Disaster and special populations

Disaster and Crisis Mental Disaster and Crisis Mental HealthHealth

Special Populations

Special PopulationsSpecial Populations•Children and youth•Older adults•People with disabilities•People with serious mental illness•People with low socioeconomic

status•Disaster workers •Cultural and ethnic groups

Key Concepts of Disaster Key Concepts of Disaster ImpactImpact

No one who sees a disaster is untouched by it.No one who sees a disaster is untouched by it.– Primary, Secondary and Tertiary victimsPrimary, Secondary and Tertiary victims

Two types of traumaTwo types of trauma– Individual (Individual (stress and grief reactionsstress and grief reactions))– Collective (Collective (Damages the bonds and social Damages the bonds and social

fabric of the community. Increases fatigue, fabric of the community. Increases fatigue, irritability, family conflictirritability, family conflict.).)


• People pull together during and after a People pull together during and after a disaster. (disaster. (high activity/low efficiencyhigh activity/low efficiency))

• Stress and grief are normal reactions to an Stress and grief are normal reactions to an abnormal situation. (abnormal situation. (transitory reactionstransitory reactions))

• Emotional reactions relate to problems of Emotional reactions relate to problems of living. (living. (abnormal and excessive disruptions abnormal and excessive disruptions to daily routinesto daily routines))

Key ConceptsKey Concepts of Disaster of Disaster ImpactImpact

• Disaster relief – can seem complex and Disaster relief – can seem complex and overwhelmingoverwhelming

• People typically do not seek out mental People typically do not seek out mental health services (health services (self reliance at all costsself reliance at all costs))

• Survivors reject help (Survivors reject help (others need it more others need it more than I dothan I do))

• Mental health services are practical rather Mental health services are practical rather than psychologicalthan psychological


• Services must be tailored to Services must be tailored to community normscommunity norms

• Support systems are crucial to Support systems are crucial to recoveryrecovery

• Interventions must be consistent with Interventions must be consistent with the phase of disasterthe phase of disaster

Physical Reactions to a DisasterPhysical Reactions to a Disaster

HeadachesHeadaches Generalized discomfort, hot or coldGeneralized discomfort, hot or cold Hypertension, heart poundingHypertension, heart pounding Gastrointestinal distressGastrointestinal distress Exacerbation of psychiatric illnessExacerbation of psychiatric illness Accelerated physical declineAccelerated physical decline Fatigue or exhaustionFatigue or exhaustion Increase or decrease in appetiteIncrease or decrease in appetite

Emotional Reactions to a Emotional Reactions to a DisasterDisaster

Feeling depressed or sadFeeling depressed or sad Feeling irritable, angry, resentfulFeeling irritable, angry, resentful Experiencing anxiety or fearExperiencing anxiety or fear Feeling despair or hopelessnessFeeling despair or hopelessness Being apatheticBeing apathetic Feeling overwhelmedFeeling overwhelmed

Cognitive Reactions to a Cognitive Reactions to a DisasterDisaster

Trouble concentrating or remembering Trouble concentrating or remembering thingsthings

Difficulty making decisionsDifficulty making decisions Preoccupation with the eventPreoccupation with the event Recurring dreams or nightmaresRecurring dreams or nightmares Questioning spiritual beliefsQuestioning spiritual beliefs

Behavioral Reactions to Behavioral Reactions to DisasterDisaster

• Isolation from othersIsolation from others• Sleep problemsSleep problems• Increased conflicts with familyIncreased conflicts with family• Hyper-vigilance, startle reactionsHyper-vigilance, startle reactions• Avoiding remindersAvoiding reminders• Crying easilyCrying easily• Not eatingNot eating

Special Special PopulationsPopulations

ChildrenChildren

Risk Factors for ChildrenRisk Factors for Children

Exposure to direct life threat and Exposure to direct life threat and injuryinjury

Witnessing mutilating injuriesWitnessing mutilating injuriesHearing unanswered cries for helpHearing unanswered cries for helpDegree of brutality and violenceDegree of brutality and violenceUnexpectedness and durationUnexpectedness and durationSeparation from familySeparation from family

