Mental Health Preparedness

Agenda Review how people react

psychologically to a crisis

Discuss relationship of mental health in public health emergency

Discuss compassion fatigue related to public health responders

What Is Meant By “Crisis?”

Some type of turning point

An emotionally significant event or radical change in one’s life

An unstable or crucial time when decisive change is impending

What Is A Crisis? A “crisis” is a situation in which a

person’s ability to cope is exceeded. “Nothing will ever be the same.” Triggering event within the last 24 – 48

hours. Response emotionally driven (not rational). Situation perceived as either physically or

psychologically threatening. If the subject feels he is in crisis he is.

Characteristics Of People In Crisis Thinking is constricted, emotions are

expansive. Lowered attention spans. Inability to discern between small and

large problems. Often do not see way out of the

situation. Try out different behaviors to reduce

stress.

During A Crisis What Do People Feel?

Wide range of emotions Fear Anxiety Anger Hopelessness Helplessness

What About Panic? Vast majority of

people Do not panic in

times of crisis Do not act

unreasonably Do not engage in

extreme behavior

What Do We Know About Stress Reactions?

Impacted by loss of control

Impacted by unpredictability

Can lead to experience/reaction called “learned helplessness”

Stress Is Evaluated By: Perceived danger/threat value

Irrelevant/harmless? Threat/challenge?

Coping mechanisms available Cognitive Behavior Neurophysiological Emotional

Why Do People Respond Differently to Stress?

Family/Genetic Influences History of physical/psychological

conditions Personality and temperament Cultural background Gender

Why Do People Respond Differently to Stress?

Past Experiences – “wisdom” Learned coping patterns Previous exposure to similar stress Lifestyle patterns

Why Do People Respond Differently to Stress?

Existing vulnerabilities/strengths Health Motivation Support at work/home Relationships with spouse/friends Financial situation Other’s health (i.e. child, parent) Other?

Why Do People Respond Differently to Stress?

Existing Beliefs and Skills Spiritual or religious influence Open communication style Moral Values Accepts help (from pastor/counselor/other) Self-Concept

Troublesome Behaviors In A Crisis

What you can count on: Those who try to bypass official

channels Vicarious rehearsal MUPS: Multiple Unexplained Physical

Symptoms Stigmatization

Mental Health And Emergencies/Disasters Responding to emotional and

psychological impact of event is critical part of response strategy

General agreement that all people involved in event are impacted some way

Mental Health And Emergencies/Disasters

Emotional reactions to the event may vary person to person

Some people may exhibit symptoms of mental illness immediately after event but few develop long-term mental health problems

Mental Health And Emergencies/Disasters

However, recent experience with catastrophic events have challenged this thinking Large scale loss of life, property and

disruption in community life reveals more serious patterns of psychological impact.

Particularly true when event is intentionally caused by human action

Directed Mental Health Interventions

A. Seriously injured victims and bereaved family members

B. Victims with high exposure to trauma, victims evacuated from disaster area

Priority Setting In Crisis Counseling

C. Bereaved extended family members, emergency workers, medical officers’ staff, service providers providing death notification or working with bereaved families

Priority Setting In Crisis Counseling

D. People who lost homes, jobs, pets, mental health providers, chaplains, emergency health care providers, school personnel working with survivors, media personnel

Priority Setting In Crisis Counseling

E. Government officials, groups that identify with target victims group, businesses with financial impact

F. Community at large

At-Risk Persons

Those with preexisting mental health problems

Children Those displaced by event particularly

if they have little support Those with preexisting medical

problems Those with disabilities

Preparedness: Developing Resiliency

Resiliency The process of adapting well in the

face of adversity, trauma, tragedy, threats, or even significant sources of stress (e.g. family problems, serious health problems, financial stressors)

“Bouncing Back” from some type of adversity

Preparedness: Developing Resiliency

Research has shown that resiliency is ordinary, not extraordinary; people demonstrate resiliency each day

Being resilient doesn’t mean that a person doesn’t experience difficulty or distress

It involves thoughts, behaviors, and actions that anyone can learn and develop

Factors Associated With Resiliency

Having caring and supportive relationships

Relationships that create love and trust Capacity to make realistic plans and

take action A positive view of yourself Skills in communication and problem

solving Capacity to manage strong feelings

Steps To Build Resiliency

Make connections Avoid seeing crises as insurmountable Accept that change is part of life Take decisive action and move toward

life goals Look for opportunities of self-discovery Keep things in perspective

Steps To Build Resiliency

Take care of yourself Learn from your past experiences

and make positive changes Stay flexible Let yourself experience strong

emotions Learn to rely on others and let

others rely on you

Examples Of Preparedness Activities

Educational campaign

Establish mental health response network with local providers

Target at-risk populations Assist in development of safety plan Assist in development of emergency kit Assign liaisons to identify specific

concerns in your community

Secondary Trauma

Defined as the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events

Secondary Trauma

Professionals who listen to the stories of fear, pain, and suffering are especially vulnerable to secondary traumatization

Emergency care workers, police officers, mental health professionals, medical professionals, clergy, and human services workers are vulnerable to secondary trauma

Secondary Trauma

• Is a state of tension and preoccupation with the individual or cumulative trauma of clients

• Can be thought of as secondary post-traumatic stress• avoidance/numbing of reminders of the

event• persistent arousal

• Secondary trauma is not “burnout”

Consequences of Secondary Trauma

• Job performance declines• Mistakes increase• Morale drops• Personal relationships are affected• Deterioration of home lives• Personality deterioration• Decline in general health

Critical Incident Stress

A “critical incident” is any event that has a significant amount of emotional reactions which have the potential to interfere with their ability to function either at the scene or at a later time

Key Ideas

Normal reactions to an abnormal event

Reactions include cognitive, behavioral, psychological

Examples of Critical Incidents

Line of duty death Serious line of duty injury Suicide of co-worker Disasters Law enforcement shooting

CIS Interventions

Demobilizations Defusings Debriefings One-on-One meetings

Self-care and Stress Management

Prior to assignment Personal Preparedness Team and Organizational Preparedness Safety of Family Members Social and Organizational Support

Self Care and Stress Management

During an Assignment Work with a partner Limit length of shifts Use stress management techniques Keep a notebook Defuse regularly Call home regularly Closures

Self-Care and Stress Management

Following an Assignment Returning home

Express gratitude to those who have covered your normal responsibilities

Expect an adjustment period of a week or two

Mild depression Physical let-down

Expect a lot of questions from others

Summary Mental health preparedness/response

must be part of all emergency management plans

Individuals respond differently to events

Promote resiliency to minimize impact of life changing events

Taking care of oneself is just as important as caring for victims