A Conversation About: Disaster Mental Health
In this episode the X-Podcast team discusses what Disaster Mental Health is and gives you an insider peek at how it is all set up. They tell you about what it is and what it is not. In addition, the team discusses some of their own personal experience with Disaster Mental health as survivors and as a helper. In addition, our Executive Producer Xiomara A. Sosa sends a special personal message out to the Ashville, NC hurricane survivors and to the Los Angeles wildfires survivors.
Listen to episode at https://blubrry.com/studio_talk_mental_health/
Tips for managing your distress related to wildfires
Even if you are not directly affected by wildfires, you may experience a sense of distress or vulnerability by living close by or watching the destruction unfold in news reports.
Even if you are not directly affected by wildfires, you may experience a sense of distress or vulnerability by living close by or watching the destruction unfold in news reports. This can be especially true if you have family or friends who may be impacted by the disaster and you do not yet know about their safety and well-being.
Tips to manage your distress
Take a news break. Watching endless replays of footage from fires can make your stress even greater. Although you’ll want to keep informed—especially if you have loved ones affected by the disasters—take a break from watching the news.
Be kind to yourself. Some feelings when witnessing a disaster may be difficult for you to accept. You may feel relief that the disaster did not touch you, or you may feel guilt that you were left untouched when so many were affected. Both feelings are common.
Keep things in perspective. Although a disaster often is horrifying, remember to focus as well on the things that are good in your life.
Find a productive way to help if you can. Many organizations are set up to provide financial or other aid to victims of natural disasters. Contributing or volunteering can be a way to gain a sense of “control” over the event.
Look for opportunities for self-discovery and recognize your strengths. People often learn something about themselves and may find that they have grown in some respect as a result of persevering through hardship. Many people who have experienced tragedy and adversity have reported later on better relationships and greater sense of personal strength.
Additional recommendations
For many people, using the tips mentioned above may be sufficient to get through the current crisis. At times, however, an individual can get stuck or have difficulty managing intense reactions. A licensed mental health professional such as a psychologist can assist you in developing an appropriate strategy for moving forward. It is important to get professional help if you feel like you are unable to function or perform basic activities of daily living.
Thanks to psychologists Raymond F. Hanbury, PhD, ABPP, Jana Martin, PhD, and APA Division 42.
Neri Street developed this helpful list of mental health tips useful for hurricanes or any natural disaster:
What is Disaster Mental Health?
Disaster mental health is the provision of mental health, substance abuse, and stress management services to disaster survivors and responders.
Mental health care is provided by licensed professionals who volunteer their time and talent during and after disasters.
Disaster mental health is based on the principles of ‘preventive medicine’. This principle has made a paradigm shift from relief-centered post-disaster management to a holistic, multi-dimensional integrated community approach to health promotion, disaster prevention, preparedness, and mitigation
Experiencing a natural disaster or other emergency can be intensely stressful.
Even when the immediate danger has passed, the impact can still be felt. People may feel grief or anger over the damage or loss, fear or hopelessness when thinking about rebuilding their lives, or they may simply feel overwhelmed and not know how to begin. Taking those first steps toward recovery can be easier with a little support.
Getting basic needs first, immediately after the disaster (food, water, shelter, safety of self and loved ones etc) is the most important thing to avoid traumatic injury. Basic physical safety is what they need in the first 12 hours. The longer that help is delayed, the more likely the effects will set in. Stressors in last 6 months - already worn down
Impact of history of mental illness, trauma, or addictive behaviors.
Knowing that the cavalry is coming soon after is a must.
Maslow’s hierarchy:
Anticipatory and post disaster
What is trauma?
Trauma is when something happens that leaves us feeling unsafe.
What is traumatic injury?
Traumatic injury happens when you never really gain your sense of personal power and safety and it starts affecting your autonomic nervous system (the part of the nervous system responsible for the control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes), your stress responses, etc. That’s when we start looking at PTSD, C-PTSD, and Cumulative PTSD.
Cumulative post-traumatic stress disorder (CPTSD) is a type of PTSD that develops from repeated or prolonged exposure to stressful situations. It can also be called complex PTSD or prolonged duress stress disorder (PDSD).
