Disaster and Crisis Mental Health

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Disaster and Crisis Mental Health
Special Populations
Center for Mental Health Services Substance Abuse
and Mental Health Services Administration U.S.
Department of Health and Human Services
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Special Populations

• Children and youth
• Older adults
• People with disabilities
• People with serious mental illness
• People with low socioeconomic status
• Disaster workers
• Cultural and ethnic groups

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Key Concepts of Disaster Impact

• No one who sees a disaster is untouched by it.
• Primary, Secondary and Tertiary victims
• Two types of trauma
• Individual (stress and grief reactions)
• Collective (Damages the bonds and social fabric
  of the community. Increases fatigue,
  irritability, family conflict.)

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Key Concepts of Disaster Impact

• People pull together during and after a disaster.
  (high activity/low efficiency)
• Stress and grief are normal reactions to an
  abnormal situation. (transitory reactions)
• Emotional reactions relate to problems of living.
  (abnormal and excessive disruptions to daily
  routines)

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Key Concepts of Disaster Impact

• Disaster relief can seem complex and
  overwhelming
• People typically do not seek out mental health
  services (self reliance at all costs)
• Survivors reject help (others need it more than I
  do)
• Mental health services are practical rather than
  psychological

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Key Concepts of Disaster Impact

• Services must be tailored to community norms
• Support systems are crucial to recovery
• Interventions must be consistent with the phase
  of disaster

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Physical Reactions to a Disaster

• Headaches
• Generalized discomfort, hot or cold
• Hypertension, heart pounding
• Gastrointestinal distress
• Exacerbation of psychiatric illness
• Accelerated physical decline
• Fatigue or exhaustion
• Increase or decrease in appetite

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Emotional Reactions to a Disaster

• Feeling depressed or sad
• Feeling irritable, angry, resentful
• Experiencing anxiety or fear
• Feeling despair or hopelessness
• Being apathetic
• Feeling overwhelmed

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Cognitive Reactions to a Disaster

• Trouble concentrating or remembering things
• Difficulty making decisions
• Preoccupation with the event
• Recurring dreams or nightmares
• Questioning spiritual beliefs

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Behavioral Reactions to Disaster

• Isolation from others
• Sleep problems
• Increased conflicts with family
• Hyper-vigilance, startle reactions
• Avoiding reminders
• Crying easily
• Not eating

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Special Populations

• Children

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Risk Factors for Children

• Exposure to direct life threat and injury
• Witnessing mutilating injuries
• Hearing unanswered cries for help
• Degree of brutality and violence
• Unexpectedness and duration
• Separation from family
• (Pynoos, 1996 Vogel and Vernberg, 1993)

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Pre-School Age Children
Common Reactions

• Sleep problems, nightmares
• Clinging, separation anxiety
• Helplessness, passivity

• Death not permanent
• Fearfulness
• Regression
• Repetitive play

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School Age Children
Common Reactions

• Sleep problems, nightmares
• Preoccupation with disaster, death
• Fears about safety
• Self blame, guilt, responsibility

• Angry outbursts
• Retelling and repetitious play
• Social withdrawal
• Somatic complaints
• School performance problems

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Pre-Adolescents and Adolescents
Common Reactions

• Sleep problems and nightmares
• Self blame, guilt, shame
• Self-consciousness
• Depression, social withdrawal

• Desire for revenge
• Somatic complaints
• Aggressive and risk-taking behavior
• School performance problems

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Factors Affecting Childrens Recovery From
Disaster

• Developmental level of child
• Pre-disaster mental health of the child
• Ability of the community to offer support
• Separation from parents
• Reaction of significant adults to the disaster

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Factors Affecting Childrens Recovery From
Disaster

• Communication between parents and child
• Belief about what caused the disaster
• The degree of damage/Violence cause by the
  disaster
• The degree to which the child was directly
  impacted by the disaster

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Special Populations

• Older Adults

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Older Adults Reactions to a Disaster
Impact of Losses for Older Adults

