Transcript Slide 1

All-Hazards
Mental Health
Michael T. “Mick” Maurer, PhD, MHA
Department of Applied Psychology, NYU Steinhardt School of Education
And
Business Continuity and Homeland Security Certificate Program
The Center for Management
Division of Business and Legal Studies
NYU School for Continuing & Professional Studies
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Short-term temporal perspectives of
contemporary New Jerseyans
• “We should never talk about what we will do in 100 years; it is too far
off to be dealt with.”
Mayor of a New Jersey coastal municipality, 1997
• “Let's hold off on major (hazard land use) policy decisions for the next
40 or 50 years.”
President of a NJ property owner lobbying group, 1997
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New Jersey’s natural hazards
1883 Newark blizzard
1917 South Cape May coastal storm
1955 flood Blairstown
2002 Pine Barrens fire
2002 drought Boonton Reservoir
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Hazard = f(Risk, Exposure, Resistance, Resilience)
Risk (e.g. tropical storm-driven waves at Belmar)
Exposure
“ …recent population increases, as
evidenced by the 2000 census, result
in more people and property at risk from
(New Jersey’s) coastal hazards. With the
prospect of accelerated rates of sea level
rise, this vulnerability is likely to increase."
•
Resistance
Resilience
(Strathmere geotextile tube under dunes)
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The post-disaster ability to return to a
pre-existing state or to achieve a new
desired state; sometimes indexed by
speed of recovery
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NJ’s Major 20th C Natural Disasters
DATE
TYPE
October 7-10, 1903
Flood after tropical
storm (dying hurricane)
Passaic River Basin
$7 million damage; year 2000 repeat - c.$3Billion
Accelerates instrumentation of NJ rivers
September 14, 1944
Tropical storm (dying
hurricane)
Long Beach Island,
Brigantine, Atlantic City,
Ocean City, Sea Isle City
8 deaths, 460 homes and 217 other buildings destroyed, c.
3,600 buildings damaged; $25 million loss
August 7-13, 1955
Flood after passage of
tropical storms Connie
& Diane
Delaware, Raritan &
Passaic River systems
At least 50 NJ and PA deaths; Worst along middle Delaware
and in Blairstown on Paulins Kill
Creation of DRBC
March 6-9, 1962
Nor’easter coastal
storm
Jersey oceanfront coast
10 deaths; $130-400 million loss; Half Cape May’s
population evacuated
April 20-22, 1963
37 major forest fires
Pine Barrens
7 deaths, 186 homes and 197 outbuildings destroyed;
190,000 acres burned
1964-68
Drought
Statewide
20th century drought of record; perhaps surpassed by 20002003 drought
September 16, 1999
Flood after tropical
storm Floyd (dying
hurricane)
Raritan and Passaic River
basins
4 deaths and $1 billion loss statewide; most expensive New
Jersey disaster on record
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LOCATION
IMPACTS
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NJ FEDERAL DISASTER DECLARATIONS 1992-99
Note: “90% of the disasters that occur in the U.S. do not result in a Federal Disaster
declaration. ” National Conference of Insurance Legislators, 2002
DATE
DISASTER NUMBER
TYPE
March 4, 1992
FEMA-936-DR
Coastal storm/flood
December 18, 1992
FEMA-973-DR
Coastal nor’easter storm
March 17, 1993
FEMA-3106-EM
Snow removal
January 13, 1996
FEMA-1088-DR
Winter storm/Blizzard
November 19, 1996
FEMA-1145-DR
Severe storm/flood
September 23, 1997
FEMA-1189-DR
Flood
March 3, 1998
FEMA-1206
Coastal storm/flood
September 17, 1999
FEMA- EM-3147
Tropical storm Floyd flood
September 18, 1999
FEMA 1295
Tropical Storm Floyd flood
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A worsening burden of hazard
• Record-setting disaster costs
• Tropical Storm Floyd (1999) - >$1.0 Billion
• Repeat of 1903 Passaic floods estimated - $3.5 Billion
• Larger numbers of impacted people
• Recent drought emergency orders affected NJ’s 8 million+ residents for
weeks to months
• Ocean County storms now affect population >2,500% larger than 1900
• Unprecedented levels of disruption
• Airport & highways closings affect region & nation
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Population Change: A Driver of Exposure
DATE
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ABSOLUTE
INCREASE
% INCREASE
1901-10
653,498
34.7
1911-20
618,733
24.4
1921-30
885,434
28.1
1931-40
118,318
2.9
1941-50
665,164
16.0
1951-60
1,241,403
25.7
1961-70
1,101,382
18.0
1971-80
196,659
2.7
1981-90
365,365
5.0
1991-2000
684,162
8.9
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20th Century Hazard Trends
