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Mental Health Response in Times of Disaster. Michelle Bowman, RN. MSN. Santa Barbara County ADMHS CARES/Mobile Crisis . OBJECTIVES. Define Disaster Identify phases of disaster Identify reactions in each of the phases Understand basic concepts of Disaster Mental Health

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mental health response in times of disaster

Mental Health Response in Times of Disaster

Michelle Bowman, RN. MSN.

Santa Barbara County ADMHS

CARES/Mobile Crisis

objectives
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
disaster
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.
typical phases of disaster and characteristics of each phase
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
typical phases of disaster and characteristics of each phase5
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
typical phases of disaster and characteristics of each phase6
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
typical phases of disaster and characteristics of each phase7
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
typical phases of disaster and characteristics of each phase8
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.
typical phases of disaster and characteristics of each phase9
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
typical phases of disaster and characteristics of each phase10
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
typical phases of disaster and characteristics of each phase11
Typical Phases of Disaster and Characteristics of Each Phase

Phase 5: continued

  • Can last months – yrs
  • Can be extended by triggers
    • Anniversary dates
typical phases of disaster and characteristics of each phase12
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
1 st steps for county staff and contractors
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
disaster service worker vs mental health worker
Disaster Service Worker vs. Mental Health Worker
  • Disaster Service Worker (DSW)
    • Goal seeks to restore pre-disaster functioning
  • Mental Health Worker (MHW)
    • Treatment services
key concepts of disaster mental health
Key Concepts of Disaster Mental Health
  • No one who sees a disaster is untouched by it.
key concepts of disaster mental health17
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.”
key concepts of disaster mental health18
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.”
key concepts of disaster mental health19
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.
key concepts of disaster mental health20
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
key concepts of disaster mental health21
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
key concepts of disaster mental health22
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.
key concepts of disaster mental health23
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
key concepts of disaster mental health24
Key Concepts of Disaster Mental Health
  • Survivors respond to active listening
    • Allow for silence
    • Attend nonverbally
    • Paraphrase
    • Reflect feelings
    • Allow for expression of emotions
key concepts of disaster mental health25
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.”
key concepts of disaster mental health26
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”
key concepts of disaster mental health27
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.
key concepts of disaster mental health28
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
normal response to abnormal situation
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
at risk groups
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.
at risk groups31
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.
at risk groups32
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.
at risk groups33
At Risk Groups
  • Adults
    • Stress associated with family, home disruption, financial setbacks, and work overload.
at risk groups34
At Risk Groups
  • Older Adults
    • Concerns with health, financial stability, living independently
at risk groups35
At Risk Groups
  • Cultural and Ethnic Groups
    • Language barriers
    • Suspicion of governmental agencies
      • Bilingual and bicultural staff
at risk groups36
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
at risk groups37
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
at risk groups38
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
at risk groups39
At Risk Groups
  • People with Physical Disabilities
    • Hearing impaired
    • Vision impaired
    • Mobility impaired
    • Developmentally disabled
    • Special medical needs
at risk groups40
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
when to refer to mental health services
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
when to refer to mental health services42
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
when to refer to mental health services43
When to Refer to Mental Health Services
  • Problematic use of alcohol or drugs
  • Domestic violence, child abuse, or elder abuse
coping for disaster services workers
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
coping for disaster services workers45
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
coping for disaster services workers46
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
coping for disaster services workers47
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
signs you may need stress management assistance as a disaster services worker
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
signs you may need stress management assistance as a disaster services worker49
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
signs you may need stress management assistance as a disaster services worker50
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
pandemic mental health response
Pandemic Mental Health Response
  • No data available mental health impacts on outbreaks of disease.
  • SARS
    • Data from SARS outbreak
      • 40% of community population increase in stress in family and work settings
      • 16% showed traumatic stress levels
      • Helpless, apprehensive
      • In another community 30% thought they would contact SARS
