The Psychological Impact of Trauma on Responders October
The Psychological Impact of Trauma on Responders October 21, 2005 FEMA Crisis Counseling Program
Overview of Presentation n n The Psychological Impact of Trauma The short term and long term effects of stress Family risk Resilience and self-care Resources 2
Importance of Psychological Responses Affect our physiological responses n Overwhelming emotions can disrupt rational problem-solving n Promote adaptive and maladaptive individual and group behaviors n 3
Effects on First Responders New Orleans, First Responders: n n n Dealt with angry people & were shot at. Responders had to leave people without food or water Saw people hurting and dying and could not help Had to separate family members in order to save some Are not used to limited success. Were exposed to bacteria & chemicals in water. 4
Effects on Katrina Responders Responding in later waves q q q Needs are overwhelming. Had to deny aid in some cases Began to close service centers, shelters People living in tents – FEMA trailers Physical Impact Emotional Impact 5
PSYCHOLOGICAL CONSEQUENCES OF DISASTER AND TERORISM Distress Responses From IOM publication “Preparing for the Psychological Consequences of Terrorism” www. nap. edu NOTE: Indicative only; not to scale 6
Critical Stress Indicators n n n Threat to one’s life Threat of harm to family Destruction of home or community Significant media attention Witnessing others’ trauma Being trapped or unable to evacuate 7
Physical Reactions n n n Fatigue, exhaustion Gastrointestinal distress Appetite change Tightening in throat, chest, or stomach Worsening of existing medical conditions Somatic complaints 8
Emotional Reactions n n n n Depression, sadness Irritability, anger, resentment Anxiety, fear Despair, hopelessness Guilt, self-doubt Unpredictable mood swings Feeling overwhelmed Apathy 9
Cognitive Reactions n n n Confusion, disorientation Recurring dreams or nightmares Preoccupation with disaster Trouble concentrating or remembering things Difficulty making decisions Questioning spiritual beliefs 10
Behavioral Reactions n n n n Sleep problems Crying easily Avoiding reminders Excessive activity level Increased conflicts with family Hyper-vigilance, startle reactions Isolation or social withdrawal Changes in appetite 11
Chronic Stressors n n n Family disruption Work overload Gender differences Bureaucratic hassles Financial constraints 12
Effects of Long-Term Stress 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Anxiety and vigilance Anger, resentment and conflict Uncertainty about the future Complicated grief reactions Diminished problem-solving Isolation and hopelessness Health problems Physical and mental exhaustion Substance use or abuse Lifestyle changes 13
Self Care and Stress Basics n Stress is: n n n n Normal Necessary Productive and destructive Acute and delayed Cumulative Identifiable Preventable and manageable 14
Normal Reactions to a Disaster Event n n n No one who responds to a mass casualty event is untouched by it Profound sadness, grief, and anger are normal reactions to an abnormal event Wanting to remain on the scene until the work is finished Overriding stress and fatigue with dedication and commitment Denying the need for rest and recovery time 15
Signs Stress Management Assistance is Needed 1. 2. 3. 4. 5. 6. 7. 8. 9. Difficulty communicating thoughts Difficulty remembering instructions Difficulty maintaining balance Uncharacteristically argumentative Difficulty making decisions Limited attention span Unnecessary risk-taking Tremors/headaches/nausea Tunnel vision/muffled vision 16
Signs that Stress Management Assistance is Needed 10. 11. 12. 13. 14. 15. 16. 17. 18. Disorientation or confusion Difficulty concentrating Loss of objectivity Easily frustrated Unable to engage in problem-solving Unable to let down when off duty Refusal to follow orders Refusal to leave the scene Increased use of drugs/alcohol 17
Individual Approaches n n Management of workload Balanced lifestyle Stress reduction strategies Self-awareness 18
How is psychological impact different for first responders? n n Chronic exposure to traumatic events Fitness for duty issues Culture of first responders Pre-existing stressors n n Family issues Health status Other losses Mental health or alcohol/drug abuse issues 19
Good news…. . n First responders generally resilient to “routine” trauma n n Same protective factors as general public Experience, gender and age Least likely to have severe impairment as result of trauma Professionalism and training increase resilience 20
Bad news…. . n Greater risk and uncertainty n n n Secondary attacks on first responders Higher rates of substance abuse, divorce, and suicide in first responder community, even greater post-event Younger and less experienced at greatest risk 21
Unique Stressors and Risk Factors for First Responders n n Stress of uncertainty, the unknown Anticipatory stress Chronic nature of stress Personal Protective Technologies 22
Unique Stressors and Risk Factors for First Responders Exposure to death n Identification with victims n Family risk n What am I bringing home? n Family coping behaviors? n n Hours of work 23
“Even heroes need to talk. ” One of the marketing slogans for Project Liberty, New York’s post 9/11 Crisis Counseling Program
Help-seeking barriers n n n n Stigma Access and cost Timing Fitness for duty Masked as physical illness Confidentiality Media interest Delayed response 25
Encourage Responders to: n n n Drink plenty of water and eat healthy snacks Take frequent, brief breaks from the scene as practicable especially if they are coming home to work in a first responder capacity Talk about their emotions to process what they have seen and done Stay in touch with family and friends Participate in memorials, rituals, and use of symbols as a way to express feelings Pair up with another responder to monitor one another’s stress 26
Strategies in Response n n n n Self-care Peer Support Humor Decide to talk Seek help from credible and trusted sources Get extra rest Use constructive coping strategies 27
Strategies in Recovery n n n Long term assessment for risk Journaling Practice “relapse prevention” Lifestyle and health promotion Role models/partnering/mentoring 28
Assignment and Supervision n n Attachment and identification issues Know risk factors and triggers, increase support as needed Use risk communication skills Monitor media attention to workers and hero identification Provide family events, support groups, etc. 29
Access to Crisis Assistance and Mental Health Services n n n EAP Peer support models Health insurance mental health benefits In-house mental health services Volunteer organizations Use of faith-based supportive counseling 30
Most effective if…. . n n n Delivered by trusted individuals Offered in non-traditional settings, Can be arranged spontaneously Handled informally Not labeled as mental health Culturally informed 31
Lynn Carter Department of Mental Health Phone: 573 -751 -4970 Email: lynn. carter@dmh. mo. gov Jenny Wiley Phone: 573 -751 -4730 Email: jenny. wiley@dmh. mo. gov
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