Mental Health Response in Times of Disaster

1. Mental Health Response in Times of Disaster Michelle Bowman, RN. MSN. Santa Barbara County ADMHS CARES/Mobile Crisis

2. OBJECTIVES • Define Disaster • Identify phases of disaster • Identify reactions in each of the phases • Understand basic concepts of Disaster Mental Health • Identify steps of self care • Identify steps on planning for the future

3. DISASTER • A disaster is a natural or human caused occurrence (e.g. hurricane, tornado, flood, tsunami, earthquake, explosion, hazardous materials accident, mass criminal victimization incident, war, transportation accident, fire, terrorist attack, famine, epidemic,) that causes human suffering. A disaster creates a collective need that overwhelms local resources and requires additional assistance.

4. Typical Phases of Disaster and Characteristics of Each Phase • Phase 1: Pre-Disaster • Characterized by fear and uncertainty. • Type of disaster • No warning • Feelings of vulnerability • Lack of security • Fears of future • Unpredicted tragedies • Sense of loss of control • Loss of ability to protect oneself and one’s family

5. Typical Phases of Disaster and Characteristics of Each Phase • Phase 1: continued • Type of disaster • With warning • Guilt • Self blame for failure to heed the warnings • Feel responsible

6. Typical Phases of Disaster and Characteristics of Each Phase • Pre-disaster phase could be as short as hours or even minutes • Terrorist Attack • Long as several months • Hurricane Season

7. Typical Phases of Disaster and Characteristics of Each Phase • Phase 2: Impact Phase • Characterized by range of intense emotional reactions • Depends on type of disaster • Shock to overt panic • Initially confusion and disbelief leads to focus on self and family preservation. • Shortest of six phases

8. Typical Phases of Disaster and Characteristics of Each Phase • Phase 3: Heroic phase • Characterized by high level of activity with low level of productivity. • Altruism • Adrenaline-induced rescue behavior • Risk assessment may be impaired • Passes quickly to next phase.

9. Typical Phases of Disaster and Characteristics of Each Phase • Phase 4: Honeymoon Phase • Characterized by dramatic shift in emotions. • Optimism • Assistance readily available • Community bonding • Good time to build rapport with affected people and groups • Lasts only a few weeks

10. Typical Phases of Disaster and Characteristics of Each Phase • Phase 5: Disillusionment Phase • Characterizedby a stark contrast to the honeymoon phase. • Realized limits of disaster assistance • Discouragement • Increase in stress • Physical exhaustion • Substance abuse • Gap between needs and assistance

11. Typical Phases of Disaster and Characteristics of Each Phase Phase 5: continued • Can last months – yrs • Can be extended by triggers • Anniversary dates

12. Typical Phases of Disaster and Characteristics of Each Phase • Phase 6: Reconstructive Phase • Overall feelings of recovery • Assume responsibility for rebuilding their lives • Adjust to the new normal • Continue to grieve their losses • Begins around anniversary dates

13. Typical Phases of Disaster and Characteristics of Each Phase

14. 1st Steps for County Staff and Contractors • Contact your supervisor and follow your county policy and procedures. • Question may include: • Are you and your loved ones safe? • Are you impacted by the event? • Are you able to report to work? • Alternative worksite • Follow your agencies policies and procedures

15. Disaster Service Worker vs. Mental Health Worker • Disaster Service Worker (DSW) • Goal seeks to restore pre-disaster functioning • Mental Health Worker (MHW) • Treatment services

16. Key Concepts of Disaster Mental Health • No one who sees a disaster is untouched by it.

17. Key Concepts of Disaster Mental Health • 2 Types of Disaster Trauma • Individual: defined by Erikson as “a blow to the psyche that breaks through one’s defenses so suddenly and with such brutal force that one cannot react to it effectively.”

18. Key Concepts of Disaster Mental Health • Community or Collective • “Is a blow to the basic tissues of social life that damages the bonds attaching people together and impairs the prevailing sense of community” it can sever social ties of survivors if they may need to relocate to temporary housing.”

19. Key Concepts of Disaster Mental Health • Disaster stress and grief reactions are normal responses to an abnormal situation. • Most survivors will show signs of emotional/psychological strain.

20. Key Concepts of Disaster Mental Health • The second disaster • Process of seeking help from government, voluntary agencies and insurance companies • Many rules, red tape, hassles, delays and disappointments

21. Key Concepts of Disaster Mental Health • Most people do not seek mental health services. • Stigma • Overwhelmed • Strategies to use for engagement • “Over a cup of coffee” • Unobtrusive interviewing

22. Key Concepts of Disaster Mental Health • MH assistance more practical than psychological in nature. • Need to deal with practical problems of everyday living. • Assist with identifying specific concerns, problem solving, decision making, setting priorities, exploring alternatives, seeking resources and choosing a plan of action.

