| When
I got home from my ten days of disaster work for
the American Red Cross (ARC) in Missouri, the
first question my husband, friends, colleagues
and patients asked was, "What did you do?"
Some of the other questions were, "How could
you possibly help people who have lost everything?"
and "Do you really think you helped anyone?"
After working twelve hours a day and counseling
hundreds of people, I was more than a little taken
aback, not so much by the questions as by the
underlying attitude that (1) mental health was
not a top priority in a disaster and (2) it would
not be possible to help in such a short period
of time.
Through this experience,
it became clear that the role of a mental health
disaster counselor has not been clearly defined
or generally accepted. This is a relatively new
concept even within the ARC where mental health
has, until recently, been subsumed under physical
health services. The Red Cross nurses had been
the primary caretakers of mental health needs.
On December 13,1991, the American Psychological
Association (APA) signed a statement of understanding
with the American Red Cross agreeing to cooperate
in implementing a national disaster mental health
preparedness program. Since that time, clinical
psychologists like myself, as well as other mental
health professionals, have been trained by the
ARC to assist in disasters.
The ARC has an
excellent two-day training program for licensed
mental health professionals. It familiarizes the
trainees with ARC and sets the limits and expectations
of a mental health disaster worker. The ARC is
very clear in defining the limit and scope of
the mental health work to crisis intervention,
debriefing, defusing, support, education and liaison
with local mental health professionals. Both disaster
victims and ARC volunteers and staff are to be
assisted. This all sounded very good sitting in
a classroom in Arlington, Virginia, but what DO
you actually DO out in the field?
I was based in
small town about 110 miles south of St. Louis
called Cape Girardeau. Between fifty and eighty
ARC staff and volunteers were based there including
two other mental health workers. The mental health
supervisor was a school nurse from Oregon. the
other was a newly graduated social worker from
Las Vegas. Each mental health worker had a car
and beeper and we split the territory, which covered
over 100 miles.
Here is what I
did and here are some of my thoughts and observations:
1. ASSISTED PEOPLE
DURING AN ACTUAL DISASTER: Floods, unlike other
disasters, go on and on. While, in most disasters,
the helpers come in after the disaster has occurred,
during the Flood of '93, new disasters were happening
daily. This provided a unique opportunity to actually
experience and observe trauma as it was occurring.
One day I was called out of bed at 5:00 a.m. to
go to a town approximately 30 miles away because
a levee had broken; water was expected to reach
the town sometime that day. By 6:00 a.m. my colleagues
and I were there with many of the townspeople,
with helicopters flying overhead, with trucks
going in and out by the main road trying to empty
the factories. When we got there, as far as you
could see was farmland. By 11 a.m., you could
see a "lake" in the distance. By 2:00
p.m. the water was on the edge of the town. Being
there, at that town, before, during and after
the water came, was probably the most valuable
function we performed. We were able to share in
the grief of the hundreds of people as we stayed
with them while their fields, houses and workplaces
were flooded. We witnessed the death of a town
and the people reacted with disbelief, anger,
sadness, and numbness. Once the water got to the
edge of the town, the beer was brought out and
the jokes were made: the wake. Each person had
a different story, but all grieved and we provided
many an opportunity to express it. People cried
as the water started rising into their houses.
Some had to watch. Some had to leave. At times
it was utterly silent as we all waited. There
was a woman whose parents sent her away during
the floods of ‘43 and she had been angry for 50
years about it. She was determined that her children
and grandchildren would see everything. I spent
12 hours that day just giving support, listening,
giving information and sometimes shedding a tear
or two myself.
2. GAVE INFORMATION:
Another important function we performed that day
and many other days was to give information. We
were in touch with ARC headquarters and not only
could give information to the townspeople about
where to get assistance but we could give ARC
information about the needs of the people. Within
a few hours a feeding center was set up a mile
from the town. We let people know about the center;
about where they could get disaster assistance
the next day; about Red Cross services. We handed
out brochures and phone numbers.
