Disasters, whether natural or man-made, are random events creating devastation that cannot be controlled. Natural disasters like earthquakes, hurricanes, tornadoes, flooding, or volcano eruptions destroy lives, homes, and communities. For centuries, the primary response to disaster has been to assist survivors to recover the basic needs of clothing, shelter, food, and water while reorganizing the crumbled remains of their lives. Over the past twenty years, increasing awareness, understanding, and recognition of the emotional toll of disasters have led to the emergence of a mental health response for survivors. Recognizing the emotional and psychological impact of a disaster, mental health workers have developed approaches and procedures to help survivors and emergency relief workers recognize the signs of trauma and assist in the recovery from the catastrophic impact.
While each disaster has unique characteristics, the universal human response to catastrophic change and loss allows for the development of information and training that can be applied worldwide. This manual has therefore been written to allow disaster workers to serve survivors in different regions of the world, taking into consideration differences in culture, language, traditions, religions, and public/private systems of organized response.
The content of this manual is the result of 20 years of field experience by many groups of workers who have helped disaster survivors in North American and Latin American countries. The information has been developed through amalgamation and identification of key content areas used in disaster programs, including the Red Cross program. It is the summation of research, observations, and on-site assistance in the aftermath of catastrophes in many parts of the world. Although the bibliography is mainly published in the U.S., worldwide literature on disasters can be obtained through the World Health Organization.
The manual is designed as a basic compendium of current knowledge, which will be supplemented with an accompanying Training Guide paralleling each chapter of the Manual for Workers. The Training Guide will be available to trainers whose responsibility is to prepare disaster assistance teams. The trainer who will train workers may develop further training resources by adding exercises, scripts and vignettes for role-playing, and reports of personal experiences in disasters in their own regions.
Key Issues in Disaster Mental Health
Goals in helping survivors:
• To increase understanding of stress so as to mitigate its effect;
• To minimize the impact of trauma by increasing coping strategies;
• To develop and improve communication and problem-solving skills in order to obtain concrete types of help;
• To restore social coping and functioning within rapidly changing systems of disaster relief resources;
• To support relationships with other survivors and staff of agencies providing health care, housing, and economic assistance;
• To work with community agencies so as to facilitate linkages between community resources and the needs of survivors;
• To continue to foster coping skills and adaptation to post-disaster changes in the community so that survivors will be able to carry on and respond normally to an abnormal traumatic event and to the changes in their lives;
The term survivor in this guide refers to individuals and families who have suffered from a disaster and its consequences. Disaster survivors have experienced an unexpected and stressful event that has impaired their ability to cope. Disaster survivors include persons of all ages, socioeconomic classes, and racial or ethnic groups because catastrophes affect the entire population in an impacted area.
Even though survivors may exhibit symptoms of physical or psychological stress, these symptoms should not be viewed as indications of psychopathology, but as signs that they are attempting to cope with unusual demands. Some survivors may suffer more than others, depending on several interrelated factors such as chronic illness or recent losses.
Survivors who may be particularly susceptible to physical and psychological reactions from a disaster include people who are:
• vulnerable as a result of previous traumatic life events;
• at risk due to recent ill health or chronic conditions;
• experiencing severe stress and loss due to the disaster;
• lacking in coping skills; and
• without social and psychological support.
Elderly individuals may find it especially difficult to cope with a disaster and its consequences. It is not unusual to find older survivors who live alone and are isolated from their support systems. As a result, they are often afraid to seek help. Typical post-disaster problems with this group include a feeling of depression, a sense of hopelessness, and a lack of interest in rebuilding their lives.
Children are also a special group because they usually do not have the capacity to understand and rationalize what has happened. Consequently, they may experience emotional or behavioral problems at home or school, including fears, sleep disturbance, loss of interest in school, and disruptive behavior, all as normal reactions to the abnormal situation.
Individuals with a history of mental illness may also require special attention. Under the stress of a disaster situation, coping difficulties often occur in this population due to the additional stress or difficulties in obtaining regular medication.
Individuals who were experiencing certain life crises at the time of the disaster may also require special assistance. This group might include people who have recently been widowed or divorced and those who have recently undergone major surgery. These survivors may display a special vulnerability to the stress generated by a natural disaster and loss of coping capacity.
The aim of disaster mental health training is to provide disaster counselors of different disciplines (nursing, social work, paraprofessionals) with the information they need to solve the problems they will face. Because disaster mental health assistance addresses problems from the broad context of social, economic, and community development, advice from many different disciplines is required, including community demography, social systems, behavioral sciences, governmental disaster policy and management, clinical medicine, and psychology. Each of these disciplines has developed specialized approaches to post-disaster intervention programs.
Although the methodologies of post-disaster assistance can be applied to different regions of a country, the procedures and approaches to the problems will differ because of differences in cultural, social, economic, and political realities. It is expected that the content of this manual will be adapted and tailored to different world regions in such a way as to fit the realities of the population served.
ORGANIZATION OF THE MANUAL
The manual is divided into five chapters. Each chapter consists of a fundamental body of knowledge which sequentially enlarges the capacity of the disaster worker to participate in emergency and post-disaster assistance programs in unison with all other governmental agencies. The workers using the manual can choose the number and combinations of chapters to read according to the task that they will face, which in turn will be determined by their assignments. Each chapter includes the following parts:
1. Learning Objectives: Identifies the knowledge, skills, and attitudes that the worker will acquire.
2. Content: Each chapter has been written incorporating material that will support the guidelines for assisting survivors. The intention is to provide enough material so that workers can select what they need to adapt their prior knowledge to the requirements of post-disaster assistance tasks.
3. Reading List: The articles have been selected to further enhance workers' knowledge, but they do not represent a complete bibliography on each subject. Additional information on topics of special interest can be obtained through a computer search or from the Documentation Center of the Pan American Health Organization, Apartado Postal 3745-1000, San José, Costa Rica, telephone: 506-296-32-52, fax: 506-231-59-73.