PSYCHOSOCIAL PREPAREDNESS FOR UNITED NATIONS CRITICAL STAFF

 Redefining Readiness: Effective Risk Communication  Impact of Pandemic on Critical Staff  Psychosocial Issues in Pandemic Influenza  Coping Strategies  Workforce Resilience

 Scientists refer to it as a “quadruple reassortant” virus, meaning it is comprised of 4 flu virus genes: 1 human, 1 avian, and 2 swine  New influenza virus causing typical flu- like symptoms (fever, cough, etc.)  Human to human transmission through spread of the virus via typical respiratory means (coughing, sneezing)

 Three Level Operational Framework:  Readiness Mode  Crisis Response  Emergency Mode

 60% of the US public would not heed official instructions to get vaccinated during a smallpox outbreak  40% of the public would not heed official instructions to shelter in place during a dirty bomb incident Lasker, RD. (2004). Redefining readiness: Terrorism planning through the eyes of the public. New York, NY: The New York Academy of Medicine.

 Closer examination suggests what support the public would need to comply with official requests:  In the case of a smallpox outbreak, 55% indicated they needed more information before they could make a decision regarding vaccination  In the case of sheltering in place, the major reason for not following instructions was concern for the safety of family members. If assurances were given that family members were taken care of, compliance dramatically increased.

 Findings emphasize critical importance of communication in a crisis  Provides guidelines for essential psychosocial human needs that must be met in a large scale crisis  Arms us with critical information regarding human decision-making processes in a crisis

Give simple, direct, truthful information Communicate clearly and often Goal #1: Ease concerns Promote positive coping behaviours Promote collective efficacy Goal #2: Give guidance on how to respond U.S. Dept of Health and Human Services (2002). Communicating in a Crisis: Risk Communication Guidelines for Public Officials. Washington, D.C.: Author.

 Potential increased risk of exposure  Need to take special precautions  Ethical dilemmas regarding competing obligations to work and family  Frustration regarding need/expectation to maintain business as usual  Compassion fatigue or burnout Centers for Disease Control. Retrieved 4/30/09. Psychological and social support for essential service workers during an influenza pandemic.

 Fear  Anxiety/Worry  Anger  Loss/Separation

 Fear is an expected response to a perceived threat to safety  Fear takes various forms and differs across individuals, groups and cultures  Some biological/physical aspects of fear are universal across cultures  Fear is often the underlying emotion that leads to panic – contagion aspect.

 Popular misconception that panic will be a common reaction to an influenza pandemic  Although people may experience significant anxiety and even periods of fear, research indicates that panic is a relatively atypical in pandemics  Panic is most likely to occur when people feel ill-prepared to deal with scarcity of resources that may arise

 Acknowledge fear as a normal reaction to threats to safety in yourself, staff and coworkers  Provide timely and accurate information  Limit large, unstructured group assemblies, as these often “feed” the fear response  Maintain regular contact/communication with staff  Address questions directly and honestly

 Can be related to specific concerns –  Economic security  Health and safety  Can also be related to nonspecific concerns  Uncertainty/fear of the unknown  Lack of control is typically the most difficult type of anxiety to tolerate  May continue for longer periods of time and lead to emotional exhaustion, OR improved coping methods if adequate support and opportunities for constructive action is provided

 Provide regular updates  Knowledge facilitates adaptive coping  Encourage active participation  Doing something constructive alleviates anxiety  Encourage healthy habits and coping resources  A regular routine can ease excessive worrying

 Anger has different sources  Some individuals/groups will express their fear through anger  Anger is a common response to helplessness and feeling out of control  Some anger may be “legitimate”, e.g. a rational response to poor communication, unequal access to resources, etc.

 Diffuse the anger through listening  “Understand first, seek to be understood later”  Differentiate between anger and aggression  Tolerate and empathize with anger (up to a point...)  Set immediate limits on aggression  Recognize anger is often a way of setting up a false “us/them” dichotomy  Emphasize solidarity – “we are all in this together”  Redirect/channel strong emotions into productive activity that promotes group cohesion  “What can we do together to help one another?”

 The pandemic influenza crisis may result in multiple losses, of various types, and at various phases:  Economic/financial  Sense of predictability/routine  Loss of mobility/freedom to travel  Health and sense of safety  General loss of feeling in control  Separation from friends/family  During later/more severe stages: Death of loved ones (death of children particularly devastating issue in pandemics)

 Empathize and validate the experience  Encourage seeking support from family, friends and coworkers  Support spiritual/religious beliefs and rituals  Provide adequate time off from duties for bereavement  Recognize the unique nature of loss in a pandemic crisis (e.g., issues of contagion,, sustained periods of uncertainty, alterations in burial rituals)

 Fear  Anxiety/Worry  Anger  Loss/Separation Social support reduces feelings of uncertainty, enhances positive coping

 Illness and death among colleagues and family members  Fear of contagion/transmitting the illness to family members  Shock, numbness, confusion, disbelief  Concern about children and family  Constant stress to continue work performance  Concern about receiving vaccines or retroviral drugs before or after others

 Psychosocial adjustment of staff can be impeded by:  Lack of information  Rumors or misconceptions  Loss of trust in institutions and leaders  Belief that medical resources are unavailable or are unfairly distributed  Increased stress, particularly sleep deprivation  Restrictions on civil liberties that are perceived to be disproportionate to the level of risk  Infection control procedures that severely limit personal contact or hinder communication

 Psychosocial adjustment of staff can be facilitated by:  An environment that emphasizes collective efficacy and enhanced team support  Adequate preparation  Opportunity to participate in decision making as appropriate  Workforce resilience programmes that support well-being

 Critical staff may be frustrated, tired, worried, distressed and irritable when they return home  Increased workloads may make regular communication difficult  Family members may experience mixed emotions (pride, guilt, fear, etc)  Family members will experience stress of increased responsibilities at home

Provide for physical and psychological safety Safety Encourage individual and collective efficacy Support Emphasize active participation in decision making Structure

Protect Direct Connect Minimize exposure to additional stressors – maintain healthy habits Focus efforts on positive and adaptive coping – healthy behaviors Emphasize social support and connection

 Maintain your regular routine as much as possible (sleep, exercise, diet, etc.)  Balance physical and mental activities  Alleviate anxiety by focusing on constructive activities that you can accomplish  Limit media exposure  Rely on your spiritual beliefs that can nurture you through the challenges

 It is impossible to prepare for everything  Concern for family and friends must be addressed  Communicate, communicate, communicate  Resiliency can be learned and enhanced  Self-care plans and peer support are essential  The primary goal of the organization when in crisis is to protect its staff members

 Two-pronged approach: 1) Organizational Factors  Work shifts and recovery periods  Maintaining a climate of safety  Support for unfamiliar roles 2) Support Services for Staff

 Monitor workforce needs for stress management and health care  Provide leadership, supervisory and management training  Improve perceptions of collective efficacy (i.e., ability to handle problems as a team)  Promote integrated health, safety and security culture (hardiness, resilience)  Implement continuity of information and communication systems  Ensure continuity of essential operations (organizational resilience)

Resilience facilitates recovery

 General information for all UN staff  Staff emergency site, such as information regarding building closures HOTLINE: UNINFO1 OR

Staff Counsellor’s Office Room S