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ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

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Learning From The Past and Planning For The Future

MENTAL HEALTH MOMENT January 10, 2003

"The time to repair the roof is when the sun is shining." - John F. Kennedy


Short Subjects
LINKS

Mental Health Moment Online

CISM/CISD Annotated Links

Gulf War Syndrome

WILDLAND FIRE INFORMATION

CONFERENCES AND WORKSHOPS:

COMING SOON:
Rocky Mountain Region
Disaster Mental Health Institute -

SPRING WORKSHOP SERIES

NIMH Meeting Announcements

The Australasian Critical Incident
Stress Association Conference

The Right Response in the
21st Century

Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers
ammp@optushome.com.au Conference Website:
http://www.acisa.org.au/ conference2003/

VIII European Conference
on
Traumatic Stress (ECOTS)

May 22 - 25 2003
Location: Berlin
GERMANY
Contact:
Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail:
trauma-conference@kfb-berlin.de
Deadlines:
Abstract Submission
30 November 2002

27th Congress of the
World Federation for
Mental Health

February 21-26, 2003
Melbourne, AUSTRALIA
Contact: ICMS Pty Ltd
(Congress Secretariat)
84 Queensbridge Street
Southbank VIC 3006, Australia
Tel: 61 3 9682 0244
Fax: 61 3 9682 0288
E-mail: wfmh2003@icms.com.au

Annual Conference Society for
Industrial/Organizational Psychology (SIOP)

April 12 - 14, 2003
Location: Orlando, Florida
USA
Contact: lhakel@siop.bgsu.edu

4th International Symposium on Bilingualism
April 30 - May 3, 2003
Location: Tempe, Arizona, USA
Contact:
4th International Symposium on Bilingualism
Arizona State University
PO Box 870211
Tempe, AZ 85287-0211, USA
Email: isb4@asu.edu

MUSIC SELECTION MAY DEPEND ON SEVERAL FACTORS, NOT JUST PLEASURE

Because people are fairly accurate in predicting which music will be most pleasurable to them, they should be given choices when music is being used to manage their moods and emotions, as in hospital rooms or during therapy, a Penn State study says. "Data from our analysis suggest that, while anticipated pleasure is a key reason for choice of music, Americans will also pick music to enhance mood or will match their musical selection with a specific activity such as jogging, aerobic dancing or reading a favorite book," says Valerie N. Stratton, associate professor of psychology at Penn State's Altoona Campus. People are also capable of changing their minds about a song they initially dislike, notes co-author Annette H. Zalanowski, associate professor of music at Penn State's Altoona Campus. Stratton and Zalanowski summarized their findings in their paper, "Anticipated Pleasure, Choice and Actual Enjoyment of Music," presented recently at the annual meeting of the American Music Therapy Association in Atlanta. Their study is on-going and the researchers will continue to explore this topic. For the full story by Paul Blaum, visit http://www.psu.edu/ur/2002/musicexpectations.html

THE MEDICAL MINUTE: COLD WEATHER INJURIES

The latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, points out that although humans are essentially built for tropical conditions, they've developed many ways to protect themselves against environmental extremes. Still, people often fail to take necessary precautions against the elements when they're close to home, and that can lead to a variety of cold-related injuries, such as frostbite, hypothermia and chilblains -- a milder form of frostbite caused by repetitive cold exposure and re-warming. Layers of dry clothing trap more heat than one thick layer. Hats reduce heat loss from the scalp which can shed up to 10 percent of the body's heat. Gloves, scarves and ear muffs are also important accessories. Shoes and socks are usually enough for dry winters, but snow and slush can lead to wet feet and increase the risk of injury from prolonged exposure to cold, but not necessarily freezing, temperatures. For the full Medical Minute, visit http://www.psu.edu/ur/2002/medicalminuteindex.html For the complete article, go here: http://www.psu.edu/ur/2002/medicalminute016.html

School-Based Prevention Mostly Cuts Alcohol, Tobacco Use

A study conducted by RAND researchers and released last week found that the most measurable benefit from school-based prevention programs was a reduction in alcohol and tobacco use.
Alcoholism & Drug Abuse Weekly 14(47) 2002 http://www.medscape.com/viewarticle/446541?mpid=8241