• Drought & floods
– Worsened; urbanized; spreading statewide
• Blizzards
– Declined; urbanized; becoming aestheticized performances
and communal catharses
• Forest fires
– Reconfigured; more numerous but smaller; more humancaused; worsened at forest edges; continuing catastrophe
potential
• Coastal storms
– Sensitized fear of hurricanes but other storms more
common and more destructive
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Droughts
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Urban drought perceived as an increasing policy problem
•
•
•
•
•
•
•
1895 - No newspaper reports
1915 - Handful of reports about crops
1930 - Concern about future shortages
– “A few years of such dry summers as that of 1930 and the communities of Northern
New Jersey would lack sufficient potable water, unless relief in the meantime had
been contrived.” NYT, 10/17/30
1957 - Pres. Eisenhower refuses to issue disaster declaration for NJ
– “The basic problem is how to atone for lack of foresight and inadequate distribution
facilities in the suburbs. The outward thrust into the suburbs since 1950 appears to
have caught water plants there unprepared.” NYT, 7/22/57
1965 - Pres. Johnson issues drought disaster declaration for NJ
1974 - Gov. Byrne issues 1st drought Executive Order.
– “…the largest municipalities in New Jersey…depend on reservoirs in the heavily
populated areas, where runoffs after heavy rains and snowfalls are considerably
reduced because of the development of open spaces.” NYT, 6/5/74
1999 - Complex problems demand sophisticated responses
– “…state and local governments and the news media have failed to recognize drought
as a complex set of phenomena that demand long range regional planning and hard
decisions after the inevitable rains come and the emergency decrees fade away. … In
general there should be a more robust public debate about how the government
functions in a liberal democracy in times of emergency.” NYT, 8/15/99
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Urban Blizzards - THEN
• Threatens
– Life (hypothermia)
– Heating supplies (coal barges)
– Food supplies (milk trains, bread)
– City transportation (ferries, freight wagons)
• “The time may not come within the present century when the
newspaper will not be hampered in its work of news collecting by
storms of such intemperate violence as that which swept the earth
yesterday, but progress is making in that direction, and ultimately
no doubt the telegraphic system of the entire country will be as
secure from damage by wind and storm …”
New York Times, March 13, 1888
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Urban blizzards - NOW
• Threatens
– Transportation (especially roads, airports)
• Benefits
– Social solidarity
– Aesthetics
– Sense of wellbeing
• “Sudden destruction of the normal order had its virtues this weekend. What
after all is so delightful about being strapped rigidly into the normal
order?… The blizzard had elbowed (people) off the treadmill and provided
a gentle adventure”
New York Times, January 9, 1996
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New Jersey forest fires by decade, 1902-2000
“Whatever else they do, men in the Pine Barrens are fire-fighters throughout their lives” John McPhee, 1967
DECADE
FIRES
BURNED ACRES
RATIO ACRES/FIRES
1902-1909*
1,509
424,984
281
1910-1919
7,085
713,215
101
1920-1929
10,241
668,751
65
1930-1939
13,841
586,176
42
1940-1949
15,020
257,619
17
1950-1959
12,573
171,418
14
1960-1969
15,165
311,540
21
1970-1979
16,746
122,718
7
1980-1989
15,776
79,580
5
1991-2000
16,147
69,497
4
124,103
3,405,498
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TOTAL 1902-2000*
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PERCEIVED CAUSES OF NJ FOREST FIRES
CAUSAL AGENT
1895
1990
Locomotives
49%
<1%
Accidents/carelessness
41%
39%
Incendiary
6%
50%
Other
2%
10%
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"Huddled masses" as hazard agents
• “Hundreds of uneducated immigrants have invaded the Pines, owing to the
cheapness of the land and proximity to large cities. Few of these have brought with
them European forestry ideas, and many of the most disastrous fires are those which
they carelessly set in clearing their farms.” (State Geologist, 1899, p. 289)
– “Many of the sufferers are poor Italians, who obtained small clearings and
enlarged them by degrees.” (New York Times, April 30, 1900)
– In September 1895 one fire was “set by an Italian back-firing in the wrong
way” and another was “set accidentally by Italians cooking in the woods”.
