Disaster Mental Health for Responders: Key Principles, Issues and
Questions
- No one who experiences a disaster is untouched by it.
- Most people pull together and function during and after a disaster, but
their effectiveness is diminished.
- Mental health concerns exist in most aspects of preparedness, response and
recovery.
- Disaster stress and grief reactions are normal responses to an abnormal
situation.
- Survivors respond to active, genuine interest and concern.
- Disaster mental health assistance is often more practical than
psychological in nature (offering a phone, distributing coffee, listening,
encouraging, reassuring, comforting).
- Disaster relief assistance may be confusing to disaster survivors. They
may experience frustration, anger, and feelings of helplessness related to
Federal, State, and non-profit agencies disaster assistance programs. They
may reject disaster assistance of all types.
Survivor Needs & Reactions (Responses differ, but
there are common needs.)
- A concern for basic survival
- Grief over loss of loved ones and loss of valued/meaningful possessions
- Fear and anxiety about personal safety and physical safety of loved ones
- Sleep disturbances, often including nightmares and imagery from the
disaster
- Concerns about relocation and the related isolation or crowded living
conditions
- A need to talk, often repeatedly, about events and feelings associated
with the disaster
- A need to feel one is a part of the community and its recovery efforts
Reactions that Signal Possible Need for Mental Health
Referral (Many responses to trauma can be expected, but some are
cause for extra attention/concern.)
- Disorientation (dazed, memory loss, unable to give date/time or recall
recent events)
- Depression (pervasive feeling of hopelessness & despair, withdrawal
from others)
- Anxiety (constantly on edge, restless, obsessive fear of another
disaster)
- Acute psychosis (hearing voices, seeing visions, delusional thinking)
- Inability to care for self (not eating, bathing, changing clothing or
handling daily life)
- Suicidal or homicidal thoughts or plans
- Problematic use of alcohol or drugs
- Domestic violence, child abuse or elder abuse
Common Disaster Worker Stress Reaction Checklist (It is
not unusual for responders to have these reactions. Check yourself and your
buddies.)
Behavioral and Emotional Responses/Symptoms
- Anxiety, fear
- Grief, guilt, self-doubt, sadness
- Irritability, anger, resentment, increased conflicts with friends/family
- Feeling overwhelmed, hopeless, despair, depressed
- Anticipation of harm to self or others; isolation or social withdrawal
- Insomnia
- Gait change
- Hyper-vigilance; startle reactions
- Crying easily
- Gallows humor
- Ritualistic behavior
Cognitive Responses/Symptoms
- Memory loss, Anomia (difficulty naming objects or people)
- Calculation difficulties; Decision making difficulties
- Confusion in general and/or confusing trivial with major issues
- Concentration problems/distractibility
- Reduced attention span and/or preoccupation with disaster\
- Recurring dreams or nightmares
Physiological Responses/Symptoms
- Fatigue
- Nausea
- Fine motor tremors
- Tics
- Paresthesia
- Profuse Sweating
- Dizziness
- GI Upset
- Heart Palpitations
- Choking or smothering sensation
Mis-Attribution of Normal Arousal (Misinterpretation of
normal physiological responses can increase anxiety and the number of
unnecessary ER visits.)
- Interpretation of normal physiological arousal as serious illness
- Misinterpretation often is increased by rumors and false information
- Increased by hyper-suggestibility in victim fueled by changes in routine
and surroundings
- Risk communication and rumor control can help reduce unnecessary drains on
healthcare
Longer-Term Effects Checklist (Potential down-stream
consequences of exposure to a natural or human-caused disaster.)
- Nightmares
- Intrusive thoughts
- Uncontrolled affect
- Relationship problems
- Job/school related problems
- Decreased libido
- Appetite change
- Blame assignation
- Decreased immune response
Sources of Stress for Responders Checklist (These can
increase stress.)
- Role ambiguity
- Lack of clarity of tasking
- Mismatching skills with tasks
- Lack of team cohesion
- Discomfort with hazardous exposure
- Ineffective communication within team, with non-team members, with
headquarters
- Lack of or too much autonomy
- Intense local needs for information (media/health officials) that cannot
await clearance delay
- Database issues, linkage between epidemiology, laboratory, and
environmental sampling
- Laboratory specimen tracking, reporting
- Resources/equipment shortages
- Command and control ambiguities
- Re-integration barriers
- Coworkers had to pick up your work or no one did and it is overwhelming
- Lack of understanding of or appreciation for what you have been through
- Domestic/family conflict
Individual Approaches to Avoid/Reduce Stress Checklist
(Things you can do to help maintain your own mental, emotional, physical,
spiritual balance.)
- Management of workload
- Set task priority levels and create a realistic work plan
- Delegate existing workload so workers not doing usual job too
- Balanced Lifestyle
- Exercise and stretch muscles when possible
- Eat nutritionally, avoid junk food, caffeine, alcohol, tobacco
- Obtain adequate sleep and rest, especially on longer assignments
- Maintain contact and connection with primary social supports
- Stress Reduction Strategies
- Reduce physical tension by deep breathing, meditating, walking
- Use time off for exercise, reading, listening to music, taking a bath
- Talk about emotions & reactions with coworkers at appropriate times
- Self-Awareness
- Recognize and heed early warning signs for stress reactions
- Accept that one may not be able to self-assess problematic reactions
- Be careful not to identify too much with survivors/victims grief and
trauma
- Understand differences between professional relationships and
friendships
- Examine personal prejudices and cultural stereotypes
- Be vigilant not to develop vicarious traumatization or compassion
fatigue
- Recognize when own disaster experience interferes with effectiveness
Self-Care Examples Checklist (Examples, by category, of
things you can do.)
- Physical Diet, exercise, sports, sleep, relaxation
- Emotional Stay in contact with family, friends, social support
- Cognitive Training, reading, perspective
- Behavioral Civic involvement, personal & family preparedness
- Spiritual Meditation, prayer, fellowship, volunteerism
Some of the Sources of Information Used in this Overview
The Centers for Public Health
Preparedness Program
American
Psychiatric Association
National Center
for Post Traumatic Stress Disorder
The
National Child Traumatic Stress Network
Uniformed
Services University of the Health Sciences
U.S.
Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration
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