Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT October 24, 2003 "Keep away from people who try to belittle your ambitions. Small people always do that,
but the really great make you feel that you, too, can become great." - Mark Twain
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
THIRD ANNUAL
CRITICAL INCIDENT STRESS MANAGEMENT
WORKSHOP SERIES
Rocky Mountain Region
Disaster Mental Health Institute
Dates & Locations:
Laramie, WY: November 12-15, 2003
Casper, WY: November 19-22, 2003
Contact: George W. Doherty
Box 786
Laramie, WY 82073
Email: rockymountain@mail2emergency.com
Download FlierIV Mexican Congress of Social Psychology
November 5 - 7, 2003
Location: Tlaxcala, MEXICO
Contact: Manuel Gonzalez, President of SOMEPSO
(Mexican Society of Social Psychology)
Phonr: +52 55 5804 4790, Fax: 5804 4789
Email: gona56@hotmail.com,
gona@xanum.uam.mx, somepso@yahoo.com
International Conference on Creativity and
Imagination in Education and Methods of Mastery
November 17-20 2003
Location: Moscow, RUSSIA
Contact: Vladimir Spiridonov
Vygotsky Institute of Psychology
The Russian State University for the Humanities
Miousskaya Square 6, 125267
Moscow , Russia
Phone: +7-095-250-61-47, 7-095-250-66-32
Fax: +7-095-250-44-33
Email: mdyadyunova@mail.ru
Middle East/North Africa Regional
Conference of Psychology
December 13 - 16, 2003
Location: Dubai, United Arab Emirates
Contact: Dr. Raymond H. Hamden
MENA RCP, PO Box 11806
Dubai, United Arab Emirates
Phone: +971-4- 331-4777
Fax: +971-4-331-4001
E-mail: menarcp@hotmail.comSociety for Judgment and
Decision Making Annual Meeting
November 10 - 11 2003
Location: Vancouver, CANADA
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
Wildfires Threaten S. California Homes
High temperatures helped fuel four wildfires burning in Southern California, including one fast-moving arson blaze that destroyed six homes in the Reche Canyon area of Riverside County, officials said. The hot weather also stoked fires in Fontana, Camp Pendleton and the hills above Burbank. The blaze in Reche Canyon was reported Tuesday afternoon and by early Wednesday had burned at least 1,000 acres, said Becky Luther, a spokeswoman for the California Department of Forestry. The fire destroyed six homes and investigators determined that it was intentionally set, Luther said. It threatened about 100 homes Wednesday morning, said CDF Capt. Rick Vogt.
Mark Josephson fought alongside firefighters as the fire threatened his Reche Canyon home. "Flames came within a foot of the house," he said. "We didn't lose anything." Josephson said friends and family members teamed with firefighters to save his property, including storage sheds, 12 horses, a goat and several sheep. The rural enclave was filled with the sound of frightened horses that could be heard neighing above the din of helicopters.
Evacuations were ordered and about a dozen residents sought shelter overnight at a nearby high school, Vogt said. More than 530 firefighters were battling the blaze and one firefighter suffered from smoke inhalation. There were no other injuries, Vogt said.
To the northeast, another wildfire scorched 2,000 acres at the far north end of Fontana in San Bernardino County. The blaze, which was burning up a slope and away from homes, was under investigation, said Bill Peters, a CDF spokesman. In the hills above Burbank, a suspicious wildfire burned about 100 acres, said Dave Starr, spokesman for the Burbank Fire Department. Fire officials expected to have the blaze contained Wednesday.
A brush fire at Camp Pendleton burned more than 1,000 acres in an uninhabited area used for training exercises at the Marine base. Authorities said the blaze was apparently sparked by some kind of ammunition.
Southern California has experienced triple digit temperatures in recent days as record highs were set across the region. Warm temperatures are expected to continue over the next few days.
