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    Mental health services for victims of disasters

    World Psychiatry. 2002 Oct; 1(3): 149–152.

    PMCID: PMC1489840 PMID: 16946836

    Mental health services for victims of disasters

    RAQUEL E COHEN1

    Author information Copyright and License information Disclaimer

    See commentary "Disaster mental health: lessons learned from the Hanshin Awaji earthquake" on page 158.

    See commentary "Disaster mental health care: the experience of Turkey" on page 159.

    See commentary "Managing the psychiatric morbidity of disasters" on page 153.

    See commentary "Special teams for medical/psychological intervention in disaster victims" on page 154.

    See commentary "Mental health services for victims of disasters in developing countries: a challenge and an opportunity" on page 155.

    See commentary "Mental health intervention and high-risk groups in disasters" on page 157.

    See commentary "Behavioral consequences of disasters: a timely reminder" on page 160.

    Disasters, whether natural or manmade, affect lives and property, devastating communities through a chain of catastrophic sequences affecting social and economic developments. They are often events difficult to predict, prevent and control. They impact on individuals to create survivors who must cope with trauma, loss and crisis. They present a challenge to mental health professionals who have to assist the traumatized population. In afflicted communities, a large number of individuals are in the ranks of survivors and rescuers.

    In order to design, organize and implement post-disaster crisis-oriented services, an integrated, interactive, flexible linkage system between the mental health organization and emergency management agencies needs to be established. It is important to realize that while mental health professionals organize to assist survivors, multiple activities are taking place within the governmental/public system. Decision making about the 'life situation post-disaster' of the survivor in our care is also managed by other agencies.

    Identification of post-disaster need differences between groups of survivors can be exemplified according to whether the physical impact of the disaster is direct or indirect (1): primary survivors are those who have experienced maximum exposure to the traumatic event; secondary survivors are the grieving close relatives of primary victims; third-level survivors are rescue and recovery personnel, medical, nursing, mental health, Red Cross, clergy, emergency staff, firefighters, police; fourth level victims are other people in the community involved in the disaster - reporters, government personnel; fifth-level victims are individuals who may experience states of distress or disturbance after seeing or hearing media reports (e.g., bodies of individuals falling down from the Twin Towers after the terrorist attack in New York in September 2001).

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    POST-DISASTER TIME FRAMES

    Dividing and labeling time frames in the sequence of a disaster is helpful to identify both the responses of survivors and the programs that are organized to assist them. Generally the phases are identified as 'threat'/'impact', 'shortterm' and 'long-term' (2). Post-traumatic responses follow a sequence that resembles the emotions, thoughts and behaviors documented in the loss and bereavement process. Although the reaction sequences are not of fixed duration, there is a developmental process that has been identified and documented. This process of biopsychosocial coping starts with feelings of disbelief, bewilderment, difficulty in focusing, using denial as the main defense. Anxiety and fear are eventually followed by varied degrees of depression and sadness. Secondary events can influence these processes toward healthy resolution or produce pathological syndromes. Variables like intensity of impact, extended geographical destruction, rapidity of assistance are examples of modifiers that have emerged to categorize reactions to trauma. The inability to comprehend the reality of the destruction of the World Trade Center in New York following the terrorist use of commercial planes unleashed varied mental health disturbances, as well documented by interviews of the mass media.

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    IMPACT PHASE

    Following the impact, the situation is dramatically and catastrophically experienced. Individuals in the affected areas will immediately mobilize themselves and participate with the efforts of rescue, shelter and safety for the citizens. During these efforts, they will organize themselves to deal with the priority of burying the dead, attending to the wounded, identifying frail members of the community, beginning to apply their knowledge of first emergency aid while waiting for resources from the outside (3).

    After the first days, when the issues of survival, shelter, food and water are dealt with, mental health issues present themselves as needing attention and generally last beyond the healing of the physical trauma. The following list presents a summary of the key activities that need to be organized and operationalized to deliver a mental health program aimed to mitigate consequences of the disaster in vulnerable populations.

