls.
DISASTER PHASES FOR WORKERS
Disaster workers go through a series of emotional phases related to the nature of their jobs.
There are times when workers may feel "out of sync" with the reactions of survivors. This is
especially common during the early hours and days of the disaster while workers are still
making heroic efforts to organize and deliver services. At other times, mental health
professionals may closely identify with survivors and experience their emotions vicariously.
While it is impossible to specify exactly what a given mental health professional will
experience at any one point in time, the following are the usual disaster worker phases
(Hartsough and Myers, 1985).
Alarm Phase
This phase involves comprehending and adjusting to the news of the disaster, collecting
and making sense of whatever facts and information are available, and gearing up to respond.
In a warning period in which workers are waiting to see whether an event will materialize
(a tornado watch, for example), they may experience vague feelings of anxiety, restlessness,
and irritability. Post impact, workers, like survivors, may initially feel shocked and stunned.
An orientation or briefing for workers before they first enter the disaster area can help to
reduce some emotional shock.
Mobilization Phase
Workers quickly recover from their initial shock and start developing and coordinating plans.
Supplies, equipment, and personnel are inventoried and community needs are assessed. Mutual
aid may be requested. Staff move into action.
Action Phase
Workers actively and constructively work at necessary tasks. There are two aspects to the
mental health action phase (New Jersey Office of Emergency Management, Dec. 1991):
1. Response: This phase occurs immediately before, during and after the impact. Mental
health response activities may include staffing at shelters, first aid stations, meal
sites, morgues, Emergency Operations Centers, or command centers. There is usually a high
level of activity and often a high level of stress. Many frustrations can occur because
of adverse conditions, lack of equipment, communication breakdowns, and the like.
Nevertheless, workers proceed diligently and often heroically, frequently ignoring their
own fatigue and injuries. On disaster operations that continue for more than a day or two,
worker burnout can occur if needs for breaks, food, sleep, and stress management are ignored.
2. Recovery: Short-term recovery includes activities intended to return vital life-
support systems to operation. Psychological first aid, crisis intervention, and defusing
are short-term mental health recovery activities. Long-term recovery activities are
designed to return life to normal or improved levels. Long-term mental health recovery
activities include outreach, consultation and education, individual and group counseling,
community organization, advocacy, and referral to community resources. Mental health
recovery services in the long-term may extend to or beyond the first anniversary of the
disaster.
Recovery phase disaster work has a slower pace and can be less immediately rewarding
than early phase response. Because disaster survivors do not usually seek out counseling
services in large numbers, outreach and community education activities comprise a large
part of recovery activities. Because of the lack of large numbers of clients, combined
with the difficulty of evaluating the effectiveness of outreach and education efforts,
workers can lose heart and question the value of their work.
The emotional impact of disasters is especially strong for workers if contact with
survivors is prolonged (Hartsough and Myers, 1985). Staff identify with and sometimes
take on the frustrations of the survivors who are struggling with setbacks and roadblocks
in their rebuilding efforts. Continuous exposure to survivors' stories of loss and grief
can be painful for workers, and, if unrecognized, can play into an unconscious desire to
avoid listening to painful material.
Letdown Phase
This phase involves the transition from the disaster operation back into the normal routine
of work and family life. It can be a difficult period for workers if feelings have been
suppressed or denied during the action phase, and the feelings now begin to surface. In
addition, workers may experience feelings of loss and "letdown" as they move out of the
challenging disaster assignment and return to their usual activities
STRESS REACTIONS OF WORKERS DURING A DISASTER
The following are lists of common disaster worker stress reactions. They are intended to
help alert workers and supervisors to the stress reactions that commonly occur and to help
them in determining if they are experiencing a problematic level of stress. The symptoms
are usually normal in every way. They simply suggest a need for corrective action to limit
the impact of a stressful situation (Mitchell, 1986; Selye, 1982). In some situations,
stress symptoms may be delayed for weeks, months, or even years following the event
(Mitchell and Bray, 1990).
There is no clear-cut guide for how and when to know if workers are experiencing excessively
high stress levels. Workers are usually not the best judges of their own stress. They tend
to become intensely involved in the disaster work. It is important to develop a buddy
system where co-workers agree to keep an eye on each other's stress reactions.