GAO Report: http://www.gao.gov/new.items/d03805.pdf
National Interagency Fire Center: http://www.nifc.gov
U.S., Russia Reaffirm Cooperative Agreement
DHS Under Secretary Michael D. Brown and Yuri Brazhnikov, Deputy Minister of the Russian Federation’s Ministry for Civil Defense, Emergencies, and Elimination of Consequences of Natural Disasters (EMERCOM of Russia), signed an agreement to continue cooperating under the Memorandum of Understanding signed in 1996. The signing follows a meeting between EMERCOM and participating U.S. Departments and Agencies to discuss accomplishments and goals in natural and man-made technological emergency prevention and response. For more information, go to: http://www.fema.gov/doc/library/protocol_en.doc and http://www.fema.gov/doc/library/delegationlist_en.doc
UN will implement recommendations of Iraq panel on security - Annan
The United Nations will implement the main recommendations of a panel that investigated the bombing of the UN headquarters in Iraq and which called for reform of the organization's security systems, a spokesperson for Secretary-General Kofi Annan said today. For Full story, go to: http://www.un.org/apps/news/story.asp?NewsID=8644&Cr=iraq&Cr1=
Annan says Madrid donors' conference for Iraq off to good start
United Nations Secretary-General Kofi Annan said today the Madrid donors' conference on the future of Iraq "is off to a good start," towards helping that country's reconstruction in "a robust and determined manner." For Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=8651&Cr=iraq&Cr1=reconstruct
RELIGIOSITY AFFECTS SEXUAL ATTITUDES MORE THAN SECULAR ONES
When a nation's overall levels of religious belief and attendance are high, its citizens voice greater disapproval of divorce, homosexuality, abortion and prostitution -- issues involving sexual morality. But religiosity is less likely to spur such disapproval for cheating on taxes or accepting bribes in public office, Penn State researchers said at a recent national conference. Roger Finke, professor of sociology, also says that religiosity is far less likely to discourage such actions as buying stolen goods or avoiding a public transportation fare. In these cases, people tend to be deterred less by religious beliefs than by secular laws applied to believers and nonbelievers alike. Read the full story at http://live.psu.edu/story/4220
THE MEDICAL MINUTE: THE COST OF GOOD HEALTH
Modern pharmaceuticals represent one reason that people live longer with better health and less hospitalization than in earlier times these days. According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, the good news is that most people spend much less on hospitalizations than in the past. For example, drugs for mental illness annually keep about 400,000 people out of psychiatric hospitals and pneumonia is commonly treated at home in all but the most complicated cases. The bad news is that many people consequently spend much more than before on prescription medications. Read the full story at http://live.psu.edu/story/4436
BASIC CONCEPTS IN UNDERSTANDING DISASTER BEHAVIOR
The key constructs used to understand how individuals respond to disaster include stress resulting from the crisis, social supports at time of crisis, and coping skills of the individual victim.
Some of the most significant work about individual response to disaster comes from theoretical formulations about stress. Dohrenwend and Dohrenwend (1981) linked stressful life events, mediated by social situations and personal dispositions, to health and mental health consequences for individuals. The authors offered several interpretations about these linkages. One interpretation is straightforward cause and effect: stressful life events result in adverse health changes. Other interpretations concern the intensification of stressful life events by social and personal dispositions. These combinations of factors result in adverse health change. Several theories relate stress to specific disaster situations, focusing on the event itself, and on individual, social, and cultural responses to such emergencies. Frederick (1980) and others theorized that technological disasters create more mental stress than do natural disasters because they are defined, not as originating from God, but as originating from man. Other theoreticians considered the phases of a disaster. Baker (1964) differentiated between more frequent immediate psychological effects of the disaster experience and less frequent long-term consequences of disaster for the individual. Others looked at the magnitude of the disaster. Kastenbaum (1974), for example, hypothesized a significant difference between disasters that affect the individual's whole environment and those that affect only a part of it.
Human service workers have little control over factors in the environment that cause stress among clients. Their efforts, therefore, are focused on increasing the social supports and coping skills of these persons so that they are better equipped to manage the stress and are less at risk for emotional problems. With regard to social supports, Taylor (1978) showed the importance of political, economic and family supports in disasters. Political supports referred to functions served by public figures at disaster sites. Economic supports were defined as financial institutions that provide funds in aid of recovery of the community. Family supports referred to the functioning of family members in warning system evacuation and extended family assistance. Barton (1969) pointed to the existence of a two-part emergency social system. The first part is identified by exploring individual patterns of adaptive and nonadaptive reactions to stress, particularly the motivational basis of various types of helping behavior (e.g., altruism and close relationship to the victim). Barton concluded that discrete patterns of individual behavior can be conceptually aggregated to reflect the community's informal mass assault on disaster-generated needs. The second part of the system is the community's formal organization. Barton broadened his initial discussion of the individual basis of helping behavior by examining a community model of the same.
Formulations that relate individual coping responses to mass disasters focus on perception, personality characteristics, and social behaviors. Slovic et al (1979) looked at the perception of risk in disaster situations. They stated that those persons who perceive the risk as great are more likely to heed warnings and to take some individual action to avoid or ameliorate consequences than those who do not. In the case of technological risks, those who perceive the risk as great are also more likely to blame the Government for politics that allow the risk to occur. Cohen and Ahearn (1980) pointed out that coping is partially dependent on emotional or psychological tools, those personal characteristics of individual strengths and weaknesses. These individual resources include ability to communicate, sense of self-esteem, and capacity for bearing discomfort without either disorganization or despair.
