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Mental Health Preparedness. Agenda. Review how people react psychologically to a crisis Discuss relationship of mental health in public health emergency Discuss compassion fatigue related to public health responders. What Is Meant By “Crisis?”. Some type of turning point

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Agenda

  • Review how people react psychologically to a crisis

  • Discuss relationship of mental health in public health emergency

  • Discuss compassion fatigue related to public health responders


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What Is Meant By “Crisis?”

  • Some type of turning point

  • An emotionally significant event or radical change in one’s life

  • An unstable or crucial time when decisive change is impending


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What Is A Crisis?

  • A “crisis” is a situation in which a person’s ability to cope is exceeded.

    • “Nothing will ever be the same.”

    • Triggering event within the last 24 – 48 hours.

    • Response emotionally driven (not rational).

    • Situation perceived as either physically or psychologically threatening.

    • If the subject feels he is in crisis he is.


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Characteristics Of People In Crisis

  • Thinking is constricted, emotions are expansive.

  • Lowered attention spans.

  • Inability to discern between small and large problems.

  • Often do not see way out of the situation.

  • Try out different behaviors to reduce stress.


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During A Crisis What Do People Feel?

  • Wide range of emotions

    • Fear

    • Anxiety

    • Anger

    • Hopelessness

    • Helplessness


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What About Panic?

  • Vast majority of people

    • Do not panic in times of crisis

    • Do not act unreasonably

    • Do not engage in extreme behavior


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What Do We Know About Stress Reactions?

  • Impacted by loss of control

  • Impacted by unpredictability

  • Can lead to experience/reaction called “learned helplessness”


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Stress Is Evaluated By:

  • Perceived danger/threat value

    • Irrelevant/harmless?

    • Threat/challenge?

  • Coping mechanisms available

    • Cognitive

    • Behavior

    • Neurophysiological

    • Emotional


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Why Do People Respond Differently to Stress?

  • Family/Genetic Influences

    • History of physical/psychological conditions

    • Personality and temperament

    • Cultural background

    • Gender


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Why Do People Respond Differently to Stress?

  • Past Experiences – “wisdom”

    • Learned coping patterns

    • Previous exposure to similar stress

    • Lifestyle patterns


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Why Do People Respond Differently to Stress?

  • Existing vulnerabilities/strengths

    • Health

    • Motivation

    • Support at work/home

    • Relationships with spouse/friends

    • Financial situation

    • Other’s health (i.e. child, parent)

    • Other?


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Why Do People Respond Differently to Stress?

  • Existing Beliefs and Skills

    • Spiritual or religious influence

    • Open communication style

    • Moral Values

    • Accepts help (from pastor/counselor/other)

    • Self-Concept


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Troublesome Behaviors In A Crisis

  • What you can count on:

    • Those who try to bypass official channels

    • Vicarious rehearsal

    • MUPS: Multiple Unexplained Physical Symptoms

    • Stigmatization


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Mental Health And Emergencies/Disasters

  • Responding to emotional and psychological impact of event is critical part of response strategy

  • General agreement that all people involved in event are impacted some way


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Mental Health And Emergencies/Disasters

  • Emotional reactions to the event may vary person to person

  • Some people may exhibit symptoms of mental illness immediately after event but few develop long-term mental health problems


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Mental Health And Emergencies/Disasters

  • However, recent experience with catastrophic events have challenged this thinking

    • Large scale loss of life, property and disruption in community life reveals more serious patterns of psychological impact.