CPTSD can be more dangerous than PTSD caused by a single traumatic event because it can go unnoticed and untreated. Some signs of CPTSD include:
Physical symptoms like insomnia, nightmares, headaches, fatigue, chest pain, diarrhea, vomiting, nausea, breathing difficulty, profuse sweating, pounding heart, twitches, grinding of teeth, dry heaves, explosive and exaggerated reactions/responses not in balance with the situation -
Emotional symptoms like irritability and emotional exhaustion
Some examples of experiences that can lead to CPTSD include:
Repeated exposure to disasters, accidents, deaths, or violent acts
Frequent need to deliver traumatic news to others
Regular exposure to the abuse of children
Long-term exposure to bullying
Chronic stressors such as financial difficulties or work-related pressures
Systemic issues like discrimination, oppression, or social injustice
Cops and Cumulative PTSD
Officers who deal with human trauma might not recognize its toll until it's too late. Estranged from family, loss of job, loss of close friends and family members, making exaggerated decisions and choices based on exaggerated reactions to life issues, etc.
Repeated exposure to trauma can weaken the ability to cope, resulting in cumulative PTSD (CPTSD).
Since it’s not linked to a specific incident, CPTSD can go undiagnosed.
Educating police officers about CPTSD can inspire preventative treatment that benefits the whole organization.
They suffer from cumulative post-traumatic stress disorder (CPTSD), or the sum reaction to a build-up of trauma over time. Invisible Wound. They blame someone else or anyone/everyone else for the bad consequences of their behavior and choices and decisions because they can’t see that they are the actual problem and cause. Blinded and distorted thinking from it. Only have people who support that thinking and behavior around them. Cumulative PTSD is more likely to go unnoticed and untreated. Left untreated, officers can become impossible to be around and estrangement sets in.
Six ‘R’s in Disaster Work:
Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long-term remedial measures using community resources), Recovery (Returning to normalcy), and Resilience (Fostering).
The prevalence of mental health problems in disaster-affected populations is found to be higher by two to three times than that of the general population.
There can be diagnosable mental health disorders within the affected community and other trauma-related symptoms.
Most of the immediate acute phase mental health issues are resolved in time, but long-term disorders can occur and require help from mental health professionals to resolve.
The first 12 hours after a trauma is the most important for people to have the social support needed to reduce the traumatic injury later on.
Disaster mental health information for mental health professionals
Mental Health professionals help their communities prepare before disaster strikes, take steps to address emotional distress during the tragedy, and build resilience skills to facilitate longer-term recovery.
When a disaster hits, there is a need for licensed, mental health volunteers to work within affected communities to provide support to organizations involved in disaster response and recovery.
Disaster training is the first step in volunteering in response efforts. Before volunteering, most organizations directly involved in disaster response require that licensed mental health professionals complete disaster mental health training.
If you want to volunteer, register with an organization of your preference to get the relevant credentials and training.
Psychological first aid: what we provide
Psychological first aid (PFA) is an initial disaster response intervention to promote safety, stabilize survivors of disasters, and connect individuals to help and resources.
The purpose of PFA is to assess the immediate concerns and needs of an individual in the aftermath of a disaster, and not to provide on-site therapy.
PFA is delivered to affected individuals by mental health professionals and other first responders.
What to expect in disaster mental health training
Disaster mental health training involves clinical skills such as interpersonal communication, empathic listening, and assessing the level of risk. A license to practice mental health is required.
Disaster mental health training is focused on making application of those skills within a disaster response operation. It is important to learn how to navigate effectively within the organizational structure so that you are an asset to the overall operation.
These are some of the major organizations that offer disaster mental health training and general preparedness training:
What to expect as a disaster responder
The three main phases of response are to prepare, respond, and recover.
Mental health clinicians do not provide therapy at the disaster site to affected individuals; instead, they help those in disastrous situations build on their internal strengths and resilience. They offer support in a multitude of ways, depending on the needs of the affected communities and individuals. They take direction from the response agency they are working with to provide the best assistance and support.
