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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT January 17, 2003 "If a battle can't be won, don't fight it." - Sun Tsu
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
COMING SOON:
Rocky Mountain Region
Disaster Mental Health Institute -
SPRING WORKSHOP SERIES
March 22 - Religious Aspects of
Domestic Violence
April -
May -
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 200227th 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
Michael D. Brown Nominated As DHS Under Secretary
President George W. Bush announced Friday his intention to nominate Michael D. Brown, deputy director of the Federal Emergency Management Agency (FEMA) to serve as the Under Secretary of Emergency Preparedness and Response in the newly created Department of Homeland Security. For the full article, go to: http://www.fema.gov/nwz03/nwz03_010.shtm
FEMA's Delivery of Individual Assistance Programs: New York - September 11, 2001 http://www.fema.gov/ig/iaprograms.shtm
WHAT'S IN THE NEWS: A SHOT OF CONFIDENCE
According to the latest edition of "What's in the News," a current events series produced for schoolchildren by Penn State Public Broadcasting, Lady Mary Wortley Montagu might have appreciated the current public debate over smallpox vaccines. Almost 300 years ago, she waged a battle in Great Britain to convince British doctors to vaccinate their patients. Lady Montagu was a poet who wrote about the cultures and traditions she observed on her travels through Asia and Europe. One practice, in particular, aroused her curiosity. Throughout the Ottoman Empire, she noted the custom of deliberately infecting a person with a mild form of smallpox so that only minor symptoms of the disease would be suffered. This strengthened the patient's immune system enough to prevent any future smallpox infection. Upon her return to England, she sponsored a test of the vaccine on six prisoners who were promised their freedom if they agreed to be vaccinated. For more information on this week's show, visit http://www.witn.psu.edu
SOUTH AMERICA
South America is made up of 12 independent countries. It’s also part of Latin America, a region that includes Mexico, Central America, and the islands of the Caribbean Sea. The term Latin America is used because most of these countries were once colonies of European nations whose people spoke languages based on Latin. For more information, go to: http://www.witn.psu.edu
Psychiatric Impairment More Likely in Children With ADHD
Children with ADHD from psychiatric and pediatric practices display similar levels of ADHD symptoms, comorbidity with mood, anxiety and disruptive behavior disorders, and cognitive, interpersonal and academic impairments, Massachusetts researchers report. Brown University Child and Adolescent Behavior Letter 18(12) 2002 http://www.medscape.com/viewarticle/446624
THE MEDICAL MINUTE: BLOOD DONATION HELPS MANY WITH ONE GIFT
During December, feelings of goodwill for humanity blossom and the spirit of giving comes alive. In January, the decorations come down and the presents are put away. Those who wish that the holiday spirit would last throughout the year should consider giving one gift that can have a positive impact on many people in need -- the gift of blood donation -- especially now, since January is National Blood Donor Volunteer Month. All blood types are needed every day, and the most common types are needed most often. Donated blood is split into its components to meet the needs of trauma victims, cancer patients, burn victims, surgical patients, premature infants and many others. Blood is a gift that literally saves the lives of many people. Volunteers who are reasonably healthy, at least 17 years old and at least 110 pounds can be donors. There is no upper age limit, and very few medical problems exclude donation. For the full Medical Minute from Penn State Milton S. Hershey Medical Center, visit http://www.psu.edu/ur/2003/medicalminute018.html
MARYLAND - Between 10 and 12 outbreaks of a Norwalk-like virus have been reported at nursing homes and assisted living facilities in Baltimore County http://www.sunspot.net/news/local/bal-md.virus15jan15,0,4778361.story?coll=bal-local-headlines
ASIA - Beijing sets up anti-terror squads http://asia.cnn.com/2003/WORLD/asiapcf/east/01/14/China.terror/
GERMANY - Sensing vulnerability, Germany steps up terror defenses http://www.csmonitor.com/2003/0115/p07s02-woeu.html
WALES - Wales's anti-terror security enhanced http://icwales.icnetwork.co.uk/0100news/0200wales/page.cfm?objectid=12533033&method=full&siteid=50082
ISRAEL - Arafat’s New Terror Weapon: Exploding Toy Planes http://www.debka.com/article.php?aid=239
RUSSIA - Basayev threatens to stage more terrorist acts in Moscow http://www.interfax.ru/one_news_en.html?lang=EN&tz=0&tz_format=MSK&id_news=5614859
ZANZIBAR - UK issues Zanzibar terror warning http://news.bbc.co.uk/1/hi/uk/2659905.stm
AFGHANISTAN - Bin Laden Has More Mysterious Allies in Afghanistan http://english.pravda.ru/main/2003/01/14/42025.html
RUSSIA - Car With Explosives Intercepted leaving Chechnya http://www.themoscowtimes.com/stories/2003/01/14/012.html
RUSSIA - FSB: Interpol Reports Threat of New Moscow Attack http://www.themoscowtimes.com/stories/2003/01/15/014.html
MENTAL HEALTH SERVICES IN DISASTER SHELTERS
Shelter Functions
When disaster survivors are unable to remain in their homes and have no other temporary place to stay, mass care shelters may be established. These shelters are usually set up in suitable and safe buildings such as schools, churches, community centers, etc. The American Red Cross (ARC) usually establishes and runs shelters. In some local jurisdictions, governmental disaster plans also assign responsibility for mass care to the Department of Social Services (DSS). In such situations, a memorandum of understanding usually exists between the ARC and DSS, outlining the roles and responsibilities of each agency.