Pre-School Age ChildrenPre-School Age Children

Sleep problems, Sleep problems, nightmares nightmares

Clinging, separation Clinging, separation anxietyanxiety

Helplessness, Helplessness, passivitypassivity

Death not Death not permanentpermanent

FearfulnessFearfulness RegressionRegression Repetitive playRepetitive play

Common Reactions

School Age ChildrenSchool Age Children

Sleep problems, Sleep problems, nightmaresnightmares

Preoccupation with Preoccupation with disaster, deathdisaster, death

Fears about safetyFears about safety Self blame, guilt, Self blame, guilt,

responsibilityresponsibility

Angry outburstsAngry outbursts Retelling and Retelling and

repetitious playrepetitious play Social withdrawalSocial withdrawal Somatic complaintsSomatic complaints School performance School performance

problemsproblems

Common Reactions

Pre-Adolescents and Pre-Adolescents and AdolescentsAdolescents

Sleep problems and Sleep problems and nightmaresnightmares

Self blame, guilt, Self blame, guilt, shameshame

Self-consciousnessSelf-consciousness Depression, social Depression, social

withdrawalwithdrawal

Desire for revengeDesire for revenge Somatic complaintsSomatic complaints Aggressive and risk-Aggressive and risk-

taking behaviortaking behavior School performance School performance

problemsproblems

Common Reactions

Factors Affecting Children’s Factors Affecting Children’s Recovery From DisasterRecovery From Disaster

• Developmental level of childDevelopmental level of child• Pre-disaster mental health of the childPre-disaster mental health of the child• Ability of the community to offer Ability of the community to offer

supportsupport• Separation from parentsSeparation from parents• Reaction of significant adults to the Reaction of significant adults to the

disasterdisaster

Factors Affecting Children’s Factors Affecting Children’s Recovery From DisasterRecovery From Disaster

• Communication between parents and Communication between parents and childchild

• Belief about what caused the disasterBelief about what caused the disaster• The degree of damage/Violence The degree of damage/Violence

cause by the disastercause by the disaster• The degree to which the child was The degree to which the child was

directly impacted by the disasterdirectly impacted by the disaster


Older AdultsOlder Adults

Older Adults Reactions to a Older Adults Reactions to a DisasterDisaster

• Intense sense of grief over Intense sense of grief over mementos, pets, etc.mementos, pets, etc.

• Feel unable to start overFeel unable to start over• Past losses re-awakenedPast losses re-awakened• Slower to respond to the Slower to respond to the

impact of the lossimpact of the loss• Experience a long term Experience a long term

decline in standard of livingdecline in standard of living

Impact of Losses for Older Adults


• Slower to recover Slower to recover psychologically psychologically and financiallyand financially

• Fear of loss of Fear of loss of independenceindependence

• DepressionDepression• WithdrawalWithdrawal

AgitationAgitation Sleep disturbanceSleep disturbance Memory lossMemory loss Disorientation and Disorientation and

confusionconfusion ApathyApathy

Stress Symptoms

Older AdultsOlder Adults Physical vulnerabilityPhysical vulnerability Chronic health conditionsChronic health conditions Medication needsMedication needs Auditory, visual, mobility, or cognitive Auditory, visual, mobility, or cognitive

impairmentimpairment Increase anxiety, confusionIncrease anxiety, confusion Loss of home health supportLoss of home health support


• Poor healthPoor health• Need assistance in daily livingNeed assistance in daily living• IsolationIsolation• Poor support systemPoor support system• Limited incomeLimited income

Environmental Stressors


• Recent losses, or cumulative unresolved Recent losses, or cumulative unresolved trauma leaves older adults at risk for trauma leaves older adults at risk for difficulty in coping with disaster aftermath.difficulty in coping with disaster aftermath.

• Successful coping in the past may create Successful coping in the past may create a reservoir of skills which increases a reservoir of skills which increases resilience and adaptability to disaster resilience and adaptability to disaster aftermath.aftermath.

Coping Experience and Life Skills


• Slower to admit full extent of their Slower to admit full extent of their losses; may miss deadline for losses; may miss deadline for applying for assistanceapplying for assistance

• Isolation may contribute to lack of Isolation may contribute to lack of awareness of resourcesawareness of resources

• Lack of transportation, limited Lack of transportation, limited mobilitymobility

• Tend to under-utilize insuranceTend to under-utilize insurance

Utilization of Assistance


• Home visits; Thorough assessment of lossesHome visits; Thorough assessment of losses• Assist with recovery of possessionsAssist with recovery of possessions• Suitable residential location/relocationSuitable residential location/relocation• Reestablish social and familial contactsReestablish social and familial contacts• Assist with securing medical and financial aidAssist with securing medical and financial aid• Assist with ways to be involved with community Assist with ways to be involved with community

recovery efforts - volunteerismrecovery efforts - volunteerism

Interventions


People With People With DisabilitiesDisabilities

People With DisabilitiesPeople With Disabilities

• Outreach model helps assure accessOutreach model helps assure access• Provisions must be made to serve:Provisions must be made to serve:

Hearing impairedHearing impairedVision impairedVision impairedMobility impairedMobility impairedDevelopmentally disabledDevelopmentally disabled

