Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT July 26, 2002 "Before you build a better mousetrap, it helps to know if there are any mice out there." - Yogi Berra
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Fifth Annual Innovations in Disaster Psychology Conference
"Psychosocial Reactions to Terrorist Attacks"
Sept. 29-Oct 1
Location: Radisson Hotel
Rapid City, South Dakota
2nd World Conference
on the Promotion of
Mental Health and Prevention
of Mental and Behavioral
Disorders: "Developing
Partnerships - Science,
Policy, and Programs
Across Cultures"
September 11-13, 2002
London, UNITED KINGDOM
Contact: The Conference Office
Clifford Beers Foundation
Mariazell, 5 Castle Way
Stafford ST16 1BS, United Kingdom
Tel: 44 (0) 1785 246668
Fax: 44 (0) 1785 246668
E-mail: michael_murray@charity.demon.co.uk4th World Congress on Stress
September 12-15, 2002
Edinburgh, Scotland
UNITED KINGDOM
Contact: Northern Networking Ltd
1 Tennant Avenue
College Milton South
East Kilbride, Glasgow G74 5NA
Scotland, UK
Tel: 44 (0) 1355 244966
Fax: 44 (0) 1355 249959
E-mail:
stress@glasconf.demon.co.uk89th International Conference:
Stress and Depression
October 20, 2002
Milan, ITALY
Contact:
Istituto di Psicologia
Clinica Rocca-Stendoro
Corso Concordia 14
Milan 20129, Italy
Tel/Fax: 39-02-782627
E-mail: ist.roccastendoro@libero.it1st Ibero-American Congress
of Psychology and
International Psychology
Students Meeting
November 7-10, 2002
Villas del Mar
DOMINICAN REPUBLIC
Contact: Lic. Alberto Gomez
Calle 5 No. 9
Cerros de Buena Vista 1
Villa Mella.
Apartado Postal 5276 (La Feria)
Santo Domingo
Republica Dominicana
Tel: 1-809-533-5721/568-4495
Fax: 1-809-535-4905/568-4495/686-0340
E-mail: albagosa@codetel.net.do
or william.quesada@codetel.net.doXXI Nordic Congress of Psychology: "Research, Practice, and Prevention - From Books to the World Wide Web"
Reykyavik, ICELAND
August 19-21, 2002
Contact: Camilla Tvingmark
Iceland Travel Conference Department
Lagmuli 4, 104
Reykjavik, Iceland
Tel: 354-585-4300; Fax: 354-585-4490
E-mail: camilla@icelandtravel.is
A-10 "FIREHOG" TO HELP SPOT WILDFIRES?
Recent press accounts noted that Air National Guard and Air Force Reserve C-130s have been employing The Modular Airborne Fire Fighting System (MAFFS) to help combat the wildfires out west. This is one of the rare times military aircraft have been called into action. But did you know that over 10 years ago there was an initiative to buy A-10 fighter aircraft from the Air Force to help spot wildfires and provide coordination and control? In fact, in 1997 The Watershed Fire Council of Southern California arranged an A-10 demonstration for fire fighters. There is a web site dedicated to this whole initiative including correspondence with the Air Force. FireHogs. It has been a very interesting dialogue. http://www.firehogs.com
DISPATCHES FROM TORNADO ALLEY:
ALL'S NOT QUIET ON THE FRONTHere is an excerpt from the fourth in a series of dispatches from College of Earth and Mineral Sciences writer Dana Bauer, who recently traveled with meteorologists from Penn State and the International H2O Project (IHOP) on the trail of storms across Oklahoma, Texas and Kansas: Jerry Guynes and I are sitting in lawn chairs in a field near the SMART radar truck waiting for the clouds to unroll. Paul Markowski is watching the sky and pacing. It's late afternoon and we're sweating in the hot sun. The clouds are gathering in front of us. Erik Rasmussen sends a message over the radio to change position. The cold front is moving rapidly to the east and we need to move our sampling box. It takes us 20 minutes to pack up and drive about a mile down the road. As soon as we start setting up in our new position we get another call to redeploy. As we pack up for the second time I can see huge clouds billowing upward in the distance. For the rest of the story, visit the Research/Penn State Web site at http://www.rps.psu.edu/storm/four.html
DISPATCHES FROM MONTANA:
