Women’s movement in the 1960s and 1970s Community Mental Health Act, 1963 Disaster Relief Act, 1974 • Section 413 Federal Emergency Management Agency (1978) Classification of PTSD as a personality disorder in the DSM-III (1980) American Red Cross establishes a mental health certification program (1990s) • Hurricane Hugo • Loma Prieta earthquake
San Fernando, CA, earthquake of 1971 • “Quake-proofing kids” Severe Flooding in 1972: • Rapid City, South Dakota • Wilkes-Barre, Pennsylvania • Operation Outreach • Logan County, West Virginia Hurricane Katrina, 2005 • FEMA
The European Network for Traumatic Stress (TENTS) • Funded by the European Union • Provides services, expertise, and support to areas of the Union that lack resources and availability of trained personnel United Nations’ Inter-Agency Standing Committee (IASC) • Published IASC Guidelines on Mental Health and Psychosocial Input Support in Emergency Situations
September 11, 2001 • Homeland Security Act Murrah Federal Building in Oklahoma City Violence in Schools: • Columbine, CO • Virginia Tech University International Events: • Suicide bombs in Israel • Hostage situation in a Russian theatre and school • Drug related guerrilla warfare in Mexico Hyper-vigilance Repetitive and Graphic Media Coverage
An ecosystemic crisis is any disruptive or destructive event that occurs at a rate and magnitude beyond the ability of the normal social process to control it. • Impacts an entire community, region, nation, or the entire world • Sudden • Slow buildup • Human-made • Natural disaster • One intense episode • Several compounding incidents
Types of Ecosystemic crises: • Metastisizing Crises • Start small but, if not contained both physically and psychologically, can quickly turn into large-scale crises • Large-Scale Crises • At a minimum affect whole communities or regions either directly or vicariously • Mega-crises • Affect entire countries or the world, either directly or vicariously
Microsystem Mesosystem • Primary Mesosystem • Super Mesosystem Exosystem Macrosystem Chronosystem • The Individual • The Society
Systems must be interdisciplinary The system must be multitheoretical Individuals are part of the ecosystem Multiple contexts must be considered Time is of the essence Meaning is important
Parsimonious interventions are needed The process is cooperative, collaborative, and consultative There is a full range of targeted interventions aimed at individuals, institutions, communities, and nationals The service characteristics of credibility, acceptability, accessibility, proactivity, continuance, and confidentiality should be adopted as “cast in stone” goals for service delivery in disaster-stricken areas
National Crisis Response Teams • Development of Crisis Response Teams (CRTs) • National Organization for Victim Assistance (NOVA) CRTs • The Red Cross • Federal Emergency Management Agency (FEMA) • National Institute of Mental Health (NIMH) Professional Organizations Constructing an Outreach Team
Vertically and Horizontally Integrated Local Emergency Management Systems • Role of Local EMA Directors • Background and Training • What Do Emergency Managers Do? • Planning for Disasters Mental Health Components of Local EMAs • Personnel • Transdisaster (0–14 Days) • Postdisaster (15–365 Days)
Lack of efficient communication Poor coordination plans Ambiguous authority relationships Who’s in charge? Everyone shifts the blame Counterterrorism versus all-hazards response Ambiguous training standards and lack of preparation Where is the “learning” in lessons learned? Performance assessment was not integrated into the process The geography of poverty Rumor and chaos Personal and community preparedness Disaster mental health and the role of mental health professionals
Psychological First Aid and Psychosocial Support as Applied to Disaster Survivors • Make initial contact in a respectful manner • Gather and provide information regarding immediate physical and safety concerns • Provide and direct people in regard to practical assistance needed • Provide for their safety and comfort by linking them with social services • Teach them basic coping skills if requested • Get information and help that will connect them to social supports When More Than PFA Is Needed The Current State of Affairs
Debriefing • An intervention designed to assist workers and survivors in dealing with intense thoughts, feelings, and reactions that occur after a traumatic event, and to decrease their impact and facilitate the recovery of normal people having normal reactions to abnormal events Debriefing Emergency Workers • Critical Incident Stress Debriefing (CISD) • Informal Defusing • Formal Debriefing Debriefing Crisis Workers • The Need for Debriefing • Precautions • Dynamics of Debriefing • Confidentiality • Understanding
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