MENTAL HEALTH MOMENT
MENTAL HEALTH MOMENT
August 11, 2000
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"The only thing new in the world is the history you
don't know." - Harry Truman
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The Cultural Tour of China - The specific details are
now available on the web site below. The tour will be
through Grand Circle Travel, in business since 1958.
Reservations need to be made as soon as possible to
hold places and dates. Prices begin at $3295 and include
round trip air fare from 18 US cities. Deposit of $250
is needed as soon as possible. Send me email if you
have questions.
https://www.angelfire.com/biz3/odocspan/china1.html
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StarD Sequenced Alternatives to Relieve Depression
http://www.edc.gsph.pitt.edu/stard
This site explains a multisite, large-scale study
exploring and comparing interventions for treatment-
resistent depression. The study, funded by the National
Institute of Mental Health (NIMH), is testing various
combinations of psychotropic drugs and psychotherapies
to better treat this type of depression. The site
provides background on the study, a newsletter and
information on patient care and family support.
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NAS Board on Neuroscience and Behavioral Health
http://www4.nationalacademies.org/IOM/IOMHome.nsf/Pages/Neuroscience+and+Behavioral+Health
Visit this site to learn about a program of the National
Academy of Sciences that fosters basic biobehavioral
research and studies of health services for neurological,
psychiatric and addictive disorders. The program's
projects monitor quality of and patient access to
behavioral health care. Projects also assess how advances
in genetics and neuroscience apply to mental health
disorders. Program reports are available on the site.
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OTHER SPECIAL RISK GROUPS IN DISASTERS
There are many feelings and reactions people share in
common response to the direct and indirect effects of
disasters. However, certain groups are more at risk for
some reactions than others.
Common Needs And Reactions
1. Concern for basic survival
2. Grief over loss of loved ones or loss of
prized possessions
3. Separation anxiety centered on self and also
expressed as fear for safety of significant
others
4. Regressive behaviors, e.g. reappearance of
thumbsucking among children
5. Relocation and isolation anxieties
6. Need to express feelings about experiences
during the disaster
7. Need to feel one is a part of the community and
its rehabilitation efforts
8. Altruism and desire to help others
MIDDLE AGE
On the face of it, middle-aged persons seem to be an
unlikely special group with specific problems. However,
they are, and it is helpful to be alert to these,
especially for the possibility of emotional problems
arising in later, rather than immediate, post-disaster
periods. Consider the family which loses its home and
most possessions in a flood. Forced to rebuild, they
must do so with far more cost and highly inflated
financial expenses. Retirement with the mortgage paid
off is now out of the question, and prospects of an old
age with adequate pension and comfortable living may
have vanished. It takes a while for these conditions
and the realizations of a reappraised future to sink in.
They may and do, however, have any number of effects
such as psychosomatic problems, relationship difficulties,
and occupational dissatisfactions.
Feeling and Behavior Symptoms
* Psychosomatic problems, ulcers, diabetes, heart
trouble
* Withdrawal, anger, suspicion, irritability, apathy
* Loss of appetite, sleep problems, loss of interest
in everyday activities
Treatment Options
* Arrange for medical care for physical symptoms
* Persuade victims to talk with family physician,
clergyman, friends, or to accept professional help
* Help find medical and financial assistance
* Keep channels of communication open with members of
the family
* Help family to recognize physical signs of depression
and need for professional counseling
OLDER ADULTS
Senior citizens of concern here are non-institutionalized
persons whose life sphere has become circumscribed due
to aging, primarily, rather than to specific multiple
disabilities. These older persons typically do not have
highly active schedules during the day. They spend their
time mostly with others of similar age and circumstances
in daily routines which have become comfortable. Others
are confined to house or apartment, frequently alone.
When these familiar routines are disrupted by the
disaster, and particularly when residential loss and
relocation occur, it would be expected that the senior
citizen might exhibit some symptoms.