Lystad (1985b) stated that coping also depends upon one's ability to seek support, understanding, and aid in problem resolution. Her work shows that disaster victims are better able to handle the losses of loved ones and property if they are well integrated into a social matrix of family, friends, and neighbors who are able to provide immediate assistance of comfort, food, clothing, housing, and physical care at times of crisis.
Phases Of Disaster-related Behaviors
The experiences of mental health professionals have shown that the postdisaster period consists of several phases related to the emotional responses of victims as they experience and cope with crisis (Cohen and Ahearn, 1980; Farberow, 1983).
The first phase occurs at time of impact and immediately afterwards. Emotions are strong and include fear, numbness, shock, and confusion. People find themselves being called upon and responding to demands for heroic action to save their own and others' lives and/or property. Altruism is prominent, and people cooperate well in helping others to survive and recover. The most important resources during this phase are the family, neighbors, and emergency service workers of various sorts.
The second phase of disaster generally extends from one week to several months after the disaster. Symptoms include change in appetite, digestive problems, difficulties in sleeping, and headaches. Anger, suspicion, and irritability may surface. Apathy and depression may occur, as well as withdrawal from family and friends and heightened anxiety about the future. On the other hand, survivors, even those who lost loved ones and possessions, develop a strong sense of having shared with others a dangerous experience. During this phase, supported by the influx of local, State and Federal agencies who offer all kinds of help, the victims clear the debris and clean out their homes of mud and wreckage. They anticipate that considerable help in solving their multiple problems will soon be available. Community groups that develop from the specific needs caused by the disaster are especially important.
The third phase of the disaster, generally lasting up to a year, is characterized by strong feelings of disappointment, resentment, and bitterness if delays occur and hopes for, and promises of, governmental aid are not fulfilled. Outside agencies may pull out, and some of the indigenous community groups may weaken or disappear. During this phase, victims may gradually lose the feeling of shared community found earlier as they concentrate on solving their own individual problems.
The last phase, reconstruction, may last several years if not the remainder of the lives of some victims. During this time, the victims of large-scale disasters realize that they will need to solve the problems of rebuilding their homes, businesses, and lives largely by themselves, and they gradually assume responsibility for doing so. The appearance of new buildings replacing old ones, the development of new programs and plans, can serve to reaffirm the victims' belief in their community and their own capabilities. When such positive events are delayed, however, emotional problems which do appear may be serious and intense. Community groups - political, economic, religious, fraternal - with a long-term investment in the community and its people become crucial elements to successful reconstruction. Postdisaster Intervention Strategies For Mental Health Problems: Acute Phase
General1. Dealing with extreme emotional stress caused by the emergency: The symptoms of extreme stress reactions include clear signs of fear, anxiety, disorganized speech, and the inability to be consoled or quieted down. A mild sedative might be used, accompanied by an attempt to find a "victim-companion" to help for a limited time. Most acute, severe reactions are short=lived when the victim is surrounded by other individuals in similar situations who offer role models with good coping skills to deal with the present situation. If the victim has received a physical trauma, then the reactions will have to be evaluated in terms of pain dependence, fear of abandonment, and central nervous system functional status as a reaction to trauma and/or medication.
2. Relocation factors likely to increase/reduce stress: One of the most painful experiences for a victim is a sense of disorientation and lack of control in his/ her life. This experience is aggravated by the further relocation activities that most victims find necessary. The process of preparing, supporting, and assisting the victims in all location changes can intensify or ameliorate their discomfort. Consideration of the fears, anxiety, and lack of knowledge about the "authorities" who are doing all the discussing and making all the decisions will guide professionals in their behavior. Any support or information that can be given to the victims to enhance their sense of control over their choices, which in turn will moderate their anxiety and elevate their self-esteem, will be helpful. Keeping closer to their support systems - friends, clergy, and family - will be beneficial for recovery of psychological health. Communicating to the victim information concerning imminent changes will also help.
3. How to lessen the stress of hospital setting and relocation: Starting with the premise that people housed in a hospital setting have been relocated and may face further relocations, it follows that some effects of the stressors will be manifested by psychophysiological reactions. Lessening the stressor impact on these populations at risk is the objective of planners and disaster workers. Two major areas are important: (1) reactions to the event itself, including the rescue, and (2) reactions to hospital conditions.