Bush Declares Federated States Of Micronesia A Federal Disaster Area

The head of the Federal Emergency Management Agency (FEMA) announced today that federal disaster aid has been made available for the Federated States of Micronesia to supplement state and local recovery efforts in areas struck by Typhoon Pongsona on December 5-7, 2002. For more, go to: http://www.fema.gov/diz03/hq03_001.shtm

Firefighters Contain Malibu Fires

The Santa Ana winds finally took a break and allowed firefighters to contain a huge fire that threatened hundreds of homes in Malibu, California. Winds had earlier gusted to more than 70 mph whipping fires and leaving thousands without power. Firefighters are hoping that the winds do not return today.

COLORADO - Norwood school shut after anthrax threat http://www.denverpost.com/Stories/0,1413,36%257E53%257E1093178%257E,00.html

NEW MEXICO - Radioactive sources stolen from construction facility http://www.kobtv.com/archive/2003/january/08/radioactive_theft.htm

WASHINGTON - Indian border lands a risk to security? INS caught Belarus man marking likely smuggling route from Canada to U.S. http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=30361

NEW YORK - Streets to bear names of 97 terror victims http://www.nydailynews.com/news/local/story/49638p-46620c.html

MARYLAND - Maryland FD Issues BioPack Bio - terrorism Protection http://cms.firehouse.com/content/article/article.jsp?id=3203§ionId=46

UNITED ARAB EMIRATES - 3rd Afghan plane was diverted because of fear of terror attack http://www.canada.com/news/story.asp?id=F486315B-5C7A-4382-AB2C-7BC45F87197C

UNITED ARAB EMIRATES - Hijack rumours spark search of five Ariana jets http://www.gulf-news.com/Articles/news.asp?ArticleID=73251

SOUTH AFRICA - Australia warns of terror risk in South Africa http://www.stuff.co.nz/stuff/0,2106,2177353a6557,00.html

ASIA - Jemaah Islamiah Terrorists will Strike Soon http://e.sinchew-i.com/content.phtml?sec=4&artid=200301080002

[Ireland Online] Al-Qaida's biological warfare research is 'advanced' http://breakingnews.iol.ie/news/story.asp?j=58888166&p=5888887z

OUTREACH TECHNIQUES AND RECOMMENDATIONS FOR DISASTER MENTAL HEALTH

The following outreach techniques and recommendations include concrete, specific recommendations for mental health workers following a disaster.

Casefinding and Outreach to Individuals

Always and in all places, mental health staff should informally be collecting information that will help them to locate disaster survivors. They should make every effort to get the survivor's original address, current address, phone number, and a message phone number.

A useful approach is to obtain lists with names and addresses of survivors. Such lists may be available through FEMA, the Red Cross, Social Services, hospital emergency rooms, the coroner's office, Department of Public Works, the building permit department, the Chamber of Commerce, the Unemployment Department (Disaster Unemployment Assistance), and newspaper/media reports. Some of these groups may consider their lists to be confidential, but it is worth a persistent try. education of the agencies about the importance of outreach and education may help. Reassurance that the lists will only be used for outreach conducted by the FEMA crisis counseling program is important. These lists can be used for sending outreach letters with brochures from the mental health recovery project. Such mailings can list common reactions to disaster, self-help suggestions, and the project's phone number. The lists can also be used for making outreach telephone calls or home visits.

Use of door-to-door visits can be one of the most effective outreach techniques. It is helpful for staff to work in pairs, because knocking on doors is often a foreign approach for mental health workers. It may feel uncomfortable at first. Additionally, the work can be discouraging for staff if people are not immediately receptive. A male-female team can alleviate suspicions as to motive of the team or safety for the resident (DeWolfe, 1992).

