Disaster Behavioral Healthcare
Disaster behavioral health is a departure from traditional behavioral health practice in many ways. Disaster behavioral health interventions are designed to address incident specific stress reactions, rather than ongoing or developmental behavioral health needs. Outreach and crisis counseling activities are the core of disaster behavioral health activities. Behavioral health professionals work hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors of the disaster in ways that may differ from their formal clinical training.
The heroism, altruism, and optimism of the early phases of disaster may make it seem that “others are so much worse off than I am.” For most people, there is a strong need to feel self-reliant and in control. Some people equate government relief programs with “welfare.” For others, especially recent immigrants who have fled their countries of origin because of war or oppression, government is not to be trusted. Pride may be an issue for some people. They may feel ashamed that help is needed, or may not want help from “outsiders.” Tact and sensitivity to these issues are important.
Most disaster survivors are people who are temporarily disrupted by a severe stress, but can function capably under normal circumstances. Much of the behavioral health work at first will be to give concrete types of help. Behavioral health personnel may assist survivors with problem-solving and decision-making. They can help them to identify specific concerns, set priorities, explore alternatives, seek out resources and choose a plan of action. Behavioral health staff must inform themselves about resources available to survivors, including local organizations and agencies in addition to specialized disaster resources workers may help directly with some problems, such as providing information for filling out forms, helping cleanup, locating health care or child care, and finding transportation. They may also make referrals to specific resources such as assistance with loans, housing, employment, permits. In less frequent cases, individuals may experience more serious psychological responses such as severe depression, disorientation, immobilization, or an exacerbation of prior mental illness diagnosis.
These situations will likely require referral for more intensive psychological counseling. The role of the disaster behavioral health worker is not to provide treatment for severely disturbed individuals directly, but to recognize their needs and help link them with an appropriate treatment resource.
Human-caused disasters seem to be more traumatic to mental health.Their higher unpredictability, uncontrollability and culpability may partly account for this. Generally, natural and human-caused disasters are differentiated based on distinct qualities of the stressor (e.g. its suddenness and severity), mediating factors such as sense of control perceived by the victims, or modifying characteristics such as effect on social support. Each of these characteristics may theoretically have a differential effect on psychological outcomes.
Westroads Response
Disaster behavioral health was deployed in the response phase following the shootings at Westroads Mall on Dec. 5th, 2007. Immediate response activities included the following:
- The American Red Cross was immediately deployed to the Westroads Mall and opened a Family Assistance Center at the Hampton Inn on December 5th;
- Omaha Metro Medical Response System and Region 6 Behavioral Healthcare activated the Medical Reserve Corp through the United Way. Behavioral Health volunteers were sent to the Family Assistance Center;
- The Girls & Boys Town National Crisis Line was activated for crisis response calls and publicized via the media;
- The Spring Center behavioral health service access line was activated and publicized;
- The American Red Cross, Medical Reserve Corp, Region 6 Behavioral Care and Salvation Army were available at the Westroads Mall when it reopened December 7th and 8th, 2007;
- The American Red Cross continued to have licensed mental health professionals available at the Mall throughout the following week;
- A Community Disaster Planning Committee was formed that included 20 local agencies.
Region 6 Behavioral Healthcare developed a community disaster planning committee in the days following the Westroads Mall tragedy. The committees first goal was to help determine how to address the long term behavioral health needs in the community. The local agencies identified two behavioral health need areas associated with the recovery phase that are not currently funded or available in the community. The first is coordination of outreach efforts to impacted populations. The second is preparation of existing service providers to deliver appropriate individual counseling. Region 6 Behavioral Healthcare was awarded federal funding to meet the local needs and to coordinate the behavioral health response.
Outreach to Impacted Populations
Traditional models of disaster outreach (e.g., going door to door) are not feasible in the wake of this event because the impacted population is large and geographically dispersed. Focused outreach to impacted populations began with three community Town Hall meetings as a way to provide education and promote recovery. One Town Hall meeting took place at the University of Nebraska Medical Center, one of the trauma centers that accepted casualties and injured from the shooting. Two additional community wide Town Hall meetings were offered at Glad Tidings Church and the Holiday Inn Convention Center on December 21 and 22, 2008 respectively. Robin Zagurski and Dennis Snook, local disaster experts, and two national disaster experts, Dr. Robin Gurwitch and Dr. Dan Nelson, both of the National Child Traumatic Stress Network, assisted with the Town Hall meetings.
The SERG (SAMHSA Emergency Response Grant) grant has funded or will provide for the following services:
- One full-time position to coordinate outreach efforts and community activities
- Three Town Hall Meetings
- Expansion of the local network of licensed professionals trained to provide disaster therapy utilizing Cognitive Behavioral Therapy (educate 100 professionals)
- Training for primary care physicians, psychiatrists, and other medical professionals in “Disaster Psychiatry”
- Training for media on their emotional response to this disaster
This was a traumatic event for people who were in the mall the day of the shooting and those who responded to the scene. The full psychological impact of the event has not been felt. Some will experience longer lasting distress or a delayed reaction that is set off by reminders of the event that may not be anticipated. A few will require professional assistance. The emerging needs will attempt to be met by a combination of services from existing providers and outreach made possible by this grant.
