Overview of Key Concepts of Disaster Behavioral Health

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Overview of Key Concepts of Disaster Behavioral
Health
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Objectives

• Participants will understand the importance of
  including disaster mental health as part of the
  overall emergency response in all stages of the
  disaster
• 2. Participants will gain an understanding of the
  general concepts of disaster mental health
  including disaster phases, factors affecting
  emotional coping and the range of normal
  reactions
• 3. Participants will understand the importance of
  participating in the development and
  implementation of their local disaster mental
  health plan.

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What is a disaster?

• A disaster is an occurrence such as a
  hurricane, flood, earthquake, explosion,
  hazardous materials accident, war, transportation
  accident, fire, famine, or epidemic that causes
  human suffering or creates collective human need
  that requires assistance to alleviate.

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What is Disaster Mental Health?

• The use of crisis intervention, support
  counseling and empowerment to stabilize, protect,
  educate and redirect the individual impacted by
  the disaster. This may be provided by peer or
  professional level counselors from a variety of
  human service agencies with disaster mental
  health training. Confidentiality is strictly
  maintained. Outreach is a primary tool.

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Disaster Mental HealthKEY CONCEPTS

• Normal reactions to abnormal situations
• Avoid mental health terms and labels
• Assistance is practical
• Assume competence
• Focus on strengths and potentials
• Encourage use of support network
• Active, community fit
• Innovative helping

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Factors Influencing The Emotional Impact Of A
Disaster

• Disaster Individual/Community
  Worker
• Characteristics Characteristics
  Characteristics
• __________________________________________________
  ______________
• With Warning v. Individual
  Expectations/
• Without warning Characteristics
  Experience
• Time of day and Social Support Diversity
• Duration Systems
• Geographic Diversity/ Physical/Emotional
• Location Demographics Health
• Scope of Impact Disaster History Personal
  Issues
• Natural v. Previous Trauma Media Coverage
• Man-made
• Post-disaster Communications

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Emotional Phases And Activities Of Disaster
Recovery
EMOTIONAL PHASES AND ACTIVITIES OF DISASTER
RECOVERY
Heroic Honeymoon Disillusionment Reconstruction
Prior to/ 1 Week to 3-6 2 Months to May Last
for Immediately After Months After 1-2 Years
After Several Years After Shock Attend to
Reality of Light at the basic needs impact
on end of the Fear in a
chaotic lives and tunnel environment communit
y Confusion Begin to put Concerns Realiza
tion the disaster Adrenalin about safety, of
losses and
behind rush food for today,
work to be done and a place to Renewed
feeling Heroic acts sleep tonight Procedures of
empowerment to get assistance People
com- Unrealistic (both government Post-traumatic
ing together expectations and insurance)
stress disorder about
recovery Community Return to Sharing
of politics begin pre-disaster resources/ to
emerge activities willingness to help
others Grieving Denial of Many
psy- extent of chosomatic needs or
complaints emotional impact Abuse
issues
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Definition of TerrorismAPA

• The basic law of terrorism is that even the
  smallest threat can ripple out to touch people a
  thousand miles away. The basic goal of
  psychological interventions is to understand the
  traumatic impact of terrorism and to use that
  understanding to minimize and contain the ripple
  effect within the individual, community, and our
  nation.
• (APA, Report on the OKC Bombing, 1997)

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Comparing Terrorism and Natural Disasters

• Causation
• Appraisal of Event
• Psychological Impact
• Subjective Experience
• World View/Basic Assumptions

• Stigmatization of Victims
• Phases of Recovery
• Media
• Secondary Injury

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Causation

• Terrorism
• Evil intent
• Deliberate sociopolitical act
• Human cruelty
• Revenge
• Hate or bias against a group

• Natural Disaster
• Act of nature
• Human impact
• CMHS, Mental Health Responses to Mass Violence
  and Terrorism, Draft 2001

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Appraisal of Event

• Terrorism
• Incomprehensible, unexpected, senseless
• Viewed by some as uncontrollable and others as
  preventable
• Violation of social order
• CMHS, Draft 2001

