1. Disaster Behavioral Health
Implications for Community and Migrant Health Care Centers

2. Taking the Next Step in Emergency Preparedness

3. Randal Beaton, PhD, EMT
Research Professor Schools of Nursing and Public Health and Community Medicine
Faculty Northwest Center for Public Health Practice University of Washington

4. “You can observe a lot by watching”*
*Berra, 1998

5. NMDS drill (May 13, 2004)

6. Aims of Disaster Behavioral Health
To prevent maladaptive psychological and behavioral reactions of disaster victims and rescue workers (to promote resilience)
and/or
To minimize the counterproductive effects maladaptive reactions might have on the disaster response and recovery

7. Objectives:
To identify the Psychosocial Phases of a Disaster with implications for Community and Migrant Health Centers
To analyze the psychological, social and behavioral patterns observed in the aftermath of disasters including resilience
To identify strategies to promote and preserve resilience in Community and Migrant Health Center patients & staff

8. Questions

9. Psychosocial Phases of a Disaster
Module 1

10. Learning Objective
Identify the psychosocial phases of a community-wide disaster and to describe the behavioral health tasks for Community and Migrant Health Centers associated with each phase

11. Psychosocial Phases of a Disaster*
* From Zunin & Myers (2000)

12. Implications/Tasks of each Phase for Disaster Personnel - Pre-disaster
Warning—e.g., weather forecast
Educate your patients and staff
Inform of hazards and risk
Instruct them in ways to stay safe
Evacuate or “stay put”

13. Pre-Disaster
Risk communication: To reduce anxiety, must also tell people what they should do (without jargon)
Education using multiple media and multiple languages and messengers, e.g., DOH pandemic influenza campaign
Drills and exercises should include mental health component

14. TopOff 2: Seattle, May 2003

15. Impact
Prepare for surge- disaster victims will arrive with minutes/80% will be walk-ins
Advise/instruct/give directions- people will follow leaders and follow instructions (panic is rare)
Risk communication update- as more is known
Leadership- is crucial: based on plan & flexible
Washington state county crisis lines – DSHS/MHD

16. WA State County Crisis Lines (DSHS/MHD)

17. Heroic
Disaster survivors themselves are true “First Responders”

18. Honeymoon (community cohesion)
Survivors may be elated and happy just to be alive
Realize this phase will not last

19. Disillusionment Reality of disaster “hits home”
Provide assistance for the distressed- no currently accepted community standard for disaster mental health care= PFA is new & largely untested
Disaster “issues”
Losses & hardships

20. Working Through Grief (coming to terms)
This is when disaster victims actually begin to need psychotherapy and/or medications (only a small fraction)
Trigger events—reminders
Anniversary reactions—set back

21. Reconstruction (“a new beginning”)
Still, even following recovery, disaster victims may be less able to cope with next disaster

22. What to Say! DO SAY: Can you tell me what happened? I’m sorry.
This must be difficult for you.
I’m here to be with you.

23. What Not to Say! DON’T Say: I know exactly how you feel. Don’t cry.
Don’t feel…
I’m here to help you.
It could have been worse.

24. Temporal Patterns of Behavioral Responses
Module 2

25. Learning Objective
Describe the various temporal patterns of behavioral health outcomes following a disaster

26. Question
What is the most common behavioral health reaction observed in the aftermath of most disasters?
A. An acute reaction of distress followed by recovery
B. The onset and persistence of PTSD
C. Delayed onset PTSD
D. Resilience

27. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster

28. Resilience Differs from recovery Individuals “thrive”
Relatively stable trajectory
Resilience is often seen in a majority of disaster survivors

29. Ways to Promote Community Resilience in the Aftermath of Disaster
Reunite family members
Engage churches and pastoral community
Ask community and migrant health clinic leaders, teachers, and authorities to “reach out”

30. Risk Factors that Deter Resilience
Job loss and economic hardships
Loss of sense of safety
Loss of sense of control
Loss of symbolic or community structure

31. Pre-existing Vulnerability Factors that May Deter Resilience (Risk Factors)
Lack of resources- lower SES
Lack of social support
Current or history of mental disorder
Lack of a sense of community connectedness and community cohesion
Lack of plan; lack of training
Child or geriatric status
Language and cultural barriers
Severity of physical injuries & kin/friend fatalities

32. Temporal Patterns of Mental/Behavioral Responses to Disaster

33. Acute Distress and Recovery
Post-disaster recovery usually occurs within:
Days
Weeks
A few months
Acute distress and recovery (with or without any intervention) is next most common pattern typically observed in 10-30% of disaster survivors

34. Temporal Patterns of Mental/Behavioral Responses to Disaster

35. Chronic Distress
Acute/Chronic Distress and/or Lasting Maladaptive Health Behavior Outcomes
This pattern, while relatively rare (typically 5-15%), accounts for a disproportionate percentage of consumables– counseling, medications and disability

36. Module 2: Temporal Patterns of Mental/Behavioral Responses to Disaster
Delayed Onset Distress

37. Delayed onset distress
This is the least frequent pattern observed; generally seen in less than 10% of disaster survivors (perhaps more common in children)
One study of 9/11 survivors in Manhattan area reported delayed onset PTSD at one year (but not at earlier times) in 5% of study subjects

38. Post trauma Growth
Research suggests that 10% or more of disaster survivors actually experience positive psychosocial changes in the aftermath of a crisis.
(Tedeschi et al., 1998)

39. Module 2: Temporal Patterns of Mental/Behavioral Responses to Distress

40. APA Fact Sheets on Resilience to Help People Cope With Terrorism and Other Disasters

41. Field Manual for Mental Health and Human Service Workers in Major Disasters

42. Summary
The disaster behavioral health needs of a disaster affected community depend on the psychosocial phase of the disaster
Most individuals are resilient and are able to cope with the stressors associated with a disaster
Some individuals and communities are more vulnerable to the negative impacts on disaster behavioral health

43. Summary (continued)
Most short-term psychological and behavioral reactions to disasters are “normal” and do not require a psychological evaluation or treatment
Some acutely distressed individuals may need and benefit from Psychological First Aid
A relatively small number of disaster victims may require long term counseling and medications