Member care in crises

1. Member care in crises Dr Debbie Hawker www.resilientexpat.co.uk

2. After a trauma:Psychological First Aid (PFA) • Ensure safety (including from rumours/ excessive media) • Help contact family members • Provide drinks, food, shelter, practical help • Comfort & reassurance • Listening • Provide information FREE MANUALS: see resource list

3. Reducing arousal • A key aim is to help reduce the arousal level of people who have been through trauma • This reduces risk of PTSD • Be a calming presence • OK to be with them in silence • Appropriate use of touch • Can be good not to sleep in the 6 hours after trauma • Activities like cross-stitch, knitting or video games can help after trauma

4. Reducing arousal • Deep, slow breathing might help • Grounding techniques: Describe where you are in detail. Be in the present moment (reduces flashbacks & panic) • Remind them of time & date & that this is a safe place • Some people sniff a smell associated with happy memories when thoughts of the trauma are triggered (e.g. a nice perfume; lavender; coffee)

5. Psychological First Aid Woman in her 70s fell over. Pedestrians stopped and: • Phoned ambulance • Help her contact her husband • Comfort, reassurance, calmed her • Provided water • Dignity & warmth (offered a coat) • Passed on a message • Listened

6. Children • Children need routine, reassurance and to be with people they know and trust • Should be protected from media • Inform school of the situation • Specialists can help children, when necessary • Help re-establish sense of hope and control • See handout for more information on helping children

7. The steps of Critical Incident Debriefing Ending Intro Coping Facts Cognitions Psy.ed. Emotions

8. Case example: You have just heard that a young woman in your team has died. Her family have not yet been informed. What needs to happen now? Who breaks the news? How?

9. Ripples… • Who needs member care? • Family • Friends • Team • Others who knew this person • Messages to other members of the organisation, Board, supporters etc

10. Breaking bad news • E.g. death, abduction or missing person • News travels fast. Want to avoid family/ friends hearing about it on media/ social media before you have told them • Someone needs to break the news

11. Breaking bad news • Should be done with great care • Booklet available at http://www.dartcenter.org/content/breaking-bad-news

12. Breaking bad news • Hearing the news might be the worst event in this person’s life • How the news is conveyed can impact how they will deal with the trauma • It is best to break the news in person wherever possible (especially if death or missing person) • If it has to be by phone, introduce yourself and ensure you are speaking to the right person

13. Breaking bad news • Where possible, get someone from their culture & language to offer support • Respect their customs • Some are not used to talking about personal matters to strangers, especially at a distance • Some dislike phone / internet • It’s OK if they don’t say much • Pass on info and say you are sorry

14. Breaking bad news • Liaise with police / embassy to see what they are doing • You might be the one to break the news, or be with family immediately afterwards with additional details

15. Breaking bad news Prepare beforehand: • Find out what exactly happened and when (as many details as you can – people often want every detail) • Where exactly is the body/ injured person? (Loved ones might want to go to them) • What name did relatives know the person by? • Prepare what you will say

16. Breaking bad news • Take a colleague with you (for emotional support and practical reasons e.g. to look after children or to take over if you become emotional) • Don’t phone in advance to say you are coming. Try to find out discretely where family are likely to be • Identify yourself and ask if you can come in • Make sure you are giving the news to the right person. • Don’t tell children first

17. Breaking bad news • The loved one might faint. Ask them to sit down • Ask where you can sit (so you don’t upset them by sitting where the deceased always sat) • Try to appear as calm as possible, to help reduce their arousal as this will help them cope.

18. Breaking bad news • Don’t delay with small-talk • Be clear, short and simple e.g. ‘I’m afraid I have very bad news. …. has died/ been killed/ is missing’ • Don’t rush. Be truthful • Be prepared for raw emotion (anger, tears, uncontrollable grief, shock). Allow time for response, questions or silence. They may be unable to speak.

19. Breaking bad news • Your presence is more important than words • Stay as long as they want you • Be prepared for many questions • Ask ‘would you like me to tell you what we know so far?’ and be guided by them about how much detail they want • Offer pen and paper and suggest they might want to write things down (as later they might fail to remember details) • Say ‘please stop me at any time, or ask me to repeat details’ • Say what you know and be honest about what you don’t know.

20. Breaking bad news • Don’t promise anything you can’t deliver • Respond to questions, but don’t overwhelm them with more information than they can take in • Don’t ask them to fill in forms at this point – those can wait. • Be prepared to repeat yourself as they might not be able to take it all in at once.

