Disaster consultation and education is one of the newest, most challenging areas of activity for mental health workers. New strategies and tactics are being developed, novel approaches are emerging, and innovative methods are being tested. In post-disaster situations, the objective of disaster consultation is to increase the capacity of the emergency worker to assist survivors and work with multiple post-disaster agencies.
The primary objective of this modality is to educate the staff of disaster emergency assistance agencies so that they can incorporate knowledge and understanding of mental health issues into the task of assisting survivors. Mental health consultants must have background knowledge of both psychosocial theories and disaster assistance procedures to accomplish this objective.
Education is used by workers who are in close contact with the public media or have an opportunity to educate groups in their community. Consultation is used by experienced workers who assist the public and private emergency relief agencies helping the survivors. Crisis counseling training, which is operationally driven, necessitates practical role-playing and continuing supervision once the workers begin to interact with the survivors. Intervention approaches need to be adapted to the cultural characteristics of survivors and the time lapse post-impact.
Some of the typical problems in post-disaster consultation with emergency relief agencies are:
• Difficulty obtaining material and human resources;
• Bureaucratic responsibilities, regulations, methodology of multiple agencies;
• Lack of a recognized plan for interagency coordination;
• Different points of view and objectives;
• Power struggles and "turf wars";
• Interdisciplinary communication.
After a disaster, when large numbers of individuals have been rescued and grouped in a safe physical setting, a spontaneous, transitional, shifting community evolves. A network of disaster assistance agencies develops, composed of lay, religious, volunteer, and official government rescue personnel. The main goal of this network is to provide physical comfort, treat bodily injuries, and ultimately proceed to help reorganize the lives of affected citizens.
The following factors affect the success of a mental health consultant working within this network of assistance workers:
• The degree to which the consultant's role is sanctioned by the emergency network linking the assistance agencies;
• The knowledge, attitudes, and skills of the consultant;
• The quality and quantity of information available to the consultant.
CONCEPTUAL MODEL AND THEORY
With the assistance of a conceptual model to support and guide the intervention, a mental health consultant can better help in integrating psychological theories and post-disaster relief operations. The lack of such a conceptual model is one of the factors that most often leads to failure in consultation programs.
The post-disaster mental health specialist must conceptualize his/her own behavior as the mobilization of a set of forces that will, in turn, be affected by the system itself. In this case, the system is composed of all the members of the disaster assistance agencies. Acting as a collaborator, the consultant can initiate a dynamic interaction with the disaster agency staff. This dynamic interaction is an essential part of the ongoing planning process that results in the strategies for approaching disaster assistance work.
Although the mental health consultant and the disaster agency emergency staff come from different professional backgrounds, they must join their efforts and combine expertise, skills, and energy toward a common goal. Certain areas of theoretical knowledge from these professional backgrounds have proven useful in other intervention activities:
• Concepts of organization and administration for post-disaster relief programs;
• Crisis intervention and assistance;
• Principles and practices of consultation;
• Principles and practices of education.
From these broad areas of social psychology and disaster assistance operations, a philosophical framework can be developed for intervention, consultation, and education in disaster programs.
The following guidelines are basic to the development of this model. Awareness of these guidelines will help the mental health consultant organize intervention strategies that address the physical, biological, and/or psychosocial needs of the survivors:
• All the consultant's activities must be directed toward developing practical procedures that will be useful to the agency member who will participate as the recipient, as well as to the survivor who will be the focus of the services.
• The consultant must be aware of the traditional and cultural practices and the accepted modes of behavior in the disaster assistance setting; resulting approaches should reflect this understanding.
• All consultation and education must be directed at specific, immediate problems and/or behavior difficulties that concern the emergency relief worker. However, potential opportunities to participate in long-range and broader planning for the agency should not be overlooked.
• The development of professional relationships should be continuously pursued at every level of organization to identify individuals who can help solve problems. However, the consultant must remain sensitive to confidentiality and the detrimental effects that a breach of trust might have on the mental health role. Sharing of data or a casual mention of something learned from the emergency relief worker has been one of the most common sources of failure for mental health activities.
• Data should be obtained, organized, and analyzed during all activities, and a continuous feedback system should be developed to share with workers and help keep the consultant focused on the objectives. A consultant can easily lose sight of the specific objectives verbally agreed upon during interagency planning meetings.
• The mental health consultant must also be aware of the resources that are available to the emergency relief workers, both individually and as a group. The consultant can then modify patterns of disaster assistance to select and support appropriate mental health approaches for crisis resolution and disaster assistance problem-solving.
• The principle of consulting and educating is based on needs identified by the emergency workers. As the scene changes, consultant and worker must reassess the worker's disaster assistance services and reconsider objectives. The emergency worker's task will change as the survivors' needs change. The mental health consultant who has current information about how the environment is changing will be best equipped to help workers evaluate their services.