    Outreach

    These activities are organized in shelters, congregated groups and homes in devastated communities. They aim to provide emotional support during the acute period following a disaster. Outreach assists survivors in expressing and understanding disastercaused stress, difficulty in sleeping and thinking clearly, and grief reactions, aiding individuals to return to a state of equilibrium and function. Information is given to clarify that their reactions and behavior are normal and are expected due to the abnormal situation in which they suddenly find themselves (4). Following the earthquake in the Republic of Armenia in 1988, which resulted in over 250,000 deaths, efforts were organized by international agencies to develop an assistance program. In her report, A. Sanentz Kalayjian (5) compares the outreach efforts of that disaster to the earthquake in San Francisco and Hurricane Andrew in Southern Florida. She describes the difference of preparation, resources and preparedness following these disasters, pointing to the necessity of organizational capacity to assist survivors.

    स्रोत : www.ncbi.nlm.nih.gov

    Survivors of Disasters Resource Portal

    Learn about possible reactions to disasters as well as resources for survivors to prepare for and cope with disasters or traumatic events.

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    Survivors of Disasters Resource Portal

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    Learn about possible reactions to disasters as well as resources for survivors to prepare for and cope with disasters or traumatic events.

    Disasters large and small, natural or human-caused regularly affect people across the United States. These disasters can range from wildfires to hurricanes to mass violence and affect people directly as well as through exposure to media coverage of the incident. Often disasters occur with little or no warning. It is common for anyone who has been affected by a disaster to experience some level of reactions.

    SAMHSA Disaster Distress Helpline

    If you need additional support following a disaster, the Disaster Distress Helpline offers toll-free crisis counseling and support. Call them at 1-800-985-5990. Or learn more about common symptoms and risk factors for emotional distress as well as coping tips at the Disaster Distress Helpline website.

    Disaster Reactions

    After a disaster, it is common to experience physical, behavioral, and emotional changes. Below are some possible feelings or changes that you may have after a disaster. It is common to experience these reactions in the days, weeks, and months following an event.

    Anxiety or fear.

    Overwhelming sadness.

    Anger, especially if the event involved violence. Visit the Coping With Anger After a Disaster page or download Tips for Survivors: Coping With Anger After a Disaster or Other Traumatic Event for more information.

    Guilt, even when you had no control over the traumatic event.

    Disconnection, not caring about anything or anyone.

    Numbness, or inability to feel either joy or sadness.

    Stomachaches or diarrhea.

    Headaches or other physical pains for no clear reason.

    Jumpiness or being easily startled.

    Trouble falling asleep, staying asleep, sleeping too much, or trouble relaxing.

    An increase or decrease in your energy and activity levels.

    Use or misuse of alcohol, tobacco, illegal drugs, or prescription medication in an attempt to reduce distressing feelings or to forget.

    Outbursts of anger, feeling really irritated and blaming other people for everything.

    The desire to be alone most of the time, self-isolation.

    Trouble remembering things.

    Trouble thinking clearly and concentrating.

    Difficulty talking about what happened or listening to others talk about it.

    For more information on common disaster reactions and how to cope with them, check out the SAMHSA DTAC tip sheet Tips for Survivors of a Disaster or Other Traumatic Event: Managing Stress or posters Have You Experienced a Disaster? and Have You and Your Family Been Affected by a Disaster? For more about helping children and teenagers cope with disaster, see the Children and Disasters web page.

    Featured SAMHSA DTAC Resources

    The SAMHSA Disaster Technical Assistance Center (DTAC) offers tip sheets and other resources to help survivors during and after disasters. Several tip sheets are available in languages other than English.

    Feeling Stressed or Anxious About the COVID-19 Pandemic? (Spanish)

    Tips for Managing Stress During the COVID-19 Pandemic (wallet card) (Spanish)

    Tips for Survivors of a Pandemic: Managing Stress (Spanish)

    Tips for Survivors: Coping With Grief after a Disaster or Traumatic Event

    Tips for Survivors: How to Cope With Sheltering in Place (Spanish)

    Talking With Children: Tips for Caregivers, Parents, and Teachers During Infectious Disease Outbreaks (Spanish)

    Tips for Survivors of a Disaster or Other Traumatic Event: Coping With Retraumatization (Spanish, Punjabi)

    Tips for Survivors: Coping With Grief After Community Violence

    Tips for Talking With and Helping Children and Youth After a Disaster or Traumatic Event: A Guide for Parents, Caregivers, and Teachers (Spanish, Punjabi)

    Disaster-Specific Resource Collections

    The SAMHSA Disaster Behavioral Health Information Series features sections specifically related to hurricanes, floods, wildfires, tornadoes, droughts, or earthquakes. These collections include resources on preparing for and recovering after specific types of disasters.