Below are some of the common stress reactions that may occur for disaster workers:
Behavioral Affective (Emotional)
Change in Activity Anxiety and fear
Decreased efficiency and effectiveness Worry about safety of self or others
Difficulty communicating Anger
Increased use of humor Irritability
Outbursts of anger; frequent arguments Restlessness
Inability to rest or "let down" Sadness, grief, depression, moodiness
Change in eating habits Guilt or "survivor guilt"
Change in sleeping patterns Feeling overwhelmed, hopeless
Change in patterns of intimacy, sexuality Feeling isolated, lost, or abandoned
Change in job performance Apathy
Social withdrawal, silence Periods of crying
Vigilance about safety of environment Identification with survivors
Avoidance of activities or places that trigger Feeling heroic, invulnerable, euphoric
memories Denial
Proneness to accidents
Exagerrated startle reaction
Somatic Imagery
Increased heartbeat, respirations Distressing dreams
Increased blood pressure Intrusive thoughts
Upset stomach, nausea, diarrhea Fitful sleep
Sweating or chills Nightmares
Tremor (hands, lips)
Muscle twitching
"Muffled" hearing Cognitive
Tunnel vision
Feeling uncoordinated Memory problems
Headaches Disorientatiom
Soreness in muscles Confusion
Lower back pain Slowness of thinking and comprehension
Feeling a "lump in the throat" Difficulty calculating, setting priorities
Fatigue Difficulty making decisions
Menstrual cycle changes Poor concentration
Change in sexual desire Limited attention span
Decreased resistance to infection Loss of objectivity
Flare up of allergies and arthritis Unable to stop thinking about disaster
Hair loss Blaming
Denial
Interpersonal Skills Drugs/Alcohol
Family relations problems Increased use of alcohol, tobacco, drugs
Frequent arguments
Angry outbursts
Social withdrawal
Irritability
Job performance problems and difficulties
interacting on the job
Avoidance of co-workers
Physical Stress Reactions Requiring Prompt Medical Evaluation
Chest pain
Irregular heartbeat
Difficulty breathing
Fainting or dizziness
Collapse
Unusually high blood pressure
Numbness or paralysis of part of body
Excessive dehydration
Frequent vomiting
Blood in stool
KNOWING WHEN STRESS REACTIONS BECOME A PROBLEM
Worker stress reactions will usually diminish with the practice of stress management techniques,
the passage of time, the ability to talk about the event and its meaning, and the support of
family, friends, and the worker's organization. Sometimes, the disaster or disaster work can
be so stressful for the worker that symptoms do not seem to diminish on their own. The following
are some guidelines for differentiating normal stress reactions from those that may be
problematic.
DurationIntensity
This is a highly subjective criterion. However, any symptoms that seem acutely intense,
disturbing, or out of control to the worker may require professional assistance. In particular,
visual or auditory hallucinations, extremely inappropriate emotions, phobic or panic reactions,
antisocial acts, serious disorientation, or suicidal or homicidal thoughts should receive
mental health assistance.
Level of Functioning
Any symptoms that seriously interfere with an individual's functioning at work, at home, or
in social relationships should be considered for mental health assistance.
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REFERENCES
Cohen, R.E. and Ahearn, F.L. (1980). Handbook for Mental Health Care of Disaster Victims.
Baltimore: The Johns Hopkins University Press.
Erikson, K.T. (1976). Everything in its Path: Destruction of Community in the Buffalo Creek
Flood. New York: Simon and Schuster.
Hartsough, D.M. and Myers, D.G. (1985). Disaster Work and Mental Health: Prevention and
Control of Stress Among Workers. Rockville, MD: National Institute of Mental Health.
Mitchell, J.T. (1986). Critical incident stress management. Response, September/October:
24-25.
Mitchell, J.T. and Bray, G. (1990). Emergency Services Stress: Guidelines for Preserving the
Health and Careers of Emergency Services Personnel. Englewood Cliffs, NJ: Prentice-Hall, Inc.
Myers, D. (1990). Before going to a disaster: Advice for workers. Unpublished Training Guide.
New Jersey Office of Emergency Management. (1991). Responsibilities and Programs Manual.
Newark, NJ: Rev. December.
Selye, H. (1982). History and present status of the stress concept. In Goldberger, G. and
Breznitz, S. (Eds.), Handbook of Stress: Theoretical and Clinical Aspects. New York: Free Press.
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