• Evaluation and an organized system of data exchange will supply more than just information; it will provide the mental health consultant a broader view of the assistance effort and greater flexibility for intervention, whether through consultation techniques or educational approaches.
• The consultant must always recognize that the assistance framework exists within the context of a changing social community. There will always be gaps in even the most current reports. Interventions must focus on operations that will mobilize both the system and the individuals interacting within the disaster assistance activities. The consultant can choose either a consultation method or suggest an educational intervention.
A mental health consultant in the temporary shelter or other disaster unit is not only an independent professional who responds to the needs of survivors. The consultant also assists numerous emergency relief agency staff in identifying problems and determining the best assistance procedures for traumatized individuals. To accomplish this, the consultant must articulate a plan of intervention that is harmonious with all the other efforts of the disaster assistance agencies.
Key components of an intervention plan include:
Knowledge: Conceptual knowledge of disasters, disaster behavior, and intervention approaches that is obtained prior to a catastrophe.
Information: Determination of the degree of loss suffered by the community, based on media sources, on-site surveys, and visits to places where survivors are sheltered. It is also essential to collect information that will offer a cultural appreciation of the disaster's effects.
Assessment: An assessment of how the emergency assistance agencies have organized themselves into a network and prioritized survivor needs to enable rapid identification of the cultural influences of the community and the psychological influences affecting both survivors and caregivers.
PROBLEMS THAT MAY ARISE DURING CONSULTATION
Problems can and do arise for mental health consultants involved in disaster program intervention. The following are examples:
Variance in Professional Training
There is often a variance in value systems, backgrounds, and training between professionals involved in post-disaster activities. The disaster agency staff's lack of familiarity with mental health methodology creates a unique problem and one which compounds the overall unfamiliarity with disaster assistance procedures. This schism between the agency staff and the mental health consultant may result in serious communication barriers.
Successful collaboration and integration of different objectives and techniques into disaster assistance will depend on how well the consultant and the relief workers can focus on the simultaneous goals of contributing to survivors' coping abilities and helping them reconstruct and reorganize their lives. This can be achieved by increasing the mental health knowledge and skills of relief workers.
Degree of Responsibility for Problem-solving
The mental health consultant must ascertain the degree of problem-solving responsibility that appears to be appropriate, based on the task at hand and the amount of professional resources and skills available. The consultant can either choose to offer expertise upon request but not become involved on an ongoing basis, or the consultant can decide to participate more actively, assuming long-range collaboration functions during all the phases of disaster assistance and interacting on many levels.
Coordination of Interventions
Procedural logistics and schedule misalignment can further complicate the coordination of interventions. In a disaster situation, where time is a critical factor, the time that a relief worker spends with a mental health consultant competes with the intense demands from survivors for the worker's time and services. This competition produces a tension of its own, although the difficulties decrease with time as both workers find methods of saving time and energy.
TYPES OF CONSULTATION
Two types of consultation are most often seen in post-disaster situations:
Case Consultation (survivor-centered)
The primary task of case consultation is to develop a plan that will help a specific survivor who is having difficulties of an unusual nature. In some cases, the mental health consultant will personally investigate the survivor's psychological and social needs. The emergency agency workers will collaborate further on the case through subsequent discussions with the mental health consultant.
Survivor-centered case consultation is the type of consultation most often needed in a disaster program. The consultant advises the agency workers about the nature of the difficulties and suggests what can be done to alleviate them.
Usually, the emergency worker will present the case material to the consultant. Sometimes, the mental health professional will meet with the survivor, reach a diagnostic impression, and offer a recommendation to the emergency program worker. The program worker translates appropriate aspects of the recommendation into a plan of action that will be feasible in the disaster assistance setting.
The following is an example of a survivor-centered case consultation:
A Red Cross nurse working in the shelter asked for assistance to deal with a woman who was unable to make decisions. The woman had been offered several options for relocation, but kept changing her mind and could not decide whether to leave the shelter. This woman had been in a previous disaster and suffered some property losses. Reflecting on the past interfered with her decisions to choose options. The mental health consultant instructed the nurse about the effect of anxiety and past memories on the woman's emotions. Subsequently, the nurse decided that she would first need to spend some time helping the woman sort out her fears so the woman could understand that this relocation would not be a repetition of her previous experience. After she calmed the woman about this fear, the nurse was able to proceed with the development of housing plans.
A second type of consultation focuses on the design and/or modification of relocation programs and administrative procedures for the purpose of prevention, early diagnosis and treatment, and rehabilitation of disaster-related psychological disturbance. The kinds of problems that the consultant will be called on to address for this type of consultation include:
• program planning;
• administrative organization;
• methods of multi-service delivery;
• recruitment, training, and use of disaster relief staff; and
• establishment of linkages with other services.