Most mass care shelters are run by the Red Cross. Therefore, it is important for mental health staff to have some understanding of the role and responsibilities of the Red Cross, and to understand the basic functions provided within a Red Cross shelter. It is highly recommended that mental health staff who will be functioning in disaster shelters take the Red Cross courses on Introduction to Disaster Services and Shelter Management.
The American Red Cross was mandated by Congressional charter in 1905 to help meet the human needs created by disasters. Congress re-affirmed this mandate in the Disaster Relief Acts of 1970 and 1974. The mandate is referenced in the published regulations of the Federal Emergency Management Agency (FEMA). A statement of understanding between FEMA and the American Red Cross was established in 1982. Therefore, the Red Cross role in disasters is a legal mandate that it has neither the authority nor the right to surrender (American Red Cross, 1982). Nevertheless, the Red Cross receives no government funding for its services. It relies solely on voluntary contributions. Local governmental responsibilities and mandates are not superseded by Red Cross authority.
Most disaster survivors seek temporary housing through their own resources, such as family, or friends, and Red Cross estimates that only 20-30% of an affected population will seek shelter in mass care facilities. Mass shelter is a short-term response to provide temporary housing. Before mass shelters are established, efforts are made to house families with friends or relatives, or to place families in hotels. Families in mass care shelters are assisted in moving back to their homes or to interim housing as quickly as possible.
There will be variations in the problems of shelter residents and the duration of their stay in the shelter based on the type of community. For example, there are differences to be found between urban and rural shelters and their populations.
In urban areas, pre-existing community problems can quickly manifest in the shelter. For example, people who were homeless prior to a disaster often turn to disaster shelters for temporary relief. In the California Loma Prieta earthquake of 1989, many low-rent housing units were destroyed, making it even more difficult for both the pre- and post-disaster homeless to find temporary housing. Drug and alcohol problems are common in urban shelters. Although it is strictly against shelter regulations, it is not uncommon to find individuals attempting to bring drugs and alcohol into the shelters. Such illegal activity is the responsibility of security and law enforcement. However, the behavior and health risks of individuals who are "high", intoxicated, or having withdrawal symptoms can become a problem for shelter management and shelter mental health staff. The juxtaposition in a shelter of "street people" with middle class homeowners, cultural groups without connections or understandings, or gangs with outright hostilities toward one another can contribute to anxiety and actual conflict.
In rural area, the population may be more homogeneous. However, the problem of finding long-term housing can be exacerbated by scarcity of pre-disaster housing. In agricultural communities, substandard housing is often rented to migrant or resident agricultural workers. Because of the age and condition of the housing, it often sustains serious damage, thereby leaving low income renters without any place to live. In the rural areas of Santa Cruz and San Benito counties following the Loma Prieta earthquake, the Federal Emergency Management Agency (FEMA) set up mobile home parks to augment existing housing in the communities. Finding immediate, short-term temporary housing for shelter residents so that mass care shelters can be closed down is a serious challenge.
Red Crtoss volunteers assigned by the local Red Cross chapter usually provide staffing for the shelter. Under ideal conditions, staff include a shelter manager, nurse, family service worker (all of whom have had Red Cross training specific to their role and responsibilities), food supervisor, storekeeper, janitor/maintenance staff. Shelter residents often voluntarily help with various functions in the shelter.
The mass care shelter is usually a large facility such as a school or church. The sleeping accommodations are usually in an area such as a gymnasium, with dormitory-style rows of cots or mats for sleeping. Areas are allocated for recreation (indoors or outdoors), childcare, food service, and storage. There may be some small rooms for office space and nursing services. There are also bathrooms or port-a-potties. At any given point during a day, some residents may be sleeping, some eating snacks, some talking, some engaging in recreation. The noise level is usually high.
