On the Scene Report of the Missouri Floods by an APA/ARC Volunteer

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.