1. Introduction to Mental Health Preparedness For local health department staff and community volunteers Developed by the North Carolina Center for Public Health Preparedness

2. This program IS intended to… Make you aware that there are mental health consequences to disasters Expose you to the common normal reactions that survivors have to disasters Help you to anticipate these normal reactions of survivors Show you what you can do to assist survivors immediately following a disaster

3. Introduction to Disasters and Normal Responses

5. Consequences of disasters 1. Physical -- destruction, injury and death 2. Mental Health – various forms of stress are common 3. More mental health injuries than physical injuries 4.Mental health of community before disaster will determine how resilient after disaster 5.Disaster mental health services are vital component of planning and response

6. Implications for public health Potential for high ratio of mental health casualties Immediate mental health services delivered by non-mental health personnel With specialized training, public health workers and volunteers can provide basic crisis intervention

7. Definition of a disaster A disaster is an occurrence such as: – Hurricane, tornado, flood, earthquake – Explosion, hazardous material accident – War, fire, famine or epidemic A disaster causes human suffering creates collective human need requires outside assistance to alleviate

8. Traumatic Events Natural Disasters Technological disasters Disasters of human intention Other interpersonal violence Sudden traumatic loss

9. Post-Traumatic Stress Disorder (PTSD) ¾ of the US population will be exposed to some event in their lifetime that meets the stressor criteria for post-traumatic stress disorder

10. Defining Traumatic Stress Traumatic stress refers to the emotional, cognitive, behavioral and physiological experiences of individuals who are exposed to, or who witness, events that overwhelm their coping and problem solving abilities. Lerner & Shelton, 2001

11. Typical disaster response patterns Cognitive 1. Distractibility 2. Duration, sequence, distortion 3. Declining school work performance 4. Recurrent intrusive recollections 5. Flashbacks, nightmares

12. Typical disaster response patterns Behavioral 1. Clinging, isolation 2. Thrill seeking behaviors 3. Re-enactments of the trauma 4. Increased substance abuse 5. Hyper-vigilance 6. Elevated startle reflex

13. Typical disaster response patterns Physical 1. Shock symptoms 2. Insomnia 3. Loss of appetite 4. Headaches 5. Muscle weakness 6. Elevated vital signs

14. Typical disaster response patterns Affective 1. Depression, anxiety 2. Numbness 3. Constricted affect 4. Guilt, shame, fear 5. Intolerance of fear response 6. Global pessimism

15. Psychological Reactions to disasters ---- First phases Threat Warning Impact

16. Psychological Reactions to disasters ---- Next phases Heroic Honeymoon Inventory

17. Psychological Reactions to disasters ---- Final phases Disillusionment Reconstruction Recovery

18. Resistance, Resilience, Recovery Resistance – defend against manifestations of distress, impairment or dysfunction Resilience – Rebound rapidly & effectively from psychological distress Recovery – regain the ability to function adaptively in the wake of distress, impairment or dysfunction

19. Healthy coping skills Ability to orient oneself rapidly Planning and execution of decisive action Appropriate use of assistance resources Tolerance of uncertainty without resorting to impulsive action Appropriate expression of painful emotions

20. Unhealthy coping skills Excessive denial and avoidance Impulsive behavior Over-dependence Inability to evoke caring feelings from others Emotional suppression Substance abuse

21. Cultural factors influence disaster reactions and coping skills National origin Customs and traditions Length of residency Language Age and generation Gender Religious and Political beliefs Perceptions of family & community Health, well-being, disability, physical ability or limitations Socio-economic status Education level Geographic location

22. Mental Health Preparedness Action Steps

23. Essential attributes and skills you bring to assist survivors Good listening skills Patience Caring attitude Trustworthiness Being approachable and culturally sensitive Non-judgmental Flexible and tolerant of chaos

24. Psychological First Aid (PFA) Approach for assisting people in immediate aftermath of disaster Designed to reduce the initial distress for children, adolescents, adults, and families Begins immediately following the disaster

25. Psychological First Aid – Core Principles Contact and engagement Safety and comfort Stabilization Information gathering Practical assistance Connection with social supports Information on coping Linkage with collaborative services

26. Psychological First Aid for first responders – what you can do Promote: 1. Safety 2. Calm 3. Connectedness 4. Self-efficacy 5. Help

27. Psychological First Aid for first responders What you should NOT do : Force people to share their stories with you Give simple reassurances like Everything will be OK Tell people why you think they have suffered Make promises that can not be kept Criticize existing services or relief efforts in front of people in need of these services

28. Managing intense emotions Communicate calmly Communicate warmth Establish a relationship Use concrete questions to help person focus Come to agreement about something Speak to person with respect Seek immediate assistance if person becomes threatening or does not respond

29. Making referrals Referral is the act of recommending that a person speak to a professional who is more competent to handle the difficulties and complexities of his/her needs Refer in consultation with your supervisor or the person who is in charge

30. Making referrals Person hints or talks openly about suicide If there is possibility of child abuse or any criminal activity Person seems to be socially isolated Person has imaginary ideas or feelings of persecution Problem is beyond your training or capabilities Person engages in risky or threatening behavior Recognize that people who talk about suicide are the ones who ultimately commit suicide Take all threats seriously and refer in consultation with your supervisor or the person in charge

31. Confidentiality Helping a person builds on trust and respect All discussions are confidential and private Personal information should not be discussed without consent ** Exception: In extreme emergency when judged person will harm self or others.

32. Additional Resources John Hopkins Center for Public Health Preparedness –www.jhsph.edu/preparedness Substance Abuse and Mental Health Services Administration (SAMHSA) –www.samhsa.gov Psychological First Aid Field Operations Guide, National Center for PTSD –www.ptsd.va.gov