    Other Helpful Resources

    Plan ahead for disasters. Visit Ready.gov for information on preparing yourself and your family for disasters.

    Visit the Disaster Financial Assistance webpage to learn about options for emergency financial assistance from the government after a disaster.

    Last Updated

    Last Updated: 10/11/2022

    स्रोत : www.samhsa.gov

    Recovering emotionally from disaster

    Understanding the emotions and normal responses that follow a disaster or other traumatic event can help you cope with your feelings, thoughts, and behaviors.

    Recovering emotionally from disaster

    Understanding the emotions and normal responses that follow a disaster or other traumatic event can help you cope with your feelings, thoughts, and behaviors.

    Date created: 2013 4 min read Trauma

    Disasters and Response

    Disasters such as hurricanes, earthquakes, transportation accidents, or wildfires are typically unexpected, sudden, and overwhelming. For many people, there are no outwardly visible signs of physical injury, but there can be nonetheless an emotional toll. It is common for people who have experienced disaster to have strong emotional reactions. Understanding responses to distressing events can help you cope effectively with your feelings, thoughts, and behaviors, and help you along the path to recovery.

    What are common reactions and responses to disaster?

    Following disaster, people frequently feel stunned, disoriented or unable to integrate distressing information. Once these initial reactions subside, people can experience a variety of thoughts and behaviors. Common responses can be:

    Intense or unpredictable feelings. You may be anxious, nervous, overwhelmed, or grief-stricken. You may also feel more irritable or moody than usual.Changes to thoughts and behavior patterns. You might have repeated and vivid memories of the event. These memories may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. It may be difficult to concentrate or make decisions. Sleep and eating patterns also can be disrupted—some people may overeat and oversleep, while others experience a loss of sleep and loss of appetite.Sensitivity to environmental factors. Sirens, loud noises, burning smells, or other environmental sensations may stimulate memories of the disaster creating heightened anxiety. These “triggers” may be accompanied by fears that the stressful event will be repeated.Strained interpersonal relationships. Increased conflict, such as more frequent disagreements with family members and coworkers, can occur. You might also become withdrawn, isolated, or disengaged from your usual social activities.Stress-related physical symptoms. Headaches, nausea, and chest pain may occur and could require medical attention. Preexisting medical conditions could be affected by disaster-related stress.

    How do I cope?

    Fortunately, research shows that most people are resilient and over time are able to bounce back from tragedy. It is common for people to experience stress in the immediate aftermath, but within a few months most people are able to resume functioning as they did prior to the disaster. It is important to remember that resilience and recovery are the norm, not prolonged distress.

    There are a number of steps you can take to build emotional well-being and gain a sense of control following a disaster, including the following:

    Give yourself time to adjust. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced and try to be patient with changes in your emotional state.Ask for support from people who care about you and who will listen and empathize with your situation. Social support is a key component to disaster recovery. Family and friends can be an important resource. You can find support and common ground from those who've also survived the disaster. You may also want to reach out to others not involved who may be able to provide greater support and objectivity.Communicate your experience. Express what you are feeling in whatever ways feel comfortable to you—such as talking with family or close friends, keeping a diary, or engaging in a creative activity (e.g., drawing, molding clay, etc.).Find a local support group led by appropriately trained and experienced professionals. Support groups are frequently available for survivors. Group discussion can help you realize that you are not alone in your reactions and emotions. Support group meetings can be especially helpful for people with limited personal support systems.Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs because they can be a numbing diversion that could detract from as well as delay active coping and moving forward from the disaster.Establish or reestablish routines. This can include eating meals at regular times, sleeping and waking on a regular cycle, or following an exercise program. Build in some positive routines to have something to look forward to during these distressing times, like pursuing a hobby, walking through an attractive park or neighborhood, or reading a good book.Avoid making major life decisions. Switching careers or jobs and other important decisions tend to be highly stressful in their own right and even harder to take on when you're recovering from a disaster.

    When should I seek professional help?

    If you notice persistent feelings of distress or hopelessness and you feel like you are barely able to get through your daily responsibilities and activities, consult with a licensed mental health professional such as a psychologist. Psychologists are trained to help people address emotional reactions to disaster such as disbelief, stress, anxiety, and grief and make a plan for moving forward. To find a psychologist in your area, visit APA's Psychologist Locator.

    स्रोत : www.apa.org

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