Red Cross and Disaster Mental Health
The Red Cross has developed a Disaster Mental Health Provider's Course. Local Red Cross chapters can train mental health providers who will be assigned a variety of roles at Red Cross disaster service sites, including shelters.
It is essential that local community mental health agencies develop collaborative relationships with the local Red Cross chapters befor a disaster strikes. Community mental health agencies will want to provide staffing in the shelters. Shelters are one of the best sites to establish early contact and rapport with survivors. It is important that roles and responsibilities of community mental health staff and Red Cross mental health volunteers in shelters be clarified as much as possible prior to a disaster. Planning between the two agencies should ensure continuity of services for survivors after shelter operations close down. A formal Memorandum of Understanding between the local Red Cross chapter and the local mental health agency is highly recommended.
red Cross mental health services are designed to supplement the local community mental health delivery system in times of emergency. Red Cross mental health volunteers primarily will provide services to Red Cross workers and their families. Local mental health agencies seek to serve the disaster survivors and other disaster workers. In communities where local mental health resources are limited, Red Cross may take a more active role in providing disaster mental health services to survivors. Red Cross mental health assistance never extends beyond assessment of mental health status and needs, stress reduction, brief counseling, crisis intervention, referral, and follow-up recommendations. The responsibility for services to individuals requiring more intensive or long-term care will resy with public or private sector mental health resources.
MENTAL HEALTH SERVICES IN DISASTER SHELTERS
Administrative Issues
The mental health agency providing staff to the shelters has responsibility for the clinical and administrative supervision of the mental health staff in the shelters. THis includes scheduling and staffing levels. The Red Cross has full responsibility for shelter management, and mental health must work in close cooperation with Red Cross management. Red Cross staff must keep mental health informed of shelter conditions or changes to allow mental health to make staffing changes in a timely manner. If difficulties arise in establishing a collaborative working relationship between mental health and the shelter manager, the mental health coordinator should speak with the Red Cross Officer or other operations administrators if required.
The number and type of mental health staff needed at a shelter will be decided by the size and characteristics of the shelter population. For example, an urban poor population will likely have a high prevalence of mental illness and substance abuse, which, in turn, affect staffing. In large shelters, the settings become more disorganized and chaotic, and the environment itself is likely to cause stress. Probability guarantees that the larger the number of shelter residents, the greater the likelihood that the population will include individuals with psychiatric illness and/or acute stress reactions. As a rule of thumb, the larger the shelter population, the larger the number of mental health staff and the more hourse of coverage needed. In a large shelter, it is prudent to attempt to provide 24-hour coverage for at least the first 49-hours, or until it is decided that the need no longer exists. If 24-hour on-site coverage is not possible or not needed, round-the-clock consultation and crisis response should be available. Ideally, staff should work no more than a 12-hour shift, with 12 hours on duty and twelve hours off duty. Mental health administration should support their staff in the shelters by scheduling adequate time off, regular breaks, etc.
The demographics and characteristics of the resident population will dictate the type of staff needed. Mental health should provide staff experienced in working with special populations such as children, older adults, the mentally ill, and people with disabilities.
It is important that mental health staff be knowledgeable about various ethnic groups impacted by the disaster. There must be staff who are fluent in languages of non-English-speaking survivors. All aspects of shelter operations must be sensitive to cultural and ethnic issues, and services must be provided in ways that are culturally appropriate. Food preferences, health care practices, help-seeking behavior, desire for privacy versus communality, and expression of emotions are but a few of the culturally dependent values and behavior that must be considered in establishing a shelter environment and providing shelter services.
If there is a high level of substance abuse in the sheltered population, staff with skills in drug and alcohol detoxification and treatment should be present. Some shelters may have large numbers of older adults, persons with medical problems, or persons with prior psychiatric problems. In such a case, round-the-clock or on-call staffing by a psychiatrist may be essential for differentiating medical from psychological problems and for prescribing medication.
The issue of administration of medications in the shelter should be worked out in advance with Red Cross health services. There should be no confusion or conflict over where yjis responsibility belong. Red Cross Health Services regulations assign the responsibility for medications to Red Cross nurses. The medication orders come from attending physicians or are based on Red Cross Medical-Nursing Protocols that have been reviewed and pre=approved by a physician. Mental health and the Red Cross may agree that mental health is responsible for prescribing and/or administering psychotropic medications. If so, it must be determined if a local pharmacy is available to fill prescriptions. If not, a supply of common psychotropic medications and a secure method to store them should be sent to the shelter. The issue of whether individuals receiving psychotropic medications "belong" in the shelter may also need to be worked out between mental health and the Red Cross. If an individual's behavior is not disruptive, disturbing, or dangerous to other shelter guests, the fact that he/she is taking psychotropic medication should be of no more consequence than an individual taking medication for another health problem.