Following up a mailing provides a good "in". DeWolfe (1992) has illustrated how a mental health worker might approach going door-to-door or making a follow-up phone call. Workers can start out by asking if the person has received the mailing describing the program. Another way of starting is to say something like "Hi, I'm John Jones from Flood Support Services and I understand that you were hit real hard by the floods right here. Do you have time to talk?" After that, the worker can go with whatever the person says first after the introduction. If it's anger about the flooding, then the worker can agree and support the person's anger and frustration. If it's children tearing up the house, the worker can talk about the challenges of parenthood. After establishing rapport, the subject of damages in the disaster can be discussed. "Can you tell me what happened? Did you have mud in your house? How deep was the water?" In the resulting discussion, the worker can assess how the person is coping and what their needs might be.

DeWolfe (1992) has also observed that people are often more comfortable talking about how others are doing at first. Ask what kinds of stress reactions they see in the neighborhood. Ask how their children are doing. These are good openers to begin talking about psychological reactions and family coping.

Provide brochures and information about common reactions and things that can be helpful, as well as phone numbers of the mental health disaster recovery project and other resources. Ask them to pass the information along to anyone who may need it.

Identify people in the community who will be familiar with the needs in the community, and can serve as "key informants". These informants may be found in:

* key agencies and groups in affected neighborhoods (health, social services, churches, schools, daycare providers, community groups, police, fire department, etc.;

* places where people congregate (thrift shops, restaurants or coffee shops, bars, grocery or liquor stores, etc.;

* other services familiar with the neighborhood (mail delivery personnel, public utility workers, building inspectors); and

* businesses or offices that survivors frequent during their recovery (thrift shops, lumber yards, and hardware stores, building permit departments).

Different people will emerge as key informants depending on the type of disaster and the phase of disaster. In early phases, such people may include Federal Emergency Management Agency (FEMA) and Red Cross workers, insurance adjusters, managers at hotels where survivors are temporarily living, demolition contractors, etc. Later, as people begin rebuilding, there will be planning department staff who issue permits, engineers, architects, contractors, building supply stores, etc. Still later, as rebuilding nears completion, survivors will be interacting with building inspectors, furniture stores, landscapers, etc.

Key informants related to the type of disaster might include fire departments (wildfires), structural engineers (earthquakes), flood control engineers (floods), geologists (landslides), etc.

Request an interview with key informants to find out the following: How do they see the stress level in this neighborhood? Are there any specific concerns they have? Are there any specific individuals or families they are concerned about?

Workers should make regular visits to places where survivors may congregate, such as senior centers, recreation halls, food kitchens, etc. Community meetings are a good place to meet survivors. By "aggressively hanging out" workers can strike up conversations and actively make connections with individual survivors.

Outreach to the General Community

Outreach to the general community has two goals:

1. Public education aimed at helping the population to realize that most stress reactions they are experiencing are normal, and providing suggestions about how to reduce/cope with disaster-related stress.

2. Resource information about services that are available and where to call for help.

Effective community outreach strategies include:
1. Newspapers and community newsletters: articles, interviews, human interest stories, paid advertisements.

2. Rdaio and television: public service announcements; special programs on effects of disasters; interviews with mental health staff, community leaders, or disaster survivors; human interest stories; call-in shows.

3. Public speakers: to civic groups, service clubs, special interest groups, PTAs, churches, etc.

4. Videotapes: for training and as an adjunct to public speaking, to educate the public and to stimulate discussion.

5. Posters: on bulletin boards, buses, bus stops, in clinics, waiting rooms, other public places.

6. Brochures and fliers: handed out door-to-door, hung on doorknobs, in grocery bags, liquor stores, thrift stores, places where survivors do business, literature racks in clinics and doctors' offices, in government offices, in church bulletins, Scouts handing them out on the street, etc. Caregivers, agencies, and departments with whom survivors have contact can be given brochures and asked to hand them out. door-to-door distribution of handouts providing public health information or mental health information on stress management will often provide an opportunity to assess levels of emotional distress and provide information or intervention.

7. Books: especially for children, combining information about the cause of the disaster and ways to be safe; coloring; stories; games.

8. Community fairs and events: information booths at fairs and festivals; games and activities for children and adults; pencils or baloons with recovery project logo and phone number.