People With Mental IllnessPeople With Mental Illness

• Same basic needs as everyone elseSame basic needs as everyone else• May have special needsMay have special needs• May “rise to the occasion”May “rise to the occasion”• Program should tailor services to ensure Program should tailor services to ensure

appropriate services are deliveredappropriate services are delivered• Often identify unserved or underserved Often identify unserved or underserved

people in completing outreachpeople in completing outreach

People With Mental IllnessPeople With Mental Illness

• Disaster stress reactions may be Disaster stress reactions may be difficult to discern from symptoms of difficult to discern from symptoms of mental illnessmental illness

• Consumers may be trained as part of Consumers may be trained as part of the preparedness processthe preparedness process

• Should be given the opportunity to Should be given the opportunity to serve the larger communityserve the larger community


Disaster WorkersDisaster Workers


• Emergency Medical ServicesEmergency Medical Services• Law Enforcement/Fire ServiceLaw Enforcement/Fire Service• Emergency ManagementEmergency Management• Voluntary AgenciesVoluntary Agencies• Utility WorkersUtility Workers


• Train peers when possibleTrain peers when possible• Recognize unique stressorsRecognize unique stressors

Conflicting roles (Conflicting roles (family vs. jobfamily vs. job))Exposure to chaos, death and Exposure to chaos, death and

destructiondestructionVery long days, exhaustionVery long days, exhaustionCommunity reactions (Community reactions (hero or hero or

scapegoatscapegoat))


Cultural and Ethnic Cultural and Ethnic GroupsGroups

Major Racial and Ethnic Major Racial and Ethnic ProportionsProportions

Hispanic AmericansHispanic Americans Asian Americans and Pacific IslandersAsian Americans and Pacific Islanders American Indians and Alaska NativesAmerican Indians and Alaska Natives African AmericansAfrican Americans

(as described in the Surgeon General’s (as described in the Surgeon General’s report)report)

Latino/Hispanic AmericansLatino/Hispanic Americans Most Latino/Hispanic Americans share the Most Latino/Hispanic Americans share the

Spanish language and other cultural Spanish language and other cultural influences, regardless of whether they influences, regardless of whether they trace their earliest ancestry to Africa, Asia, trace their earliest ancestry to Africa, Asia, Europe or the Americas.Europe or the Americas.

Despite these commonalities, there is Despite these commonalities, there is great variability in language use, cultural great variability in language use, cultural practices, and the context of immigration. practices, and the context of immigration.

Asian Americans and Pacific Asian Americans and Pacific IslandersIslanders

Over 40 different ethnic groupsOver 40 different ethnic groups Fastest growing racial group in the USFastest growing racial group in the US Speak more than 100 languages and Speak more than 100 languages and

dialectsdialects

American Indians and Alaska American Indians and Alaska NativesNatives

The U.S. Census Bureau estimated that The U.S. Census Bureau estimated that 4.1 million American Indians and Alaska 4.1 million American Indians and Alaska Natives (Indians, Eskimos and Aleuts) Natives (Indians, Eskimos and Aleuts) lived in the United States in 2000.lived in the United States in 2000.

African AmericansAfrican Americans Increasing in diversity as greater numbers of Increasing in diversity as greater numbers of

black immigrants arrive from Africa and the black immigrants arrive from Africa and the Caribbean.Caribbean.

Repercussions from a legacy of discrimination Repercussions from a legacy of discrimination continue to influence their social and economic continue to influence their social and economic standing, relations with other groups, and standing, relations with other groups, and personal outlooks.personal outlooks.

Special Considerations when Special Considerations when Working with RefugeesWorking with Refugees

LanguageLanguage CultureCulture Economic marginalization and differencesEconomic marginalization and differences Fractures social relationsFractures social relations Experience of traumatic stressors and of Experience of traumatic stressors and of

lossloss Family dynamics and role changesFamily dynamics and role changes

Cultural Differences

Cultural differences exist between rural and urban survivors, across differences in education and socioeconomic backgrounds, age groups, and among different religious and non-religious groups.

Community CultureCommunity Culture The culture of the community provides the The culture of the community provides the

lens through which its members view and lens through which its members view and interpret the disaster, and the community’s interpret the disaster, and the community’s degree of cohesion helps determine the degree of cohesion helps determine the level of social support available to level of social support available to survivors.survivors.

Cultural Group InformationCultural Group Information Meanings associated with the eventMeanings associated with the event Experience with emergency responseExperience with emergency response Trauma and violence in country of originTrauma and violence in country of origin Signs and symptoms of trauma, griefSigns and symptoms of trauma, grief View about mental health, providersView about mental health, providers Tips for professional courtesyTips for professional courtesy

Key Concepts to RememberKey Concepts to Remember

• The target population is normalThe target population is normal• Avoid mental health labelsAvoid mental health labels• Be innovative in offering helpBe innovative in offering help• Fit program services into the Fit program services into the

community contextcommunity context

Cultural Competence – Cultural Competence – Semantics and ConceptsSemantics and Concepts

Cultural diversityCultural diversity Cultural awarenessCultural awareness Cultural sensitivityCultural sensitivity Cultural competenceCultural competence

Cultural DiversityCultural Diversity

The heterogeneity of social class, gender, race, ethnicity and life style present in a neighborhood, community or geographic locale impacted by the disaster.