Feeling and Behavior Symptoms
* Depression, Withdrawal
* Apathy
* Agitation, anger
* Irritability, suspicion
* Disorientation
* Confusion
* Memory loss
* Accelerated physical decline
8 Increase in number of somatic complaints
Treatment Options
* Provide strong and persistent verbal reassurance
* Assist with recovery of physical possessions; make
frequent home visist, arrange for companions
* Give special attention to suitable residential
relocation, e.g., familiar surroundings and
acquaintances
* Help in re-establishing familial and social contacts
* Assist in obtaining medical and financial assistance
* Help re-establish medication regime
* Provide escort and transportation services
An important issue is the despair accompanying loss of
property and objects, which is a loss of ties with the
past. Often, because loss of life has occurred among
neighbors or friends, mourning the loss of sentimental
objects and loss of property seems "inappropriate".
However, these can and do constitute significant
psychological loss.
SOCIOECONOMIC CLASSES
Socioeconomic circumstances are important influences
on attitudes and reactions of people in stress
situations. More importantly, these factors have a
strong effect on the readiness with which individuals
will seek or accept help voluntarily for emotional
distress. For example, persons in lower economic
circumstances are generally more inclined to seek
medical rather than psychological treatment. This
re-emphasizes the importance of "outreach" efforts
in disaster relief work. Otherwise, these people will
not be reached and may not get the help they need.
By contrast, people in intermediate and upper income
economic circumstances are more aware of and less
likely to resist accepting all kinds of help when
needed. These social groups would also be expected to
be more likely to understand the possibilities of
long-range benefits from early use of the services
offered, i.e., heading off future problems by dealing
with them now. Upper income people might be less
inclined, however, to welcome outreach and "free"
services as compared with lower and middle income groups.
CULTURAL AND RACIAL DIFFERENCES
Reports from disaster relief workers in recent years
have emphasized the importance of social and cultural
differences, especially of races, language, economic
levels, class, and ethnicity. There are also reports of
socially isolated groups who display what amounts to
subcultural differences of attitudes and daily life
patterns as a result of geographical isolation and
dependence on a single occupational source, for example,
small mining towns.
For these groups it is essential that outreach efforts
be channeled through representatives or facilities
within the subculture area. Differences of language
and custom, if ignored, will lead to frustration and
failure by those attempting to render services.
Feelings and Behavior Symptoms
* Depression
* Apathy
* Feelings of helplessness and hopelessness
* Resignation (to God's will)
* Suspicious of help offered by "outsiders"
* Ignoring or rejecting available sources of
"outside" help
* Tendency to close ranks and accept assistance only
from family and close friends
Treatment Options
* Channel all assistance through local religious and
community sources
* Place emphasis on informational and educational
assistance
* Outreach all services with the exception of those
requiring special facilities such as hospitals and
clinics
INSTITUTIONALIZED PERSONS
Individuals who are in institutions during a disaster
are susceptible to frustration, anxiety, and panic as
a consequence of their limited mobility and helpless
dependence on their caretakers. The circumstances will
vary widely depending on the type of institution.
However, there are some common reactions which might
be expected to occur in general medical hospitals,
mental hospitals, adult and juvenile correctional
agencies, and convalescent facilities.
Feelings and Behavior Symptoms
* Fear
* Frustration
* Anxiety
* Helplessness
* Anger
* Panic
* "Escape"
Treatment Options
* Assist in relocation to safe housing
* Provide reassurance and information
regarding disaster status
* Assist in making contact with loved ones and
friends
* Encourage involvement in housekeeping and
rehabilitation duties
* Provide opportunities for group discussions of
fears and anxiety
PEOPLE IN EMOTIONAL CRISES
When a person is experiencing an emotional crisis, it
is usually apparent even to the casual observer. In a
disaster it might be expected that the direct and
indirect effects of the catastrophe might produce severe
emotional crises for some people. Precipitating causes
could be death or separation from loved ones, sudden
loss of contact with friends and familiar routines and
settings, or simply the physical force of the disaster
itself. The last mentioned can in some cases bring
about overwhelming feelings of inadequacy in some who
are suddenly confronted with their own feelings of
helplessness and mortality.