Mental Health Training

The purpose of mental health training in the community is to increase awareness within the community of the mental health aspects of disaster recovery. This can generate a "ripple effect" and maximize the mental health knowledge and skills available in the recovering community. Training also develops skills, instills confidence, fosters collaboration, and creates involvement in the mental health efforts toward disaster recovery. Training can be provived to mental health, human service professionals, and other community caregivers.

Additionally, citizens who provide a support system for survivors can benefit greatly from education about the mental health aspects of disaster recovery. THese individuals include relatives, friends, and neighbors. They often lack knowledge of common phases of recovery, issues being dealt with in each phase, and normal stress and grief reactions. People are often unsure about when and how to offer their support. Friends of survivors often subscribe to some commonly held myths about trauma and loss: "Talking about it just keeps it all stirred up." "It's time to put the past behind you and get on with your life." "Dwelling on it is morbid." Education about the process of recovery and how best to support survivors can strengthen the contribution of the informal support system to the healing process.

Target groups and suggested topics of training include:

1. Mental health professionals not involved in the disaster recovery project, but who may be seeing survivors in their practice
Suggested topics include:

a. Understanding disaster behavior and recovery

* definition of disaster

* myths and realities of human behavior in disaster

* factors affecting the psychological response of individuals and the community to disaster

* "at risk" groups following disaster

* phases of disaster (including stressors and reactions common in each phase)

b. Key concepts of disaster mental health

c. Special populations in disaster: children, older adults, people with disabilities, specific ethnic groups

d. Clinical issues and interventions:

* symptomatology and assessment of posttraumatic stress and grief

* stress management and self-help approaches

* crisis intervention/brief treatment

* support groups

e. Disaster assistance resources/agencies
2. Human service professionals and other caregivers
* social services, child and adult protective services

* human needs centers

* volunteer center

* special population programs (older adults' services, drug and alcohol programs, parenting programs, services for specific ethnic groups, etc.)

* health services (physicians, nurses, public health and school nurses, emergency room personnel, emergency medical technicians and paramedics)

* schools, preschools, daycare providers, foster parents

* clergy

* police and fire department personnel

* disaster agencies: FEMA, Red Cross, Salvation Army, other volunteer agencies active in disasters

* "natural helpers"

Suggested topics include:
a. Understanding disaster and disaster recovery

b. Special populations in disaster (children, older adults, disabled, ethnic populations)

c. Disaster stress symptomatology: normal reactions, and when and where to refer

d. Helpful skills and styles of relating to disaster survivors (listening, problem-solving, crisis intervention)

e. Self-help and stress management skills for disaster survivors

f. Recovery resources

3. Citizens who serve as support networks for disaster survivors (friends, relatives, neighborhood groups, church groups, etc.)

Suggested topics include:

a. Phases of disaster recovery and common issues, stressors, and needs in each phase

b. Ways to help: listening skills; what to do and say that can be helpful

c. Resources and referrals: when, how, and where to refer Consultation

Consultation to community caregivers and agencies has a goal similar to that of training. The purpose is to increase awareness of the mental health facets of disaster recovery, and expand the mental health knowledge and skills available to survivors in the community.

The goals of consultation are:

1. To facilitate the work of other professionals and caregivers in the mental health aspects of helping disaster survivors.

2. To encourage other professionals, caregivers, and programs to incorporate mental health principles and approaches into their services.

3. To assist other professionals and caregivers in linking disaster survivors with appropriate resources, including mental health.

Cohen and Ahearn (1980) emphasize that mental health must first establish trust and collaboration with agencies to whom it will be consulting. Consultants need to understand the mission and methods of the agency or individual to whom they are providing consultation, and not threaten existing methodology. It is also important to work out unrealistic expectations or perceptions of what mental health can do.

Consultation may be of two types (Cohen and Ahearn, 1980):

1. Case-oriented: case consultation involving a mental health professional assessing a client or providing consultation about a client to a worker.