3. VISITED DISASTER
ASSISTANCE CENTERS AND FAMILY SERVICE CENTERS:
We spent time each day in both Federal Emergency
Management Agency (FEMA) centers and ARC centers
talking to the people who came for assistance
and listening to them. The stress could be seen
in their faces and the fear in their eyes. Depression
and anxiety prevailed. They were having trouble
sleeping: they often used food or alcohol to relieve
stress and many were having headaches and stomach
aches. All of the people I talked to were frustrated
and often took out their frustration on ARC or
FEMA workers. I approached people as they were
waiting in line for assistance. Once engaged,
they talked about their fears, worries, kids,
parents, etc. One woman I talked to had not slept
for five days. She sat up all night and watched
the levee. She lived in constant fear that it
would break. My intervention was to help her understand
her unconscious would awaken her if something
happened and she could have someone else in the
family like her teenage son "stand guard"
for her. She agreed and set up a plan for herself
to get sleep that night. Many people asked for
help in dealing with their children. I also talked
to many children at these centers. I took paper
and pencils and crayons and coloring books. Some
drew pictures of their flooded houses. One little
girl drew a picture of her cat who drowned. The
children were depressed and fearful. I listened
carefully to them and gave them some coping strategies.
4. VISITED SHELTERS:
Another function of the mental health worker is
to go to shelters and work with the people in
the shelter and also with the staff running the
shelter. The population in the shelters in Missouri
were the very poor who had had almost nothing
before the floods and now were totally wiped out.
Many had chronic mental illness, alcohol and drug
problems. Their symptoms were exacerbated. They
felt hopeless and helpless. The children were
needy, hyper, angry and loud. They needed structure,
activities and hope. I got many of the children
and adults to begin journals, to draw and to talk.
I helped some of the people get the medication
they needed and get help from the local mental
health community.
5. PERFORMED LIAISON
WITH LOCAL MENTAL HEALTH RESOURCES: An important
first step was getting information about local
mental health people. We worked closely with the
local Mental Health Community Center staff who
had a FEMA grant to do disaster counseling. We
kept them up to date with ARC information and
they shared resources with us. When new flooding
occurred and new centers were opened, we coordinated
with their staff in covering the areas and worked
side by side with them during and after disasters.
6. WORKED WITH
ARC STAFF AND VOLUNTEERS: The ARC staff and volunteers
are putting in long hours and doing very stressful
work. They often get stressed and there are occasional
personnel problems. The mental health worker can
be very helpful to supervisors in dealing with
their staff and personnel problems. It was important
to get to know ARC people and to let them know
that you were available. At headquarters, it is
important to be friendly and open and to listen
to people. Let them vent. Be supportive. Don't
wait for people to come to you. Also it is the
job of the mental health workers to debrief all
volunteers and staff before they leave the area.
Let the nurses, family service people and drivers
of Emergency Response Vehicles (ERV) know who
you are, and volunteer any help you can give.
The ERV drivers deliver meals at least three times
a day to disaster victims. They talk to the people
and can help identify those who may be highly
stressed. I went out on ERV's occasionally and
at times followed the ERV so I could stay and
talk to people and not hold them up. The nursing
staff and family services staff also come in contact
with many people and need to know you are available
to help them deal with problems and refer people
to you.
7. MADE HOME VISITS:
I made several home visits during the floods to
people the ERV drivers asked me to see. They got
permission from the people in advance. I visited
one woman in the midst of the flood area whose
son had died of AIDS in San Francisco a few days
before. She felt she could not talk to people
in her small town about it because of the stigma.
I was able to give her support and information
about local mental health resources. There were
lots of life's disasters going on in the midst
of the flood. The local mental health people were
going from door to door in the flood areas making
sure everyone was ok. I went out and make some
visits with them also.
My Red Cross trip
was an outstanding experience. I learned that
mental health workers at ARC are "new kids
on the block." We are at the forefront of
developing disaster mental health strategies.
It's a whole new area of mental health and a much-needed
one. We can be of invaluable service during a
disaster if we are willing to actually go out
into the community and give service. Unlike most
other Red Cross volunteers, we do not give the
disaster victims food or clothing or lodging.
What we do is not readily tangible or measurable.
Once at a disaster site, the mental health worker
may have little supervision. Be prepared to be
active, available and innovative. Remember: the
mental health person is never off-duty during
a disaster. It can be very rewarding work, and
don't worry, there is plenty to do.
©1997
by The American Academy of Experts in Traumatic
Stress, Inc. |