The recipient of the administrative-centered consultation may be an emergency agency administrator, a group of program directors from the Red Cross, or a committee such as a task force of government officials. The mental health consultant's focus would be the program in question.
The following is an example of a administrative-centered case consultation:
After a devastating ocean storm that damaged numerous homes, survivors were housed in a large motel, where families of three or four members were assigned to one room. Fixed amounts of money were approved for meals in the motel dining room. One of the most severe problems was the lack of good communication channels between the disaster assistance agencies, the staff of the motel, and the families. The manifestation of the difficulties appeared in the behavior of the adolescents who had no means of getting around. Sporadic acts of vandalism, theft, and raucous behavior aggravated the tense relations between the motel administrators and the survivor population. Some women began to exhibit signs and symptoms of depression, insomnia, irritability, and hostility. They also made unrealistic demands of the service staff. Mental health consultants were dispatched to the motel as part of a team. After spending several days meeting with every group and obtaining the information necessary to analyze and understand the complexities of the problem, it became evident that the agency staff lacked the knowledge to understand and handle the daily problems of the group. A mental health consultant met with the agency's administrator and discussed the human dimension of the problem. To address the "burn-out syndrome of the workers, the administration changed procedures and began to rotate staff so that there could be a "rest and relaxation" component to the staff operations schedule. The consultant contributed both knowledge and help with attitudes to remedy this identified need.
EDUCATION AND COLLABORATION
The mental health consultant assists other agency staff in reorganizing and reconstructing the lives of disaster survivors, as well as promoting the incorporation of mental health components in communities devastated by disaster. These components should be designed to ensure the early detection and prompt treatment of survivors who suffer psychological consequences of the calamity.
Mental health professionals will be best equipped for their role as consultants and will increase their potential as a crucial link in the disaster assistance network if the support model is based on integrated application of disaster assistance principles and theories of psychosocial behavior.
The consultant has an opportunity to carry out educational activities every time there is a request for assistance in disaster relief operations. All collaborative activities in post-disaster relief operations have an educational aspect that the consultant can address to help relief workers with the problems they are encountering, and relief workers can benefit from this assistance, which enhances their personal repertoire of skills and reduces areas of misunderstanding.
It is this educational aspect of collaboration that makes it an important survivor resettlement method. The goal is to spread the consultant's mental health knowledge to the many agencies that will continue working with survivors' resettlement across the changing developmental stages of post-disaster behavior.
To be effective in helping workers deal with the problems of a survivor, the mental health consultant needs to define, set limits, and design specific boundaries with the maximum educational carryover, given the realities of the crisis climate, time constraints, shift of personnel, and rapid changes of policy in disaster assistance programs. A direct, precise, well-defined educational component will therefore be more practical and effective than the slower, methodical, and repetitive conditions needed for the process of changing the attitudes, stereotypes, and prejudices of relief workers. The targets for such educational activities are government disaster relief agencies and their staffs, as well as the community at large and civic, social, and political groups in the area of human service.
EDUCATION FOR THE RELIEF WORKER
To implement educational activities, mental health consultants must have skills in community organization, verbal and written communications, crisis intervention, and supervision. Perhaps the most needed skill is that of teacher - i.e., the ability to impart to others the knowledge, methods, or confidence for understanding disaster behavior and the needs of survivors.
To accomplish the training objectives, mental health consultants must design short- and long-term programs for professionals and nonprofessionals. In the immediate aftermath of a catastrophe, both mental health and emergency relief workers require quick, flexible orientation immediately following the disaster. Later on, a planned effort to provide continued training and support for the emergency program's professional and nonprofessional staff must be devised. Training content will vary depending on the experience, the specific needs, and educational background of the relief and mental health workers.
The primary training need is the acquisition of knowledge and understanding of how survivors react after a disaster. By reviewing the time phases of a disaster (pre-impact, impact and post-impact), the types of physical and emotional problems survivors may be expected to suffer at each phase can be examined. Training in the concepts of stress, loss, and mourning; social and emotional support; and coping and adaptation are crucial in overcoming disaster-related problems.
Public education must begin immediately after the disaster strikes and should continue until the project terminates. The emphasis of the effort will vary over time. The purpose of a public education campaign associated with a disaster assistance program is to:
• gain widespread support for the program;
• reconstruct the community;
• anticipate changes in emotions and behavior as normal reactions to the consequences of the disaster;
• publicize services for survivors; and
• report to the community on activities and progress.
Community approval and support are necessary for the effective planning and implementation of programs for disaster survivors. Also, when a program begins, the dissemination of information about the program's activities and location of services is essential. This type of publicity may take several forms. It may educate the public and the survivors about the fact that physical and emotional discomfort following a calamity is a normal reaction to stress. If there is a need for help, survivors may seek assistance from the programs by calling and asking for help.