(State Geologist, 1899, p. 164.)
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General Findings
• The burden of hazard has grown and shifted repeatedly as New
Jersey added population and investments at different rates in
different areas that are themselves differentially exposed to
natural risks.
• Broad unplanned societal changes have affected the hazard
ecology of New Jersey at least as much as the deliberate
efforts of hazard management agencies and individuals.
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Value of NJ experience to policy making - I
• State's leading role in national research & policy
•
•
•
•
First systematic study of forest fire in USA
First USGS reports on flooding
Formative research on beach processes
Capitalize on this experience especially with respect to
innovations for the future
• Continuing trend towards broader perspectives
• Broader interpretations of hazard issues
• Broader solutions
• We will increasingly have to think in interdisciplinary ways
that mediate among conflicting conceptions and contradictory
goals.
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Value of NJ experience to policy making - II
• Natural hazards and disasters provide a basis for public intervention and
open up opportunities for institutional innovation
• Without the threat of fires would there be Pinelands regulation?
• Without the 1955 Delaware floods would there be a DRBC?
• Disjunctive change can fundamentally restructure old arguments; beware
of relying on assumptions about continuation of current trends
• Limitations of relying on tightly coupled prediction & response systems
• No hurricanes BUT
– Plenty of tropical storms and nor’easters
– Inland impacts instead of coastal ones
• Plan for surprises; consider kinds of risk as well as degrees of
risk; shift emphasis “upstream” to mitigation of material losses
"New Jersey hazards in the 20th century"
Mitchell - November 16, 2004
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“Terrorism is the deliberate and systematic assault on
civilians to inspire fear for political ends.”
“Terrorism is the intentional use of, or threat to
use violence against civilians or against civilian
targets, in order to attain political aims.”
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‘Suicide’ Bombings
Public Transport – Haifa , Dec 2 , 2001
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To be a 'shahid' or not to be…
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METROPOLITAN DESK | September 10, 2004, Friday
Terror in the Age of Eisenhower; Recalling the Mad Bomber, Whose Rampage Shook
New York
By CHARLES DELAFUENTE (NYT) 1226 words
Late Edition - Final , Section B , Page 1 , Column 2
There was a bomber on the loose
in New York City.
On the evening of Dec. 2, 1956, 1,500 people were at the Brooklyn
Paramount Theater watching ''War and Peace'' when a pipe bomb
beneath a seat exploded at 7:50 p.m. Six people were injured, including
Abraham Blumenthal, who was lifted out of his seat by the blast. The
next day, Police Commissioner Stephen P. Kennedy ordered what he
called the ''greatest manhunt in the history of the Police
Department.''
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At the time of that bombing, the police had been searching for
the man known as the Mad Bomber for years. He first struck in
the city in 1940 and 1941, planting two bombs that did not
explode. He resurfaced in 1951, planting 22 bombs that did
explode and several more that did not.
Bombs were left in crowded public places: train, bus and
subway stations, Macy's, movie theaters, office buildings and the
New York Public Library. The fact that a place had been bombed
before was no assurance that it was subsequently safe. Grand
Central Terminal was the site of five bombs; there were three
at Pennsylvania Station; two were planted at the Port
Authority Bus Terminal; and two at Radio City Music Hall.
Fifteen people were injured by the bombs.
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Though no one was killed, the city's nerves were
rubbed raw.
