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close this bookMental Health Services in Disasters: Manual for Humanitarian Workers (PAHO; 2000; 92 pages) [ES]
View the documentPreface
View the documentObjectives
View the documentIntroduction
open this folder and view contentsChapter 1: Historical Overview and Mental Health Role
open this folder and view contentsChapter 2: Basic Mental Health Content
open this folder and view contentsChapter 3: Developmental Stages of Survivor Behavior
open this folder and view contentsChapter 4: Post-disaster Intervention Programs
close this folderChapter 5: Populations with Special Needs
View the documentChildren
View the documentElderly Populations
View the documentPersons with Mental Illness
View the documentPersons with HIV/AIDS infection
View the documentPersons With Substance Abuse Problems
View the documentPost-disaster workers
View the documentMental Health Services in Disasters: Manual for Humanitarian Workers
 

Post-disaster workers

Disasters bring together emergency service workers from diverse backgrounds. Some arrive immediately with clear responsibility and priority assignments. Others arrive with different levels of previous experience and skills and different assigned post-disaster jobs. All emergency workers attempt to be helpful and proceed to rescue the wounded, gather the dead, and use triage methods to determine the priority of intervention. They work long hours with little thought to food or sleep. This group of workers represents a challenge for planning and operationalizing a program of post-disaster intervention.

Each type of post-disaster worker works within different organizations that interrelate within the common goal of disaster assistance. After individuals are recruited to a site to help, there is little opportunity to identify or work out a good fit between worker and assignment. This situation generally produces role conflict, ambiguity, and discomfort. Workers generally have multiple functions. They often attend to diverse, and at times, conflicting, needs of survivors.

The mental health worker should focus on the emotional impact of these stressors on disaster workers, as well as their reactions, behavior, and feelings, as a guide for selecting the best methods of helping them do their jobs. These reactions can range from good coping and growth to pathological and chronic sequelae that leave a dysfunctional individual and persist for months after the worker has returned to his/ her home and previous job.

BURN-OUT

"Burn-out" is the term used to describe the many aspects of the occupational stress experienced by disaster workers. Most disaster workers are not taught to look for, identify, and address their own physical and emotional needs. They often do not acknowledge that their needs are normal in these very abnormal situations. They often fail to understand that, unless they meet their needs continually, they will not be able to function in a supportive, consistent, and sensitive manner.

The following factors have been identified as barriers to the use of preventive methods to diminish burn-out:

 

• High professional standards and high self-expectations;

• Reluctance or discomfort in discussing feelings for fear of showing weakness and doubt about performance;

• Denial or suppression of feelings during difficult situations in order to function;

• Discomfort in acknowledging and discussing feelings as soon as they emerge;

• Fear that acknowledging the need for help will reflect negatively on job performance evaluation and opportunities for promotion;

• Difficulties in judging one's own reactions and performance when overwhelmed and distressed;

• Shame over the contrast between one's personal situation and that of survivors.

Various approaches are available to disaster planners and program directors to prevent burn-out and assist disaster workers. These methods help workers acquire techniques and skills for coping with stress. The need for exercise, diet, relaxation, and recreation is now recognized in employment conditions.

"Debriefing" focuses on the cognitive and emotional reactions of workers who are trying to cope with novel internal sensations that accumulate from their painful experiences. These debriefing interventions are done in small groups, with specific objectives and confidentiality boundaries.

The structure of the debriefing includes the following sequence of processes:

 

• Description of the workers' activities in interacting with survivors;
• Identification and recognition of paradoxical and unusual emotional reactions of workers;
• Recognition of ambivalent feelings in some situations;
• Linkage of feelings to disturbance of sleep and appetite, impulse control, and irritability.

The mental health "leader" summarizes the discussion, answers questions, and reinforces the message that the emergency workers' responses are normal reactions to abnormal situations. A critical incident session is generally conducted with individuals who have participated in extremely traumatic situations and are experiencing signs of psychophysiological stress. The session is confidential and nonjudgmental.

