POST-DISASTER
INTERVENTION PROGRAM
R.E.Cohen MD
The most severe blizzard to strike the
Before
it ended, the storm set state records for most snow accumulation in a 24 hour
period at 23 inches. The snow raised the
area’s total seasonal snowfall to 68.5 inches, the most in 30 years. It also was identified as the 10th
worst disaster in U.S history.
The
storm lasted 33½ hours, during which wind gusts of 69 miles per hour were
recorded in
The
disaster killed 28 individuals and caused over 2,250 injuries and over 450
hospitalizations statewide as a direct result of the blizzard. Over 2000 homes were destroyed, while 35,000
homes were damaged which required over 30,000 individuals to be evacuated from
their neighborhoods. On the highways,
over 3,000 cars were stranded and a large number of individuals were trapped in
their cars for over 36 hours. Shelters
were used by as many as 20,000 individuals who were fed and cared for over the
next several weeks.
Mental Health professionals employed by the
The
Red Cross also was present and was aware of the mental health needs of
survivors, which facilitated the triage methods we put into practice. The physical setting had been divided into
different areas of group activity, for example living quarters for families,
quiet areas for adult relaxation, administrative areas for resource allocations,
and settings for medical assistance. The
National Guard and State/local officials, who rapidly mobilized many resources
to assist the families who had lost their homes and needed transitional
shelters, directed these shelters.
The
types of problems for which the mental health professionals were called to
assist by the emergency caregivers ranged from problems of uncontrollable
crying, emotional/functional maladaptive behavior, fear
of miscarriage, drug/alcohol withdrawal symptoms and former mental patients who
had no access to their medication. As
documented by emergency health professionals, two major areas of support were
crucial to assist them in helping their patients: 1) specialized professionals who could
directly take over the medical problems that had strong emotional and deviant
behavior components; and 2) their awareness that they could not be saddled with
having to take responsibility for problems they could not handle and which demanded
a large amount of time to solve. The use
of time and energy within the first-aid model was the single most useful
cooperation appreciated by the 2 groups - medical and Red Cross. The flow of individuals from the “living”
settings to the specialized “health-mental health” setting was the operative
structure. Professionals from the three
units moved through each others’ units and worked with the survivors in the
shelter. If any member of the groups
identified a need for further service, they would escort the individual to the
area where the needed services were “housed”.
Many first-aid interventions were given sitting on a cot or even on the
floor of the high school gym. This
fluid, rapid, and
effective approach allowed the staff to work in a task-focus
manner including additional volunteers that joined us a few days later.
It
was evident that during the assistance activities provided by a small number of
multidisciplinary professionals aiming to service a large population, the ratio
of individuals to survivor needs was imbalanced.
At
the present time little is known of the time and number of mental health
professionals needed to assist large number of survivors of a catastrophic
disaster. This important component needs
to be researched so as to develop planning operations and be able to set up
rapid mobilization ready to assist the survivors. One of the most valuable lessons from this
experience was that development of previous relations the professionals
involved in the disaster allowed us to mobilize ourselves at the same time as
the State Emergency Assistance personnel.
We were able to demonstrate our usefulness and ability to assist
survivors in many areas of maladaptive coping and painful expressions of “normal reactions to abnormal circumstances”.
This perception of the non-mental health workers who relied on our expertise remained for the duration of the post-disaster phases of the recuperation and reconstruction periods.
The rapid deployment and entry by mental health workers into the shelter setting started without a prior organizational plan or logistics appraisal to develop a division of tasks.
As
the immensity of demands for different activities emerged, there was a need to allot
the scheduling of time and staff so as to have continuous attendance by mental
health personnel. Decisions had to be
made to plan prospectively for use of resources in parallel with the emergency
assistance agencies’ planning structures.
Issues of 1)
logistics; 2) amount of hours/staff; 3) communication links with government
liaison staff; 4) dealing with the media; and 5) determining volunteers’ certification
credentials used many hours to administer.
The
first week could be described as a “first aid mental health intervention”, with
the immediate objective to orient, offer support and try to return survivors to
a semblance of self-organized and coping behavior capability. The survivors had to adapt to new routines,
lack of privacy, and spartan settings while living in
the stressful environment of shared intimacy during daily activities with
hundreds of other stressed survivors.
