Keeping the Faith: Disaster Care

Keeping the Faith: Disaster Care Sheldon Rosenzweig Compassion Coalition of Tuscaloosa County, Inc. Presented December 4, 2008 This presentation is adapted from FEMA CCP Training, NIOSH, CDC, Washington State Department of Mental Health, Project Rebound (Alabama State Department of Mental Health) and other sources.

Overview • Characteristics of Disasters and Reactions • Stress and Grief – Be Your Own Advocate • Coping and Recovery – Tests of Faith • Professional Care – Giving and Receiving

Every Disaster is Different Disasters cause disruption and changes that can include: • Loss of life and/or property; • Injury and/or illness; • Disruption of community support systems and/or infrastructure; • Disruption to family and/or relocation; • Unemployment; • Changes in school configurations; • Interaction with large bureaucracies; • Influx of outsiders into the community; and • Increase in substance use or abuse.

Community Reactions:Phases of Disaster Adapted from CMHS, 2000.

Disaster Reactions • People pull together during and after a disaster; • Stress and grief are common reactions to an uncommon situation; • Most people’s natural resilience and support systems will support their recovery; • Some may question faith.

Key Concepts of Disaster Reactions • Small percentage will have severe adverse emotional, psychological, or substance use/abuse reactions; • Very few progress into diagnosable mental health or substance abuse conditions; • People typically do not seek mental health or substance abuse treatment services (self-reliance at all costs, stigma issues, reliance on faith alone); and • Survivors often reject help (“others need it more than I do”).

At-Risk Populations (Potential Risk Groups) • Children, Youth, and Adults with Children; • Older Adults; • People with Serious Mental Illnesses; • People with Disabilities; • Special Socioeconomic Groups; • First Responders/Public Safety Workers; and • People with a History of Substance Abuse.

Being Your Own Best Advocate:It’s Okay to Take Care of Yourself • Dealing with persons and clients in a crisis is very stressful; • Dealing with bureaucracies and other aid groups in a crisis can also be stressful; • Prioritize recovery tasks to reduce stress; • Maintain good lines of communication with other groups and agencies; • Assist co-workers and staff in using skills such as communication techniques, problem solving, conflict resolution, and stress management.

Dealing with the Weight of Disasters For some crisis volunteers and workers, disasters - • May trigger memories of previous disasters or other trauma; • May cause spiritual exhaustion; • Old negative behaviors may reappear.

Disaster Recovery Combats Negative Reactions • PTSD; • Flashbacks and Reliving; • Unhealed Grief; • Inappropriate Spirituality; • Cumulative Effect of Crisis Work.

Exchanging information on life situations helps develop new ways of adapting (turn to your right, give that person your business card); Increasing social support network helps develop better relationships; Sharing of similar stories helps to normalize each other’s experience. Isolation does not work! Importance of Co-Worker/Peer Support

Ways to Encourage Recovery • Reminder that faith is an avenue of recovery; • Foster support systems with friends and family; • Exercise, diet, and healthy sleeping patterns; • Humor is good; • Take a mental health day.

Community Support • Community gatherings, memorials, and rituals promote recovery; • Sharing with others who have similar experiences lessens the burden; • Participating in the natural community recovery process, sometimes by just being a “compassionate presence” aids healing; • Acknowledging that there are many spiritual paths to recovery respects diversity.

Types of Disaster Reactions • The following are some kinds of individual reactions that may be experienced by disaster survivors: • Physical; • Emotional; • Cognitive; and • Behavioral.

Physical Reactions • Gastrointestinal problems; • Headaches, other aches and pains; • Weight loss or gain; • Sweating or chills; • Tremors or muscle twitching; • Being easily startled; • Chronic fatigue or sleep disturbances; and • Immune system disorders. • Positive Responses include alertness and activation.

Emotional Reactions • Feeling heroic, euphoric, or invulnerable; • Denial; • Anxiety or fear; • Depression; • Guilt; • Apathy; and • Grief. • Positive Responses include feeling challenged, involved, and pressured to act.

Cognitive Reactions • Memory problems; • Disorientation and confusion; • Slow thought processes, lack of concentration; • Difficulty setting priorities or making decisions; • Loss of objectivity; • Recurring dreams or nightmares or flashbacks; • Preoccupation with disaster; • Avoidance; and • Questioning spiritual beliefs. • Positive Responses include determination, sharper perception, and fearlessness.

