How do health care professionals contribute to community disaster preparedness?
Based on a very helpful set of principles of preparedness, we offer the following specific ways in which health care professionals might contribute to mental health community planning for disasters in ways that will allow you to respond personally and also be able to do your important work in your communities. Some of this information is based on a document prepared by the American Association of Pediatrics that you may want to consult in its entirety.
- Educate yourself about the mental health components of disasters as they relate to health care using the resources of your professional organization along with this website.
- Bring your perspectives to a disaster mental health plan (PDF) through consideration of:
- Community Demographic Characteristics
- Who are the most vulnerable people in the community? Where do they live? What are their specific health care needs?
- What kinds of families live in the community (i.e. single-parent households)?
- How could individuals be identified and reached in a disaster?
- Are policies and procedures in place to collect, maintain, and review current demographic data for any area that might be affected by a disaster?
- Cultural Groups
- What cultural groups (ethnic, racial, and religious) live in the community?
- Where do they live, and what are their special needs?
- What are their values, beliefs, and primary languages as they relate to health care and to mental health disaster preparedness?
- Who is knowledgeable about the culture or is an informal leader in the community?
- Socioeconomic Factors
- Are there recognizable socioeconomic groups with special needs?
- How many live in rental property? How many own their own homes?
- Does the community have any special economic considerations that might affect people’s vulnerability to disaster and their health care needs?
- Mental Health Resources
- What mental health service providers serve the community?
- What skills and services does each provider offer?
- What gaps, including lack of cultural competence, might affect disaster services?
- How could the community’s mental health resources be used in response to different types of disasters?
- What is the relationship between the health care and the mental health care communities?
- Non-governmental Organizations’ Roles in a Disaster
- What are the roles of the American Red Cross (ARC), interfaith organizations, and other disaster relief organizations?
- What resources do non-government agencies offer, and how can local mental health services be integrated into their efforts?
- What mutual aid agreements exist?
- How can mental health providers collaborate with private disaster relief efforts?
- Community Partnerships
- What resources and support would community and cultural/ethnic groups provide during or following a disaster?
- Do the groups hold pre-existing mutual aid agreements with any state or county agencies?
- Who are the key informants/gatekeepers of the impacted community?
- Has a directory of cultural resource groups, potential volunteers, and community informants who have knowledge about diverse groups been developed?
- Are the community partners involved in all phases of disaster preparedness, response, and recovery operations?
- Emphasize the health care implications of disasters in your contribution to preparedness. Although this may seem obvious, bringing to the public some specific health care perspectives (PDF) is an essential contribution to mental health.
Remember that in many disasters the obvious victims are only the tip of the iceberg: - The Impact Pyramid
- Individual victims
- Family and social networks
- Rescue worked, medical care providers, their families, and social networks
- Vulnerable populations and impacted businesses
- Ordinary people and their communities
- Help disaster preparedness and planning groups tailor disaster planning to the local risk situation. Hurricanes and tornadoes and floods (PDF) for example, are far more likely in Georgia than are earthquakes.
- Collaborate with other professionals working in the mental health field, such as social workers, psychologists, and especially schools.
- Emphasize the psychosocial implications of disasters (PDF) in your planning, as systems of health care delivery are often disrupted in the event of a disaster. Make yourself available to community and school boards and as a guest speaker, taking advantage of disaster-specific lecture materials (PDF) to lend your perspectives on the health care components of preparedness.
- Volunteer through your professional organization or through the Red Cross (PDF) to enhance your familiarity with disaster preparedness and your contribution to community planning.
Web Links
Joint Commission Planning Guide
Nursing Disaster Preparedness (PDF)
Coping and disaster recovery for the health care professional
During the recovery phase following the disaster, both you and your patients will continue to experience stress, grief, and perhaps even some symptoms of depression and anxiety (PDF). During this recovery phase, physical problems such as changes in sleep and appetite, digestive problems, more susceptibility to colds or other illnesses, and increased use of alcohol and other drugs are also common. We may also have emotional responses, such as fear, irritability, nightmares, difficulties concentrating, feelings of betrayal, and loss of interest in everyday activities.
What can you do to cope, and to facilitate patient coping, in your journey toward recovery from disaster? Here are some helpful suggestions:
- Use grounding, a technique designed to keep your experience in the “here and now” and remind you that you are alive and present to life. Teach patients this technique as well.
- Take time every day to focus on your breathing (PDF) as a calming and centering strategy. You can educate patients about the contribution of conscious breathing to wellness, and demonstrate this in your work as well.
- Experiment with watching your thoughts to identify those that may be catastrophic or lead to feelings of hopelessness and helplessness. A healthy outlook on life, for both you and your patients, makes resiliency and recovery more achievable.
- Challenge negative beliefs. Replace such thoughts as, "I always have bad luck...nothing will better from now on...everything is going wrong," with, "Is there any real reason to think that...maybe things will change for the better?"
- Adjust self-talk. Convert negative messages into positive ones. For example, replace "I’ll never get through this," with "I can do this, but it’s normal and okay to feel scared and overwhelmed."
- Use previous ordeals that have been successfully overcome as a "power base."
- Consider alternative outcomes for worst-case scenarios. For example, "I can still see my friends, I can enjoy the little things in life."
- Imagine how this event will be viewed in the future, remembering how things do change over time.
Some patients will be resistant to these strategies and perceive you as suggesting that their struggles are “all in their heads.” Educating them with some easily understood techniques and examples will tend to diminish this perception.
- Learn to manage anxiety (PDF) through such strategies as guided imagery and relaxation (PDF). Include information about anxiety and its management in your office literature and handouts.
