Oklahoma Emergency Mental Health

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Oklahoma Emergency Mental Health Disaster
Response ConferenceDisaster Mental Health 101

• Brian W. Flynn, Ed.D.
• RADM/Assistant Surgeon General (USPHS. Ret.)
• Associate Director
• Center for the Study of Traumatic Stress
• Uniformed Services University of the Health
  Sciences

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How Do We Know What We Know/Dont Know?

• Disaster mental health research
• Disaster experience
• Extrapolate from other research/types of events
• Best guess

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Lenses Through Which We View The Disaster
Experience

• Orientation of most mental health professionals
  pathology based
• Professional/guild bias
• Scope of our interest Prevent/reduce illness?
  Promote mental health? Individual/group/community
  focus?

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Relative Readiness...

• Natural disasters--
• Human caused (non-terrorist)--
• Conventional terrorism--
• WMD terrorism-- unprepared

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Guiding Concepts

• No one who experiences a disaster is untouched by
  it
• There is always both individual and collective
  trauma
• Behavioral health concerns are present in nearly
  all aspects of preparedness, response, and
  recovery
• Most response is a normal reaction to an abnormal
  situation

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Event Characteristics Influencing Trauma

• Threat to physical well being
• Physical harm or injury
• Exposure to the grotesque
• Sudden violent death of loved one
• Exposure to noxious agent

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Event Characteristics Influencing Trauma (Cont.)

• Uncertain duration of event
• Scope of event
• Human error
• Malicious intent
• Lack of warning

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Factors Influencing Individual Trauma

• Gradient of exposure
• Seriousness of threat to personal safety
• Exposure to grotesque situations
• Diminished health status
• Magnitude of loss
• Trauma history

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Research On Status Factors Psychological
Response

• Gender
• Age
• Socioeconomic status
• Marital status
• Pre-disaster functioning
• Interaction among factors

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Factors Influencing Collective Trauma

• Degree of community disruption
• Predisaster family and community stability
• Role of community leadership
• Sensitivity of recovery efforts

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Nature Of Mental Health Sequelae

• DisordersPTSD, Depression, Acute Stress Disorder
  
• Disaster related stress
• Perhaps even more healthy!
• Areas of controversy--substance abuse, domestic
  violence

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Physiological Signs Of Stress

• Fatigue
• Nausea
• Fine motor tremors
• Tics
• Parestesias
• Profuse Sweating

• Dizziness
• GI upset
• Heart palpitations
• Choking or smothering sensation

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Emotional Signs Of Stress

• Anxiety
• Grief
• Irritability
• Feeling overwhelmed
• Anticipation of harm to self or others

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Cognitive Signs Of Stress

• Memory loss
• Anomia
• Decision making difficulties
• Confusing trivial with major issues
• Concentration problems/distractibility
• Reduce attention span
• Calculation difficulties

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Behavioral Signs Of Stress

• Insomnia
• Gait change
• Hypervigilence
• Crying easily
• Gallows humor
• Ritualistic behavior

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Longer Term Effects Of Stress

• Nightmares
• Intrusive thoughts
• Uncontrolled affect
• Relationship problems
• Job/school related problems

• Decreased libido
• Appetite change
• Blame assignation
• Decreases immune response

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Illnesses Related To Stress

• Migraine headaches
• Heart attacks
• Gastric Ulcers
• Colitis
• Impaired immune system
• Emerging research on pervasive biological impact
  of stress

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Intervening In A Crisis
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What Works...

• Range of interventions
• Treatment education
• Outreach
• Individual collective healing
• Intervention collaborations
• Much is unknownlittle intervention research

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Contextual Factors For Psychological
Interventions

• Membership in high risk group
• Prior trauma history
• Prior coping history/style
• Intactness of support system
• Gradient of exposure
• Health/MH status
• Perceived/actual chance of retraumatization
• Cultural factors

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Key Components Of Early Intervention

• Secure basic needs
• Psychological first aid
• Needs assessment
• Monitoring the rescue and recovery environment

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Key Components Of Early Intervention (Cont.)

• Outreach and information dissemination
• Technical assistance, consultation, training
• Fostering resilience/recovery
• Triage
• Treatment

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Key Precepts Of Working With Disaster Victims

• Being there
• Have a range of interventions available
• Assumed competence
• Normalization
• Directive caregiving
• Help organize tasks

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Key Precepts Of Working With Individuals (Cont.)

• Active and repeated listening
• Discouraging blame
• Realistic expectations
• Referral
• Cultural considerations

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Areas Of Controversy

• Roles of professionals and non-professionals
• Treatment vs. crisis counseling
• Guild rivalries
• Organizational rivalries
• Duration of effort
• CISD/CISM

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Special Issues Of Terrorism
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Never Forget The Purpose!

• Not to injure
• Not to kill
• Not to destroy
• To create fear/panic/to change behavior and
  destabilize individuals and institutions

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Terrorism/Natural Disasters

• Psychological Sequelae are
• More
• More serious
• More complex
• More long-term
• More organizationally complex
• Involvement with criminal aspect of event
• Special issues for rescuers

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Terrorism using Weapons of Mass Destruction

• WMD events are different
• Mental health consequences will be massive
• Among NBC events--biological are most complex

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How are WMD Events Psychologically Different?

• Knowledge of event may be dependent on monitoring
  or claiming credit
• Perhaps no site of disaster
• Scope may be enormous
• Little public knowledge of agents
• Reaction based on massive myth and misinformation
• Primal fear of the invisible

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A More Complex Set of Players

• Homeland Security
• Other Federal Agencies (CDC, SAMHSA, FDA, VA,
  others)
• State Health Authorities
• Military
• Hospitals
• Local providers
• Multi-jurisdictional complexities

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A Public Health Conceptualization

• Anthrax is not contagious-fear is!
• Focus on the sources of infection
• Focus on the vectors of the infection
• Provide appropriate treatment to those infected
• Reach out to the population with services and
  information
• Continue to monitor

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Where Health Mental Health Come Together

• Surveillance/early warning
• Overwhelmed health care resources
• Assisting potential victims while they wait for
  testing or results
• Healthcare workers as first responders
• Psychological consequences of health information
• Combined/coordinated tx

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Partners In Psychological Preparation And Response

• Government command and control agencies
• Hospitals
• State and local public health and mental health
  providers
• Professional organizations
• Schools
• Electronic and print media (especially in risk
  communication)
• Primary care

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Special Concerns Regarding Responders
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Whoever fights monsters should see to it that in
the process he does not become a monster and when
you look long into the abyss, the abyss also
looks into you.

• -Nietzche

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Special Considerations For Intervening With First
Responders

• Stigma of mental health
• Culture of not seeking help
• Unrealistic expectations of self
• Concern over fitness for duty
• Seek help later than others
• Mixed message regarding who can help
• Controversy/polarization around CISD/CISM
• Issues of secondary gain

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Lessons Learned From 20 Years Of Disaster Work

• Resilience of the human spirit
• Centrality of blame
• Expectation of immediate gratification
• Quality of disaster workers
• Importance of religion in this culture
• Many people on the margin
• Importance of symbolism and ritual
• Ignorance about mental health

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Contact Information

• BRIAN W. FLYNN, ED.D.
• RADM / Assistant Surgeon General
• U.S. Public Health Service (Retired)
• P.O. Box 1205
• Severna Park, MD 21146
• Phone [phone]
• EmailBrianwflynn_at_aol.com