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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT December 6, 2002 "Only a fool tests the depth of the water with both feet." - African Proverb
USING VOLUNTEERS AND MUTUAL AID PERSONNEL IN THE MENTAL HEALTH RESPONSE TO DISASTERS - Part 2
DISASTER RESPONSE
In the event of a moderate or large-scale disaster, mental health will need to assign at least one individual as coordinator of volunteer and mutual aid resources. Volunteers themselves can sometimes help with some parts of this coordination.
Activating Mutual Aid Agreements
If formal mutual aid agreements are in place, they should be activated by the mental health representative in the Emergency Operations Center (EOC), using the local government's official mutual aid procedures. While the mental health volunteer coordinator will likely function from the mental health office, rather than the EOC, all volunteer recruitment and deployment should be coordinated with the mental health representative in thye EOC.
Identifying Resources
If mental health has not identified potential volunteer and mutual aid resources predisaster, the steps outlined for identifying resources need to be followed. The volunteer coordinator will immediately begin contacting individuals and agencies who can help. A telephone tree can be used to contact other counties for assistance. Several counties can be called and each is asked, in turn, to contact several others. The mental health agency can put out a call for volunteers via the media, through the local public information officer, with procedures for where volunteers should call or check in.
The liklihood is that volunteers and mutual aid resources will begin contacting the impacted mental health agency in person or by phone, or simply begin appearing at disaster sites such as damaged neighborhoods or shelters.
Converging Volunteers
The convergence of volunteers, well-meaning but often untrained or unsuited to the job to be done, is a universal phenomenon in disasters. Quarantelli (1965) pointed out that "whatever planning is undertaken, it can rarely prepare for the quantity and quality of volunteers that appear." The United States has a long and vigorous tradition of volunteerism in the fire service, in ambulance services, and in many social and philanthropic causes (Auf der Heide, 1989; Dick, 1982). This altruism does not vanish in the face of disaster. If anything, it becomes stronger (Quarantelli, 1970; Dynes, 1970).
Organizations often have difficulty coordinating efforts of volunteer workers, especially if people have never worked together previously. Volunteers have varying skill levels, knowledge of community resources, and quite likely are unfami8liar with the organization's routines and operating procedures. Difficulties with volunteers may be lessened if procedures are developed to integrate them into the formal organizational response. Even if mental health has a pre-existing cadre of volunteers trained in disaster response, the agency should be prepared to deal with the convergence of additional volunteers.
Screening Spontaneous Volunteers
One approach is to develop a check-in area where volunteers can report and where an inventory can be made of their skills, abilities, and experience. The check-in area might only be open several hours a day, with hours posted and advertised. It is important for security personnel at roadblocks to be aware of the check-in areas for volunteers and to direct volunteers to these locations.
Another approach is to screen volunteers by phone. Following the 1989 Loma Prieta earthquake, volunteer groups nationwide called the California Department of Mental Health offering their assistance. The Department compiled the offers into an "Earthquake Emergency Resource List" which it updated and faxed daily to the mental health department in each impacted county. Counties then made their own requests for assistance directly to the persons on the list. The resource list included the name and title of the caller, phone number, agency he/she represented, resources available (numbers and types of staff, language capabilities, written materials, etc.), and whether the volunteer had been committed to a certain county. Local mental health agencies can duplicate this procedure by screening and logging offers of assistance. Resources can then be called upon as needed.
Individual volunteers will need to be screened for appropriateness of their knowledge, skills, and experience. While this is not easy in the midst of a disaster response, it is possible. Spontaneous volunteers should be asked to fill out the same volunteer application form used for prescreened volunteers. The volunteer coordinator can then review the application and decide the appropriateness of the applicant.
Freelance Volunteers
It is very likely that there will be more than a few mental health volunteers who show up at disaster sites without any linkage to the formal mental health response. If mental health staff are already established at the site, they should talk with the volunteers and clarify the roles and responsibilities of the mental health agency in directing and providing mental health services. Usually, the volunteers are well-intentioned and simply do not understand the organizational structure of disaster response. Once it is explained, they are usually happy to eork within the existing structure.
In some situations, mental health volunteers will continue to work independently of the mental health agency. This can cause confusion among disaster response organizations who may assume that the volunteers are part of the official local response. It can result in conflicy if an independent group of volunteers establishes itself as a service provider for a survivor group that is the responsibility of the local mental health jurisdiction. Sometimes, freelance volunteers with no prior experience or training attempt to participate in disaster response. During rescue operations at the Cypress Structure freeway collapse in Oakland, California after the Loma Prieta earthquake, many experienced disaster mental health workers, working for county mental health, were approached by volunteers. These inexperienced volunteers asked them if they had "any kind of guidelines for how to run a debriefing" before providing interventions for rescue personnel. In more than a few instances, mental health "volunteers" not under the umbrella of the official mental health response have engaged in practices of borderline ethics. Examples include handing out personal business cards, referring individuals o their private practice, and billing groups for services provided at the disaster.