Cultural AwarenessCultural Awareness

Cultural awareness suggests that it Cultural awareness suggests that it may be sufficient for one to be may be sufficient for one to be cognizant, observant and conscious of cognizant, observant and conscious of similarities and differences among similarities and differences among cultural groups in order to meet their cultural groups in order to meet their needs.needs.

Cultural SensitivityCultural Sensitivity

Awareness of the various cultural groups affected by the disaster. This includes racial and ethnic groups hardest hit by the disaster, language barriers and people with suspicion of the government.

Basic Cultural SensitivityBasic Cultural Sensitivity Convey respect, good will, courtesyConvey respect, good will, courtesy Ask permission to speak with peopleAsk permission to speak with people Explain the role of the mental health Explain the role of the mental health

workerworker Acknowledge differences in behavior due Acknowledge differences in behavior due

to cultureto culture Respond to concrete needsRespond to concrete needs

Cultural CompetencyCultural Competency

Awareness of one’s own values and prejudices. Being committed to learning about cultural differences, and being creative, flexible and respectful to others’ values and beliefs in our interventions and outreach approaches.

Cultural CompetenceCultural Competence Valuing of diversityValuing of diversity Recognition of and respect for differencesRecognition of and respect for differences Understanding cultural definitions of mental health, Understanding cultural definitions of mental health,

well-being, coping and recoverywell-being, coping and recovery Use of mental health and other interventions that “fit”Use of mental health and other interventions that “fit” Services and information provided in primary Services and information provided in primary

languageslanguages Use of empowerment-based approachesUse of empowerment-based approaches Ongoing cultural awareness and sensitivity trainingOngoing cultural awareness and sensitivity training

Guiding Principles for Cultural Guiding Principles for Cultural Competence in Disaster Mental Competence in Disaster Mental

Health ProgramsHealth Programs Recognize the importance of cultureRecognize the importance of culture Determine the cultural composition of the Determine the cultural composition of the

community; recruit and train disaster workers who community; recruit and train disaster workers who represent the communityrepresent the community– Community profileCommunity profile– Staff recruitmentStaff recruitment– Cultural competence trainingCultural competence training

Ensure that services are accessible, appropriate Ensure that services are accessible, appropriate and equitableand equitable


Health ProgramsHealth Programs Recognize the role of Recognize the role of

– help-seeking behaviors, help-seeking behaviors, – customs and traditions for healingcustoms and traditions for healing– customs and traditions in trauma and losscustoms and traditions in trauma and loss– natural support networks.natural support networks.

Involve as “cultural brokers” community Involve as “cultural brokers” community leaders and groups representing diverse leaders and groups representing diverse groups.groups.


Health ProgramsHealth Programs Ensure that services and materials are Ensure that services and materials are

linguistically appropriatelinguistically appropriate– Availability of trained bilingual/bicultural staffAvailability of trained bilingual/bicultural staff– Translation of educational materials and Translation of educational materials and

documentsdocuments– Language and sign-language interpretationLanguage and sign-language interpretation

Elements of a Culturally Elements of a Culturally Competent Disaster Competent Disaster

PreparednessPreparedness Needs assessmentNeeds assessment Program planProgram plan

– OutreachOutreach– Community educationCommunity education– Community networkingCommunity networking– In-Service training and consultationIn-Service training and consultation– School based programsSchool based programs– Anniversary eventsAnniversary events

Organizational ApproachesOrganizational Approaches

Effective management structureEffective management structure Effective managers and supervisorsEffective managers and supervisors Clear purpose and goalsClear purpose and goals Functionally defined rolesFunctionally defined roles Team supportTeam support Plan for stress managementPlan for stress management

Community OutreachCommunity Outreach Initiate contact at gathering sitesInitiate contact at gathering sites Set up 24-hour telephone hotlinesSet up 24-hour telephone hotlines Outreach to survivors through media, Outreach to survivors through media,

InternetInternet Educate service providersEducate service providers Use bilingual and bicultural workersUse bilingual and bicultural workers

Community InterventionsCommunity Interventions

Memorials and ritualsMemorials and rituals Usual community gatheringsUsual community gatherings Anniversary commemorationsAnniversary commemorations Symbolic gesturesSymbolic gestures

Disaster and special populations

Health & Medicine

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