Conditions Present in Occupational Stress

• Time pressures
• Work overload
• Minimal positive reinforcement
• High probability of conflict
• Prolonged expenditure of energy and attention to survivors
• Coincidental incidents of crisis involving several survivors at the same time
• Personal crisis in the life of the post-disaster worker

READING LIST

American Academy of Pediatrics Work Group on Disasters. Psychosocial issues for children for children and families in disasters. Washington, D.C.: U.S. Department of Health and Human Services; 1995. (DHHS Publication No. (SMA) 95-3022).

Burke JD, Borus JF, Burns BJ et al. Some factors in the emotional reaction of children to disaster. American Journal of Psychiatry 1982; 139:1010-1014.

Cohen R, Culp C, Genser S. Human problems in major disasters: a training curriculum for emergency medical personnel. Washington, D.C.; Government Printing Office; 1987. (DHHS Publication No. (ADM) 87-1505).

Cohen RE. Intervention program for children. In: Lystad M (ed.). Mental health for mass emergencies: theory and practice. New York: Brunner/Mazel; 1988: pp. 262-283.

Cohen RE, Poulshock S. The elderly in the aftermath of a disaster. Gerontologist 1975; 15:357-361.

Duckworth DH. Psychological problems arising from disaster work. Stress Medicine 1986; 2:315-323.

Dyregov A. Caring for helpers in disaster situations: psychological debriefing. Disaster Management 1989; 2: 25-30.

Eth S. Responding to disaster: a guide for mental health professionals, clinical response to traumatized children. Washington, D.C.: American Psychiatric Press, Inc.; 1992: pp. 101-123.

Faber NIL, Gorton N. Manual for child health workers in major disaster. Rockville, Maryland: National Institute of Mental Health; 1986. (DHHS Publication No. (ADM) 86-1070).

Hartsough DM, Myers DG. Disaster work and mental health: prevention and control of stress among workers. Rockville, Maryland: National Institute of Mental Health; 1985. (DHHS Pub No (ADM) 85-1422).

Kenardy JA, Webster RA, Lewing TJ, Carr VJ, Hazell PL, Carter GL. Stress debriefing and patterns of recovery following a natural disaster. Journal of Traumatic Stress 1996; 9:37-49.

Kilinanek T, Drabek T. Assessing long-term impacts of a natural disaster: a focus on the elderly. The Gerontologist 1979; 19(6):555-566.

Klingman A, Koenigsfeld E, Markman D. Art activity with children following disaster. Arts Psychotherapy 1987; 14:153-166.

Krause N. Exploring the impact of a natural disaster on the health and psychological well-being of older adults. Journal of Human Stress 1987; 13(2): 61-69.

McFarlane AC. Post-traumatic phenomena in a longitudinal study of children following a natural disaster. Journal of the American Academy of Child and Adolescent Psychiatry 1987; 26:764-769.

Mitchell JT. Helping the helper. In: Lystad M (ed.).: Role stressors and supports far emergency workers. Washington, D.C.: Government Printing Office; 1984: pp. 105-118. (DHHS Publication No. (ADM) 85-1908).

Mitchell JT. Too much help too fast. Life Net 1995; 5:3-4.

Mitchell JT. When disaster strikes: the critical incident stress debriefing. Journal of Emergency Medical Services 1983; 8:36-39.

National Institute of Mental Health. Preventive and control of stress among workers: a pamphlet for workers. Rockville, Maryland: NIMH; 1987. (DHHS Publication No. (ADM) 87-1496).

National Institute of Mental Health. Responding to the needs of people with serious and persistent mental illness in times of major disaster. Rockville, Maryland: NIMH; 1996. (DHHS Pub. No. (ADM) 96-3077).

Phifer JF, Kaniasty KZ, Norris FH. The impact of natural disaster on the health of older adults: a multiwave prospective study. Journal of Health and Social Behavior 1988; 29:65-78.

Shalev AY. Debriefing following traumatic exposure. In: Ursano RJ, McCaughey BC, Fullerton CS (eds.). Individual and community responses to trauma and disaster: the structure of human chaos. Cambridge: Cambridge University Press; 1996: pp. 201-219.

Talbot A. The importance of parallel process in debriefing crisis counsellors. Journal of Traumatic Stress 1990;3: 265-278.

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