• Natural Disaster
• Expectations defined by disaster type
• Awe about power and destruction of nature
• Disasters with warnings increase controllability
• Recurring disasters pose ongoing threat

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Psychological Impact

• Terrorism
• Significant physical and emotional effects due to
  severe threat to life and casualties
• Higher rates of PTSD, anxiety, traumatic
  bereavement over longer period of time

• Natural Disasters
• Reactions related to property losses, relocation,
  financial stress, daily hassles
• Disaster reactions resolve over 18 months, lower
  rates of diagnosable disorders

CMHS, Draft 2001
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Subjective Experience

• Terrorism
• Terror, fear, horror, helplessness, sense of
  betrayal and violation
• Withdrawal and isolation due to distrust and fear
• Outrage and blame of individual or group
  responsible, revenge, demand for justice

• Natural Disaster
• Separation from family members, evacuation, lack
  of warning, life threat, trauma and loss of
  irreplaceable property and homes
• Anger and blame toward agencies and individuals
  responsible for prevention, mitigation and
  disaster relief

CMHS, Draft 2001
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World View/Basic Assumptions

• Terrorism
• Shattering of assumptions about humanity, that
  world is secure, just and has order
• Evil things can happen to good people
• Loss of illusion of invulnerability

• Natural Disaster
• Spiritual beliefs may be shaken
• Loss of security in terra firma- the earth is
  solid and dependable
• Loss of illusion of invulnerability. Everyone is
  vulnerable to random acts of nature
• CMHS Draft 2001

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Stigmatization of Victims

• Terrorism
• Some victims may come to feel humiliation, guilt,
  self-blame, and ashamed
• Larger community may distance themselves to avoid
  confronting similar vulnerability
• Hate crimes reinforce discrimination and stigma

• Natural Disasters
• Disasters tend to have greater impact on those
  with fewer economic resources
• Survivors from cultural, racial, and ethnic
  groups, single parent families, people with
  disabilities, older adults on fixed incomes who
  are more heavily impacted may be stigmatized

• CMHS Draft 2001

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Media

• Terrorism
• The greater the horror and psychological impact,
  the greater the media interests
• Risk of violations of privacy and
  retraumatization through graphic media

• Natural Disaster
• Short-term temporary media interest fosters sense
  in community that the rest of the world has moved
  on
• Risk of violation of privacy, need to protect
  children from media exposure

CMHS Draft 2001
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Reactions Indicating Longer Term Difficulties

• Prolonged or severe numbing of emotions
• Persistent intrusive recall of the event or
  reliving it
• Avoidance of memories or reminders
• Prolonged startle reflex and hyper vigilance
• Alcohol/drug abuse
• Suicidal thoughts or attempts

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Normal Physical Reactions

• Fatigue, exhaustion
• Gastrointestinal distress
• Appetite change
• Tightening in throat, chest, or stomach
• Worsening of chronic conditions
• Somatic complaints

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Normal Cognitive Reactions

• Confusion, disorientation
• Recurring dreams or nightmares
• Preoccupation with disaster
• Trouble concentrating or remembering things
• Difficulty making decisions
• Questioning spiritual beliefs

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Normal Emotional Reactions

• Depression, sadness
• Irritability, anger, resentment
• Anxiety, fear
• Despair, hopelessness
• Guilt, self-doubt
• Unpredictable mood swings

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Normal Behavioral Reactions

• Sleep problems
• Crying easily
• Avoiding stress
• Excessive activity level
• Increased conflicts with family
• Hyper vigilance, startle reactions
• Isolation or social withdrawal

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Psychological Tasks for Recovery

• Acceptance of the disaster and losses
• Identification, labeling and expression of
  emotion
• Regaining sense of mastery and control
• Resumption of age-appropriate roles and activities

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When to Involve Disaster Mental Health

• In preparation stages to develop the plan and in
  drill practices
• Mobilize in immediate stage- early intervention
  reduces long term effects
• Coordinate and utilize effectively through
  recovery