November 1st, 2011

Disaster mental health plays key role in emergencies

Psychologist Ann Raynolds, Psy.D., is a trauma specialist, but she was not prepared for Hurricane Irene’s floodwaters that devastated her corner of Vermont, washing out roads and bridges and inundating her office in Quechee. She lost books, files, equipment and personal items accumulated over a 30-year practice.

“I had to recognize this was quite a displacement, my beautiful office condo, which I owned,” Raynolds says. “It’s kind of a shock to lose things like that. I just had to take a deep breath and ask, `what do we do next?’”

Disasters, whether natural or man-made, might each be different, but the immediate response has characteristic phases, say disaster mental health practitioners. It starts with basic survival and safety needs – food, water, shelter – and continues with a compassionate ear.

“Most disaster mental health is more listening than talking,” says Kathryn Dardeck, Ed.D, chair of the Mass. Disaster Response Network. “We’re a compassionate, non-judgmental presence to give people some breathing room to vent and express what’s going on for them.”

These first steps, known as psychological first aid, can help mitigate debilitating long-term effects from traumatic stress that results from any kind of disaster.

After three days, the water receded enough for Raynolds to deliver food and water to households that were still cut off. She was amazed at how quickly a sense of comradeship and community connection sprung up that she had never seen before. But emergency coordinators were worried about the mental health of the deliverers who were experiencing secondary trauma reactions.

“My mantra for deliverers is just to listen. People are not asking for mental health services, just an agreement to be neighbors and tell them we care about them,” Raynolds says. “When I go out, I can tell we’re serving much more than food.”

Once the immediate danger has passed, disaster mental health responders become victim advocates, helping to assuage the frustration inherent in filling out FEMA applications and insurance claims, getting replacement medications and finding family members.

“There are so many things going on, we keep people from the dysfunction of being overwhelmed,” says Jackson Schonberg, Ed.D., the Disaster Response Network (DRN) coordinator for the Vermont Psychological Association in conjunction with the Red Cross.

In Connecticut, coastal towns were hard hit by the hurricane, says Stephanie Schacher, Psy.D., who practices in Branford, just east of New Haven. Only after people had dealt with the immediate impacts to their lives did the phones start to ring, she says.

“Whatever personal problems and relationship issues you are dealing with, a disaster or crisis intensifies them to the point that whatever coping skills you did have, have been pushed to the edge,” Schacher says. “Disasters can also act to put personal issues in perspective, and thereby reinvigorate personal coping resources.”

Some anxiety or depression just after a disaster, known as the acute stress reaction, is normal, Dardeck says. After about 30 days, it should diminish.

“Even after 30 days, it’s not necessarily PTSD, as long as symptoms continue to diminish,” Dardeck says. “But if they get worse, you might want to seek help via clergy or therapy. Whatever works for you.”

In a disaster, everyone could use some help, even the therapists. Schacher was living and working in New York City in Sept. 2001. After the attack, she and her colleagues noticed they were focused on their clients to the detriment of dealing with their own pain and suffering.

“Clients were talking about what happened, and we were talking about what happened and after a while, it was, ‘whose therapy session is this’?” Schacher says. “Disaster can dissolve the boundary between therapist and client and it can feel confusing.”

Another facet of disaster mental health is animal care. Schonberg says that because shelters don’t typically cater to pets, 30 to 40 percent of people who should go to shelters in an emergency don’t. Thus Disaster Animal Response Teams have sprung up all over the country to provide care and shelter for companion, service and farm animals.

“Most people look at pets as family members,” Schonberg says. “It becomes a significant disaster mental health issue, which became evident during Hurricane Katrina.”

Disaster mental health responders wish the media would be more circumspect. During 9/11, Dardeck knew a seven-year-old who thought more planes were ramming the twin towers each time it was shown on TV. Certainly the news needs to be reported, but 10 years on, television is showing the same thing.

“For a lot of people it’s traumatic, and it’s retraumatizing as it keeps going on,” Dardeck says. “I think there’s tremendous opportunity for the media to play a slightly different role, not just in reporting, but by referring the public to resources and support that most people don’t know about.”

Schonberg says that in an emergency, the media can provoke the “worried well” who despite good intentions, can interfere with a systematic response.

“We tell people to turn off the damn TV,” Schonberg says. “Information is one thing, obsession is another.”

By Nan Shnitzler

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