For these reasons, it is critical that the local mental health agency maintain a directory of volunteers who are working under its auspices. The agency should have official identification cards for volunteers, which are recognized by law enforcement and emergency management personnel. If a question arises in the field about whether a mental health volunteer is representing the official mental health agency, a check of identification or of the official volunteer list should be made.
Deploying Volunteer and Mutual Aid Personnel
Ideally, volunteers should work in teams with known co-workers. However, this may not be possible for private practitioners. Mutual aid agencies sending personnel, however, should try to send two or more individuals. Coordination of volunteers can be enhanced if assignments are made keeping these work groups intact. This provides a "buddy" system for both support and stress management. Additionally, it can preserve the existing coordination and communication procedures of intact groups. The quality of volunteers' contributions to disaster activity is improved if their organizational structures are kept intact (Dynes, 1974).
For groups of workers coming from outside the disaster area, it is advisable that each group be asked to commit to a tour of duty of at least one week in length. When groups come into an area for only a day or two, the time required to brief, train, and debrief them significantly reduces their service time, and unnecessarily taxes the volunteer coordinator's efforts.
Mental health will probably have to provide some help to mutual aid staff in finding living accommodations in the area. At the very least, a list of hotels and motels will be helpful to volunteers in making their own reservations. The mental health volunteer or logistics coordinator may take on the task of making hotel reservations for personnel, but the job is enormous and is best left to the volunteers.
Most emergency agencies using mutual aid in a large-scale disaster use the concept of a staging area for briefing incoming staff and demobilizing departing personnel. If a situation is urgent, personnel will be sent immediately to the scene. Mental health is rarely involved in lifesaving efforts. Utilizing the staging area approach to deployment of volunteer teams can help to simplify coordination.
For mental health's purposes, the staging area can be a large room at the mental health agency or community meeting hall. Volunteers should be told the time and day to report to the staging area for field assignment and orientation prior to their deployment. No volunteer is to report to a field assignment before attending an orientation. An orientation can also be conducted in the field, but orienting volunteers at numerous sites becomes time-consuming and fragmented.
Volunteers need to know what to bring with them to their disaster assignment, including whether they must provide their own transportation for use in the field. If mutual aid workers are providing their own transportation, they should be asked to bring at least one vehicle for every two workers. This allows mutual aid teams the mobility to cover numerous sites.
Mutual aid workers should bring personal supplies that will enable them to be fairly self- sufficient once in the field.
Orienting Volunteers
It is strongly suggested that mental health schedule no more than one orientation session per day (preferably, two or three per week). Volunteers can be oriented in large groups. If possible, the orientation should be kept to under three hours. Volunteers should sign any necessary forms and be issued identification.
Training and Supervising Volunteers
Volunteers selected for disaster response should ideally have prior training and experience in disaster or large-scale crisis intervention. Sometimes, however, volunteers without such experience are the only staff available. In such situations, "quick and dirty" brief training will be critical prior to deploying volunteers. Every effort should be made to link inexperienced volunteers with more experienced workers. A great deal of "on the job training" can take place in the field. For instance, an experienced outreach worker can show a new volunteer, by example and discussion, effective techniques such as "working the floor" of a disaster shelter or Disaster Application Center.
The mental health agency should provide more in-depth training as soon as possible, utilizing an experienced disaster consultant or trainer whenever possible.
A basic principle of mutual aid is that the responsible local official in whose jurisdiction an incident has occurred shall remain in charge of mutual aid personnel (California Disaster and Civil Defense Master Mutual Aid Agreement, 1980). This also holds true in the supervision of volunteers and mutual aid personnel in the field.
Volunteers in Traumatized Communities
Following a disaster, relationships among survivors take on a special power. There is a sense that "outsiders" cannot possibly understand the survivors' reality, and a bounmdary may develop to safeguard the traumatized community from harm and to promote psychic healing. Lindy and Grace (1986) have termed this psychosocial boundary the trauma membrane, which has meaning at the intrapsychic, interpersonal, and community level. Like a newly developing outer surface of an injured cell, the trauma membrane forms to guard the inner reparative process of the organism and protect it from noxious stimuli. The membrane seems to have early permeability to anyone willing to help. However, this boundary later becomes tightly sealed and outsiders are allowed in only under certain circumstances and functions.
Disaster response agencies in a traumatized community may, themselves, develop a trauma membrane concerning helpful "outsiders". The psychological issues of vulnerability, helplessness, and need for control are as evident in agencies as they are in individual survivors, and require equal respect and sensitivity. The healing process involves re-establishing and maintaining a sense of control. As a result, a traumatized agency may develop ambivalence about wanting or not wanting help from outside resources. While agencies such as community mental health may recognize the need for outside assistance, they may experience ambivalence or outright distrust of volunteers "meddling in our disaster".
Mutual aid personnel coming into a traumatized community can be met with a confusing mixture of gratitude and resentment. Volunteers may experience scrutiny, ambivalence, double messages, and being pushed and pulled in different directions.
Early integration in the formal, local mental health response, before the trauma membrane closes, can enhance collaboration. it is essential for mutual aid personnel to respect local agency authority, control, and self-determination. If volunteers "jump in" and attempt to help without being well integrated into official local efforts, they will likely alienate local leadership and generate turf issues. Confusion often arises as to "who is providing services to whom," and there are often problems of continuity and unnecessary duplication. Such well-meaning but organizationally naive volunteers are often denied access to survivors because their activities are outside the official disaster response.
