Behavioral Health in a Disaster

• 1. Texas Department of State Health Services (DSHS) Disaster Behavioral Health (DBH) Presented By: Behavioral Health In a Disaster

2. Tokyo Sarin Attack

• Ratio of behavioral: medical casualties was 5:1

• Five years post event PTSD was at approximately 14%

3. Hurricane Katrina

• 85% of individuals directly impacted experienced two or more stressors

• PTSD which normally decreases several months after a disaster has increased

4. What do you expect to learn from this overview? 5. OUR GOAL Provide a useful overview of Disaster Behavioral Health in Texas 6. Objectives Participants will be able to:

• Identify the phases of a disaster

• Identify six emotional concepts of a disaster

• Identify common stress reactions

• Identify duties of DMHS

• Identify how DBH fits into response framework

7. Phases of Disaster 1 to 3 Days ------------------- TIME- ------------------------------1 to 3 Years Warning Threat Pre-disaster Heroic Honeymoon (Community Cohesion) (Coming to Terms) Working Through Grief Reconstruction A New Beginning Disillusionment Trigger Events and Anniversary Reactions Impact Inventory Zunin/Meyers 8. Psychological Consequences of a Disaster From IOM publicationPreparing for the Psychological Consequences of Terrorism www.nap.edu NOTE:Indicative only; not to scale Distress Responses 9. What is Disaster Behavioral Health (DBH)

• DBH is a specialized field of mental health expertise

• It is the primary goal of DBH to decrease the stress of an event

• DBH modalities may include Psychological First Aid, Pastoral Care, Substance Abuse services, CISM, Crisis Counseling and, other disaster specific support

10. What is Disaster Behavioral Health (DBH) Cont..

• Community based

• Focus on strengths & coping skills

• Restore functioning

• Confirms reactions are normal

• Focus is educational

11. Department of State Health Services Disaster Behavioral Health Services During a Disaster

• DSHS is responsible for DBH preparedness, response and recovery in Texas

• Preparedness and response are housed in the Community Preparedness Division

• Recovery is housed in the Mental Health/Substance Abuse Division

12. Why Disaster Behavioral Health?

• The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting. The resulting trauma can affect even with those not directly affected by the disaster

13. Emotional Concepts of a Disaster

• No one who sees a disaster is untouched by it

• Everyone experiences stress

• Everyone responds differently to stress

• Stress and grief are normal reactions to trauma

• Reactions often relate to survival and recovery issues

• People do not seek out mental health services

• Support systems are crucial to recovery

14. Normal Reactions to a Disaster

• Trouble concentrating

• Difficulty making decisions

• Preoccupation with the disaster

• Frequent dreams or nightmares

• Increased alcohol/drug use

• Feeling depressed, sad, irritable or angry

• Tiredness or low energy for no reason

• Increase or decrease in appetite

15. Coping with Stress

• Set realistic limits and daily goals

• Seek social support

• Treat yourself

• Eat well; sleep well

• Drink plenty of fluids

• Read for pleasure

• Smile! Use humor

16. Coping with Stress cont..

• Share experiences

• Get back into or establish new daily routines

• Do physical exercise every day

• Children are particularly susceptible to stress and dont know how to tell you. Spendtime each day with your child and reassure them that they are safe(Note: Playtime works for childrenandadults!)

17. Psychological First Aid (PFA)

• Definition

• An approach designed to provide basic comfort and support, to reduce the initial stress caused by traumatic events and to foster short and long term adaptive functioning

18. Psychological First Aid Who?When?Where?

• Used during and immediately after trauma/disaster

• PFA can be used by anyone

• May be used for everyone, adults and children

• May be used anywhere

• Provides immediate emotional and practical support

19. Psychological First Aid Basic Objectives

• Listen

• Help people feel safe

• Offer practical assistance

• Connect to social supports

• Provide information on response, recovery, stress and coping

• Take care of yourself

20. Psychological First Aid Delivery

• • Be visible

• • Maintain confidentiality

• • Operate within your organizational rules of survivor engagement

• • Be calm, courteous, organized and helpful

• • Be sensitive to cultural, ethnic and community concerns

• • Operate within your comfort level

21. Psychological First Aid Behaviors To Avoid

• • Neverpresume to know what the person is experiencing

• • Do not assume that everyone is traumatized

• • Do not label/diagnose or patronize

• • Do not debrief

22. Spiritual Counseling

• Often, amongst first on scene

• Often provides an array of services

• Provides secular and spiritual First Aid and emotional support

23. Why Disaster Spiritual Care?

• 43-50% of people with emotional problems turn first to religious/spiritual leaders for help

• Prayer, faith and spiritual practices are the most widely reported methods for coping with traumatic life events

• 96% of Americans state that they believe in God or a Higher Power

• • Koenig,Spirituality in Patient Care

24. Who me?

• Responders also experience stress.

