ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
October 19, 2001
"What we call the beginning is often the end. And to make an end is to make a beginning.
The end is where we start from." - T.S. Eliot
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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: https://www.angelfire.com/biz3/news/cismuw.html
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Listen To Hearings On Capitol Hill
http://www.capitolhearings.org
Visit this site to receive live audio of Senate hearings on Capitol Hill. The site lists the
current day's activities with participant and topical information for each event. Users can
click on the room number identified with the hearing they would like to attend and be an instant
fly on the wall.
* * * * * * * * * *
FELLOWSHIPS
The National Humanities Center is offering 40 residential fellowships for advanced study
during the 2002-03 academic year. Most of the fellowships are unrestricted, though there
are designated awards for: one fellowship in art history or visual culture; three fellowships
for scholars in any humanistic field whose research concerns religion; and three fellowships
for scholarship concerning nature, environmental history or ecological concerns. Stipends are
up to $50,000, plus a research fund of $2,500. Contact: email: nhc@ga.unc.edu
Web Site: http://www.nhc.rtp.nc.us:8080
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DISENGAGING FROM THE DISASTER ASSIGNMENT
Concluding the disaster assignment, whether it involved immediate response or long-term recovery
work, can be a period of mixed emotions for workers. Disaster work can be both stressful and
rewarding. While there may be some relief that the disaster operation is ending, there is often
a sense of loss and "letdown", with some difficulty making the transition back into family life
and the regular job. Anticipatory guidance and an opportunity to talk about feelings and common
transition dynamics can greatly help workers. There are several interventions that can provide
education and help to ease the disengagement and transition process for workers.
"Defusing" is a spontaneous or organized staff meeting immediately following a shift or
operation. It is an informal opportunity for staff to begin to talk about their experience in
the disaster. It is usually kept short (no more than 30 to 45 minutes)(Mitchell and Bray, 1990)
and can be led by any of the staff with group process skills. An outside facilitator is usually
not necessary. Workers are usually asked "what was the worst part" of the shift or the work
assignment, and allowed to ventilate and share feelings. Feelings are acknowledged but there is
no probing or dwelling on feelings. The key is to keep the tone positive and supportive. Workers
should not be criticized for how they feel or how they functioned. The meeting is not a critique
of the operation. Team members should check on each other's well-being and provide support.
Sometimes a defusing may be all that is necessary for staff to deal with their feelings. In
other cases, the need for a more thorough, formalized debriefing will become clear.
The purpose of a formal debriefing is to address the emotional and psychological impact of the
disaster assignment on the worker. There is an added level of empathy, understanding , and
peer support when the debriefing is conducted for a group of people who have worked together.
A debriefing should be run by a mental health facilitator with experience in disaster and
specialized training in debriefing techniques. While few outcome evaluations on the effect of
formal debriefing have been conducted, participants usually report that it has a therapeutic
effect. They report that debriefings help them to identify and talk about the feelings associated
with the disaster assignment, provide "normalization" of their responses, and lend peer support.
Debriefing serves an educational purpose. It informs workers about the common stress and grief
reactions, transition issues, and ways for them to cope. Handouts specific to disaster workers'
reactions during and after disaster can be distributed.
For disaster assignments of any length, workers may need to talk about multiple stressful
situations that they have experienced. Skilled facilitators can manage this specialized
debriefing using a multiple stressor debriefing model (Armstrong, O'Callahan, and Marmar, 1991).
It is important to bring an ending, or closure, to the disaster job. A critique is a critical
evaluation of how the operation proceeded. It is different and separate from a debriefing,
which attends to the psychological and emotional impact of the work on personnel. A critique can
result in positive changes in the disaster plan, policies, and procedures to improve mental
health's approach in the next situation. A critique can also help workers to take pride and feel
a sense of ownership in the operation. It helps them to see the positive effect of their efforts
in the disaster.
Recognition of workers' participation in the disaster effort can mean a lot to staff and
volunteers. Mental health staff appreciate a letter or certificate of recognition from the
mental health director or the board of supervisors. A small souvenir from the project director,
such as a picture, coffee mug, or t-shirt, says in concrete terms how much the workers'
involvement was appreciated. Workers who stayed behind at the regular worksite "minding the
store" while disaster workers were in their special assignments should also be recognized for
their essential contribution to the success of the disaster operation.
