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Disaster Mental Health for States: Key Principles, Issues and Questions

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NOTE: These materials represent highlights of the kinds of mental-health related information that might be beneficial in a disaster. Because of their brevity, they do not provide an exhaustive, formal review or compilation of the wealth of available knowledge on disaster mental health. This is a starting point. There are companion pieces that provide similar information for Responders and as a general primer. Sources of additional information are listed at the end of this document.

What Should Happen During First Four Weeks of a Disaster (Important first steps would include the following actions.)

Meet basic needs (food, shelter, clothing…)
Provide Psychological First Aid (ABCs)

Arousal: Decrease excitement (provide safety, comfort, consolation)
Behavior: Assist survivors to function effectively in disaster
Cognition: Provide reality testing and clear information

Provide needs assessments
Monitor the recovery environment (conducting surveillance)
Provide outreach and information dissemination
Provide technical assistance, consultation and training
Foster resilience, coping and recovery
Provide triage
Provide treatment

Questions to Address in Disaster Mental Health Response Plan (Answering these questions before a disaster can help you and your team better prepare.)

Community Demographic Characteristics

Who are the most vulnerable people in the community? Where do they live?
What kinds of families live in the community (i.e., single-parent households)?
How could individuals be identified and reached in a disaster?
Are policies and procedures in place to collect, maintain, and review current demographic data for any area that might be affected by a disaster?

Cultural Groups

What cultural groups (ethnic, racial, and religious) live in the community?
Where do they live, and what are their special needs?
What are their values, beliefs, and primary languages?
Who is knowledgeable about the culture or is an informal leader in the community?

Socioeconomic Factors

Are there recognizable socioeconomic groups with special needs?
How many live in rental property? How many own their own homes?
Does the community have any special economic considerations that might affect people’s vulnerability to disaster?

Mental Health Resources

What mental health service providers serve the community?
What skills and services does each provider offer?
What gaps, including lack of cultural competence, might affect disaster services?
How could the community’s mental health resources be used in response to different types of disasters?

Government roles and Responsibilities in a Disaster

What are the Federal, State, and local roles in disaster response?
How do Federal, State, and local agencies relate to one another?
Who would lead the response during different phases of a disaster?
What mutual aid agreements exist?
How can mental health services be integrated into the government agencies’ disaster response?
Do any subgroups in the community harbor any historical or political concerns that affect their trust of government?

Nongovernmental Organizations’ Roles in a Disaster

What are the roles of the American Red Cross (ARC), interfaith organizations, and other disaster relief organizations?
What resources do nongovernment agencies offer, and how can local mental health services be integrated into their efforts?
What mutual aid agreements exist?
How can mental health providers collaborate with private disaster relief efforts?

Community Partnerships

What resources and support would community and cultural/ethnic groups provide during or following a disaster?
Do the groups hold pre-existing mutual aid agreements with any State or county agencies?
Who are the key informants/gatekeepers of the impacted community?
Has a directory of cultural resource groups, potential volunteers, and community informants who have knowledge about diverse groups been developed?
Are the community partners involved in all phases of disaster preparedness, response, and recovery operations?

Example of State Mental Health Assoc. Response to Terrorism

Pre-Event Phase

Build relationships with public health officials, community stakeholders, private and public medical providers, and school officials
Identify alternate channels of information to and from targeted communities
Conduct baseline health surveillance (to look for both physical and mental health outcomes)
Identify special populations and characteristics relevant to recovery
Collaborate with public health and emergency response planning groups
Train mental health professionals and qualified paraprofessionals to perform a range of appropriate interventions including Psychological First Aid, triage, outreach and education
Train provider groups including public health nurses, school health professionals, community support workers, etc. in psychosocial consequences of terrorism/disasters
Train and exercise agency and state preparedness plans under public health and emergency management response leads
Prepare public education and risk communication templates

Response Phase

Consult on the development of risk communication
Meet basic safety and security needs of target populations
Perform Psychological First Aid at impact site(s) (“States” document has more information)
Monitor the impact environment and initiate responses appropriate to the findings
Distribute educational information appropriate to the event
Offer technical assistance, consultation and training to emergency response managers

Recovery Phase

Institute surveillance and needs assessment across the affected communities
Monitor emerging needs of special populations
Field evidence-informed interventions to support natural recovery processes, foster resilience, and treat acute distress
Train and enhance capacity of social support networks
Promote availability of and ongoing need for recovery resources
Anticipate and plan to deal with trauma reminders

Potential Risk Groups (Certain individuals/groups are more vulnerable than others.)

Age groups (Infants, children and seniors)
Cultural and Ethnic Groups (immigrants, non-English speakers, undocumented aliens etc.)
Low-visibility groups (homeless, mobility-impaired, unemployed, mentally-challenged etc.)
People with Serious and Persistent Mental Illness
People in Group Facilities (hospitals, nursing homes, assisted living homes, prisons)
Human Service and Disaster Relief Workers

Risk Factors For Children (Example from just one special needs population)

Death or serious injury of family member or close friend
Witnessing grotesque destruction in person or via the media
Exposure to life threat
Separation from parents
High level of family stress
Recent stressful life events
Prior functioning problem

Common Disaster Worker Stress Reactions (See list in: “Disaster Mental Health for Responders: Key Principles, Issues and Questions”)

Organizational Approaches to Avoid/Reduce Stress Checklist (Several important things can be done to minimize or reduce unnecessary sources of stress.)

Effective Management Structure and Leadership

Clear chain of command and reporting relationships
Available and accessible clinical supervisor
Disaster orientation provided for all workers
Shifts no longer than 12 hours with 12 hours off
Briefings provided at beginning of shifts as workers exit/enter
Necessary supplies available (paper, pens, PCs…)
Communication tools available (cell phones, radios…)

Clear Purpose and Goals (clearly defined intervention goals/strategies)
Functionally Defined Roles

Staff oriented and trained with written role descriptions
When setting is under other agency’s jurisdiction, roles clear

Team Support

Buddy system for support and monitoring stress reactions
Positive atmosphere of support and tolerance. Say “good job” often

Plan for Stress Management

Workers’ functioning assessed regularly
Workers rotate between low-, mid-, and high-stress tasks
Breaks and time away from assignment encouraged
Education about signs/symptoms of workers stress & coping strategies
Individual and group defusing and debriefing considered (might be contraindicated)
Exit plan for workers leaving operation (reentry, efforts recognized)
Number of tours of duty clarified