Understanding the emergency response infrastructure
An important aspect of disaster mental health work is to become familiar with local, state, and federal emergency response systems.
Get the appropriate disaster response training from an established emergency response organization.
Always work through the appropriate emergency response systems.
Each locality, state, and/or territory has legal and operational resources available to respond to natural and man-made disasters. Understanding the scope and level of interaction between different agencies helps an organization prepare and respond to an incident. Each incident or declared emergency elicits a specific set of agency roles and responsibilities that impact the functioning of the government and private sector, in addition to the lives of the general public.
At the state level, a set of statutory regulations exists to address emergencies and guide state officials, such as the governor, director of homeland security, or the director of the appropriate emergency management agency, if the declaration of a state of emergency is warranted.
Types of emergencies for which the power is granted are determined by individual state law and generally include broad terms such as “disasters,” “emergencies,” and/ or “public health emergencies.” Further, the type of emergency declared may trigger the activation of state response plans, emergency operation centers, and incident command systems to deliver aid and supplies and deploy personnel, equipment, and/ or technological assistance.
If the scope of the disaster necessitates a federal response and assistance to the states and localities, this may be authorized by the Secretary of Health and Human Services or the president of the United States, with or without a declaration of federal emergency. Under these conditions, emergency provisions and services such as financial, personnel, logistical, and technical assistance may be granted per federal laws, or interagency agreements and coordination.
Mental health professionals looking for disaster response information on a state and local level can visit these websites:
Volunteer options, onsite or remote
Volunteers do not have to be present at a disaster site to provide disaster mental health support. There are several ways that you can be involved and participate from afar. Here are just a few of the different ways you can get involved, whether directly onsite at disaster, remotely, or through the phases of disaster preparedness, response, and recovery.
The three main phases of response
Prepare
Register to volunteer with a disaster response agency so you are already on an organization’s volunteer list before disaster strikes.
Participate in community disaster planning meetings, drills, and exercises.
Teach disaster mental health courses to other psychologists and mental health professionals in your area.
Serve as an expert for your community and state, provincial, and territorial psychological associations to help develop resources on disaster preparedness and coping with trauma.
Respond
Offer disaster mental health support to survivors and response workers to enhance their resilience skills.
Assist local and county emergency response agencies with disaster response operations. This could be through virtual volunteering, as some response organizations seek support through phone and web-based efforts.
Be a virtual volunteer or screener from your home or office. This requires mental health providers with disaster response experience to screen potential new volunteers to make sure they are fit for volunteer services.
Be a resource to local media covering news stories on the psychological aspects of a disaster.
Recover
Help community organizations with recovery needs and efforts.
Offer psychoeducational programming to community groups on common challenges that occur months and years after the disaster.
Work with your state, provincial, or territorial psychological association to disseminate resources in your community to promote community support and build resilience.
Disaster-related organizations
Nonprofits
Government agencies
U.S. Department of Homeland Security
WHAT IS DISASTER?
Disasters can be defined as violent encounters with nature, technology, or humankind.
In 1978, Lazarus & Cohen defined it as a specific cataclysmic event, that is, a stressor depicted by immense power, large scope, suddenness, and placing excessive demands on individual coping.
Similarly, in 1992 the World Health Organisation (WHO) defined disaster as ‘a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community’.
In 1995, the Federal Emergency Management Agency of the US defined ‘disaster’ as, ‘Any natural catastrophe, regardless of cause, any fire, flood, or explosion that causes the damage of sufficient severity and magnitude to warrant assistance supplementing State, local, and disaster relief organization efforts to alleviate damage, loss, hardship, or suffering’.
The Disaster Management Act 2005 of India, disaster is defined as a catastrophe, mishap, calamity, or grave occurrence in any area, arising from natural or manmade causes, or by accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of property, or damage to, or degradation of, environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area.
From the above various definitions, it is clear that there is no single acceptable definition of disaster. However, there are some common characteristics across all definitions. They are:
Sudden onset,
Unpredictability,
Uncontrollability,
Huge magnitude of destruction,
Human loss and suffering and
Greatly exceeds the coping capacity of the affected community.
HOW CAN WE CLASSIFY DISASTERS?
