Mental Health Consequences of Disaster events

1. Mental Health Consequences of Disaster events By Dr. Mathew. P. Zachariah PhD Consultant Clinical Psychologist LASUCOM / LASUTH

2. Basic learning points Psychology of trauma & stress

3. Traumas

5. trauma scenarios • Traumas can be: • Primarily physical – with psychological reactions: • survivors of accidents. • Primarily psychological – but having physical impact: (Weakening of immune system) • bereavement. • Both physical and psychological. • kidnapping • Rape. • trauma – bereavement combination (double trauma) in accidents; victims of terrorist attacks.

6. Context of traumas • A trauma is a wound. • It is not a disease. • If the wound is not healed, it can become an illness. • Depending on the intensity of the wound, the impact of the trauma (physical but more often psychological) may last a short time • More often than not, it may last a long time.

7. Impact of trauma(Short Term) • Shock • Confusion • Helplessness • Anxiety • depression

8. Impact(medium / long term) • Ptsd. • Repeated reliving in memory of event. • Intrusive thoughts. • Reduced responsiveness. • Detachment from others. • Constriction of emotional expression. • Decreased interest.

9. Event is more traumatic when… • Event is unexpected • Many people die, especially children • Event lasts a long time • The cause is unknown • Event is poignant or meaningful • Event impacts a large area

10. Psychological toll • Shattering of basic assumptions. • Belief in personal invulnerability. • Perception of world of world as meaningful and comprehensible. • View of self in positive light.

11. The experience of trauma

12. Chinua Achebe

13. Stress Stress is: • Normal • Productive or destructive • Acute or chronic • Cumulative over time • Preventable • Manageable

14. Life is inherently stressful

15. Stressors • Events or situations that produce physical or psychological reactions • Stressors can be: • Real or imagined • Internal or external • Absolute or perceived

16. The Stress Response • Physical – Body Reactions • Emotional – Feelings • Cognitive – Thinking and decision making • Behavioral – Actions • Spiritual – Beliefs and values

17. Common Physical Reactions to Traumatic Stress in Adults • Elevated heart rate • Elevated blood pressure • Elevated blood sugar • Stomach upset, nausea • Gastrointestinal problems (diarrhea, cramps) • Sleep difficulties • With extended stress, suppression of immune system functioning

18. Common Physical Reactions to Traumatic Stress in Children • Headaches • Stomachaches • Nausea • Eating problems • Other physical reactions

19. Common Emotional Reactions to Traumatic Stress in Adults • Fear and anxiety • Sadness and depression • Anger and irritability • Feeling numb, withdrawn, or disconnected • Feeling a lack of involvement or enjoyment in favorite activities • Feeling a sense of emptiness or hopelessness about the future

20. Common Emotional Reactions to Traumatic Stress in Children • Anxiety, fear, vulnerability • Fear of reoccurrence • Fear of being left alone • Especially if separated from family during event • May seem like an exaggerated reaction to adults • Loss of “Sense of Safety” • Depression • Anger • Guilt

21. Common Cognitive Reactions to Traumatic Stress in Adults • Difficulty concentrating • Difficulty with memory • Intrusive memories • Recurring dreams or nightmares • Flashbacks • Difficulty communicating • Difficulty following complicated instructions

22. Common Behavioral Reactions to Traumatic Stress in Adults • Family challenges (physical, emotional abuse) • Substance abuse • Being overprotective of family • Keeping excessively busy • Isolating self from others • Being very alert at times, startling easily • Problems getting to sleep or staying asleep • Avoiding places, activities, or people that bring back memories

23. Common Behavioral Reactions to Traumatic Stress in Children • “Childish” or regressive behavior • May not be deliberate acting out • Bedtime problems • Sleep onset insomnia • Midnight awakening • Fear of dark • Fear of event reoccurrence during night

24. Common Reactions to Traumatic Stress – Faith & Spirituality in Adults & Children • Reliance upon faith • Questioning values and beliefs • Loss of meaning • Directing anger toward God • Cynicism

25. The Trauma Process(Adapted from Hans Selye’s GAS model of stress) Resistance (2) • Coping failure (3) • Progression to disease condition • Alarm (1) • Changes characteristic of initial exposure to trauma coping process (counseling, symptom treatment)

26. What is a Disaster? A disaster is an occurrence that causes human suffering or creates human needs that the victim cannot alleviate without assistance. All Disasters Begin Locally.Get Prepared Locally!

27. What is a Critical Incident? A natural or man-made event or situation that has the potential to temporarily overwhelm the ability to maintain psychosocial equilibrium.