• Intense sense of grief over mementos, pets, etc.
• Feel unable to start over
• Past losses re-awakened
• Slower to respond to the impact of the loss
• Experience a long term decline in standard of
  living

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Older Adults Reactions to a Disaster
Stress Symptoms

• Slower to recover psychologically and financially
• Fear of loss of independence
• Depression
• Withdrawal

• Agitation
• Sleep disturbance
• Memory loss
• Disorientation and confusion
• Apathy

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Older Adults

• Physical vulnerability
• Chronic health conditions
• Medication needs
• Auditory, visual, mobility, or cognitive
  impairment
• Increase anxiety, confusion
• Loss of home health support

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Older Adults Reactions to a Disaster
Environmental Stressors

• Poor health
• Need assistance in daily living
• Isolation
• Poor support system
• Limited income

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Older Adults Reactions to a Disaster
Coping Experience and Life Skills

• Recent losses, or cumulative unresolved trauma
  leaves older adults at risk for difficulty in
  coping with disaster aftermath.
• Successful coping in the past may create a
  reservoir of skills which increases resilience
  and adaptability to disaster aftermath.

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Older Adults Reactions to a Disaster
Utilization of Assistance

• Slower to admit full extent of their losses may
  miss deadline for applying for assistance
• Isolation may contribute to lack of awareness of
  resources
• Lack of transportation, limited mobility
• Tend to under-utilize insurance

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Older Adults Reactions to a Disaster
Interventions

• Home visits Thorough assessment of losses
• Assist with recovery of possessions
• Suitable residential location/relocation
• Reestablish social and familial contacts
• Assist with securing medical and financial aid
• Assist with ways to be involved with community
  recovery efforts - volunteerism

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Special Populations

• People With Disabilities

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People With Disabilities

• Outreach model helps assure access
• Provisions must be made to serve
• Hearing impaired
• Vision impaired
• Mobility impaired
• Developmentally disabled

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People With Mental Illness

• Same basic needs as everyone else
• May have special needs
• May rise to the occasion
• Program should tailor services to ensure
  appropriate services are delivered
• Often identify unserved or underserved people in
  completing outreach

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People With Mental Illness

• Disaster stress reactions may be difficult to
  discern from symptoms of mental illness
• Consumers may be trained as part of the
  preparedness process
• Should be given the opportunity to serve the
  larger community

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Special Populations

• Disaster Workers

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Disaster Workers

• Emergency Medical Services
• Law Enforcement/Fire Service
• Emergency Management
• Voluntary Agencies
• Utility Workers

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Disaster Workers

• Train peers when possible
• Recognize unique stressors
• Conflicting roles (family vs. job)
• Exposure to chaos, death and destruction
• Very long days, exhaustion
• Community reactions (hero or scapegoat)

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Special Populations

• Cultural and Ethnic Groups

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Major Racial and Ethnic Proportions

• Hispanic Americans
• Asian Americans and Pacific Islanders
• American Indians and Alaska Natives
• African Americans
• (as described in the Surgeon Generals report)

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Latino/Hispanic Americans

• Most Latino/Hispanic Americans share the Spanish
  language and other cultural influences,
  regardless of whether they trace their earliest
  ancestry to Africa, Asia, Europe or the Americas.
• Despite these commonalities, there is great
  variability in language use, cultural practices,
  and the context of immigration.
• (cult comp pub)

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Asian Americans and Pacific Islanders

• Over 40 different ethnic groups
• Fastest growing racial group in the US
• Speak more than 100 languages and dialects

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American Indians and Alaska Natives

• The U.S. Census Bureau estimated that 4.1
  million American Indians and Alaska Natives
  (Indians, Eskimos and Aleuts) lived in the United
  States in 2000.