With regard to the first source of stress, helping victims share their stories and ventilate some of their pent-up tensions is very valuable. With regard to the second source of stress - the living conditions in the hospital - some flexibility could be instituted by providing information about their physical status, prognosis, plans of care, and guidance and support in relation to schedules of medical intervention. Daily bulletins with clear information and methodes for dealing with rumors about what has happened to their neighborhood are helpful.
Identification of problem-solving hospital teams that can expedite simple requests or explain to victims when some of their problems cannot be solved or attended to immediately is useful. This type of education can diminish expectations that could, if unchecked, culminate in further painful disappointments. Most victims would prefer to be busy, active, and helpful, so functions that realistically could be assigned to them will prove to be morale boosting. Household and clerical tasks, organization of recreational activity, and group exercises are examples.
Personnel trained to absorb painful, emotional, angry expressions of distress without reacting personally and becoming defensive, or without promising immediate solutions, are a most valuable resource in lowering effects of the stressor and mitigating victims' reactions.
4. Guidelines for the use of psychotropic medication with disaster victims: Basic medical precautions are needed when prescribing medication to victims. In general, the approach should be conservative in dealing with anxiety and psychophysiological reactions (headaches, stomachaches, and sleeplessness), which are the primary manifestations during the first few days. Although the victim may wish to short-circuit very uncomfortable emotions, some consideration should be given to first trying some reassurance and counseling, with attention to the living conditions, to test if the anxiety ameliorates without medication. If this does not happen, and psychological efforts are ineffective or the anxiety is overwhelming, then anxiolytic medication may be necessary.
Medication for pain should be provided as needed. Pain itself is a major cause of stress./
Appropriate medication should be used for individuals with a history of severe mental disorder, for example those diagnosed as suffering from schizophrenia, who are living in the community. Also, patients with dysthymic disorders (mania or depression).
Medication usage has to be continually monitored as victims' judgement may occasionally become dysfunctional.
5. How to mobilize social support systems after an emergency: An outpouring of interest and resources is characteristic of individuals in the community during and after a disaster's aftermath. The problem of support systems is not the quantity, but the quality. That is, the appropriate fit between the needs of the victim (age, sex, culture, socioeconomic status, health, etc.) and the presence of interested, available human support groups. The matching of assistance to victims has to be organized in some professional manner, which could be flexible and simple, but with genuine and serious attention to motivation, consistency, and appropriateness.
Many organized groups exist in different regions of the United States whose objectives are to assist individuals in crisis. Also, religious groups are available from the different denominations if the victims ask for special religious affiliation.
A list of available groups could be identified on regional bases. The informational support groups (nonfamily), while generally generous and enthusiastic, may need some management and organization to genuinely assist the victim.
6. How to coordinate with mental health professionals: Ideally, predisaster planning at the State level should incorporate mental health components in emergency situations. A direct line of communication to mental health professionals potentially available for disaster work should be already established. When this is the case, once the decision to participate and the plan of action is in effect, mental health professionals can assist in the triage operations, in crisis counseling, and in debriefing of disaster workers. To smoothly coordinate all these efforts the administrative design should include the mental health professional in decisionmaking, logistics, schedules, and function priorities. When this is not the case, local community mental health centers and mental health associations should be contacted for assistance.
7. Use of mental health professionals in the initial post- disaster period - how they can assist in triage: Disaster triage operations are the procedures used by mental health professionals to evaluate behavior, ascertain level of crisis, and supply information. This knowledge is provided to the assisting team so that disaster planning can alleviate the severity of the psychophysiologic reactions of victims. Since victims become cognitively and emotionally impaired for a short interval of time, intervention focuses on increasing awareness of the emotional effects of disaster and improvement of the ability to cope.
The mental health professional has begun to enhance the disaster emergency efforts by bringing knowledge that is needed to deal with behavior patterns not only of the victim but of the helpers as well. The knowledge base of mental health professionals working side by side with medical teams is continually increasing as more begin to practice at a field level.
8. Use of mental health professionals in the initial postdisaster period - How they can assist in crisis counseling to victims: Postdisaster crisis counseling is a mental health intervention technique that seeks to restore the capacity of individuals to cope with and resolve stressful situations as well as to provide assistance for individuals in reordering and integrating their new circumstances. This is accomplished by a process of education about and interpretation of the overwhelming feeling which results from postdisaster stress. It is designed to instill a greater sense of self confidence and hope.
Postdisaster intervention offers a unique model for mental health services by broadening the perspective of service providers and offering the possibility of a resolution to crisis reactions for victims. To be effective, however, the mental health component of the intervention program must prove useful to the victims and comfortable for the community service providers.
