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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. |