2. Program-oriented: consultation aimed at influencing programs, administrative structures, and staff. Goals include early detection and intervention with mental health problems, increased coordination and linkage among programs, decreased fragmentation of services, and making services as responsive to needs of disaster survivors as possible. Issues addressed in program oriented consultation will probably include such topics as program design and planning; administrative structures; methods of service delivery; policies and procedures; and recruitment and training of staff.

Community Organization

Community organization is the process of bringing together community members for defining and working to solve their own problems (Ross, 1967; Taillie, 1969). Issues may include social policy in disaster reconstruction, disaster preparedness at the neighborhood level, or other issues of neighborhood concern.

While the content around which people organize may not be the usual arena for mental health, the process is uniquely tailored to help disaster recovery in the following ways:

1. It can help people deal with concrete problems of concern to them.

2. It can re-establish feelings of control, competence, self-confidence, and effectiveness that were weakened by the disaster.

3. It can establish, re-establish, or strengthen social bonds and support networks that may have been fragmented by disaster.

An example of community organization common after many disasters is the organization of self-help networks for disaster preparedness. Citizens gather in a series of neighborhood meetings. They inventory and mitigate local hazards, such as clearing brush that is a fire hazard. They find resources in the neighborhood (skills such as nursing or fire-fighting; equipment such as CB radios or camping gear). They also survey household needs in a disaster, such as children home alone after school who would need care. Neighbors decide task assignments for neighbors usually home during the day, such as turning off utilities in the neighborhood, providing first aid, and helping children who are home alone. They meet periodically to review and modify the plan (annually and as new neighbors move in). The group0s hold periodic drills or practice sessions, often making them "fun" in the process (e.g., a potluck supper prepared and eaten without electricity or gas).

Such groups have organized around emergency preparedness following floods, mudslides, earthquakes, and wildfires. Group members report a marked increase in people's sense of safety and well-being, confidence in their ability to act effectively in an emergency, and sense of support among survivors. Many individuals report satisfaction in getting to know and work with their neighbors, and groups often expand their scope to work together on a variety of other neighborhood concerns (Garaventa, Martin and Scremin, 1984).

Community organization techniques may also be used to mobilize informal resources within the community. For example, after floods and mudslides devastated Inverness, California in 1982, no formal agency in the community existed to help survivors with the grueling work of digging mud out of their basements and crawl spaces. This was a particular problem for frail elderly who were unable to perform the labor themselves. When this problem surfaced at a community meeting, young adults and teens organized a group they named the "Mole Patrol", which made its sole mission the digging out of mud. When the job was done many months later, the informal group disbanded.

SUMMARY Because the entire community is affected by a disaster, and because survivors generally do not seek out mental health resources, outreach will be a key component of a successful mental health disaster recovery program. Outreach will be to individual survivors and to the community as a whole. It may take the form of casefinding and outreach to individuals, public education, mental health training, consultation, community organization, and advocacy. Mental health workers will do well to incorporate the characteristics of successful outreach programs learned from prior recovery projects in order to successfully reach the affected population of survivors.

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REFERENCES

Cohen, R.E. and Ahearn, F.L. (1980). Handbook for mental health care of disaster victims. Baltimore: The Johns Hopkins University Press.

DeWolfe, D. (1992). A guide to door-to-door outreach. Final Report: Regular Services Grant, Western Washington Floods. State of Washington Mental Health Division.

Garaventa, D., Martin, P. and Scremin, D. (1984). Surviving the flood: Implications for small town disaster planning. Small Town, 14(4): 11-18.

Ross, M. (1967). Community organization: Theory, principles, and practice. New York: Harper and Row.

Taillie, D. (1969). The role of the psychiatric nurse in community organization. Unpublished Master's thesis, Yale University. New Haven, CT.

Williams, H. (1992). Serving the Hispanic community after a natural disaster. Final Report: Regular Services Grant, Western Washington Floods. State of Washington Mental Health Division.

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

In the Wake of 9/11: The Psychology of Terror

by Thomas A. Pyszczynski, Sheldon Solomon, Jeff Greenberg, Jeff Greenburg


 

Book Review

November 15, 2002 Reviewer: Rev. Tom Reiber from Summit, NJ United States In the Wake of 9/11: The Psychology of Terror (Washington: American Psychological Association, 2002), Tom Pyszcynski, Sheldon Solomon and Jeff Greenberg.