28. Physical symptoms (shaking, headaches, fatigue, loss of appetite, aches & pains) Anxiety, fear Weeping, grief and sadness Guilt, shame (for having survived, or for not saving others) Elation for having survived Being on guard, jumpy Anger, irritability Immobile, withdrawn Disoriented - not knowing one’s name, where one is from or what happened. Not responding to others, not speaking at all Feeling confused, emotionally numb, feeling unreal or in a daze Unable to care for oneself or one’s children (not eating or drinking, not able to make simple decisions) Distress Reactions to Crisis

29. ACTION PLAN PSYCHOLOGICAL FIRST AID

30. Psychological First-Aid Resources • American Red Cross • American Psychological Association • Centers for Disease Control & Prevention (CDC) • Substance Abuse and Mental Health Services Administration (SAMHSA) • National Institute for Mental Health (NIMH) • Minnesota Department of Health (MDH) • Minnesota Department of Human Services • Minnesota Hospital Association (MHA) • National Center for PTSD, Terrorism & Disaster Branch

31. What PFA Is? • Humane, supportive and practical assistance to fellow human beings who recently suffered exposure to serious stressors, and involves • Non-intrusive, practical care and support • Assessing needs and concerns • Helping people to address basic needs (food, water) • Listening, but not pressuring people to talk • Comforting people and helping them to feel calm • Helping people connect to information, services and social supports • Protecting people from further harm

32. What PFA is NOT? • It is NOT something only professionals can do • It is NOT professional counseling • It is NOT “psychological debriefing” • No detailed discussion of the distressing event • It is NOT asking people to analyze what happened or put time and events in order • Although PFA involves being available to listen to people’s stories, it is NOT pressuring people to tell you their feelings or reactions to an event

33. Examples: The place of PFA in overall mental health and psychosocial response Mental health care by mental health specialists (psychiatric nurse, psychologist, psychiatrist etc) Specialised services Basic mental health care by PHC doctors Basic emotional and practical support by community workers (Psychological First Aid) Focused (person-to-person) non-specialised supports Activating social networks Communal traditional supports Supportive child-friendly spaces Community and family supports Strengthening community and family supports Advocacy for basic services that are safe, socially appropriate and protect dignity Basic services and security Social considerations in basic services and security

34. PFA: For Whom? • Very distressed people who were recently exposed to a serious stressful event. • Can be provided to adults and children • Not everyone who experiences a crisis event will need or want PFA. • Don’t force help on those who don’t want it, but make yourself available and easily accessible to those who may want support

35. People with serious life-threatening injuries People so upset they cannot care for themselves or their children People who may hurt themselves People who may hurt or endager the lives of others Who needs more advanced support than PFA alone?

36. PFA: When? Upon first contact with very distressed people, usually immediately following an event, or sometimes a few days or weeks after.

37. PFA: Where? • Wherever it is safe enough for you to be there. • Ideally with some privacy, as appropriate to preserve confidentiality and dignity

38. Frequent Needs of People After Crisis Event • Basic needs: shelter, food, water, sanitation • Health services for injuries or help with chronic medical conditions • Understandable and correct information about event, loved ones and available services • Being able to contact loved ones • Access to specific support related to one’s culture or religion • Being consulted and involved in important decisions

39. Crisis situations can be chaotic • Often require urgent action Wherever possible BEFORE you enter a crisis site, try to obtain accurate information so you can be safe and effective.

40. Wherever possible, before you enter a crisis site, try to learn about…

41. PFA Action Principles Prepare ------------------- Look Listen Link

42. PFA Action Principles

43. Group 1 Learning Points (natural disaster) • Readiness: consider your health and personal situation • Gather as much accurate information as you can about: who is affected, how severely affected, where they are • Work in pairs/teams for support/safety • Your agency may be able to provide you with: equipment, updated information, support with coordination

44. Group 1 Learning Points (naturaldisaster) • Safety issues: fallen or unstable buildings • Services (i.e., emergency medical) may be disrupted • Look for seriously injured or trapped people • Look for people who are upset, anxious or in shock • Look for people who may need special assistance: separated children, immobile/elderly

45. Crisis situations can change rapidly. • What you encounter may be different from what you learned before entering. • Take time - even a quick scan - to LOOK around you before offering help Be calm Be safe Think before you act

47. People who Likely Need Special Attention (to be safe…to access services) • Children and adolescents • Especially those separated from caregivers • People with health conditions and disabilities • Chronic illness, elderly, pregnant or nursing women, non-mobile, hearing/visual impairments (deaf/blind) • People at risk of discrimination or violence • Women, certain ethnic or religious groups, mental disabilities

50. Help People Feel Calm • Keep your tone of voice soft and calm • Maintain some eye contact • Reassure them they are safe and that you are there to help • If someone feels “unreal”, help them make contact with: • Themselves (feel feet on the floor, tap hands on lap) • Their surroundings (notice things around them) • Their breath (focus on breath & breathe slowly)