Disasters can be classified as natural and man-made ones.
WHAT IS THE PRINCIPLE OF DISASTER MENTAL HEALTH?
Disaster mental health services are based on the principles of ‘preventive medicine’.
Shift from relief-centered post-disaster management to a holistic multi-dimensional integrated community approach.
WHAT ARE THE DIFFERENT PHASES OF DISASTER MENTAL HEALTH?
The community's and individual's reactions to the disaster follow predictable phases.
They are the heroic phase, the honeymoon phase, the disillusionment phase, and the restoration phase.
Immediately after the disaster, survivors in the community usually show altruistic behavior like rescuing, sheltering, feeding, and supporting fellow human beings. This phase usually lasts from a day to weeks depending upon the severity, duration of exposure, and availability of the relief sources from various agencies.
Once the relief agencies step in, survivors are relocated to safer places like relief camps. Media attention, free medical aid, free food and shelter, VIP visits to the camp, administration’s sympathy, compensation package, and rehabilitation promises provide an immense sense of relief and faith in survivors that their community will be restored in no time and their loss will be accounted for through monetary benefits. This is the honeymoon phase, which usually lasts for 2-4 weeks.
At the end of 2-4 weeks, relief materials and resources start weaning. VIPs and politicians visit stops. Media coverage reduces. Administration, relief agencies and NGOs' involvement start fading. Survivors are now facing the harsh reality of post-disaster life. The reality of the complex process of rebuilding and rehabilitating feels like a distant dream because of administration hurdles, bureaucratic red tape, discrimination, injustice, and corruption. This harsh reality in the disillusionment phase is where mental health disorders and issues show up and last for 3-36 months before harmony is restored. The role of mental health workers is immense during this phase.
WHAT ARE THE NORMAL HUMAN RESPONSES TO A DISASTER?
Grief is the response to any loss. Grief reactions are normal responses to abnormal situations. Its intensity is directly proportional to the severity, duration, and intensity of exposure to the disaster. The grief process occurs through various stages and is often experienced in wave cycles or episodes with periods of intense and painful emotions. Usually, normal grief follows the above phases with a possibility of some variation and resolves over a few months. Remember, survivors are normal people in abnormal situations. This issue needs to be kept in mind. The validation of their emotions needs to be done during the therapy to address the issues of:
Survivor's guilt,
Fear of losing control of overwhelming emotions,
Becoming mentally ill,
Substance use,
Death wishes and suicidal ideas. By validation of emotions, a sense of justification is provided to the overwhelming emotions.
WHAT ARE THE ABNORMAL HUMAN RESPONSES TO A DISASTER?
Abnormal grief reactions can be classified as delayed, absent, oscillating, and exploding grief responses. Abnormal or complicated because they interfere in the process of healing and also interfere in biological, social, and occupational functioning.
The resolution of abnormal grief reactions can be helped by fostering the cultural-religious rituals of grieving. Mental health professionals need to work with the disaster relief administration, educate themselves about proper cultural norms in this process, and help facilitate the grieving through cultural-religious death rituals of grieving. Many of the survivors may require trauma/grief-focused interventions, within a comprehensive disaster recovery program.
WHAT ARE THE COMMON MENTAL DISORDERS SEEN IN THE DISASTER-AFFECTED POPULATION?
Common disorders are Adjustment disorders, depression, post-traumatic stress disorder (PTSD), anxiety disorders, non-specific somatic symptoms, and substance abuse. Researchers have assigned PTSD as the signature diagnosis among post-disaster mental morbidity.
Mood disorders, PTSD, and substance use disorders are diagnosed frequently along with other psychiatric disorders.
Depression is a well-known comorbidity.
Mental health morbidity continues to be prevalent even after 3-5 years in the disaster-affected community.
WHO ARE AT RISK OF DEVELOPING MENTAL HEALTH MORBIDITY?
The severity of the disaster, threat to life, loss of life, loss of family members, and duration of exposure. Recent additions are Female gender, children, elderly, physically disabled, single, ethnic minority, displaced population, poverty, substance use like smoking, loss of economic livelihood, poor social support, and family support.