''There was a lot of fear, especially in the subways,''
recalled Arthur Gelb, a former managing editor of The
New York Times.
''People thought twice before taking the subway,'' said
Mr. Gelb, who was a Times reporter during the series
of attacks. ''Many people took buses because they felt
the subways were where he would attack.''
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• There have been other bombers in New York, both before and after the Mad
Bomber. German saboteurs struck in 1916, during World War I, and attackers
believed to be Bolsheviks planted a bomb on Wall Street in 1920. Another
serial attacker, known as the Sunday Bomber, left bombs in a subway car, a
subway station, the Staten Island Ferry and public buildings in late 1960,
killing one person. That bomber was never caught.
• Members of the Weather Underground, a radical group, committed at
least a dozen bombings in New York in 1969 and 1970 to protest the war in
Vietnam. The only fatalities were three of the radicals, who were killed
when a townhouse in the Village, described by the police as a bomb
factory, exploded.
• And in 1974, the Armed Forces of National Liberation, better known as
F.A.L.N., the initials of its Spanish name, began a decade-long bombing
campaign in New York that killed five people.
But no one person left as many bombs around the city
as the Mad Bomber did.
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When Mr. Metesky appeared in court, he ''resembled a beaming
church deacon,'' according to an account of the proceedings in The
Times. He was clinging to a copy of The Journal-American, whose
headline proclaimed ''LETTERS TO JOURNAL TRAP THE MAD
BOMBER.''
There was quite a bit of surprise that the Mad Bomber, who had
terrorized the city for years, turned out to be so ordinary looking.
''Nobody,'' Mr. Pelleck said, ''knew it was going to turn out to be
this doddering old man.''
Photos: Police officers put a container holding a bomb into a protected van at Grand Central Terminal in 1956. Right, pieces of letters to
the police from the Mad Bomber. (Photo by New York Police Department); (Photo by Neal Boenzi/The New York Times)(pg. B1);
George P. Metesky, 53, at the jail in Waterbury, Conn., shortly after his arrest in January 1957.
He was later brought to New York for trial. (Photo by Edward Hausner/The New York Times)(pg. B6)
Copyright 2005
The New York Times Company
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Population Exposure model
A Seriously injured victims • bereaved family members
B
Victims with high exposure to trauma • victims evacuated from the disaster
zone
Bereaved extended family members and friends • rescue and recovery
C workers with prolonged exposure • medical examiner's office staff • service
providers directly involved with death notification and bereaved families
People who lost homes, jobs, pets, valued possessions • mental health
providers • clergy, chaplains, spiritual leaders • emergency health care
D
providers • school personnel involved with survivors, families, of victims •
media personnel
E
Government officials • groups that identify with target victim group •
businesses with financial impacts
F Community-at-large
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Agency
Type of Event
Who is Eligible
What is Provided
FEMA/
CMHS
Crisis
Counseli
ng
Natural or human
caused disaster. Must
have Presidential
declaration.
Anyone living, working, or
in the declared area at
the time of the disaster.
Outreach, short-term
counseling, referral, and
psychoeducational activities
provided by mix of
professionals and trained
paraprofessionals.
Typically for about a year
following a disaster. Does
not provide long-term
treatment.
Red
Cross
Mental
Health
Services
Any emergency.
Special authorities in
transportation
emergencies.
Anyone in affected areas.
Can provide services to
families outside disaster
area.
Counseling and referral by
licensed mental health
professionals.
Typically only for a few
days/week following the
event.
Office for
Victims
of Crime
Criminal acts only
(including terrorism).
Crime victim's location
not critical.
Variety of advocacy and
other services including
support for short- and longterm mental health services.
As long as necessary
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When Provided
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Natural vs. Human-Caused Disasters
Natural
Human-Caused
Causes
Forces of nature
Human error, malfunctioning
Examples
Earthquakes,
hurricanes,
floods
Airplane crashes, major chemical leaks, nuclear
reactor accidents
Blame
No one
Person, government, business
Scope
Various locations
Locations may be inaccessible to rescuers, unfamiliar
to survivors, little advance warning
High
Higher, often felt by family members not involved in
actual disaster
Postdisaster
Distress
Source: CMHS. Psychosocial Issues for Children and Families in Disasters.