23. Key Concepts of Disaster Mental Health • Services tailored to the community served • Urban, suburban, rural areas have different needs, resources, traditions and values about giving and receiving help. • Essential to consider ethnic and cultural groups in the community

24. Key Concepts of Disaster Mental Health • Survivors respond to active listening • Allow for silence • Attend nonverbally • Paraphrase • Reflect feelings • Allow for expression of emotions

25. Key Concepts of Disaster Mental Health • Do say: • “These are normal reactions to a disaster” • “It is understandable that you feel this way” • “You are not going crazy” • “It wasn’t your fault, you did the best you could” • "Things may never be the same, but they will get better and you will feel better.”

26. Key Concepts of Disaster Mental Health • Don’t say: • “It could have been worse” • “You can always get another pet/car/house” • “I know just how you feel” • “You need to get on with your life”

27. Key Concepts of Disaster Mental Health • Interventions must be appropriate to phase of disaster. • Different psychological and emotional reactions are expected during each phase of disaster.

28. Key Concepts of Disaster Mental Health • Social support systems are crucial to recovery. • Strengthen social ties, build new ones • Make time for family and friends • Make time for recreational activities • Work together in post disaster chores

29. Normal Response to Abnormal Situation • No one who experiences a disaster is untouched by it. • Normal to fee anxious about safety • Profound sadness, grief, and anger are normal • Acknowledge feelings • Focus on strengths and abilities • Accepting help is healthy • We each have different needs and ways of coping

30. At Risk Groups • Age Groups • Pre-school (ages 1-5) • Age and development determine their capacity to understand and help to regulate their emotional responses.

31. At Risk Groups • Childhood (ages 6-11) • Developing cognitive capacity to understand dangers to family and environment. • Need to understand what has happened and concrete steps they can take for protection and preparedness in the future.

32. At Risk Groups • Pre-adolescent and Adolescent (ages 12-18) • More vulnerable to difficulty if experience other stress in year preceding the disaster • Divorce, a move, death of family member or pet.

33. At Risk Groups • Adults • Stress associated with family, home disruption, financial setbacks, and work overload.

34. At Risk Groups • Older Adults • Concerns with health, financial stability, living independently

35. At Risk Groups • Cultural and Ethnic Groups • Language barriers • Suspicion of governmental agencies • Bilingual and bicultural staff

36. At Risk Groups • Differing cultural values • Death, grieving, home, spiritual practices use of particular words, celebrating, mental health and helping. • Mental health workers must learn cultural norms, traditions, local history, community politics

37. At Risk Groups • Socioeconomic Groups • High income families • Vulnerability • Low income families • Fewer resources • Greater pre-existing vulnerability • Developed more crisis survival skills • Recovery prolonged and arduous

38. At Risk Groups • People with Serious and Persistent Mental Illness • Same responses as general population • Reluctant to seek help • May “rise to the occasion” • Special needs, stress exacerbates symptoms

39. At Risk Groups • People with Physical Disabilities • Hearing impaired • Vision impaired • Mobility impaired • Developmentally disabled • Special medical needs

40. At Risk Groups • Human Service and Disaster Relief Workers • Workers in all phases of disaster relief. • Human suffering, injuries and fatalities • Need ongoing mental health services during the course of recovery program

41. When to Refer to Mental Health Services • Disorientation • Dazed • Memory loss • Inability to give date, time, recall events over the past 24 hrs • Understand what is happening

42. When to Refer to Mental Health Services • Mental Illness • Hearing voices • Seeing visions • Delusional thinking • Excessive preoccupation with an idea or thought • Pressured speech • Inability to care for self • Suicidal or homicidal thoughts

43. When to Refer to Mental Health Services • Problematic use of alcohol or drugs • Domestic violence, child abuse, or elder abuse

44. Coping for Disaster Services Workers • On the Job • Pre-briefing/orientation • 12 hrs on /12 hrs off • High stress to lower stress functions • Rotate work rotations from the scene to routine assignments • Counseling assistance • Drink plenty of fluids • Good nutrition/snacks

45. Coping for Disaster Services Workers • Frequent breaks • Talk about emotions, what you have seen and done for the day • Stay in touch with family and friends • Work in pairs • Debriefing

46. Coping for Disaster Services Workers • Self Care • Talk to someone • Don’t hold self responsible • Promote physical and emotional healing • Daily routines • Eat healthy • Rest • Exercise • Relaxation • Meditation

47. Coping for Disaster Services Workers • Maintain normal household and daily routines • Limit demanding responsibilities on self and family • Spend time with family and friends • Participate in memorials, rituals and use of symbols • Use existing support groups • Establish a family emergency plan

48. Signs You May Need Stress Management Assistance as a Disaster Services Worker • Difficulty communicating thoughts • Difficulty remembering instructions • Uncharacteristically argumentative • Difficulty making decisions • Limited attention span • Unnecessary risk taking • Tremors/headaches/nausea

49. Signs You May Need Stress Management Assistance as a Disaster Services Worker • Tunnel vision/muffled hearing • Disorientation or confusion • Difficulty concentrating • Easily frustrated • Unable to let down when off duty • Refusal to follow orders • Refusal to leave the scene

50. Signs You May Need Stress Management Assistance as a Disaster Services Worker • Increased use of drugs/alcohol • Unusual clumsiness • Unable to engage in problem solving