Planning
for continuing mental health assistance had to anticipate the change of shelter
living organizational programs of the government. The “shelters” closed within a couple of
weeks and individuals were moved to hotels and motels while others found places
with friends and relatives. Parallel to
the availability of living in the shelters, the survivors were able to go to
the Federal Disaster Centers (FEMA) being organized to systematically assist
the distressed and weary populations to offer and rapidly process physical and
economic resources. Within this federal
setting the mental health-crisis counseling intervention made its official
appearance. This assistance was
sanctioned by the Disaster Relief Act Amendment of 1974, Section 413 (Pl
93-288) that states “the President is authorized (through NIMH) to provide
professional counseling services, including financial assistance to state or
local agencies or private mental health organizations. They will provide such services or training
for disaster workers to victims of major disasters in order to relieve mental
health problems caused or aggravated by such major disasters or their aftermath.”
The funding for mental health counseling was granted to the state after a grant
documenting needs and the appropriate budget was submitted to the funding
agencies. This generally meant that for six
weeks the manpower needed to assist immediately the survivors had to be
obtained from the state budget.
Due
to the above facts, the professionals that manned the program during the first three
weeks were all state employees and other volunteers who suspended their usual
full time jobs and moved into the disaster area. The professionals divided
their responsibilities within different settings, setting their priorities and
choosing assignments to meet selected objectives. One group manned the
The
activity was reported as being helpful to the operations and objectives of both
groups by all workers. Another of our
activities was to offer consultation and assistance to all the federal and
state emergency staff that manned the many tables and desks. We had the ability to notice or single out
individuals who appeared distressed, approach them while they were waiting to
be assisted, and informally ascertain their interest in talking to us simply by
asking “how are you feeling”?
We
also developed an educational program by presenting to different groups of workers
the type of knowledge that would help them relate to survivors. We tried to assist and inform the emergency
workers to understand the dynamics of the survivor’s situation and efforts to
cope with the tragic outcome of their loss. We underscored the need to develop
a supportive, empathetic, but not paternalistic, approach while at the same
time paying attention to the workers’ own fatigue, sadness and
over-identification with the survivor’s plight,
Several
weeks post-disaster, the survivors were moved from the shelters into motels and
hotels. In this setting we became aware
that the survivors needed recreational/occupational activities. They seemed to have too many unoccupied hours
and the adolescent population was getting into mischievous problems. Many of them were exhibiting high levels of
stress and frustration manifested by acting out behavior and uncontrollable
out-bursts of emotion with little provocation.
As we looked further into what was fueling these emotions, we realized
we had thought housing them in a comfortable hotel setting would be appropriate,
not realizing that the hotel staff was unable to deal with the needs of this
displaced traumatized multi-generational population. Offering consultation to
the federal planners who were responsible for housing programs ameliorated this
situation.
We
organized meetings with the hotel management who needed constant support due to
the fact that this was a novel and difficult situation.
It
became aggravated by minor destructive activities of adolescent survivors and
complaints presented by anxious and irritated adults. Constant and varied
activities to support these disparate groups thrown together by fate were
helpful in ameliorating the suffering of the survivors, and was a
challenging experience for our team.
Our
concern for the child population led us to develop support groups for children
and their parents. The objectives of the
children’s programs were to develop a preventive structure to organize
activities that would give the children a sense of security and constructive
discharge of energy. Because of the road
conditions following the disaster, the hotels were isolated and it was
extremely difficult to transport individuals out of the hotels. Occasionally, we could rent buses to take the
children to program activities using public pools, gyms, and recreational
settings. A team of educators was
brought to the hotels and they were very helpful in developing both
recreational and educational programs during the daytime. Offering them regular counseling sessions
plus medical or psychological help assisted the parents. The sheltering and
housing needs for individuals who have lost their homes can either benefit or
obstruct emotional recovery depending on how it is handled.
In two
of the hotels where our program and services for intervention were put rapidly
into operations, the close collaboration with the Red Cross and the teams
assisting the physical, recreational and practical needs continued to show
alliance benefits.
Agencies
started making plans to close their operations within a few weeks after the
blizzard. This necessitated a shift in the planning of the mental health
assistance format. Families began to find more permanent housing or were able
to obtain vouchers for rent. The
·
Screening and diagnostic services
·
Crisis counseling
·
Further outreach approaches to find survivors
·
Consultation to non-mental service agencies
·
Training caregivers
·
Education and information to the public
We
believe that the “volunteer” experience in the first month allowed us to focus
on the specific needs of the survivors and permitted us to select the best
services for this population. The factors that allowed for a rapid
collaboration included prior joint work in community programs, the availability
of capable professionals and students in the