A Guide for the Primary Care Physician. Washington, D.C.: U.S. Department
of Health and Human Services; Publication No. (SMA) 96-3077, 1996.
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Percentage Distribution of the Population
By Race and Hispanic Origin
(Includes foreign and native-born populations)
American
Indian/
Alaska
Native*
*
Asian and
Pacific
Islander
Hispanic/
Latino
Origin*
Year
White
Black/ African
American
1995
73.6
12.0
0.7
3.3
10.2
2000
71.4
12.2
0.7
3.9
11.8
2010
67.3
12.5
0.8
4.8
14.6
2050
52.8
13.2
0.8
8.9
24.3
2100
40.3
13.0
0.7
12.6
33.3
* Persons of Hispanic/Latino origin may be of any race. Groups listed under “Race” are not of Hispanic origin.
** Includes American Indians, Alaska Natives, and Aleuts.
Source: U.S. Department of Commerce, Bureau of the Census. (2000). Projections of the resident population by race,
Hispanic origin, and nativity: Middle series, 1999 to 2100. Washington, DC: U.S. Department of Commerce.
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Disaster Projects Confront
Distrust
• Several disaster crisis counseling projects supported by the
Federal Government have had to address the distrust of
ethnic minority groups and their reluctance to use available
resources. For example, following the 1994 California
earthquake, the disaster crisis counseling project found that
many immigrants’ distrust of government posed a barrier to
their use of disaster services. Likewise, some of the
survivors of a hurricane in Alabama were immigrants from
Asian Communist countries who did not trust any
government and were not accustomed to receiving
Government assistance.
California Final Report, 1995 • Alabama Final Report, 1999
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Damage from Mississippi
Tornadoes Unequal
• In the late 1950s, several tornadoes struck rural
Mississippi. The only persons killed were black.
A subsequent study found that many people in
the black community had great difficulty in
coming to terms with this disaster. They did not
understand how a just God could discriminate in
such a fashion between white and black.
Perry and Perry, 1959
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Civil Unrest Causes Emotional
Problems for Refugees
• The civil unrest and fires in Los Angeles that
came in the wake of the Rodney King verdict
affected a community inhabited by many
refugees from Central America and Asia. For
immigrants who came from war-torn countries,
the Los Angeles disturbances reactivated fears
and emotions associated with their homeland.
Many experienced increased agitation,
depression, confusion, and recollections of prior
bereavements.
California Final Report, 1994
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Disaster Strikes a Highly Diverse
Community
•
On January 17, 1994, a major earthquake struck Los Angeles and
Ventura Counties. The Northridge earthquake was the largest and
most violent to hit an urban area in the United States since the 1906
San Francisco quake. The post-disaster recovery effort provided
mental health services to 1.9 million persons, representing myriad
ethnic groups, special populations, and lifestyles.
• The size and scope of the two affected counties, as well as the ethnic diversity of their
residents, constituted a challenge to disaster mental health providers. For example,
Ventura County is home to many undocumented migrant farm workers, the majority of
whom do not speak English and are mistrustful of government at any level. Language
and cultural barriers had to be overcome for persons from several Asian cultures as well.
The diverse population in the affected areas also included other special populations, such
as physically challenged persons and runaway youth, two groups that required special
outreach strategies.