Recognizing and understanding the concept of the trauma membrane can help volunteers to avoid some pitfalls in gaining access to survivors and providing needed assistance to disaster stricken communities.
Disengagement, Critique, and Debriefing
Workers should not be sent home from their disaster assignment without a formal process of disengagement. the simplest way to handle the logistics is for all outgoing personnel to report at an assigned time at the staging area. Staff should ideally be disengaged from their assignments in teams who worked together in the same field assignments.
The purpose of a formal disengagement process is to help workers in making the transition from the disaster assignment back to their homes and regular jobs.
It is common for volunteers and mutual aid personnel returning home to an area not affected by the disaster to experience a sense of isolation. They often feel that no one has seen what they have seen and no one understands what they have been through. It is helpful for workers to continue to talk to each other about their experiences and feelings. For workers who did not come to the disaster with a team of co-workers, it may be helpful for them to exchange phone numbers and addresses with their disaster colleagues for postdisaster support.
POSTDISASTER
Thanks and Recognition
While disaster work is inherently exciting and rewarding, it can also be challenging, stressful, exhausting, and traumatic. For volunteers who have worked without pay, the work may cut into their personal budget. For workers "on loan" from mutual aid agencies, work piles up on their office desks while they are away. A sincere attempt by the host mental health sagency to learn the first names of volunteers during their disaster stay pays immediate dividends in terms of feelings of recognition, self-esteem and a sense of personal appreciation. It is also extremely important for mental health to provide a thank-you to those who volunteered. Ideally, a letter of thanks should go to each worker. If this is not possible, a letter should go to each contributing agency with a request that each worker receive a copy. The letter of thanks should come from a high ranking offivial such as the county mental health director, the county administrator, or a member of the Board of Supervisors. If possible, a certificate of recognition with the volunteer's name on it should accompany the letter of thanks. Such "small" remembrances are always deeply appreciated by the volunteers who gave so much of themselves.
Incorporating Lessons Learned
It will be helpful in future disasters to have a written chronology of events and lessons learned. It is advisable for the volunteer/mutual aid coordinator to write an after-action report, including what worked and what didn't. Appropriate input from critiques should be included.
Besides the after-action report, "lessons learned" should be incorporated into the mental health disaster plan, policies and procedures, with resulting changes communicated to staff in the next regular disaster training.
SUMMARY
The logistics of recruiting, deploying, supervising, caring for, and demobilizing a cadre of volunteers and mutual aid personnel can be very complicated. The task is best managed if planned for in advance, with an assessment of potential resources and, ideally, a pre-selected and trained team of volunteers. Even with a pre-designated team, however, mental health will likely be faced with a convergence of spontaneous volunteers. This article outlined the issues and challenges that need to be addressed, with suggestions from mental health managers who have faced the challenge in the past.
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REFERENCES Auf der Heide, E. (1989). Disaster response: Principles of preparation and coordination. St. Louis: The C.V. Mosby Company.
California Disaster and Civil Defense Mutual Aid Agreement (1980).
Dick, T. (1982). 1982 Almanac of emergency medical services. Journal of Emergency Medical Services, 7(1): 41.
Dynes, R.R. (January/February, 1970). Organizational involvement and changes in community structure in disaster. American Behavioral Scientist, 13(3): 430.
Dynes, R.R. (1974). Organized behavior in disaster. Newark, DE: Disaster Research Center, University of Delaware.
"Establishing a volunteer force of mental health professionals in the case of a disaster." (1983). In Project VOPE: A community-based mental health response to disaster. Final Report: FEMA Crisis Counseling Project. County of Santa Cruz Community Mental health Services.
Herman, R.E. (1982). Disaster planning for local government New York: Universe Books.
Lindy, J.D. and Grace, M. (1986). The recovery environment: Continuing stressors versus a healing psychosocial space. In Sowder, B.J. and Lystad, M. (Eds.), Disasters and mental health: Contemporary perspectives and innovations in services to disaster victims. Washington, DC: American Psychiatric Press, Inc.
Quarantelli, E.L. (1965). Mass behavior and governmental breakdown in major disasters: Viewpoint of a researcher. Police Yearbook, p. 105.
Quarantelli, E.L. and Dynes, R.R. (January/February, 1970). Introduction: Special issue on organizational and group behavior in disaster. American Behavioral Scientist, 13(3): 325.
Seismic Safety Commission: Preliminary Reports Submitted to the Seismic Safety Commission on the May 2, 1983, Coalinga, California Earthquake. Publication No. SSC 83-08, Sacramento, CA.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos
by Robert J. Ursano (Editor), Brian G. McCaughey (Editor), Carol S. Fullerton (Editor)
Book Description
Coping with disaster is an overwhelming and often baffling task for survivors, rescue workers, and clinicians. This volume looks in depth at how people experience trauma and suggests practical strategies for treatment, in a broad range of situations.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
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