STRAWBALE CENTER BEGINS TO TAKE SHAPEThe following is the first in a series of excerpts from dispatches by Penn State students who are at work in Montana helping build a literacy center for the Northern Cheyenne tribe using strawbale architecture. This dispatch is written by Schreyer Honors Scholar Cori Thatcher, a junior from State College who is majoring in Latin American Studies: Well, we're finally on-site. A group of 60 students, faculty and alumni--representing the span of the continent from Penn State to the University of Washington--descended upon the small town of Lame Deer, Mont. It's wonderful and amazing to see so many people from so many different academic backgrounds--from art history to architecture to anthropology--excited to work together for a common cause. It's a new world to me; one I have been anxious to experience since I signed up for this course last fall, with hopes of learning about the strawbale trend in sustainable development and of raising my awareness of American Indian life and culture. For the full dispatch and more information on the project, visit http://www.psu.edu/ur/dispatch/montana/
A Shortened Version of a Gene may make people more likely to experience anxiety, researchers at the National Institute of Mental Health reported in the journal Science.
Statement By FEMA Director Joe M. Allbaugh On Big Elk Wildfire Fatalities
"We were saddened to learn about the deaths Thursday of an air tanker crew, whose firefighting plane went down at the Big Elk fire near Estes Park, Colorado."
FEMA Funds Authorized For Colorado's Big Elk Fire
The Big Elk fire, which started Wednesday in Larimer County, is the latest to qualify for fire suppression assistance from the Federal Emergency Management Agency (FEMA) .
Chata’an Leaves Trail of Damage in Guam
American Red Cross damage assessment teams in flood-ravaged Guam have described a scene of massive destruction after Typhoon Chata’an slammed the Pacific island.
Photo Essay: The Children We Help
In the past few years the lives of many children in Central America have been devastated due to natural disaster, poverty, and disease. The lives of the children in these photos have been improved thanks to your generous donations.
>
SELECTING AND TRAINING DISASTER MENTAL HEALTH STAFF
Skills and competencies that are required of disaster mental health workers are enough different from the typical inpatien/outpatient clinical practice to require more specialized selection and training. When a disaster strikes a community, having a cadre of specially trained mental health professionals who can be quickly mobilized, oriented, and deployed is critical. If the impacted area does not have this capacity, mutual aid agreements with those communities that have trained and experienced disaster mental health workers will be helpful in the chaotic times immediately following impact.
PREDISASTER PLANNING
Much of the confusion and stress present at the time of disaster impact can be eliminated when a mental health agency has a core staff pre-designated and trained as a disaster response team. Regular in-service training and participation in disaster exercises in the local jurisdiction can help maintain and fine tune skills. If the resources permit, the team can respond to smaller crises which occur in the jurisdiction. This will provide staff with some first-hand experience they can use when a larger disaster strikes.
Funds for training are hard to come by and sometimes non-existent. Training is considered a necessary and appropriate aspect of the Federal Emergency Management Agency (FEMA) Crisis Counseling programs, both in the Immediate and Regular Programs. Mental health planners and administrators should include realistic training budgets in their grant applications.
SELECTING DISASTER MENTAL HEALTH STAFF
Disaster mental health work is not for everyone. It is challenging and rewarding work which requires mental health professionals to be flexible and socially extroverted. Despite their altruism and sincere desire to help, not all individuals are well-suited for disaster work. Whether designating and training disaster staff prior to or during a disaster, the mental health manager should consider several selection issues.