- Teach your patients about the need for support systems or groups (PDF) to reach out and connect with others, especially those who may have shared the stressful event. Consider affiliating with the a disaster-specific subgroup such as these for physicians, chiropractic (PDF), physical therapists (PDF), and nurses.
- Use empathic listening (PDF) in your interactions with patients around disaster. Also, seek out in your circle of friends, family, and spiritual community those who will listen empathically to you.
- Teach patients the need for emotional expression (PDF), and practice this yourself. “Getting things out” helps.
- Exercise (PDF) can contribute to greater well-being following disaster. Teach patients this principle (PDF) and help them to develop an appropriate exercise plan. Practice it yourself.
- Use prayer, meditation, or other spiritual practices, which are common and helpful coping strategies.
- Understand that your service to others (PDF), even in the midst of your own response to the disaster, can help you cope with your struggles in a kinder and clearer way.
- Use creativity (PDF) to fill your life with “food for your soul.”
- Take planned breaks such as going to the movies or doing some light reading to remind yourself that you are recovering and that you are well.
- Maintain relationships with your pets to give and be given coping gifts.
- Nourish yourself through healthy eating and drinking, and avoid self-medication, alcohol, or other drugs.
- Write about (PDF) your experience in detail, just for yourself or to share with others.
Remember that people who engage fully in recovery from disaster discover unexpected benefits. As they gradually heal their wounds, survivors and health care providers alike find that they are also developing inner strength, compassion for others, increasing self-awareness, and -- often the most surprising -- a greater ability to experience joy and serenity than ever before.
Web Links
Stress Management for Patient and Physician (PDF)
Returning home from a disaster assignment
Disaster work can be a unique and very rewarding experience as disaster response workers feel part of a family and all work toward a common goal. There is a sense of adventure as we face the unique problems of each disaster setting, a sense of shared pride as we ease the suffering of survivors, and a sense of personal satisfaction in our ability to help.
But we also experience things that most people -- including our families, friends, and co-workers -- could not begin to understand or appreciate, things far apart in time and space and power from our everyday lives. One of my practicum students spoke of an “airlock” between the hospital entrance and the psychiatric inpatient ward, in which he experienced the distance between that space and the space in which he ordinarily lived, both going into and coming out of that space. Here are some suggestions, excerpted and elaborated from this document (PDF), on how to ease the airlock transition from the disaster place to your home place.
Return is a Process, not an Event: I think in my own work about the process of atmospheric reentry (PDF): too direct an approach to returning home and you burn up, too indirect and you bounce off. Try to get it just right. Be patient with yourself.
Rest: Often, you may not get enough rest while working on a disaster, and when you return home you will feel exhausted. It may take several days to catch up, and both family members and employers need to understand that you need time to yourself before beginning a full schedule of normal activities.
Pace: On a disaster relief operation, you perform your job as fast as possible to provide the greatest amount of assistance in the shortest possible time. It may take time to return to the more relaxed pace of your co-workers and family members.
Sharing: You will want to talk to family members and co-workers about your experiences, and they will be eager to tell you about theirs. What you were doing may seem much more exciting and significant, but remember that their experiences are as important to them as yours are to you. If they seem to accuse you of being away when the washer overflowed, or the kids threw up, it’s only their way of saying, “We missed you.”
Emotions: When you return home, some feelings or emotional swings associated with disaster-related stress may surprise or frighten you. If you anticipate some of these emotions, you can manage them better.
Disappointment: You may find that others are not interested in hearing about your experiences, or that your reunion with your family and co-workers does not live up to your expectations. You may expect they will be happy to have you home and be surprised to find they are angry at your absence. Anticipating this response will help you in managing it better as well.
Frustration and conflict: Your needs may not match those of family or colleagues. Although you may want nothing more than a good home-cooked meal, your family may be looking forward to going out to eat.
Anger: Problems presented by your family, friends, or co-workers may seem very trivial compared to those facing the disaster victims you just left. Try to remember that the folks at home feel that their problems are just as important to them right now. Appreciate how your own anger and grief.
Survivor identification: The actions or characteristics of people at home may remind you of your experience with disaster victims. You may experience emotional reactions that can surprise and confuse not only you, but also them. Patiently try to help others understand the reasons behind your reactions.
Daydreaming: This is a part of response to trauma, and is healthy dissociation (PDF) and part of your own response to trauma. You may find yourself wishing you could return to the disaster you just left, or be sent out again right away. Remember you are more important to the folks at home than you can imagine; they just express their appreciation differently.
Mood swings: These are normal after returning home, as they are one of the ways to resolve conflicting feelings you have experienced on the operation. You may change from happy to sad, tense to relaxed, or outgoing to quiet without much warning. When you have time to put your disaster work into perspective, they will pass.
Children: It can be hard to explain to children why you must be away. If you tell them why you are leaving, and call home while you are away, it will help calm their fears. When you return home, try not to frighten them with stories about what you have seen and done. Tell them about the disaster in a way that is appropriate to their level of development, and involve them in preparedness efforts for your family. This will help them feel as if they are part of what you have been doing and reduce their fears about similar disasters at home.
Your participation in disaster relief work is a gift to the world. Practicing self-care and developing resiliency during the process of your return will allow you to continue giving your gifts.
Web Links
Adjusting to life after relief work
National Consensus Statement on Mental Health Recovery
Our approach to mental health recovery is consistent with the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration (SAMHSA) which has developed the following guidelines:
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
The 10 Fundamental Components of Recovery
Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.
Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.
Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.
Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.
Non-Linear: Recovery is not a step-bystep process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.
Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). Th e process of recovery moves forward through interaction with others in supportive, trust-based relationships.
Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.
Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.
Hope: Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefi ts individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefi ts of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.
Resources
www.samhsa.gov
National Mental Health Information Center
1-800-789-2647, 1-866-889-2647 (TDD)
Original Link