Most children and young people are resilient, but also very vulnerable to the psychosocial effects of disasters.
People with pre-existing mental disorders are well known to relapse during disasters.
People with poor coping capacity, substance use, and chronic general medical conditions are also at high risk.
Disaster rescue workers are at high risk of developing mental health issues.
WHAT IS THE ROLE OF MENTAL HEALTH PROFESSIONALS IN DISASTER SITUATION?
They have to play a multi-dimensional role from educating, training, negotiating, administrative, fundraising, collaborative, skill transferring, treating, advocating, and rehabilitating.
Role of mental health professionals in disaster
They address a spectrum of problems during post-disaster. These include therapy; education; support groups etc. They provide important components of psychosocial rehabilitation such as normalizing, stabilizing, socializing, defusing emotions and feelings, and restoration of a sense of identification with others and of safety and security. They help in the prevention of adverse mental health consequences.
Another important role is providing care to the disaster relief workers. Disaster relief workers encounter considerable stress while providing services to people affected by a disaster and they are exposed to the same risk factors that affect clients, so disaster workers are at risk for compassion fatigue, burnout, and vicarious trauma.
Vicarious trauma can also impact the relief worker's personal life, as well as the relief operation. It is essential to monitor the disaster relief workers' mental and physical health status.
Psychological First Aid
Survivors may exhibit a range of physical, emotional, and cognitive symptoms. This heightened emotional state is similar to the classical fight/flight/freeze reaction of stress.
Affected people may not be in a position to think and act rationally during a disaster. Similar to medical first aid, psychological first aid techniques can be performed by minimally trained nonprofessionals within the affected community. Disaster relief workers need to be trained in assessing the high-risk survivors.
The assessment needs to be initiated by the relief worker for the assessment of:
Dangers to self and others
Disoriented to time/place/person
Death of family member/s in disaster
A direct threat to life because of disaster
Disaster-related significant physical injury to self or family members
Delayed relief/evacuation
Missing family member/s and
History of mental illness and substance use.
After the brief assessment, appropriate steps need to be taken by providing psychological first aid.
Cognitive Behavioral Intervention (CBT)
CBT is effective after exposure to disaster.
Other interventions
Recently there has been a re-emergence of interventions such as Eye Movement Desensitization and Reprocessing (EMDR) and trauma counseling in the management of disaster.
Community-Based Interventions
Non-specific community-based interventions play a major role in fostering the healing process. These intervention include, structuring of daily activities; avoiding displacement; fostering the family, cultural and religious rituals; group discussions; validation of the emotions of the survivor's experience and also survivor's guilt; providing factual information; educating parents and teachers; engaging the children in various informal education methods with innovative ideas like drawing, sketching, singing, miming and so forth by using available community resources; engaging the adult survivors in camp activities like cooking, cleaning and assisting in relief work; to start schools in the disaster affected area at the earliest so that normalization and structuring of the daily activities occurs in children; at least to initiate informal education; teaching simple sleep hygiene techniques; educating survivors about harmful effect of substance use; community-based-group interventions can be planned like art therapy (painting/drawing), group discussions, dramas, storytelling, structuring their day, engaging in activities, prayers, yoga, relaxation, and sports/games; stress management of the relief worker is essential; engaging the willing survivors in spiritual activities and involving the survivors in re-building their community is essential.
These non-specific interventions not only help the high-risk population but also the affected disaster general population.
Xiomara A. Sosa
Creator, Host and Executive Producer
#TheXPodcast #MentalHealth #Podcast
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Resources
Disaster assistance and resources for Veterans
https://www.thex-studio.org/resources
You can find psychologists near you by contacting your state psychological association or visiting the Psychologist Locator.
References
https://www.apa.org/topics/disasters-response/disaster-mental-health-psychologists
https://www.redcross.org/about-us/our-work/disaster-relief/disaster-mental-health.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649821
http://www.ncptsd.va.gov/publications/disaster/index.html
http://nidm.gov.in/DM_act2005.pdf 2005
https://www.psychologytoday.com/us/blog/shadow-boxing/202110/cops-and-cumulative-ptsd