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African Americans

• Increasing in diversity as greater numbers of
  black immigrants arrive from Africa and the
  Caribbean.
• Repercussions from a legacy of discrimination
  continue to influence their social and economic
  standing, relations with other groups, and
  personal outlooks.
• (cult comp pub)

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Special Considerations when Working with Refugees

• Language
• Culture
• Economic marginalization and differences
• Fractures social relations
• Experience of traumatic stressors and of loss
• Family dynamics and role changes
• (cult comp pub p. 75)

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Cultural Differences
Cultural differences exist between rural and
urban survivors, across differences in education
and socioeconomic backgrounds, age groups, and
among different religious and non-religious
groups. Jackson Cook, 1999
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Community Culture

• The culture of the community provides the lens
  through which its members view and interpret the
  disaster, and the communitys degree of cohesion
  helps determine the level of social support
  available to survivors.
• (from cultural comp pub)

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Cultural Group Information

• Meanings associated with the event
• Experience with emergency response
• Trauma and violence in country of origin
• Signs and symptoms of trauma, grief
• View about mental health, providers
• Tips for professional courtesy

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Key Concepts to Remember

• The target population is normal
• Avoid mental health labels
• Be innovative in offering help
• Fit program services into the community context

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Cultural Competence Semantics and Concepts

• Cultural diversity
• Cultural awareness
• Cultural sensitivity
• Cultural competence

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Cultural Diversity
The heterogeneity of social class, gender, race,
ethnicity and life style present in a
neighborhood, community or geographic locale
impacted by the disaster.
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Cultural Awareness

• Cultural awareness suggests that it may be
  sufficient for one to be cognizant, observant and
  conscious of similarities and differences among
  cultural groups in order to meet their needs.

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Cultural Sensitivity
Awareness of the various cultural groups
affected by the disaster. This includes racial
and ethnic groups hardest hit by the disaster,
language barriers and people with suspicion of
the government.
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Basic Cultural Sensitivity

• Convey respect, good will, courtesy
• Ask permission to speak with people
• Explain the role of the mental health worker
• Acknowledge differences in behavior due to
  culture
• Respond to concrete needs
• (Paniagua, 1998 Young, 1998)

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Cultural Competency
Awareness of ones own values and prejudices.
Being committed to learning about cultural
differences, and being creative, flexible and
respectful to others values and beliefs in our
interventions and outreach approaches.
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Cultural Competence

• Valuing of diversity
• Recognition of and respect for differences
• Understanding cultural definitions of mental
  health, well-being, coping and recovery
• Use of mental health and other interventions that
  fit
• Services and information provided in primary
  languages
• Use of empowerment-based approaches
• Ongoing cultural awareness and sensitivity
  training

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Guiding Principles for Cultural Competence in
Disaster Mental Health Programs

• Recognize the importance of culture
• Determine the cultural composition of the
  community recruit and train disaster workers who
  represent the community
• Community profile
• Staff recruitment
• Cultural competence training
• Ensure that services are accessible, appropriate
  and equitable

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Guiding Principles for Cultural Competence in
Disaster Mental Health Programs

• Recognize the role of
• help-seeking behaviors,
• customs and traditions for healing
• customs and traditions in trauma and loss
• natural support networks.
• Involve as cultural brokers community leaders
  and groups representing diverse groups.

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Guiding Principles for Cultural Competence in
Disaster Mental Health Programs

• Ensure that services and materials are
  linguistically appropriate
• Availability of trained bilingual/bicultural
  staff
• Translation of educational materials and
  documents
• Language and sign-language interpretation

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Elements of a Culturally Competent Disaster CCP

• Needs assessment
• Program plan
• Outreach
• Community education
• Community networking
• In-Service training and consultation
• School based programs
• Anniversary events

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  Organizational Approaches

• Effective management structure
• Effective managers and supervisors
• Clear purpose and goals
• Functionally defined roles
• Team support
• Plan for stress management

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Community Outreach

• Initiate contact at gathering sites
• Set up 24-hour telephone hotlines
• Outreach to survivors through media, Internet
• Educate service providers
• Use bilingual and bicultural workers

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  Community Interventions

• Memorials and rituals
• Usual community gatherings
• Anniversary commemorations
• Symbolic gestures

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For More Information
www.ojp.usdoj.gov/ovc/