21. Breaking bad news • Write down their questions if you don’t know answer, and offer to try to find out and let them know • Explain that you wanted to tell them as soon as possible and all the facts are not yet known. • Helpful phrases include ‘I am so sorry about this news’ • Don’t say ‘I know how you feel’

22. Breaking bad news • If children are in the house, they may also need to hear the news. Parents might be best to tell them themselves, perhaps with you still present. • Avoid terms such as ‘he’s gone to sleep’ or ‘she is in the arms of Jesus’ about someone who has died. • If children then leave the room, one of you may need to look after them

23. Breaking bad news • Say that you will be the point of contact (or name who will be) • Ask who in the family you should contact when you have more information and check best phone number(s)

24. Breaking bad news • Be prepared for this to take hours, with comfort breaks • Ask if there is anyone else they want to contact or to be with them now • Who else needs to be told? The family should generally tell people themselves but they might need help with transport/ a phone – say don’t drive after this news

25. Breaking bad news • Is there anything else they want you to do? • The family may wish to discuss funeral arrangements (e.g. if body needs to be flown home or they want to fly to body), or these might be left for later after they have got over shock

26. Guide for bereaved families FCO provide a lot of practical information in ‘Guide for bereaved families’, http://www.fco.gov.uk/resources Family might be unable to cope with this so you can talk them through step by step

27. Breaking bad news • ‘I will leave you shortly, so that you can be by yourselves. Is there anything else you want to ask while I am still here?’ • ‘You might want to write down any questions which come to mind, and ask me next time we speak’ • Give them a contact number and let them know when they can call you

28. Breaking bad news • If appropriate book your next visit or phone-call (especially if there is more information you have not been able to give this time, or you have paperwork to complete) • Write this down for yourself AND the family • If appropriate, ask the family what they need to do after you leave (e.g. contact people; collect children; arrange time off work) • Suggest they think about who can help them at this time

29. Common reactions Shock Anger Despair, grief Moving on

30. Handling the media • Give the family advice about handling the media

31. Future meetings • Tell them how long you have (e.g. ‘we have about an hour today’) • Family may go to collect the body – will someone accompany them? And provide a translator if necessary? • Ask about funeral arrangements and whether someone from the organisation can attend/ whether they would like you to speak

32. Honouring the dead • You may wish to discuss a memorial service • It means a lot to the bereaved if you honour the dead. How can you best do this e.g. through literature or press releases?

33. Contacting family • Hierarchy is important in some cultures • Can the International Director write to the family? • Write to let family know how much you valued the contribution their loved one made

34. Don’t forget colleagues and friends • What support do the team on the ground need? • How can they contribute to articles or letters for the family? • Will they have a memorial service too?

35. Longer-term • It is important that the family feel supported • Particularly acknowledge special occasions (e.g. the first birthday or Christmas without their loved one; or the first anniversary of the event) – perhaps send a card or flowers saying you are praying for them

36. Longer-term • Don’t let the family become emotionally dependent on you, or they will face a second ‘bereavement’ when you pull out. • Encourage them to accept support from friends, family, church etc • You have an important role to play, in encouraging them to seek further help if you think they would benefit

37. Further help • Doctor might be able to provide help (e.g. for depression, insomnia, PTSD or alcohol abuse) • Or find a local counsellor • Or charity e.g. www.crusebereavementcare.org.uk or Support after Murder and Manslaughter (SAMM) Abroad www.SAMMabroad.org

38. Self-care • You also need support and occasional relief from this role • After handling a crisis, take care of yourself • Do you need time off?

39. Back to case study 1 • A young woman died • Police broke news to parents (after waiting for their return) & left after a few minutes while they were still in shock. Police didn’t have the details family wanted • 2 people from the organisation spent a long time with parents – comforting, giving details, answering questions

40. Case study 1 cont. • The same 2 people remained in touch with parents and attended the (traumatic!) funeral service • Ongoing support given during the long process of inquest • Colleagues also needed to be informed and supported by the organisation • Housemates supported while they were investigated (Why sudden death?)

41. Handling the media Provide written information about handling the media, e.g. the handout ‘A family’s guide to handling the media during and after a kidnapping’ downloaded from www.hostageuk.org

42. Handling the media: Info for families In most cases it is NOT advisable to speak to the media as it can be very stressful (and in the case of abduction it may have negative impact on the hostage, making them seem more ‘valuable’, which can prolong negotiation and may lead to selling the hostage on)

43. Handling the media: Info for families • Explain that they don’t have to tell the media anything • If the family DO want to talk to the media, advise them to think clearly about what they want to achieve, and what they will say.

44. Handling the media: Info for families • Journalists might turn up at the door, phone landline or mobile, or try to speak to neighbours, extended family, friends or colleagues • Ask people not to comment • Consider having one person as the point of contact for media, and request that no other family/ friends speak to media. Maintain a consistent message.

45. Handling the media: Info for families • Try to be polite with the media. You might want their help at some point. • Note the name, paper and contact details of each journalist you speak to

46. Handling the media: Info for families • If you decide to talk to media, first write down what you want to say. • Stick to that and don’t say more than you planned. • You can email quotes rather than talking to journalists • Note the name, organisation and contact details of each journalist you speak to

47. Handling the media: Info for families • If you speak to 1 journalist, flocks of others might come to your door, each wanting more information/ a ‘better story’. • To avoid this, set up a single interview to be shared around papers and TV channels • You can read or issue a prepared statement rather than answering questions

48. Handling the media: Info for families • You can report a journalist to their employer and to the Press Complaints Commission or the police if they trespass on your property or harass you • You can record any conversations with journalists

49. Social media: Info for families • Increase privacy settings on the Facebook/ MySpace etc of the hostage. The media might try to access it for photos and private information. If you don’t know how to do this, you can ask the Foreign Office for assistance

50. How long should family support continue? • Depends on the situation and people involved • After a month family might start to rebuild their own lives. Encourage them to receive support from friends • Let them know how to access professional help if appropriate (e.g. counselling)