Three questions often are asked by survivors and emergency response team members:
2. What factors increase the risk of lasting readjustment problems?
1. What psychological problems result from disaster experiences?
Most child and adult survivors experience normal stress reactions for several days.
Survivors are at greatest risk for severe stress symptoms and lasting readjustment problems if any of the following are either directly experienced or witnessed during or after the disaster:
3. What can disaster survivors do to reduce the risk of negative psychological consequences and to best recover from disaster stress?
- Life threatening danger or physical harm (especially to children)
- Exposure to gruesome death, bodily injury, or bodies
- Extreme environmental or human violence or destruction
- Loss of home, valued possessions, neighborhood, or community
- Loss of communication with/support from close relationships
- Intense emotional demands (such as faced by rescue personnel or caregivers)
- Extreme fatigue, weather exposure, hunger, or sleep deprivation
- Extended exposure to danger, loss, emotional/physical strain
- Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)
- Some individuals have a higher than typical risk for severe stress symptoms and lasting PTSD, including those with a history of:
- Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)
- Chronic medical illness or psychological disorders
- Chronic poverty, homelessness, unemployment, or discrimination
- Recent or subsequent major life stressors or emotional strain (such as single parenting)
- Disaster stress may revive memories of prior trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems.
Observations by disaster mental health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote post-disaster readjustment:
- Protect: find a safe haven that provides shelter, food and liquids, sanitation, privacy, and chances to sit quietly, relax, and sleep at least briefly.
- Direct: begin setting and working on immediate personal and family priorities to enable you and your significant others to preserve or regain a sense of hope, purpose, and self-esteem.
- Connect: maintain or re-establish communication with family, peers, and counselors in order to talk about your experiences – take any chance to "tell your story" and to be a listener to others as they tell theirs, so that you and they can release the stress a little bit at a time in disaster's wake.
- Select: identify key resources such as FEMA, the Red Cross, the Salvation Army, or the local and state health departments for clean-up, health, housing, and basic emergency assistance.
Taking every day one-at-a-time is essential in disaster's wake. Each day is a new opportunity to FILL-UP
- Focus Inwardly on what's most important to you and your family today;
- Look and Listen to learn what you and your significant others are experiencing, so you'll remember what is important and let go of what's not;
- Understand Personally what these experiences mean to you as a part of your life, so that you will feel able to go on with your life and even grow personally.
Helping disaster survivors, family members, and emergency rescue or disaster relief personnel requires preparation, sensitivity, assertiveness, flexibility, and common sense
- First priority is being a team player, by respecting and working within the site chain of command, as well as pitching in to provide basic care and comfort to survivors and workers.
- A close second priority is to make personal contact on a down-to-earth basis with survivors and rescue workers – listen, don't give advice; ask how they (or their children) are doing and what you can do to help; make them comfortable with food, beverages, practical supplies (e.g., clothes, blankets, sunscreen, magazines, writing implements, telephone), and a comfortable place to sit.
- A third priority is helping them to "defuse" by spontaneously "telling their story" – ask
- Have you ever been through anything like this before?
- How's it going getting a place to stay and the assistance you need?
- Is there anyone I can help you get in touch with?
- What do you find yourself remembering most since this all happened?
- Where were you when this started?
- What are your top three immediate priorities, for the next few hours or days?
- A fourth priority is a careful assessment of the risk factors and symptomatic problems, to identify and set up referrals for the persons or families most likely to be in need of further care.
What are the Goals of Mental-Health Providers in the Wake of a Disaster?
PROTECT: help preserve survivors' and workers' safety, privacy, health and self-esteem
DIRECT: get people where they belong, help them to organize, prioritize and plan
CONNECT: help people communicate supportively with family, peers, and resources
DETECT: screen, triage, and provide crisis care to persons at-risk for severe problems
SELECT: refer people to health, spiritual, mental health, social, or financial services
VALIDATE: use formal and informal educational opportunities to affirm the normalcy and value of each person's reactions, concerns, ways of coping, and goals for future.