Selection of professional or paraprofessional staff should consider the demographics of the disaster-affected population, including ethnicity and language; the personality characteristics and social skills of the staff member; the disaster phase; and the roles the worker may play in disaster response and recovery efforts. Workers who are selected for disaster response and recovery work should not be so severely impacted by the disaster that their responsibilities at home or their emotional reactions will interfere with participation in the program, or vice versa.
POPULATION DEMOGRAPHICS
Managers should choose staff who have special skills that match the needs of the population. For example, staff who have special expertise working with children and the local schools should be included. If there are many elderly persons in the community, the team should include persons skilled in working with older adults.
ETHNICITY AND LANGUAGE
Survivors will react to and recover from disaster within the context of their ethnic background, cultural viewpoint, life experiences, and values. Those who have limited English-speaking skills may experience difficulty communicating needs and feelings except in their native language. All aspects of disaster operations must be sensitive to cultural issues, and services must be provided in ways that are culturally appropriate.
It is essential that mental health staff be both familiar and comfortable with the culture of the groups affected by the disaster. It is very desirable that they also be fluent in the languages of non-English speaking groups affected. Mental health staff should include individuals who are indigenous to specific cultural groups affected by the disaster. If such staff are not immediately available, mutual aid staff with the required ethnic backgrounds and language skills should be recruited from other community agencies or mental health jurisdictions for the immediate post-disaster phase. Indigenous personnel can be recruited and trained for the longer term recovery work at a later time.
PERSONALITY
The ability to remain focused and to respond appropriately are necessary qualities for individuals who participate directly in a disaster. Disaster mental health staff must be able to function well in confused, often chaotic environments. Workers must be able to "think on their feet", and have a common-sense, practical, flexible and often improvisational approach to problem-solving. They must be comfortable with changing situations. They must be able to function with role ambiguity, unclear lines of authority, and a minimum of structure. Many of the most successful disaster mental health workers perceive these factors as challenges rather than burdens. Initiative and stamina are required, as well as self-awareness and an ability to monitor and manage their own stress.
Workers need to be able to work cooperatively in a liaison capacity. They need to be aware of and comfortable with value systems and life experiences other than their own. An eagerness to reach out and explore the community to find people needing help, instead of a "wait and treat" attitude, is essential (Farberow and Frederick, 1978). Workers must enjoy people and not appear lacking in confidence. If the worker is shy or afraid, it will interfere with establishing a connection (DeWolfe, 1992). Staff must be comfortable initiating a conversation in any community setting. In addition, workers must be willing and able to "be with" survivors who may be suffering tragedy and enormous loss without being compelled to try to "fix" the situation.
DISASTER PHASES
In the immediate response phase of disaster, an "action orientation" is important. Workers who do well with the pace of crisis intervention do well in this phase. Personnel who have worked in emergency services in a local mental health center or a hospital emergency room are frequently well-suited to this phase of disaster work.
Some people cannot and do not function well when exposed to the sights and sounds of physical trauma. These staff should obviously not be asked to provide mental health services at the scene of injuries or in first aid stations, hospital emergency rooms, or morgues. This does not mean that they cannot be on the disaster response team. There are many other roles that they can play. Involved personnel should openly discuss such issues during initial formation of the team so that individuals best suited to these roles can be pre-designated.
Long-term mental health recovery programs, covering the period from about one month to one year post-disaster, are different in nature and pace from the immediate response phase. Mass care shelters and disaster application centers (DACs) are closed or closing. Locating disaster survivors is more difficult. Mental health workers need to be adept and creative with outreach in the community.
Results of outreach and education efforts are often difficult to measure. Survivors do not traditionally seek out mental health service. There are few "clients" to treat and count. Clinically oriented staff who are accustomed to an office-based practice often question their usefulness and effectiveness. "Action-oriented" staff who thrived in the immediate response phase may not enjoy or function well in the longer-term recovery phase wher patience, perseverance, and an ability to function without seeing immediate results are assets.
ROLES AND RESPONSIBILITIES OF DISASTER MENTAL HEALTH WORKERS
Disaster mental health roles and responsibilities are diverse. Thoughtful matching of worker skills and personalities to the specific assignment can help ensure success of mental health efforts.