Behavioral Reactions • Increase or decrease in activity level; • Substance use or abuse (alcohol and/or drugs); • Difficulty communicating or listening; • Irritability, outbursts of anger, frequent arguments; • Inability to rest or relax; • Decline in job performance, absenteeism; • Frequent crying; • Hyper-vigilance or excessive worry; and • Avoidance of activities or places that trigger memories. • Positive Responses include affiliation, helping response, and altruistic behavior.

When to Seek or Recommend Professional Help Some possible indicators for more professional help are: • Poor work or family relationship functioning; • Suicidal thoughts; • Alcohol or drug use/abuse; • Phobically avoiding important situations; • Auditory, visual, tactile, or olfactory hallucinations, paranoia, or delusions; • Severe sleeping problems and/or panic attacks; • Doesn’t feel like eating or getting out most days; • Can’t stop thinking about the event; • Can’t enjoy life at all; and • Acting very differently from before the trauma.

When Is Professional Care Urgent? • Person has suicide plan and/or means; • Person has homicidal ideation plan and intent/means to harm others; • Functioning is so poor that person’s (or dependent’s) safety and welfare is endangered; • Excessive substance use puts person or others at risk; and • Severe psychiatric symptoms (such as psychosis or major depression).

When is Faith Questioned ? Disaster equals loss and upheaval. Survivors suffer loss of safety and security, loss of property, loss of community, loss of a job, loss of status, loss of health, home, pets, friends, or a loved one. The recovery process through mourning and grief may involve questioning of faith. This is normal behavior.

Some Stages of Grief • Denial – It can’t be true! • Anger – Powerlessness. • Depression - Loss, grief and detachment. • Acceptance – Looking toward the future. The normal process of mourning takes several months or even years.

Sudden Death • No preparation, unfinished business • No goodbye • Can overwhelm the survivors • Sense of unreality • Search for the reason • Sense of helplessness • Feelings of rejection & abandonment

Informing a Person of Death • Only about 50% of the persons who die each year do so in a hospital. • The rest leave survivors who are informed of the death by neighbors, friends, family, caregivers, police officers, clergy, etc. • All of us may have to do this task at some point, and not just during a disaster.

Protocol for Disaster Personnel (Iowa State Model) • Speak in a private area. • Notify the parent, partner, or child in person. • Whenever possible, go with another volunteer, policeman, clergy, family member, etc. • Deliver the news as soon as possible once identity has been positively established. Do not wait until morning.

Protocol, continued • Use plain, direct language. Say “dead, died, was killed”, not “passed away” or “fatally injured”. • Refer to the deceased by name, not “the body.” • Show compassion. Expression of grief may take many forms. • Remain with the family for at least 30 minutes, but not so long as to intrude on a very private time. • Answer questions if asked, but do not speculate. Speak in a clear and sympathetic way. Leave a written phone number for follow-up contact.

Disasters Do Not Discriminate • Everyone is affected. • It does not matter where you live. • It does not matter who your Higher Power is. • It does not matter what you do for a living. • Everybody suffers.

Men in Disasters • Immediately after a disaster, care often focuses on women. Women are more verbal. • Men hurt, too. Men often try to work through pain alone, in a more private manner. • Men may try to deny their feelings and appear strong for their families. Pain denied sometimes translates to anger, negative behaviors and questioning of faith. • It is important for men survivors not to isolate themselves, especially from other men.

Women in Disasters • Surviving a natural disaster lowers the life expectancy for women more than men. • The stronger the disaster, the greater the effect. • It is important for women disaster survivors to take good care of themselves, find ways to reduce stress, make health and therapy appointments, and develop new social networks.

Recovery Phase: The Good News • You have been through a life-changing event. Healing takes time. Be patient with yourself and others. • There is the potential for post-traumatic growth. About 10% of disaster survivors will experience emotional and developmental growth following a disaster.

Thank You Funding for this program has been made available by the American Red Cross Hurricane Recovery Program and United Ways of Alabama The American Red Cross is especially qualified to be a partner in recovery due to its extensive experience in responding to major national disasters. The Hurricane Recovery Program (HRP) is committed to helping survivors on the road to recovery while providing careful stewardship and accountability for the resources entrusted to it by the American public.

Sheldon L. Rosenzweig, MA, LPC P.O. Box 2312 Tuscaloosa, AL 35403 205-391-9520 slrosenz@aol.com Special Thanks to: Compassion Coalition of Tuscaloosa County.

Keeping the Faith: Disaster Care