Introduction-Disaster-and-Mental-Health.pdf

 A Brief Overview of the Practice of Disaster Mental Health “if you’ve seen one disaster, you’ve seen one disaster”  DEFINING DISASTER “A major disaster is defined as any natural catastrophe, or regardless of cause, any fire, flood, or ex...

 A Brief Overview of the Practice of Disaster Mental Health “if you’ve seen one disaster, you’ve seen one disaster”  DEFINING DISASTER “A major disaster is defined as any natural catastrophe, or regardless of cause, any fire, flood, or explosion that causes damage of sufficient severity and magnitude to warrant assistance supplementing State, local, and disaster relief organization efforts to alleviate damage, loss, hardship, or suffering” 3  DEFINING DISASTER Is often defined as a critical incident whose negative impact is characterized by great physical damage, loss of life, or hardship. A disaster is a non-routine event that exceeds the capacity of the affected area to respond to it in such a way as to save lives; to preserve property; and to maintain the social, ecological, economic, and political stability of the affected region. This definition of disaster does the following: 1. Disasters are unusual events, complex and difficult to respond to, and their impacts may last for generations. 2. It takes into consideration the capacity of the local area to respond to an incident. This is important because, in most cases, large communities, simply because of the number of their available resources, are more capable of handling very serious situations than are small communities. 3. Takes into consideration the importance of maintaining the social, ecological, economic, and political stability of the affected area. This is important because, clearly, when people are killed and homes are destroyed, those who survive will suffer long-lasting emotional and psychological effects  Introduction Each day disasters occur, and each year millions of people are affected. Whether natural or human-made, the extreme and overwhelming forces of disaster can have far-reaching effects on individual, local community, and national stability. Long-term recovery varies significantly due to the complex interaction of psychological, social, cultural, political, and economic factors. 8  Disaster Characteristics and their Mental Health Impact Disaster Characteristics and their Mental Health Impact - Disasters are not uncommon events - Notwo disasters are exactly alike, but certain characteristics tend to be associated with specific reactions among survivors Predictors of Survivor Reactions Disaster Individual Response characteristics characteristics characteristics Survivor reaction Characteristics of Disasters 1. Size 2. Cause 3. Expected or unexpected 4. Timing  Characteristics of Disasters: Size Greater scope, intensity, and/or duration  Characteristics of Disasters: Cause - Natural - Human-caused - Na-tech - Public health emergencies Disaster’s Impact: A Range of Reactions - Common vs. Extreme - Recovery as the expectable outcome Post-disaster traumatic stress does not equal posttraumatic stress disorder  Post-disaster traumatic stress Vulnerable populations - groups that may have more intense needs before, during, and after disaster, include: u Children u The elderly (particularly the frail elderly) u People with serious mental illness u People with physical disabilities u People with substance dependency u People living in poverty Common Reactions Physical Emotional Cognitive Behavioral Spiritual Life Cycle of Disaster Reactions Reactions occur in stages/phases: Pre-impact: Disasters with warnings allow people to prepare and initiate coping mechanisms Impact: Magnified arousal levels (fight, flight, or freeze); usually little panic; behavior in this phase is related to later recovery Post-impact: Reactions unfold over the heroic, honeymoon, disillusionment, and reconstruction phases 1. Pre-disaster phase Disasters with no warning can cause feelings of vulnerability and a sense of loss of control or the loss of the ability to protect yourself and your family. 2. Impact phase. Slow, low-threat disasters have psychological effects that are different from rapid, dangerous disasters. 3. Heroic phase. Characterized by a high level of activity with a low level of productivity. 4. Honeymoon phase. A dramatic shift in emotion. Disaster assistance is readily available. Community bonding occurs. Optimism exists that everything will return to normal quickly. Disillusionment phase. Communities and individuals realize the limits of disaster assistance. Optimism turns to discouragement and stress continues to take a toll. Reconstruction phase. Characterized by an overall feeling of recovery. Individuals and communities begin to assume responsibility for rebuilding their lives, and people adjust to a new normal while continuing to grieve losses.  DISASTER MENTAL HEALTH SERVICES Clinical Roles In a major disaster, effective mental health response requires the delivery of both clinical and administrative services in ways that differ from services typically provided by mental health professionals. The primary objective of disaster relief efforts is to restore community equilibrium. Disaster mental health services, in particular, work toward restoring psychological and social functioning of individuals and the community, and limiting the occurrence and severity of adverse impacts of disaster-related mental health problems (e.g., post-traumatic stress reactions, depression, substance abuse). 23  Administrative Roles Following a disaster, administrators are faced with the challenge of having to quickly become familiar with disaster protocols (grant applications) and resources (mutual and other aid), while meeting rapidly emerging and changing disaster-precipitated needs. KEY CHARACTERISTICS & HELPING BEHAVIORS OF DISASTER MENTAL HEALTH WORKERS Disaster mental health work requires a personal orientation toward adventuresomeness, sociability, and calmness. Equally important is having systems savvy, the ability to exhibit empathy, genuineness, positive regard for others, and the ability to provide therapeutic structure. Generally speaking, adventuresomeness, sociability, calmness, systems savvy, and therapeutic acumen transcend theoretical orientation and are applicable across various disaster response settings. Moreover, they are essential to communicating with survivors and rescue workers whether informally or while providing practical help, defusing, debriefing, or information  Adventuresomeness Disaster work is a constant creative challenge with relatively few cardinal rules to provide a priori guidance. The inclination toward curiosity and learning from experience as well as the willingness to develop creative solutions to complex problems is necessary for disaster work. The person who relies upon routine with minimal uncertainty is likely to feel overwhelmed and adrift. 28  SOCIABILITY Disaster mental health work demands long hours each day, as well as being on call throughout assignment. Survivors and workers alike are at their best and worst in a disaster – courageous, selfless, dedicated, resourceful, and compassionate... yet also plagued by doubts, selfishness, resignation, confusion, and irritability. To work with people who may be experiencing extreme stress, and to maintain the stance of a sensitive and observant listener and helper, requires not just a professional commitment to others, but the capacity to enjoy and find the best in others. 29  Calmness Disaster work is a form of non-stop crisis intervention challenging the equanimity of unexperienced and experienced clinicians alike. When nothing seems to be happening for hours at a time, powerful undercurrents of anxiety, despair, rage, and uncertainty threaten to break loose at any moment. Working and living conditions are often chaotic: noisy settings, long hours, substandard lodging, unstructured schedules, ambiguous roles and rules – these high-stress circumstances call for emotional poise. 30  Systems Savvy Disasters are political events. Turf and organizational politics are pervasive and volatile at disaster services sites, Incident Command center(s), and at national headquarters of response agencies. The disaster mental health professional represents a distinct interest – that of supporting and enhancing the psychosocial safety and functioning of helpers, survivors, and their community. By becoming familiar with the scope of disaster relief operations (i.e., community, state, and national political arenas), the mental health professional can better assume the role of an impartial mental health advocate. 31  Therapeutic Acumen To provide therapeutic assistance without “therapizing” disaster survivors or workers, the mental health professional’s perspective must be grounded in empathy, genuineness, and respect. These “facilitative conditions” have been found to be essential across the spectrum of psychotherapy’s theoretical models and help quickly promote a positive relationship between helper and survivor. 32  FACILITATIVE CONDITIONS 33