From the Massachusetts Nurse Newsletter
March 2007 Edition
The goal of this article is to assist local public health officials in promoting emotional resilience in their own towns or cities and to plan for the needs of specialized populations. It serves a brief guidance to 1) introduce the topic of emotional resilience; 2) frame the issues; and 3) give some "quick tips" on how public health can begin the process and include disaster behavioral health elements into local planning initiatives.
Building emotional resilience among residents is one of the recommended goals for municipalities when designing emergency plans and conducting preparedness. In the field of psychology, the term resilience is used to describe how people cope with stress and catastrophe. When used in the context of disasters, it describes how people can learn to mitigate the emotional impact. It is understood that every person who experiences a trauma or traumatic incident during his or her lifetime is affected by it. Research has shown that persons impacted by trauma have what are considered normal reactions to experiencing the incident. In order to diminish the long-term effects or lessen the severity of impact on community members, providing incident-appropriate crisis counseling, psychological first aid or mental health and substance abuse assessments are an important service resource for emergency response.
Evidence informed work with individuals and communities that experience trauma show that normal reactions to trauma are such things as:
- Increased levels of anxiety and worry
- Heightened levels of fear and helplessness
- Shattered or reduced sense of safety
- Feelings of outrage and anger
- Physical symptoms when re-triggered by memories of the incident such as sweating, nausea and sleeplessness
- Feelings of sadness and grief
- Loss in belief of importance of life or religious beliefs
- Feelings of relief and guilt about surviving the incident, especially when others did not (SAMHSA)
Work with those affected by a disaster— survivors, family members, response workers and community members among others—shows that if the emotional effects are not mitigated, there is a risk people may experience a reduction in overall functioning. Affected individuals may experience reduced ability or inability to go back to work or school, suffer mental disorders (namely depression, anxiety disorders and PTSD), shattered or disrupted relationships or have difficulty rebuilding their lives. If communities prepare for, and make promoting resilience a component of emergency planning, they can have positive outcomes in assisting citizens in returning to normalcy faster and with less risk of developing emotional difficulties as a result of experiencing the trauma of a disaster incident.
Affected community members become their own population with special needs as a direct result of being part of the incident and will need individualized services. Local public health departments are tasked with determining what emotional support services are needed as part of a response to abate the adverse affects. Local public health, in collaboration with mental health experts, substance abuse and human service providers, can work to do the following:
- Provide educational opportunities: Educate community members prior to an incident about the affects of trauma and ways they can protect themselves by becoming resilient. Some recommended preventative measures are to create personal and family emergency plans, practice on-going self-care and stress management techniques, and become involved in community emergency preparedness initiatives at the local level.
- Build response capabilities: Local public health should determine what mental health, substance abuse and crisis counseling services are already available in the community for a response, pre-incident.
- Plan: Participate in planning efforts to care for populations with specialized needs during disasters and determine which would be most vulnerable.
- Survey: Determine who in the community will most likely need specialized services to assist them with their unique circum stances (i.e., learn the make-up of your population). The reason that public health should develop a community-wide special population approach as part of preparedness and planning initiatives is to conduct a pre-incident assessment to mitigate risk. It is not easy to pre-determine which people, pre-incident, will need behavioral health services. This is because no method has been discovered which can accurately assess which people will need help. It is difficult to do this because it is nearly impossible to determine how all the variables of a particular disaster will affect each unique member of a community, although we can make some educated guesses.
It has often not proved accurate to inappropriately assume which persons or groups may need help post-disaster. Some affected individuals show amazing resilience against all expectations, while others may not. Such variation speaks to the importance of teaching methods of resilience across the community and ensuring outreach to populations, which may be most at risk.
Members of specialized populations can be individuals with pre-existing mental disorders, substance abuse, the deaf and hard of hearing, or the disabled. Working with populations with specialized needs can be particularly challenging, but is an initiative that needs to be addressed. The work is challenging because existing research does not prove members of the traditionally categorized special populations do better or worse than citizens not assigned into these classification groups. Some data indicates that members of special populations, who have support systems in place, do better than individuals with no prior history of trauma or pre-existing condition. With this said, specific work can be done on the local level to generally prepare existing population groups in the community to build their resilience.
In terms of an overall public response, one strategy that can be developed for the community is a protocol for providing disaster behavioral health services door-to-door if members are sheltering in place. At the local level, a way to start this process and determine what might work best is to review which groups or individuals living in the community that are most at risk and vulnerable. These might be people identified as lacking adequate support systems, whose resources are already stressed, or have prior histories of trauma, emotional illness, substance abuse, or other disabling circumstances. In order to prepare for an emergency to create effective plans, local public health should not only collaborate with other providers of services and local emergency management, but should consider how to incorporate these groups with potential specialized needs in building resilience. Another key part of planning is to include members of populations with special needs into the planning process to solicit their input, including people with psychiatric disabilities.
Recognizing that all disasters are local, public health officials and their partners can work to develop strategies for populations who may need specialized services and to implement overall resilience education for the community. A multi-phase plan that includes working with both the general public as well as specialized populations serves to inoculate and build the resistance of the entire community. Providing educational material, including information that has already been pre-developed (MassSupport: www.mass/gov/mhsa or Substance Abuse and Mental Health Services Administration: http://mentalhealth.samhsa.gov/disasterrelief) to community mental health centers, doctors offices, and to school systems is another way to assist in building resilience. Training sessions on psychological first aid could be offered at community venues as well. Lastly, local public health can assist by ensuring a planning elements for providing disaster behavioral health services* are incorporated into your city or town’s overall all-hazards emergency plan.
A well-developed system does not need to be overly complex to be effective. The key to fostering resilience and a robust disaster behavioral health response is to engage in pre-planning, creating relationships with your existing service infrastructure and raise the level of knowledge the community has about emergency response and its emotional impact. It is also helpful to enlist your partners at the local, state and federal level who can assist you in the process. The goal of promoting emotional resilience is to build communities who are better prepared for emergency incidents and their traumatic impact.
*Disaster behavioral health is used in Massachusetts to describe the collaboration by mental health and substance abuse specialists to provide effective services during and post-incident.
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