    • Particularly true when event is intentionally caused by human action


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Directed Mental Health Interventions

  • Seriously injured victims and bereaved family members

  • Victims with high exposure to trauma, victims evacuated from disaster area


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Priority Setting In Crisis Counseling

C. Bereaved extended family members, emergency workers,

medical officers’ staff,

service providers providing death notification or working with bereaved families


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Priority Setting In Crisis Counseling

D. People who lost homes,

jobs,

pets,

mental health providers,

chaplains,

emergency health care providers,

school personnel working with survivors, media personnel


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Priority Setting In Crisis Counseling

E. Government officials,

groups that identify with target victims group,

businesses with financial impact

F. Community at large


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At-Risk Persons

  • Those with preexisting mental health problems

  • Children

  • Those displaced by event particularly if they have little support

  • Those with preexisting medical problems

  • Those with disabilities


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Preparedness: Developing Resiliency

  • Resiliency

    • The process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress (e.g. family problems, serious health problems, financial stressors)

    • “Bouncing Back” from some type of adversity


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Preparedness: Developing Resiliency

  • Research has shown that resiliency is ordinary, not extraordinary; people demonstrate resiliency each day

  • Being resilient doesn’t mean that a person doesn’t experience difficulty or distress

  • It involves thoughts, behaviors, and actions that anyone can learn and develop


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Factors Associated With Resiliency

  • Having caring and supportive relationships

  • Relationships that create love and trust

  • Capacity to make realistic plans and take action

  • A positive view of yourself

  • Skills in communication and problem solving

  • Capacity to manage strong feelings


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Steps To Build Resiliency

  • Make connections

  • Avoid seeing crises as insurmountable

  • Accept that change is part of life

  • Take decisive action and move toward life goals

  • Look for opportunities of self-discovery

  • Keep things in perspective


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Steps To Build Resiliency

  • Take care of yourself

  • Learn from your past experiences and make positive changes

  • Stay flexible

  • Let yourself experience strong emotions

  • Learn to rely on others and let others rely on you


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Examples Of Preparedness Activities

  • Educational campaign

  • Establish mental health response network with local providers

  • Target at-risk populations

    • Assist in development of safety plan

    • Assist in development of emergency kit

    • Assign liaisons to identify specific concerns in your community


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Secondary Trauma

  • Defined as the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events


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Secondary Trauma

  • Professionals who listen to the stories of fear, pain, and suffering are especially vulnerable to secondary traumatization


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Emergency care workers, police officers, mental health professionals, medical professionals, clergy, and human services workers are vulnerable to secondary trauma


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Is a state of tension and preoccupation with the individual or cumulative trauma of clients

Can be thought of as secondary post-traumatic stress

avoidance/numbing of reminders of the event

persistent arousal

Secondary trauma is not “burnout”

Secondary Trauma


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Consequences of Secondary Trauma or cumulative trauma of clients

  • Job performance declines

  • Mistakes increase

  • Morale drops

  • Personal relationships are affected

  • Deterioration of home lives

  • Personality deterioration

  • Decline in general health


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Critical Incident Stress or cumulative trauma of clients

  • A “critical incident” is any event that has a significant amount of emotional reactions which have the potential to interfere with their ability to function either at the scene or at a later time


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Key Ideas or cumulative trauma of clients

  • Normal reactions to an abnormal event

  • Reactions include cognitive, behavioral, psychological


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Examples of Critical Incidents or cumulative trauma of clients

  • Line of duty death

  • Serious line of duty injury

  • Suicide of co-worker

  • Disasters

  • Law enforcement shooting


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CIS Interventions or cumulative trauma of clients

  • Demobilizations

  • Defusings

  • Debriefings

  • One-on-One meetings


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Self-care and Stress Management or cumulative trauma of clients

Prior to assignment

  • Personal Preparedness

  • Team and Organizational Preparedness

  • Safety of Family Members

  • Social and Organizational Support


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Self Care and Stress Management or cumulative trauma of clients

During an Assignment

  • Work with a partner

  • Limit length of shifts

  • Use stress management techniques

  • Keep a notebook

  • Defuse regularly

  • Call home regularly

  • Closures


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Self-Care and Stress Management or cumulative trauma of clients

Following an Assignment

  • Returning home

    • Express gratitude to those who have covered your normal responsibilities

    • Expect an adjustment period of a week or two

      • Mild depression

      • Physical let-down

    • Expect a lot of questions from others


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Summary or cumulative trauma of clients

  • Mental health preparedness/response must be part of all emergency management plans

  • Individuals respond differently to events

  • Promote resiliency to minimize impact of life changing events

  • Taking care of oneself is just as important as caring for victims


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