9. Use of mental health professionals in the initial postdisaster period - How they can assist in debriefing disaster workers: A mental health debriefing is an organized approach to the management of stress responses following a traumatic or critical incident. It is a specific, focused intervention to assist workers in dealing with the intense emotions that are common at such times. It teaches them about normal stress responses, specific skills for coping with stress and providing support for each other. A debriefing involves a one-to-one or group meeting between the worker(s) and a trained facilitator. Group meetings are recommended, as they provide the added dimension of peer support.
A debriefing is not a critique. A critique is a meeting in which the incident is discussed, evaluated, and analyzed with regard to procedures, performance, and what could have been improved. A critique is a valid and important meeting. It can help workers to sort out facts, get questions answered, plan for what to do in the future. A debriefing, though, has a different focus, that of dealing with the emotional aspects of the experience.
10. Use of mental health professionals in a later post- disaster period - How can they help in long-term referrals of victims or disaster workers: Although most disaster victims do not suffer adverse mental health effects, a conservative estimate is that 10 percent experience mental health consequences over time. Larger percentages are found in disasters that are sudden and unexpected, where many deaths and injuries occur, when the potential for recurrence is higher, and where the affected population is high risk. Mental health professionals can evaluate those individuals who continue to appear emotionally stressed and unable to cope in order to refer them to appropriate community mental health facilities for longer term care.
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SELECTED REFERENCES Baker, G. (1964). Comments on the present status and the future direction of disaster research. In: Grosser, G., Wechsler, H. and Greenblatt, M., eds. The threat of impending disaster. Cambridge: Massachusetts Institute of Technology Press.
Barton, A. (1969). Communities in disaster. Garden City: Doubleday and Company.
Cohen, R. and Ahearn, F. (1980). Handbook for mental health care of disaster victims. Baltimore: The Johns Hopkins University Press.
Dohrenwend, B. and Dohrenwend, B., eds. (1981). Stressful life events and their contexts. New York: Prodist.
Frederick, C. (1980). Effects of natural vs human-induced violence upon victims. Evaluation and Change. Special Issue: 71-75.
Kastenbaum, R. (1974). Disaster, death and human ecology. Omega 5 (1): 65-72.
Lystad, M. (1985a). Innovative mental health services for disaster victims. Children Today 14(1): 13-17.
Kystad, M. (1985b). Human response to mass emergencies: A review of mental health research. Emotional First Aid 2(1): 5-18.
National Institute of Mental Health (1986). Training manual for human service workers in major disasters. by Farberow, N. DHHS Pub. No. (ADM) 86-538. Washington, D.C.; Supt. of Docs., U.S. Govt. Print. Off.
Slocic, P.; Lichtenstein, S.; and Fischoff, B. (1979). Images of disaster. Perception and acceptance of risks from nuclear power. In: Goodman, G. and Rowe, W., eds. Energy Risk Management. London: Academic Press, pp.223-245.
Taylor, V. (1978). Futures directions for study. In: Quarantelli, E., ed. Disasters: Theory and research. Beverly Hills, CA: Sage Publications, pp. 251-280.
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
Children and Disasters
by Norma S. Gordon, Norman L. Farberow, Carl A. Maida
Book Description
When disaster strikes, survivors suddenly find themselves in a world that has become confusing and unfamiliar. Such traumatic events impose severe psychological strain on every member of a community, but children are a particularly vulnerable group requiring special attention. Children and Disasters addresses the needs of this specific population by examining the impact of major disasters on the mental health and emotional functioning of children.
The programs described in this book are designed to provide early intervention to children and families undergoing stress reactions to a catastrophic event. The authors offer interventions aimed at enhancing the skills of mental health professionals, educators, and peer counselors in responding to the intensified demands of disasters. These intervention approaches provide information regarding the event itself, reinforce the legitimacy of the anxieties and fears that children and their families are experiencing, and encourage the expression of feelings in group and individual settings (for the younger child, through drawing and play). Furthermore, they build on the coping capacity of individuals and theirs families and provide concrete coping skills and techniques to alleviate stress reactions.
The intervention model can be applied to programs for individual children and their families, multi-family groups, and groups for children in mental health, educational, and community settings. The practical "hands-on" approach to program design makes this book an attractive resource for mental health professionals, social workers, rehabilitation specialists, professional and volunteer counselors, and suicide intervention workers. It will also be useful for school personnel, including teachers, school counselors, and administrators, as well as federal and state emergency planners and coordinators.
Additional Readings at: Disasters and Culture in the search engine. Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
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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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