California Final Report, 1995
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Vulnerable Groups Underserved by
Science and Technology
• Elderly shut-ins during heat and cold
waves
•
Illegal immigrants crossing southern border
•
Victims fearful of revealing identities
Publics vulnerable to terrorist attacks at home,
in workplace, in mass transit, at play
•
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Common Stress Reactions
• Behavioral
Increase or decrease in activity level
Substance use or abuse (alcohol or drugs)
Difficulty communicating or listening
Irritability, outbursts of anger, frequent arguments
Inability to rest or relax
Decline in job performance; absenteeism
Frequent crying
Hyper-vigilance or excessive worry
Avoidance of activities or places that trigger memories
Becoming accident prone
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• Physical
Gastrointestinal problems
Headaches, other aches and pains
Visual disturbances
Weight loss or gain
Sweating or chills
Tremors or muscle twitching
Being easily startled
Chronic fatigue or sleep disturbances
Immune system disorders
• Psychological/Emotional
Feeling heroic, euphoric, or invulnerable
Denial
Anxiety or fear
Depression
Guilt
Apathy
Grief
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• Thinking
Memory problems
Disorientation and confusion
Slow thought processes; lack of concentration
Difficulty setting priorities or making decisions
Loss of objectivity
• Social
Isolation
Blaming
Difficulty in giving or accepting support or help
Inability to experience pleasure or have fun
(Adapted from CMHS, 2004)
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Extreme Stress Reactions
Post Traumatic Stress Disorders (PTSD)
Type I, II, III
- Associated Disorders
• Major Depressive Episode
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder
• Panic Disorder
- Associated Complications
• Suicide
• Substance Abuse
• Self-Medication
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Crisis Counseling Programs for the Rural
Community
•
•
•
•
•
•
•
CHARACTERISTICS OF RURAL AREAS
High poverty levels
Increasing percentage of older adults
High unemployment
High levels of social and health related problems
Pockets of minorities within a largely homogeneous
population
Heavy dependence on agricultural, oil, mining, or
tourism related businesses
Large numbers of people involved with and reliant
upon organized religion
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Challenges Encountered by Rural Crisis
Counseling Programs
• Emotional Isolation and Independence of the
Rural Population
• Reaching Farm Families
• Geographic Isolation
• Accessing Hard-to-Reach Groups
• Cultural Values in Rural Populations
- Individualism
- Mental Health Stigma
- Spiritual Traditions
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The impact of a disaster in an area where agriculture accounts for a major
portion of the local economy may not be evident until months after the event.
Stress is generated by:
•
Uncertainty (level of crop damage, price fluctuations, etc.)
•
Time limits on applying for assistance
•
The culture, competition, and beliefs on self-reliance as a measure of
worth
•
Distrust of outsiders and government intervention
•
A maze of programs, red tape, and paperwork in the disaster recovery
process
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Key Concepts of Disaster Mental Health
•
No one who sees a disaster is untouched by it.
•
There are two types of disaster trauma—individual and community.
•
Most people pull together and function adequately during and after a
disaster, but their effectiveness is diminished by the effects of the
event.
•
Stress and grief in disasters are normal reactions to abnormal
situations.
•
Many emotional reactions of disaster survivors stem from problems of
daily living brought about by the disaster.
•
Disaster relief assistance may be confusing to some survivors. They
may experience frustration, anger, and feelings of helplessness
related to Federal, State, and private-sector disaster assistance
programs.
•
Most people do not see themselves as needing mental health services
following a disaster and will not seek such services.
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• Survivors may reject disaster assistance of all types.
• Disaster mental health assistance is often more practical than
psychological in nature.
• Disaster mental health services must be tailored to the culture of
communities where they are provided.
• Mental health workers should set aside traditional methods,
avoid mental health labels, and use an active outreach approach
to intervene successfully in disaster.
• Survivors respond to active, genuine interest, and concern.
• Interventions must be appropriate to the phase of disaster.
• Social support systems are crucial to recovery.
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During the Crisis—At the Scene
Minimizing Stress During the Crisis—At the Scene
•
Clearly define individual roles and reevaluate if the situation changes.
•
Institute briefings at each shift change that cover the current status of the work
environment, safety procedures, and required safety equipment (CMHS, 1994).
•
Partner inexperienced workers with experienced veterans. The buddy system is an
effective method to provide support, monitor stress, and reinforce safety procedures.
Require outreach personnel to enter the community in pairs (CMHS, 1994).
•
Rotate workers from high-stress to lower stress functions (CMHS, 1994).
•
Initiate, encourage, and monitor work breaks, especially when casualties are involved
(McCarroll, Ursano, Wright, & Fullerton, 1993). During lengthy events, implement longer
breaks and days off, and curtail weekend work as soon as possible.