pandemic mental health response52
Pandemic Mental Health Response
  • Nurses who treated SARS
    • 11% traumatic stress reactions
    • Depression
    • Anxiety
    • Hostility
    • Somatization of symptoms
pandemic mental health response53
Pandemic Mental Health Response
  • Preparedness
    • Education
      • Before pandemic occurs
      • Embedded in existing disaster public education campaigns
        • TV, radio, Red Cross, CDC
        • http//www.hhs.gov/pandemicflu/plan/
pandemic mental health response54
Pandemic Mental Health Response
  • Leadership Preparation
    • Public officials understand populations at greatest risk.
  • Sustaining Preparedness Measure
    • Maintenance of motivation, capital assets, equipment and funding
pandemic mental health response55
Pandemic Mental Health Response
  • Leadership Functions
    • Identify community leaders, spokespersons who can affect the community.
      • Media, celebrity groups
pandemic mental health response56
Pandemic Mental Health Response
  • Early Pandemic Response
    • Communication
      • Recommendations to prevent exposure, infection or halt disease transmission will be met with skepticism hope and fear
      • Media can either amplify skepticism or promote a collaborative approach.
      • Public must clearly and repeatedly be informed of rationale and mechanism for distribution of limited supplies.
pandemic mental health response57
Pandemic Mental Health Response
  • Tipping Points
    • Certain events that can dramatically increase or decrease fear
    • Management of community wide distress and loss
      • Community rituals
        • Speeches
        • Memorial services
        • Funerals
        • Collection campaigns
        • TV specials
pandemic mental health response58
Pandemic Mental Health Response
  • Surges in Demands for Health Care
    • Important Public Health Preparedness Activities
      • Health Demand Surge needs to be addressed
        • Hospital, clinics medical responses
        • Availability of vaccines
        • Shortages, vaccines, supplies, beds
pandemic mental health response59
Pandemic Mental Health Response
  • Intervention planning
    • Efforts to increase protective health behaviors and response behaviors
      • Need for reminders to take care of own health
        • Taking medication
        • Giving medications to elderly and children
        • When to go for vaccinations
pandemic mental health response60
Pandemic Mental Health Response
  • Good safety communication
    • Clear, simple and easy-to-do measures for protecting self and family
  • Public education
    • Address
      • Fears of contagion
      • Danger to family and pets
      • Mistrust of authority and government
pandemic mental health response61
Pandemic Mental Health Response
  • Psychological first aid
    • Establish safety; identify safe area and behaviors
    • Maximize individuals’ ability to care for self and family
    • Teach calming skills and maintenance of natural body rhythms (sleep, rest, exercise)
pandemic mental health response62
Pandemic Mental Health Response
  • Maximize and facilitate connectedness to family and other social supports.
    • This may require electronic rather than presence
  • Foster hope and optimism while not denying risk
the three elements of recovery
The Three Elements of Recovery
  • TALK
    • Teach survivors about the healing qualities of talking to friends, loved ones and counselors about their thoughts and feelings as they go through the recovery process.
the three elements of recovery64
The Three Elements of Recovery
  • Biggest myths
    • “If you don’t talk about it, it will go away”
    • “Talking about it only keeps things stirred up”
the three elements of recovery65
The Three Elements of Recovery
  • TEARS
    • Recovery entails grief. Grief is the healing process by which individuals and the community separate from a major loss. Including the world as we once knew it, and our assumptions about the world. Tears are an essential, natural, cleansing and healing part of the process.
the three elements of recovery66
The Three Elements of Recovery
  • TIME
    • Provides an opportunity for reflections, allow people to look back and recognize the challenges they have overcome. By the one year anniversary of the disaster, most people can look inward and appreciate the courage, stamina, endurance and resourcefulness within themselves and each other. No longer see themselves as victims but as survivors.
planning for the next disaster
Planning For The Next Disaster
  • Be Prepared
    • Escape Routes
      • Where to meet
    • Family communication
      • Out of state contact
planning for the next disaster68
Planning For The Next Disaster
  • Utility shut off and safety
    • Natural gas
    • water
planning for the next disaster69
Planning For The Next Disaster
  • Insurance and vital records
    • Insurance papers
    • Inventory of home possessions
    • Important documents
    • Money
planning for the next disaster70
Planning For The Next Disaster
  • Caring for animals
    • Identify shelters
    • Pet supplies
    • Proper ID
    • Up to date vet records
    • Provide a pet carrier and leash
planning for the next disaster71
Planning For The Next Disaster
  • Safety skills
    • First Aid
    • CPR
    • Fire extinguisher
planning for the next disaster72
Planning For The Next Disaster
  • Basic Disaster Supplies Kits
    • Home, car, office
    • Recommended items
      • 3 day/2 week supply non perishable food
      • 3 day /2weeks of water,

1 gallon/person/day

      • Portable, battery operated radio/TV
      • Flashlight
planning for the next disaster73
Planning For The Next Disaster
  • Extra batteries
  • 1st aid kit and manual
  • Sanitation and hygiene items
  • Matches and waterproof container
  • Whistle
  • Extra clothing/sturdy shoes
  • Kitchen accessories, cooking utensils,

can opener

planning for the next disaster74
Planning For The Next Disaster
  • Photocopies of credit and ID cards
  • Cash and coins
  • Special items
    • Eye glasses
    • Medications
    • Hearing aid
  • Items for infant care
  • Items unique to your family
planning for the next disaster75
Planning For The Next Disaster
  • For more information/checklists

go to:

  • http://www.fema.gov/areyouready/
    • Appendix A, B & C