• Responders often try to justify the warning signs of stress within themselves.

Common expressions: Im fine Dont worry about me, I will be okay I have been doing this for a long time; I can handle anything 25. Job-Related Stressors

• Working long hours

• Staff shortage

• Repeated exposure to traumatic stories

• Exposure to survivors reaction to disaster

• Away from family/friends for extended periods

26. Signs of Burnout

• Loss of concentration at work

• Loss of empathy

• Forgetfulness

• Feeling overwhelmed with job

• Feeling of inadequate reward/recognition

• Desire to seek other employment

27. Responder Self-Care Plan

• Be realistic in job expectations

• Take frequent breaks

• Dont over identify with survivors

• Learn about compassion fatigue

• Meet regularly with others to discuss problems

• Eat well/healthy

• Exercise and relax regularly

• Take time off

28. Critical Incident Stress Management (CISM) CISM is a comprehensive, integrative, multi-component crisis intervention system CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis 29. CISM THE SEVEN CORE COMPONENTS of CISM( Adapted from: Everly and Mitchell, 1997) 30. ELEMENTS OF CISM

• Pre-incident education, preparation

• Assessment

• Strategic Planning

• Large Group Crisis Intervention:

• • Demobilizations (large groups of rescue/ recovery)

• • Respite/Rehab Sectors

• • Crisis Management Briefings(CMB)

31. ELEMENTS OF CISM

• Small Group Crisis Intervention:

• • Defusings (small groups)

• • Small group CMB

• • Debriefing Models :Critical Incident Stress Debriefing (CISD); HERD; NOVA; Multi-stressor debriefing model; CED

• One-on-one crisis intervention, including individual PFA

• Family CISM

• Organizational/ Community intervention, consultation

• Pastoral crisis intervention

• Follow-up and referral for continued care

32. Crisis Counseling Program (CCP)

• Two FEMA funded grants to the State Mental Health authority

• Funds immediate, short-term crisis counseling and support for the emotional recovery of all those impacted by the disaster

• CCP services include outreach, stress management, individual and group crisis counseling, education, and referral

33. CCP continued

• No cost

• Not Diagnostic and no medication

• Targets special populations

• Case management, fund raising, transportation not allowed

34. Work in Progress

• PFA

• DMH Emergency Management Plan

• Building DMH Provider Capacity

35. QUIZ

• Question 1.What does DBH Stand for?

• Disaster Behavioral Health

• Question 2. Consuming alcohol is a healthy way to deal with stress?

• False

• Question 3. How many components does CISM consist of?

• Seven. Pre-crisis preparation, Demobilization, Defusing, Critical Incident

• Stress Debriefing, Individual crisis intervention, Family CISM, and follow-

• up/Referral

• Question 4. Stress and grief are _________ emotional reactions.

• Normal

• Question 5.Who can benefit from Psychological First Aid (PFA)?

• Any and Everyone

36. Contact Information

• Community Preparedness Section

• Public Health Preparedness Unit

• Disaster Behavioral Health Services

• Ed Maldonado - Ext. 6936

• Melva Richardson - Ext. 3093

• 1100 W. 49 thStreet, G-310

• Austin, TX 78756

• Office (512) 458-7111 Fax: (512) 458-7231

• For more complete information and printable brochures, forms, etc

• http://www.dshs.state.tx.us/comprep/dmh/default.shtm

37. Contact Information cont.. Public Health Preparedness Unit CISM (Critical Incident Stress Management) Paul Tabor(512) 458-7111 Ext. 7128 Fax: (512) 458-7472 http://www.dshs.state.tx.us/comprep/cism/default.shtm Crisis Counseling Program North Star & Special InitiativesChance Freeman /Yelena Brodkorb 909 W 45 th Austin, TX 78751 Office (512) 206-5516 Fax: (512) 206-5019