SELF-CARE FOR DISASTER MENTAL HEALTH WORKERS:
ADVICE FOR BEFORE, DURING AND AFTER DISASTER
Pre-disaster Planning: Prevention
Some of the most important stress management interventions for disaster workers take place
pre-disaster. Preparation can help minimize the effects of stress when it occurs and can help
individuals cope with stress in a more effective manner. Following are some useful pre-disaster
interventions:
1. Agency Planning, Orientation and Training
Each mental health agency should have a disaster plan outlining worker roles and
responsibilities in disasters. Training for the mental health workers' disaster roles
should be provided as part of workers' initial on-the-job orientation and ongoing in-service
training. Specialized training in disaster mental health response can help staff to develop
the skills necessary to their disaster roles. Education can also help to prepare staff for
the stresses they may experience in their work. It can help to decrease their vulnerability
and increase their effectiveness in dealing with job-related stresses when they occur.
2. Pre-disaster Personal Emergency Preparedness Plans
Having a personal and family emergency plan will help individuals to cope with whatever
emergencies may occur while they are at home. Every emergency worker should be familiar
with hazards and potential emergencies inherent in the local geographic area, and should have
contingency plans for self and family. This is important to the safety of the family and to
the availability of the worker for disaster assignment. The more quickly things can be taken
care of at home, the more quickly the worker can report to work with some worries about the
family taken care of. Similarly, if the worker is at work when a disaster occurs, peace of
mind and concentration will be enhanced if the worker's family is prepared and able to cope.
Every family emergency plan should include the following:
* A home inspection to identify and eliminate hazards.
* A plan for different types of emergencies that might occur in the area, such as tornado,
hurricane, earthquake, or hazardous materials spill; training for what to do before, during,
and after each emergency.
* A home fire safety plan, including smoke detectors, fire extinguishers, and pre-planned
escape routes.
* An evacuation plan: what to take, where to go, where to meet or re-unite.
* A plan to care for children, individuals needing assistance (the ill or those with disabilities),
and pets in the event that adults cannot get home following a disaster.
* Training of every capable family member in how to turn off utilities and in first aid.
* Prominent posting of emergency phone numbers.
* A plan for how family members will locate each other if separated at the time of a disaster,
e.g., an out of the area phone contact who can be called by all family members (long distance
phone lines often work when local lines are down).
Emergency supplies and equipment should include the following:
* food and water for 72 hours; include special diets, infant formula, and pet food.
* Portable radio, flashlight, and batteries.
* An adequate supply of prescription and over-the-counter medications, eyeglasses, extra
batteries for hearing aid, etc.
* First aid kit and book.
* Personal hygiene supplies.
* Blankets or sleeping bags.
* Fire extinguisher.
* Sanitation supplies (plastic bags, bleach).
* Alternate lighting: camping lantern, candles, matches.
* Safety equipment: hose for fire fighting, heavy shoes and gloves, work clothes.
* Tools
* Cooking supplies: charcoal, sterno, camp stove.
An abbreviated cache of supplies should be kept in the trunk of the car, especially for those
individuals with a long commute. A cellular phone in the car is also a good resource.
A plan is of use only if all family members are familiar with it. They should review it
regularly, and hold practice "drills" of what they would do in a variety of potential disaster
situations.
Every family should be familiar with the disaster plan in the children's school. Also, family
members should know about the disaster plans at the adults' workplace. In this manner, families
who are separated at the time of a disaster can have some peace of mind knowing what plan exists
to care for their loved ones.
It is a good idea to establish a mutual aid system within the neighborhood. with a bit of
pre-planning, neighbors can arrange to look out for and help one another in times of emergency,
pooling supplies and skills. Many neighborhoods develop emergency preparedness plans as part
of the Neighborhood Crime Alert network. Such a mutual aid arrangement can give disaster
workers more peace of mind about their families' welfare.