Feelings and Behavior Symptoms
* Emotional shock
* Apathy
* Numbness
* Agitated depression
* Disorientation and confusion
* Perseverative behavior
* Hyperactivity
* Minimal emotional control, e.g. explosive anger,
uncontrollable crying
* Physical symptoms, e.g., dizziness, nausea, fainting
spells, headaches, hyperventilation, rapid heartbeat
Treatment Options
* Give verbal and physical reassurance
* Assist in coping with some specific and tangible
problem
* Help in relocating loved ones
* Help in getting care for loved ones who are injured
* Help in locating and making arrangements for
loved ones who did not survive
* Give assistance and encouragement in assessing
extent of damage to personal property and beginning
to repair or rebuild damaged home or business
* Assist in getting medical attention if needed
PEOPLE REQUIRING EMERGENCY MEDICAL CARE
Those who are in need of immediate and surgical treatment,
in addition to suffering from physical shock, may also
experience anxiety caused by separation from loved ones
or a lack of information about the extent of damage to
home, place of business, or the community itself. The
degree of anxiety experienced by the injured person
may aggravate his/her physical state and affect response
to medical treatment. Having mental health services
available at medical treatment facilities during and
following the disaster has been found useful. The
worker may provide invaluable relief and reassurance to
the injured person by obtaining information about loved
ones or about the status of property and possessions.
HUMAN SERVICE AND DISASTER RELIEF WORKERS
Workers in all phases of disaster relief - whether
protective services, nongovernmental shelters, clothing
and food services, governmental rehabilitation and
reclamation services, or human service workers - expose
themselves to unprecedented personal demands in their
desire to help meet the needs of the victims. For many
the disaster takes precedence over all other responsibilities
and activities, and the workers devote all their time
to the disaster-created tasks, at least in the immediate
post-impact period. As some order returns, many of the
workers, especially volunteers, return to their regular
jobs, but at the same time attempt to continue with their
disaster work. The result of the overwork is the "burn-
out" syndrome, a state of exhaustion, irritability, and
fatigue which creeps up unrecognized and undetected
upon the individual and markedly decreases his/her
effectiveness and capability.
The best way to forestall the "burn-out" syndrome is
to expect it, to be alert to its early signs, and to
act authoritatively in relieving the stress. Four
primary areas of symptomatology have been identified:
Symptoms
Thinking: Mental confusion, slowness of thought,
inability to make judgments and decisions, loss of
ability to conceptualize alternatives or to prioritize
tasks, loss of objectivity in evaluating own functioning,
etc.
Psychological: Depression, irritability, anxiety,
hyperexcitability, excessive rage reactions, etc.
Somatic: Physical exhaustion, loss of energy,
gastrointestinal distress, appetite disturbances,
hypochondria, sleep disorders, tremors, etc.
Behavioral: Hyperactivity, excessive fatigue,
inability to express self verbally or in writing, etc.
Management
The first step is to be aware of, to be alert for, and
to recognize the symptoms of "burn-out" syndrome when
they first appear. The earlier they are recognized the
better. All personnel need to be indtructed about the
early symptoms so that they may recognize it not only
in themselves but also in their fellow workers. Any
such observations, either about themselves or about
others, should be reported to their supervisors. The
latter also need to be alert to any early symptoms in
their staff so that they can intervene.
The supervisor should talk to the individual and try to
get him/her to recognize the symptoms in him/herself.
The supervisor can then make sure the person is relieved
from his/her duties for a short period of time. Guilt
over leaving the activity is relieved by giving official
permission to stop and by pointing out how the worker is
no longer helping because of the loss of his/her effectiveness.
The worker can be reassured that he/she can return and
that he/she will have improved greatly as a result of the
short recuperation. The supervisor should at first
attempt to persuade the helper to take the time off, but,
if necessary, should order it. The syndrome may appear
early or well into the post-disaster period, from 2 weeks
to a year. On the average, it seems to take about 4 to
6 weeks for most of the symptoms to appear.
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To search for further information on this topic, go to
the search engine below. Start by using the following
descriptors: grief, disasters, disaster mental health,
anxiety, depression, burn-out, children and disaster,
relocation, middle-age, disaster and treatment, emotions
and disaster, older adults, socioeconomics and disaster,
culture and disaster, race and disaster, institutionalized
and disaster, crisis intervention, human service workers
and disaster, relief workers, etc.
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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