Disaster and Crisis Mental Health

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Disaster and Crisis Mental Health
The Federal Perspective for Community Response
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CMHS Federal Partnerships for Crisis Mental Health
Consultation on Trauma Research - RAPID Grants
Interagency Agreement for Crisis Counseling
Program
Consultation on School Violence Response
Interagency Agreement for Consultation, Training,
and Technical Assistance major criminal incidents
Interagency Agreement for National Technical
Assistance Project
Information exchange on transportation incidents
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CMHS Emergency Services and Disaster Relief
BranchCore Functions

• Disaster Mental Health Services
• Victims of Crime Mental Health
• Training and Education
• Emergency Preparedness Planning
• Stress Management Consultation
• Interagency Collaboration

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What is a Disaster?

• A disaster is an occurrence such as a hurricane,
  tornado or flood that causes human suffering or
  creates a collective human need that requires
  assistance to alleviate. There are natural,
  technological, health, social and terrorist
  disasters.

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Types of Disasters Human Caused

• Plane crash
• Terrorism incidents (eg. Bombings)
• Nuclear accidents
• Shootings
• Riots

• Arson
• Immigration emergencies
• Environmental
• Chemical/biological

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Terrorism Within the U. S.

• An activity that involves a violent act or an act
  of dangerousness to human life that is in
  violation of the criminal laws of the United
  States, or of any State ...and that appears to be
  intended to intimidate or coerce a civilian
  population...or to influence the policy of
  government by assassination or kidnapping.
• 18 U.S.C. 3077

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Factors Associated with Disasters

• Significant (number and duration) employment loss
• Significant family disruption/relocation
• Interface with large bureaucracies
• Significant disruption of support system
• Changes in school configurations
• Disruption to community infrastructure
• Significant influx of outsiders into the community

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Typical Phases of Disaster
1 to 3 Days -------------------TIME---------------
----------------------------1 to 3 Years
Zunin/Meyers
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Effects of Disasters in Stages

• First stage during and immediately after a
  disaster
• Second stage a few days to several weeks after
  the disaster
• Third stage months to years later

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Comparing Criminally Human-Caused 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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Effects of Trauma

• Vary by a persons age, developmental stage,
  prior condition, degree of personal impact
• Vary by the disasters severity, the amount of
  advance warning, the level of community
  preparedness
• May include physical, emotional, cognitive or
  behavioral reactions

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Psychosocial Concerns

• Disruption of existing social/community
• Impact of new social patterns
• Duration of recovery
• Cross cultural impact

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Effects of Long-Term Disaster Stress

• Anxiety and vigilance
• Anger, resentment and conflict
• Uncertainty about the future
• Prolonged mourning of losses
• Diminished problem-solving
• Isolation and hopelessness
• Health problems
• Lifestyle changes

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Disaster Stress and Grief Reactions

• Normal responses to abnormal situation
• Reactions
• emotional and psychological strain
• acute stress
• post traumatic stress
• grief reactions
• immediate and practical problems in living
• Often transitory in nature

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Physical Reactions

• Fatigue, exhaustion
• Gastrointestinal distress
• Appetite changes
• Tightening in the throat or chest
• Other somatic complaints

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Emotional Reactions

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

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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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Behavioral Reactions

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

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Chronic Stressors in Disaster

• Family disruption
• Work overload
• Gender differences
• Bureaucratic hassles
• Financial strain

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Other Long-Term Reactions

• Major depression
• Suicide thoughts and attempts
• Alcohol and drug abuse
• Anxiety disorders
• Dissociative disorders

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Acute Traumatic Stress Disorder(one description
of short-term trauma)
The development, within one month of the event,
of at least 3 of the following

• dissociation, emotional numbing,
• a re-experiencing of the event,
• behavioral avoidance,
• increased physiologic arousal and
• social-occupational impairment.

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Long Term TraumaFor some victims it may last for
months or years.

• The rates of PTSD are much higher among victims
  of violent crime than victims of other types of
  traumatic events (such as California floods).
• Crime victims who believed they would be killed
  or seriously injured were much more likely to
  develop PTSD than victims whose crimes did not
  involve life-threatening injury.

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Post Traumatic Stress Disorder

• Persistent re-experiencing of the event
• Avoidance of things associated with event
• Symptoms of increased arousal
• Distress or impairment in social, occupational or
  other areas

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Factors Which Influence Recovery

• Natural vs. Human caused
• Degree of personal impact
• Size and scope
• Probability of recurrence

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Survivor Risk and Resiliency Factors

• Psychological
• Capacity to tolerate stress
• Prior trauma history
• Socioeconomic education level
• Family stability
• Social support
• Female gender
•  

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Key Concepts of Disaster Mental Health

• No one who sees a disaster is untouched by it
• People experience individual and collective
  trauma
• Securing disaster relief can be emotionally
  stressful
• Most people pull together during and after a
  disaster but their effectiveness is diminished
• Most people do not see themselves as needing
  mental health services following a disaster and
  will not seek out such services

