1. Mental Health Preparedness

2. 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

3. 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

4. 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.

5. 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.

6. During A Crisis What Do People Feel? Wide range of emotions Fear Anxiety Anger Hopelessness Helplessness

7. What About Panic? Vast majority of people Do not panic in times of crisis Do not act unreasonably Do not engage in extreme behavior

8. What Do We Know About Stress Reactions? Impacted by loss of control Impacted by unpredictability Can lead to experience/reaction called “learned helplessness”

9. Stress Is Evaluated By: Perceived danger/threat value Irrelevant/harmless? Threat/challenge? Coping mechanisms available Cognitive Behavior Neurophysiological Emotional

10. Why Do People Respond Differently to Stress? Family/Genetic Influences History of physical/psychological conditions Personality and temperament Cultural background Gender

11. Why Do People Respond Differently to Stress? Past Experiences – “wisdom” Learned coping patterns Previous exposure to similar stress Lifestyle patterns

12. 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?

13. 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

14. 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

15. 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

16. 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

17. 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

18. Directed Mental Health Interventions A. Seriously injured victims and bereaved family members B. Victims with high exposure to trauma, victims evacuated from disaster area

19. 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

20. 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

21. Priority Setting In Crisis Counseling E. Government officials, groups that identify with target victims group, businesses with financial impact F. Community at large

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

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

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

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

32. 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”

33. 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

34. 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

35. Key Ideas Normal reactions to an abnormal event Reactions include cognitive, behavioral, psychological

36. Examples of Critical Incidents Line of duty death Serious line of duty injury Suicide of co-worker Disasters Law enforcement shooting

37. CIS Interventions Demobilizations Defusings Debriefings One-on-One meetings

38. Self-care and Stress Management Prior to assignment Personal Preparedness Team and Organizational Preparedness Safety of Family Members Social and Organizational Support

39. 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

40. 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

41. 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