In addition, every worker who might be called out on a disaster assignment is wise to have an
emergency bag pre-packed. Supplies should be tailored to the nature of the worker's likely
assignment. If the assignment will entail any length of time away from home, the bag should
include the following:
* Clothes, including sturdy shoes and clothes for inclement weather.
* Eyeglasses and medications (including over-the-counter remedies for personal stress reactions -
antacids, aspirin, antidiarrhea medicine, etc.).
* Personal hygiene supplies.
* Flashlight, portable radio, and batteries.
* Small first aid kit
* Food and water (one gallon/day) for three days.
* Paper and pens, clipboard.
* Forms or supplies necessary to the worker's disaster assignment.
* Sleeping bag
* Cash and change for pay phones (these circuits usually work when other phone lines are out
of service).
* Official identification to allow access into restricted areas.
* A picture of one's family and at least one comforting item from home.
* A good book, a deck of cards, crossword puzzles, etc.
Excellent materials on home emergency preparedness specific to a given geographic location are
available from local chapters of the American Red Cross, local Offices of Emergency Services,
or the regional office of the Federal Emergency Management Agency.
Interventions During The Disaster
Following are some suggestions for mental health staff for management of stress while working
on a disaster operation:
1. Request a briefing at the beginning of each shift to update yourself and coworkers on the
status of things since your last shift. This can help you gear up for what you may encounter
during your shift.
2. Develop a "buddy" system with a co-worker. Agree to keep an eye on each other's functioning,
fatigue level and stress symptoms. Tell the buddy how to know when you are getting stressed
("If I start doing so-and-so, tell me to take a break."). Make a pact with your buddy to
take a break when he or she suggests it, if the situation allows.
3. Encourage and support co-workers. Listen to each other's feelings. Don't take anger too
personally. Hold criticism unless it's essential. Tell each other how good a job they are
doing ("doing grest" and "Good job"). Give co-workers a pat on the back. Bring each other
a snack or something to drink.
4. Try to get some activity and exercise. Gently stretch out muscles that have become tense.
5. Eat regularly. If not hungry, eat frequently, in small quantities. Try to avoid excessive
sugar, fats, and caffeine. Drink plenty of liquids.
6. Humor can break the tension and provide relief. Use it with care, however. People are highly
suggestible in disaster situations, and survivors or co-workers can take things personally
and be hurt if they feel they are the brunt of "disaster humor".
7. Use positive "self-talk", such as "I'm doing fine" and "I'm using the skills I've been
trained to use."
8. Take deep breaths, hold them, then blow out forcefully.
9. Take breaks if effectiveness is diminishing, or if asked to do so by your supervisor. At a
minimum, take a break every four hours.
10. If possible, limit the length of shifts you are working to 12 hours maximum. A 12-hour
shift should be followed by 12 hours off duty.
11. Use a clipboard or notebook to jot things down. This will help compensate for the memory
problems that are common in stressful situations.
12. Try to keep noise to a minimum in the worksite. Gently remind others to do the same.
13. Try to avoid unnecessarily interrupting co-workers when they are in the middle of a task.
Think twice before interrupting.
14. Let yourself "defuse" at the end of each shift by taking a few minutes with co-workers to
talk about your thoughts and feelings about the day.
15. When off duty, enjoy some recreation that takes your mind off the disaster. Draw on supports
that nurture you. This may include friends, meditation, reading, or religion.
16. Pamper yourself in time off. Treat yourself to a special meal, get a massage, or take a
long shower or bath.
17. If needed, give yourself permission to spend time alone after work. However, don't totally
withdraw from social interaction.
18. Get adequate sleep. Learn relaxation techniques that can help you fall asleep.
19. On long disaster assignments, attend periodic debriefing or worker support groups to talk
about the emotional impact upon yourself and co-workers. Use stress management programs if
they are available. If such programs are not offered, try to get them organized.
20. On disaster assignments away from home, remember the following:
* Try to make your living accommodations as personal, comfortable, and homey as possible.
Unpack bags and put out pictures of loved ones.
* Make new friends. Let off steam with co-workers.
* Find local recreation opportunities and make use of them.
* Remember things that were relaxing at home and try to do them now; take a hot bath or
shower, if possible; read a good book; go for a run; listen to music.