Many have observed that America will never be the same in the wake of the terrorist attacks on US soil on the morning of September 11, 2001. The sudden impact of the explosions, captured in vivid detail and replayed over and over again on television, fundamentally altered the illusion of invulnerability that Americans had enjoyed since World War II. Beginning almost immediately a host of Middle Eastern analysts and academics of all stripes supplied an endless stream of hypotheses concerning "why they hate us" and the general nature of terrorism, all in a well-meaning effort to come to terms with a national tragedy.

But to plumb the depths of terrorism one must look beyond the sound bites, beyond the narrow focus on Middle Eastern politics, beyond popular opinion concerning the supposed differences between Islamic and Judaeo-Christian cultures. This is one of the chief accomplishments of In the Wake of 9/11: The Psychology of Terror. Its authors have succeeded in recasting the psychology of terror against a general theory of human nature. Working in the tradition of cultural anthropologist Ernest Becker, they trace the roots of terrorism to the troubling yet inescapable reality of human mortality. Becker long ago proposed that there exists at all times a latent fear of death that threatens to upend societal equilibrium. To shield ourselves from the ever-present threat of death anxiety, we seek to bolster our self-esteem through group loyalty. Hence competing worldviews threaten us at a very deep level.

Becker's prolific publications were hailed by many as brilliant and garnered him a Pulitzer Prize (for his 1973 classic, The Denial of Death). But he was unable to gain widespread acceptance within the academy. His interdisciplinary methodology ran contrary to the emerging trend toward specialization. And there was the recurring criticism that his bold and far-reaching ideas, while intriguing, were ultimately untestable. Like many pioneering visionaries, Becker's death was followed by a period of neglect and dormancy.

That changed with the appearance of three social psychologists (Pyszczynski, Solomon and Greenberg) who possessed the ingenuity to do what others said could not be done: put Becker's ideas to the test. Their results demonstrate conclusively that Becker's ideas are not only theoretically compelling, they are empirically verifiable. Years prior to the devastating events of 9/11, they were testing and developing what came to be called "terror management theory." Fine tuning Becker's ideas, they discovered, among other things, a clear and testable relationship between the awareness of mortality and hostility toward those who appear to subscribe to a different worldview. More specifically, they found people who were asked to consider their mortality would be more favorably predisposed to people who shared their basic world view, and conversely, more negatively predisposed toward outsiders of one kind or another. These findings fit both the surge in patriotic hoopla and the hostility toward foreigners in the aftermath of the 9/11 attacks.

While acknowledging that "terrorism results from the interaction of a wide range of social, political, ideological, and psychological forces," the authors set out to "illuminate the psychological aspects of the problem" (p. 187). The result is a veritable calculus of depth psychology that identifies the factors inclining groups toward violence. Drawing from their cumulative research efforts (spanning over 150 empirical studies) the authors provide a concise overview of their research (Chapters 1-3), then proceed to apply their findings to the social and cultural milieu of post 9/11 America (Chapter 5). Chapter 6 is devoted to the application of terror management theory to Islamic extremists, while Chapters 8 & 9 point to the way out of the cycle of violence. Acknowledging the enormity of the issues and the gravity of the current socio-political state of affairs, the authors suggest that hope resides in new, more inclusive worldviews that are neither too rigid nor too diffuse.

Much has been written concerning Becker's allegedly bleak view of human nature and his seemingly macabre fascinations with humanity's destructiveness. But those familiar with his writings can attest to his great compassion for the human condition and the reverence for the "life force" that sustained his long descent into the night. "In ways that are yet unknown to us, this spirit will continue giving birth to its own possibilities" (Becker, Angel in Armor, p. 118). In the Wake of 9/11 adds another important chapter to the story Becker so urgently wanted to tell.

Additional Readings at: Click here and Enter the terms September 11 and Psychology in the search engine

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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

MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news



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