•
Establish respite areas that visually separate workers from the scene and the public. At
longer operations, establish an area where responders can shower, eat, change clothes,
and sleep (CMHS, 1994).
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•
Implement flexible schedules for workers who are directly impacted by an
event (CMHS, 1994). This can help workers balance home and job
responsibilities.
•
Reduce noise as much as possible by providing earplugs, noise mufflers,
or telephone headsets (CMHS, 1994).
•
Mitigate the effects of extreme temperatures through the use of protective
clothing, proper hydration, and frequent breaks.
•
Ensure that lighting is sufficient, adjustable, and in good working order.
•
Lessen the impact of odors and tastes, and protect workers' breathing by
supplying facemasks and respirators (McCarroll et al.,1993).
•
Provide security for staff at facilities or sites in dangerous areas, including
escorts for workers going to and from their vehicles (CMHS, 1994).
•
Provide mobile phones for workers in dangerous environments. Ensure
that staff know who to call when problems arise (CMHS, 1994).
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After the Crisis
Minimizing Stress for Workers After the Crisis
•
Allow time off for workers who have experienced personal trauma or
loss. Transition these individuals back into the organization by initially
assigning them to less demanding jobs (CMHS, 1994).
•
Develop protocols to provide workers with stigma-free counseling so
that workers can address the emotional aspects of their experience
(CMHS, 1994).
•
Institute exit interviews and/or seminars to help workers put their
experiences in perspective (Bradford & John, 1991) and to validate
what they have seen, done, thought, and felt.
•
Provide educational inservices or workshops around stress
management and self-care.
•
Offer group self-care activities and acknowledgments.
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Research on children from the September 11th, 2001
attacks & the Oklahoma City Bombing.
• Two factors related to increased stress
symptoms were:
1) amount of television coverage viewed by
the child,
2) parental distress.
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The Effect of FIRST Responder-Related
PTSD on Children
• Transgenerational effects of combatrelated/FIRST Responder-Related PTSD
have critical implications for a veteran’s
interpersonal and family life
• Children of combat veterans/FIRST
Responder with PTSD generally exhibit
one of three response patterns.
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The “over-identified” child.
• Through a process Rosenheck and Nathan (1985) has
termed secondary traumatization, children come to
experience an emotional disequilibrium similar to the
veteran with PTSD.
• Children with secondary traumatization are often that
parent’s closest companion and are at risk for "relieving"
their father’s trauma, experiencing his flashbacks, and
sharing his nightmares.
• These children fail to develop their own friendships
because their lives revolve around their father.
• In school, they often have difficulty with concentration
because they are distracted by their concern for their
father’s well-being.
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The "rescuers"
• Whereby they take on parental roles and
responsibilities.
• They often feel guilty about trouble at home and
blame themselves.
• They assume that if they are good, life at home will go
well.
• They believe it is their responsibility to keep their
parents happy and to insure nothing goes wrong.
• These children often lose spontaneity and interest in
daily activities.
• Similar to children of alcoholics, these children are
at risk for continuing this pattern into adult life.
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Third pattern Child
• Children who are emotionally uninvolved in family life.
• They often know about their father's war experience and
need for support, but generally receive little emotional
support themselves from their parents.
• In an effort to gain recognition, they are apt to perform
well academically,
• Their emotional and social constriction may cause
symptoms of depression and anxiety,
• and later cause problems in their adulthood efforts to
form intimate relationships.
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Make Better Use of Existing
Science
• Target Underserved Populations
• Extend management time horizons
• Take advantage of present societal
trends
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All-Hazards Mental Health
• Addressing regional disasters;
• Increasing attention to terrorism and bioterrorism;
• The occurrence of Natural disasters (fires, floods,
hurricanes) has remained high even as the threat of
terrorism has increased.
• Mental health and substance abuse must be fully
integrated into the public health emergency response.
• Little political will to focus on disaster mental health over
many years once a disaster passes;
• Mental health being overlooked in favor of safety and
security concerns;
• The lack of well-defined, studied, and easily
implemented programs in disaster mental health that can
be adopted widely.
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TERRORISM IS REAL AND IT'S HERE
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Questions?
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