* Stay in touch with people at home. Write or call often. Send pictures. Have family visit
if possible and appropriate.
* Avoid excessive use of alcohol and caffeine.
* Keep a journal.
Intervention After A Disaster
Following are some suggestions that may be useful for workers in the first hours, days, and
weeks after a disaster:
1. Attend a debriefing if one is offered. Try to get one organized if it is not offered.
2. Request a critique if you or others are feeling the need to critically evaluate how the
operation went. Looking at how things went and what could be changed next time around can
help to bring a sense of "closure" to the disaster response.
3. Talk about feelings as they arise, and listen to each other's feelings. Try alternative
forms of expression besides talking: art, writing, music.
4. When listening, try to keep war stories to a minimum. It is not helpful to hear that
someone else has gone through something worse.
5. Don't take anger too personally. Anger is a common feeling following a disaster. It sometimes
gets vented at co-workers inadvertently.
6. Recognition is important. Give co-workers appreciation and positive feedback for a job well
done.
7. Eat well and try to get adequate sleep in the days and weeks following the disaster. Avoid
excessive use of alcohol and caffeine.
8. Practice relaxation and stress management techniques. Recreation and exercise are helpful.
9. Try to re-establish your normal routine.
10. Be aware that you may experience some "letdown" when the disaster operation is over.
11. If you have been away from home on a disaster assignment, your family may have expectations
and needs that differ from your needs when you get home. Try to anticipate the problem and
negotiate your respective needs carefully.
12. You may experience mood swings after the disaster, where you change from happy to sad,
tense to relaxed, outgoing to quiet, wanting to talk about the disaster to not wanting to
talk about it. These mood swings are normal and natural and will pass with time.
13. Allow yourself some time alone if you feel the need. However, don't totally withdraw from
others.
14. Avoid becoming distracted, reckless, or accident-prone.
LIFE FOLLOWING DISASTER
Being involved in a disaster can change a person in many ways. Working in a disaster recovery
project engages mental health workers in activities that may be intensely meaningful as well
as stressful. Workers' experiences may be both very positive and very painful. Following a
disaster response or recovery project, it is not unusual for staff to feel some ambivalence
about giving up their disaster roles. Staff often feel that their live have been changed by
their experience, but have not had time to reflect on how they have been changed. They may
feel a sense of loss that the project is over, and concern about what their future employment
may be. They may finish the project in a state of physical and emotional fatigue, and may feel
relief that the project is ending. The mixture of relief and sadness can be confusing. It is
helpful for mental health staff to remind hemselves about the concept of transition and the
transformation it involves.
Bridges (1980) describes transition as involving four components:
1. An ending, involving loss and letting go.
* disengagement
* disidentification
* Disenchantment
* disorientation
2. A period of confusion or distress.
3. A period of working through and making sense of feelings.
4. A new beginning.
It can help mental health staff in making the transition from disaster work to
life-after-disaster if they reflect on a few questions. If the disaster work has been of a
short duration, these questions can be used as part of a post-operation debriefing. If staff
have been engaged in long-term recovery work, discussing these questions in a group meeting
a few weeks before the end of the project can help to prepare them for the transition.
1. What will I be leaving behind when the disaster operation ends?
* Positives?
* Negatives?
2. What do I anticipate my transition will be like as I leave the disaster operation and go
on to life after the disaster?
What difficulties do I have with these types of transitions?
What helps me with transitions?
3. In what ways have I been changed by working in this disaster?
Is there anything unfinished for me about my experience in the disaster?
Is there anything I need to do before or after leaving to help bring closure to the
experience?
4. Where am I going from here?
What am I taking with me from this experience?
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REFERENCES
Armstrong, K., O'Callahan, W.T. and Marmar, C.R. (1991). Debriefing Red Cross disaster personnel:
The multiple stressor model. Journal of Traumatic Stress, 4(4): 581-593.
Bridges (1980). In Cohen, R.E. and Ahearn, F.L. Handbook for Mental Health Care of Disaster
Victims. Baltimore: The Johns Hopkins University Press.
Mitchell, J.T. and Bray, G. (1990). Emergency services stress: Guidelines for preserving the
health and careers of emergency services personnel. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.
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