Mental health staff should be provided with a debriefing session following their tour of duty. For a disaster assignment of longer than a few days' duration, debriefing may be provided at regular intervals as a stress management tool.
All disaster workers, including mental health personnel, should be trained to be as "self-sufficient" as possible in a disaster. However, certain logistical support services are necessary for workers in a disaster shelter. These include official identification, access to the disaster site, food and lodging, supplies, etc.
The Disaster Shelter as a Mental Health Worksite
The activities of mental health wprkers in a shelter will differ from their functions in a clinical setting in several ways. First, the work environment will be significantly different from the usual clinic or office environment. Even though there are structure, roles, responsibilities, policies and procedures in a shelter, conditions will likely seem chaotic. There are continuous request, demands, questions, and interruptions. There is a lack of privacy and a high level of noise. It is easy for both staff and shelter residents to feel overwhelmed. Although the stress level in such a setting is high, most disaster survivors do not see themselves as needing mental health services. They rarely seek out staff at a mental health table or counseling room. Obviously, a traditional, clinical approach is neither possible nor appropriate. Staff need to feel comfortable circulating and making contact with individuals in the milieu. Disaster mental health staff call this approach "aggressively hanging out" or "mental health by walking around (MHBWA)", and it is an essential part of providing mental health services in a shelter.
The role of shelter mental health workers will be broad and diverse. They often report that their activities in a shelter seem more "practical" than psychological. This is due to the many concrete, pragmatic needs of the survivors at this phase of the disaster. For example, mental health staff may help family members in locating loved ones, in finding out information about damage to their homes, and in obtaining information about disaster recovery resources. Follow-through by mental health is critically important. Even if a worker is unable to obtain a requested piece of information, reconnecting with the survivor is important. Shelter residents already feel considerable loss of control. Therefore, workers' reliability can convey some much needed predictability.
Mental health staff may also assist in setting up the shelter environment, registering the residents, providing language translation, or making snacks if these activities need to be done. As the days pass in the shelter, residents generally become more bored, restless, and frustrated if their needs are not being addressed adequately. The residents who remain the longest are generally those with the fewest coping skills. Mental health should anticipate these changes in mood and residents' needs as they progress into the "disillusionment" phase of disaster. Mental health interventions must be tailored according to current needs.
While flexibility in performing practical tasks is necessary, mental health staff may also need to explain their mental health skills and capabilities to shelter management. The manager may be unfamiliar with what mental health personnel can provide within the shelter. Commonly, roles and activities will develop in adaptation to situations as they arise. The mental health worker may be establishing collaborative relationships with other professionals in the disaster environment with whom there are few collaborative precedents, and roles may need to be flexible and negotiable (Cohen, 1986). Sometimes, mental health workers may not be welcome at a shelter. Under these circumstances, it will be necessary to start by establishing roles and a collaborative relationshjip at the Red Cross Headquarters.
The disaster and the shelter environment will affect yje disaster workers themselves, including the mental health staff. An important function for mental health staff in shelters is monitoring staff stress, mitigating stressful situations when possible, and encouraging physical health and stress management practices. Mental health staff should work within the context of a team in the shelter. Staff should work in pairs, which provides a "buddy system" for monitoring stress and providing support and assistance. Mental health staff should meet together at the beginning and end of each shift to discuss mental health issues that they should communicate to the next shift. These team meetings are also a time for staff to "defuse" and talk about their reactions and feelings from the shift.
There should be a coordinator of the mental health team who works closely with the shelter manager and the shelter nurse or nursing supervisor. The mental health coordinator may have vakuable input about mental health issues affecting residents and staff, about the shelter environment, or about the psychological implications of operations and activities. Therefore, the coordinator should ideally be a part of all decision-making team meetings about the operation of the shelter. However, this level of collaboration may take time to achieve.
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REFERENCES American Red Cross (1982). Disaster services regulations and procedures: Authority and legal status of Red Cross disaster services (ARC 3001).
Cohen, R.E. (1986). Crisis counseling principles and services. 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.
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
Terrorism, Trauma and Tragedies: A Counselor's Guide to Preparing and Responding
by Debra D. Bass (Editor), Richard Yep (Editor), Daniel J. Gelo
Book Review
Editorial Reviews From Book News, Inc. This spiral wire-bound manual offers strategies from counselors who have provided services to those directly affected by terrorist attacks and other traumatic events and includes first-hand accounts by those who have dealt with school shootings and other tragedies. It includes handouts for parents, sample crisis plans, and sample letters. Bass is a communications consultant. Yep is executive director of the American Counseling Association.Book News, Inc.®, Portland, OR
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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