Mental Health Issues in Public Health Emergencies

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Mental Health Issues in Public Health Emergencies

• Pamela K. Jennings, MS, LCPC
• October 27, 2004

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No one who sees a disaster is untouched by it.
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Kia Erickson, Everything In Its Path

• I felt for a moment as though I were in the
  company of people so wounded in spirit that they
  almost constituted a different culture the sense
  of being in the presence of deep and numbing pain
  remained an important part of the emotional
  climate in which the study was done. I was
  driving down Buffalo Creek late that night when
  the storm that had been threatening all day
  finally broke with mountain vengeance. I pulled
  over to the side of the road near one of the
  several trailer camps on the creek and stayed
  there as half of the lights in the camp flashed
  on, children began to cry and small groups of men
  trudged out into the darkness to begin a wet
  vigil over the stream. Something of the mood of
  that camp reached across the creek to where I was
  parked and I had to fight off a compelling urge
  to drive away, to escape. I had been in the
  hollow for only twelve hours.

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I didnt know anyone who died but I have never
felt more lonely in my life.

• New York Resident
• Evening Subway
• September 15, 2001

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This session is intended to.

• Introduce the Public Health Response Team member
  to the central concepts of providing
  psychological first aid to victims of public
  health emergencies.
• Provide information about the types and
  prevalence of traumatic events.

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This session is intended to..

• Describe the typical and atypical reactions of
  individuals and communities to traumatic events.
• Address the impact of the event on the Public
  Health worker, along with advice on managing
  secondary or vicarious traumatic stress.

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What is Traumatic Stress?

• Traumatic stress refers to the emotional,
  cognitive, behavioral and physiological
  experiences of individuals who are exposed to, or
  who witness events that overwhelm their coping
  and problem solving abilities.
• (Lerner and Shelton, 2001)

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What is Traumatic Stress?

• Traumatic stress disables people, causes
  disease, precipitates mental disorder, leads to
  substance abuse, and destroys relationships and
  families. Additionally, traumatic stress
  reactions may lead to Post-traumatic Stress
  Disorder (PTSD).

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Definition of Disaster

• A disaster is an occurrence such as a hurricane,
  tornado, flood, earthquake, explosion, hazmat
  accident, fire, famine, mass shooting,
  transportation accident, or epidemic that causes
  human suffering or creates collective human need
  that requires assistance to alleviate.

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Categories of Disasters
Human-caused
Natural
Error or neglect
Terrorism
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Typical Response Patterns

• Physical
• - Shock symptoms
• - Insomnia
• - Loss of appetite
• - Headaches
• - Muscle weakness
• Affective
• - Depressed, anxious
• - Numbing
• - Constricted affect
• - Guilt, shame, fear
• - Intolerance of fear response
• - Global pessimism

• Cognitive
• - Distractibility
• - Duration/Sequence distortion
• - Declining school work
• - Recurrent intrusive
• recollections
• - Flashbacks, Nightmares
• Behavioral
• - Clinging, isolation
• - Thrill seeking, counter-phobic
• behavior.
• - Re-enactments of the trauma
• - Increased substance abuse
• - Hypervigilance
• - Elevated startle response

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Atypical Response Patterns

• Physical
• - Chest pain
• - Respiratory Trouble
• - Loss of Consciousness
• - Cardiac arrhythmias or palpitations
• Affective
• - Suicidal Ideation
• - Homicidal Ideation
• - Catatonia, Mania

• Cognitive
• - Pervasive disorientation
• - Blackouts
• - Psychotic Symptoms
• - Amnesia
• Behavioral
• - Self-injurious acts
• - Total lack of self-care
• - Dangerousness to self, others and property

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Factors Influencing Response to Trauma

• Pre-trauma Factors
• Multiple traumatic exposures
• History of mental illness
• Low Social Economic Status (SES)
• Intensity and Duration of Traumatic Exposure
• Age

• Post-trauma Factors
• On-going support
• Opportunity to share their story
• Sense of closure
• Media exposure
• Substance Abuse
• Re-exposure or re-victimization

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Basic Rules of Disasters

• 1. No one who sees a disaster is untouched by it.
  
• 2. There are two types of disaster trauma.
• 3. Most people pull together and function during
  and after a disaster, but their effectiveness is
  diminished.

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Rules to Remember

• 4. Disaster stress and grief reactions are a
  normal response to abnormal situations.
• 5. Disaster relief procedures have been called
  The Second Disaster.
• 6. Disaster Mental Health assistance is more
  practical rather than psychological in nature

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Rules to Remember.

• 7. Survivors respond to active interest and
  concern.

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Primer for Psychological First Aid

• Accept every persons right to have her or his
  own feelings. Try not to tell victims how they
  should feel.
• Interrupt as little as possible until they have
  told you their story.
• Accept the victims limitations as real.
• Accept your own limitations

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Psychological First Aid

• Right from the beginning make every effort to
  explain to the victim what has happened, what is
  being done about it and what the likely positive
  outcome will be.
• Communicate confidence in yourself, and in your
  ability to help the victim.

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Fundamentals of Disaster Mental Health Assessment

• Assess the individuals ability or willingness to
  change their focus to a social conversation
• Responsiveness
• Medical needs
• Dangerousness
• Supports
• Basic Activities of Daily Living (ADLS)

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Key Characteristics of Effective Disaster Workers

• Adventuresomeness
• Sociability
• Calmness
• Systems Savvy
• Therapeutic Acumen

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The Disaster Worker Culture(Myers, 1987)

• Gentleness
• Trust
• High Self-confidence
• Dependence
• Toughness

• Great Strength
• Caution
• High Self-criticism
• Independence
• Sensitivity

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Secondary Trauma is.

• A state of tension and preoccupation with the
  individual or cumulative trauma of victims as
  manifested in one or more ways, including
  re-experiencing the traumatic events, avoidance
  or numbing of reminders of the events and
  persistent arousal.

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Risk Factors forSecondary Traumatization

• Exposure to the stories or images of multiple
  disaster victims.
• An empathic sensitivity to their suffering.
• Any unrelated emotional issues that relate to the
  suffering seen.

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Impact of Secondary Trauma

• Sadness
• Anger
• Fear
• Grief
• Depression

• Anxiety
• Nightmares
• Flashbacks
• Physical Ailments
• Social Withdrawal
• Hyper-arousal

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Effective Self Care for Disaster Workers

• 1. Good nutrition
• 2. Eliminate substances which either depress or
  stimulate the physiological system.
• 3. Get plenty of rest
• 4. Talk it out

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Effective Self Care for Disaster Workers

• 5. Exercise - Work it out
• 6. Use effective coping mechanisms for stress
• 7. Set appropriate boundaries
• 9. Seek outside help

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All We Really Need to Know About Disaster
Response We Learned From Noahs Ark

• Plan Aheadit wasnt raining when Noah built the
  ark.
• Stay fitwhen youre 600 years old, someone might
  ask you to do something really big.
• Dont listen to critics, do what has to be done
• Build on high ground

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All We Really Needed to Know About Disasters We
learned From Noahs Ark

• For safetys sake, travel in pairs.
• Two heads are better than one.
• Dont forget we are all in the same boat.
• Stay below deck during the storm
• Remember the woodpeckers inside are often a
  bigger threat than the storm outside

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Helpful Brochures

• How Do I Deal With My Feelings?
• Helping Young Children Cope With Trauma
• When Bad Things Happen
• Why Do I Feel Like This?
• Terrorism - Preparing for the Unexpected

FOR MORE INFO...

• Go to www.redcross.org