1. Outreach: Working in neighborhoods, mass care shelters, disaster application centers, or other community settings requires workers who are adept at such non-traditional mental health approaches as "aggressive hanging out" and "over a cup of coffee" assessments and interventions.2. Public education: Public education efforts require staff who are interested and effective in public speaking and working with the media. Development of fliers and brochures requires good writing skills.
3. Community liaison: Establishing and maintaining liaison with community leaders requires someone who understands and is effective in dealing with organizational dynamics and the political process. Working successfully in the "grass roots" community requires someone who understands the local culture, social network, formal and informal leadership, and is effective in establishing relationships at the neighborhood level. Liaison activities might include everything from attending grange or church gatherings, participating in neighborhood meetings, or providing disaster mental health consultation to government officials.
4. Crisis counseling: For most disaster survivors, prolonged psychotherapy is not necessary or appropriate. Crisis intervention, brief treatment, support groups, and practical assistance are most effective. Mental health staff must have knowledge and skills in these modalities.
DISASTER MENTAL HEALTH WORKER QUALIFICATIONS
The disaster mental health team should be multi-disciplinary and multi-skilled. Staff should be experienced in triage, first aid, crisis intervention, and brief treatment. They should have knowledge of crisis, post-traumatic stress and grief reactions, and disaster psychology. Survivors are often reluctant to come to mental health centers for services. Therefore, staff must be able to provide their services in non-traditional, community-based settings. Prior disaster mental health training and experience are highly recommended. In situations of mutual aid where licensed professionals cross state lines to provide assistance in disaster, licensing in the impacted state may be waived under the Good Samaritan law. This issue should be investigated in instances of cross-state mutual aid.
Staff should be well-acquainted with the functions and dynamics of the community's human service organizations and agencies (Farberow and Frederick, 1978). They should have experience in consultation and community education. Excellent communication, problem-solving, conflict resolution, and group process skills are needed, in addition to an ability to establish rapport quickly with people from diverse backgrounds.
Managers should pay careful attention to the state's scope of practice laws for various mental health professional disciplines. Individuals providing formal assessment and counseling which fall into the definition of psychotherapy should be appropriately licensed and insured for professional liability.
QUALIFICATIONS FOR PARAPROFESSIONALS
Paraprofessionals can be excellent choices for outreach and community workers. This is especially so if they are familiar with the community and trusted by its residents. They may already be employed by a mental health, social service, health, or other community-based agency, or they may be recruited from among community residents. Characteristics and qualifications should include the following (Collins and Pancoast, 1976; Farberow and Frederick, 1978; Tierney and Baisden, 1979):
1. Possess at least some high school education (to master information and concepts to be taught).
2. Are indigenous to the area, if possible.
3. Represent a cross section of the community/neighborhood members with regard to age, sex, ethnicity, occupation, length of residence in the community, etc.
4. Are motivated to help other people, like people, and have sensitivity and empathy for others.
5. Are functioning in a stable, mature, and logical manner.
6. Possess sufficient emotional and physical resources and receive sufficient personal rewards to be truly capable of helping.
7. Can work cooperatively with others.
8. Are able to work with people of other value systems without inflicting their own value system on others.
9. Are able to accept instructions and do not have ready-made, simplistic answers.
10. Have an optimistic, yet realistic, view of life, i.e., a "health engendering personality".
11. Have a high level of energy to remain active and resourceful in the face of stress.
12. Are committed to respecting the confidentiality of survivors and are not inclined to gossip.
13. Have special skills related to unique populations (e.g., children or older adults, particular ethnic groups) or useful to disaster recovery (e.g., understanding of insurance, building requirements).
14. Are able to set personal limits and not become too involved with survivor recovery (e.g., understand the difference between facilitating and empowering survivors as opposed to "taking over" for the survivor).
WHY TRAINING?