Zunin and Meyers, 1994
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Overarching Concepts

• Normalcy
• Flexibility/improvisation
• Non-central role
• Nontraditional settings
• Understanding the culture and the community

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Crisis Counseling and Traditional Mental Health
Practice
Traditional Practice
Crisis Counseling

• Primarily Home Community Based
• Assessment of Strengths, Adaptation Coping
  Skills
• Seeks to Restore Pre-Disaster Functioning
• Accepts Content at Face Value
• Validates Appropriateness of Reactions and
  Normalizes Experience
• Psycho-educational focus

• Primarily Office Based
• Focus on Diagnosis Treatment of Mental Illness
• Attempt to Impact Personality Functioning
• Examines Content
• Encourages Insight into Past Experiences
  Influence on Current Problems
• Psychotherapeutic Focus

Source ESDRB Program Guidance, December, 1996
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Interventions Appropriate for the Phase of
Disaster

• Varying psychological and emotional reactions
• Talking with a person in crisis does not always
  mean talking about the crisis
• People titrate their dosage when dealing with
  pain, sorrow, periods of normalcy and respite

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Keys to Intervention in Crisis

• Assumes competence
• Active/directive care giver
• Program/community fit
• Innovative in helping

• No concept of mental illness
• No classification of people
• Focus on strengths and potentials
• Focus on support structure

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Disaster Mental Health Interventions

• Rapid assessment and triage
• Crisis intervention
• Supportive listening
• Problem-solving immediate issues
• Education about disaster stress
• Debriefing and community meetings
• Information and referral

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Crisis Intervention

• Promote safety and security
• Gently explore trauma experience
• Identify priority needs and solutions
• Assess functioning and coping
• Provide
• Reassurance
• Psychoeducation
• Practical assistance

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Longer-Term Interventions

• Community outreach
• Counseling
• Support groups
• Crime victim assistance
• Psychoeducation

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Community Outreach

• Initiate contact at gathering sites
• Set up 24-hour telephone hotlines
• Outreach to survivors through media, Internet
• Educate service providers
• Use bilingual and bicultural workers

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Key Events with Mental Health Implications

• Death notification
• Ending search and recovery
• Criminal justice proceedings
• Returning to impacted areas
• Funerals and memorials

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  Community Interventions

• Memorials and Rituals
• Usual community gatherings
• Anniversary commemorations
• Symbolic Gestures

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Examples of Crisis Counseling Program Services

• Outreach
• Screening and Assessment
• Counseling
• Information and Referral
• Public Education

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Program Limitations

• Medications
• Hospitalization
• Long-term Therapy
• Providing Childcare or Transportation
• Fundraising activities
• Advocacy
• Case Management

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Shared Concepts and Values

• Building on Individual and Family Strengths
• Supporting Existing Community Services
• Evolving Expertise and Experience

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Special Populations
Children and Youth Older Adults People with
Disabilities People with Serious Mental
Illness People with Low Socioeconomic
Status Cultural and Ethnic Groups Disaster
Workers Displaced Workers
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  Cultural Competence

• Valuing of diversity
• Recognition of and respect for differences
• Understanding cultural definitions of mental
  health, well-being, coping and recovery
• Use of MH and other interventions that fit
• Services and information provided in primary
  languages
• Use of empowerment-based approaches
• Ongoing cultural awareness and sensitivity
  training
•  

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Cultural Differences
Cultural differences exist between rural and
urban survivors, across differences in education
and socioeconomic backgrounds, age groups, and
among different religious and non-religious
groups. Jackson Cook, 1999
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  Organizational Approaches

• Effective management structure
• Effective managers and supervisors
• Clear purpose and goals
• Functionally defined roles
• Team support
• Plan for stress management

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Linking with Adjacent Jurisdictions

• Collaborative planning
• Mutual Aid agreements
• Coordinated training
• Collaboration with voluntary agencies
• Contact information
• Administrative coordination
• Creating a seamless system

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Coordination of Services

• Information Exchange
• Joint Planning and Memoranda of Understanding
• Training/Cross Training
• Post Disaster Meetings

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Ethical Issues
As to diseases, make a habit of two things--to
help, or at least, to do no harm -Hippocrates,
Epidemics
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Crisis

• Presents both opportunity and danger
• Can create a particular openness to the
  environment
• People in crisis tend to reach out to others for
  help and guidance
• Others in the environment tend to reach out to
  those in crisis
• Reciprocal openness - opportunities to utilize,
  mobilize, strengthen and support these linkages

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Lessons Learned

• Resilience of the human spirit
• Variety of coping responses
• The centrality of blame
• Trigger events
• Need for novel solutions

• Importance of ritual and spirituality
• Importance of symbolism
• Value of natural supports, individual and
  community
• Our ignorance about mental health

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For More Information
www.ojp.usdoj.gov/ovc/