Mental health professionals often assume that their clinical training and experience are more than sufficient to enable them to respond adequately in disaster. Unfortunately, traditional mental health training does not address many issues found in disaster-affected populations (FEMA, 1988). While clinical expertise, especially in the field of crisis intervention, is valuable, it is not enough. Mental health personnel need to adopt new procedures and methods for delivering a highly specialized service in disaster. Training must be designed to prepare staff for the uniqueness of disaster mental health approaches.
Though disasters profoundly affect individuals, people rarely disintegrate or become incapable of coping with the situation. Nor does mental illness suddenly manifest in a full-blown florid state. Problems do appear. They vary in nature and intensity (Farberow, 1978). However, most of the problems and post-disaster symptomatology are normal reactions of normal people to abnormal events. Few require traditional psychotherapy. Very few people seek out mental health assistance following disaster, and mental health staff who simply open the doors of their clinics to clients or patients will have little to do.
As a result, outreach to the community is essential. Outreach is more than simply setting up decentralized clinical services in impacted areas, or sending out brochures advertising mental health services. Outreach also means mingling with survivors in shelters and DACs and meal sites and devastated neighborhoods. The key to effective outreach is the mental health worker's ability to establish rapport and to have therapeutic intervention with individuals in an informal, social context in which there is not a psychotherapeutic "contract".
In addition to the impact on individuals, disasters are political and bureaucratic events. They profoundly affect the community and its social systems. Everyday resources for basic human needs may be destroyed or damaged. Transportation and communication may be disrupted. In a large-scale disaster, specialized emergency response and recovery agencies move into action and exert a significant influence on the post-disaster environment. Resources, structures, and individuals change as specialized response groups finish their jobs and move on and as new, grass-roots groups spring up. Mental health staff need to understand and be able to function effectively in a complex and fluid political and bureaucratic network.
Disaster mental health training will help staff to understand the impact of disaster on individuals and the community. It will provide information about the complex systems and resources in the post-disaster environment. It will also help staff to fine tune clinical skills that are relevant and useful in disaster. It will aid them in learning effective community-based approaches.
Through videotapes, role play, and other exercises, training allows staff to experience vicariously the emotional climate of disaster recovery work. Sometimes, staff may decide they are not well suited to this type of work. Usually, the experiential aspects of the training will provide workers with some measure of "emotional inoculation" that will help them to anticipate the emotional aspects of the work. Training must also provide staff with awareness of the personal impact of disaster woek, and with strategies for stress management and self-care.
BEFORE TRAINING
It is essential for disaster mental health workers to begin to process their own emotions about the disaster before attempting to help survivors. While workers may talk about their own reactions during the training, training is not designed to be a debriefing. If workers come to the training with unmet needs related to their own feelings, the training will not be able to proceed effectively. A debriefing or other group format for discussion of workers' reactions to the disaster should be conducted for workers before training. A trained facilitator who has not been directly involved in service delivery, yet thoroughly understands the demands of disaster work, should provide the debriefing.
************************************************************************************************
REFERENCES
Collins, A.H. and Pancoast, D.L. (1976). Natural helping networks: A strategy for prevention. Washington, DC: National Association of Social Workers.
DeWolfe, D. (1992). Final report: Regular grant services, Western Washington floods. State of Washington Mental Health Division.
Farberow, N.L. and Frederick, C.J. (1978). Training manual for human service workers in major disasters. Rockville, MD: National Institute of Mental Health.
Federal Emergency Management Agency (1988). Disaster assistance programs: Crisis counseling program: A handbook for grant applicants. DAP-9, Washington, DC.
Tierney, K.J. and Baisden, B. (1979). Crisis intervention programs for disaster victims: A source book and manual for smaller communities. Rockville, MD: National Institute of Mental Health.
************************************************************************************************
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
********************************************************************************************************************************************
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.
**********************************************************************
George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
||| Volume 1 ||| Volume 2 ||| Volume 3 ||| Volume 4 ||| Volume 5 ||| Volume 6 ||| Additional Links |||
Mental Health Moment Online
