Coping with mental health problems following disaster, emergency situations

By Chuck Frank / chuck@theklaxon.com / 02.08.2010

Updated on: 02.10.10 at 1:36 pm

In an effort to help individuals’ mental health post disasters, The Klaxon spoke with Dr. Gerald Cohen, director of clinical affairs for the Division of Mental Hygiene at New York City Department of Health and Mental Hygiene. Cohen offered the following tips for individuals experiencing psychological problems after an emergency.

The Klaxon: Natural or human-made disasters are, by definition, disturbing and stressful. Most people exposed to traumatic events can show signs of stress in the immediate and short-term aftermath of the event. What are the signs of disaster stress reactions?

Cohen: All of us are affected by disasters and people can experience a wide range of psychological reactions. The way people react varies from to person to person, and it is important to remember that there is no right or wrong way to react. Some people may experience and express very strong reactions. Others may have only very mild reactions. Some experience reactions immediately while others can experience reactions days, weeks or even months later after the event. One’s reactions may change over time.

Emotional reactions are very common and can include feeling numb, sadness, anxiety, anger, grief, irritability, helplessness and guilt. Some people withdraw, feel restless or on edge, have trouble functioning at work or home, or report simply not acting like themselves. Some have increased alcohol or drug use. Confusion and difficulties with concentration, memory and making decisions can occur. Physical reactions are also quite common- these can include fatigue or exhaustion, general aches and pains, headaches and stomach aches. A number of people report flu-like symptoms, trouble with appetite, or trouble sleeping. Some experience nightmares or recurring dreams about the disaster. Some have spiritual reactions where their religious beliefs and convictions are shaken, such as questioning one’s belief in God.

For many people these reactions to disasters are temporary and often resolve over days to weeks. We like to say these are normal reactions to an abnormal situation. Reactions or symptoms that persist or worsen are of increased concern. Mental health consultation should be considered when such reactions persist or worsen over time, or when they interfere with impairment in normal functioning, such as at work or home.

The Klaxon: Helping people affected by traumatic events requires preparation, sensitivity, and common sense. What type of intervention is recommended to help maintain and stabilize the psychological injuries of victims and their families in the immediate aftermath of a traumatic event?

Cohen: We educate disaster responders and care providers about essential elements of psychological first aid as a way to strengthen resiliency and enhance recovery in the immediate aftermath of disasters. These elements include promoting safety, calm, connectedness, hope and self-efficacy. Promoting safety includes helping to ensure people’s basic immediate needs, such as emergency medical care, food and shelter are being met. We can promote calm by compassionately listening to those impacted who wish to share their experiences and feelings, and by providing accurate information. Other important interventions include helping those impacted by the disaster connect with family, making them aware of and helping them utilize available support services, educating those directly and indirectly impacted and their families about common psychological reactions, and also facilitating referrals to mental health professionals when needed.

The Klaxon: Some persons are more vulnerable and may be at potential risk for developing sustained severe and long-lasting reaction to trauma. What are some of the factors that contribute to the rest of long-term psychological impairment?

Cohen: Although most people are resilient and recover relatively quickly, especially with support from their family, friends and community, a minority of people exposed to disasters develop longer term problems and can have persistent anxiety and other symptoms or develop mental health conditions such as post-traumatic stress disorder and major depression. For example, findings from our World Trade Center Registry are that about one-quarter of survey participants directly exposed to the Sept. 11, 2001, terrorist attack report event-related post traumatic stress symptoms at two to three or five to six years after the disaster.

Many factors may affect vulnerability to longer term psychological problems after disasters. These include the proximity, duration and intensity of exposure to life threatening or horrifying events, the nature and scope of a disaster, and the enduring psychosocial stressors on those impacted. People with pre-existing mental health conditions and a history of previous traumatic experiences are at greater risk Those who experienced loss of loved ones or personal property, who sustained serious physical injuries and who lack family or community supports to help them cope effectively are also at greater risk. More research is needed to better understand the influence of these and other factors contributing to psychological impairment following disasters.

The Klaxon: What is the best way to help children during times of trauma?

Cohen: Just as in adults, children can react to disasters in a variety of ways. Here are some tips to help our children cope.

Try to limit the amount of TV our children watch about the disaster. Exposure to too many upsetting images and news can increase their anxiety, worry and confusion.

When they do watch the news watch it with them, and be available to answer their questions and explain facts honestly, and in age appropriate ways they can understand.

Not all children will want to express their feelings and thoughts about the disaster. When they do, acknowledge their feelings and reactions. Help them find ways to express themselves in a way they are comfortable, such as by talking, through play, or through their artwork.

Monitor you own reactions. The way parents react and cope in a disaster can affect our children. If you seem excessively worried, they can become anxious and afraid. You can help your children feel safe if you stay calm and show you can cope with the situation.

Keep to regular and healthy routines as much as possible. Although in some disaster situations keeping our child’s daily routines such as play dates and afterschool activities may not always be possible, keeping to a daily routine will help give them a sense of security. We should try to keep to basic routines such as family meals and bed time stories as much as possible. We should also try to keep them healthy and make sure that they eat well, sleep enough, and get adequate physical exercise.

The Klaxon: Cultural groups have considerable variation regarding views of loss, death, grieving and may present challenges for helpers. What are some of the guiding principles in providing culturally appropriate mental health services for diverse populations affected by traumatic events?

Cohen: It’s important for us always to be sensitive to cultural differences. Culture reflects how we communicate, how we celebrate life, and how we deal with stress. It also influences people’s “help-seeking” behaviors. Whenever we are working with a population affected by disaster, it’s important for us to consider the cultural context, including religious beliefs ,norms, and values that are specific to a particular group. It’s important to understand where people go to seek help and whom they trust.. Many seek help first in their churches or houses of worship, seeking support from their spiritual leaders. Others will seek help initially from primary care physicians, but not from mental health providers. It’s important to involve and coordinate disaster mental health efforts with community and faith leaders who understand or are part of affected cultural groups. Such coordination can help reach and identify those most in need of emotional support and help facilitate referral for those who may need professional mental health services.

The Klaxon: How do you manage a healthy state-of-mind and body and care for yourself and family members after exposure to disasters and other traumatic events?

Cohen: Here are some tips on taking care of yourself after a disaster.

Recognize the stress you are experiencing: People vary in their emotional reactions to disasters; there is no right or wrong way to react. Some react with sadness, guilt, anger or anxiety. Many have trouble sleeping and difficulty concentrating. Others may experience physical reactions such as fatigue or, aches and pains. Still others may feel they are not acting like themselves.

Keep to your daily routine: Give yourself time to mourn your losses, and time to heal. Maintain your daily routine as much as possible, in order to give your life structure.

Stay informed but not preoccupied: Get information from reliable resources but try not to become preoccupied with the news. Watching and listening to too much coverage about the event can be upsetting to you and those around you, especially your children.

Stay connected with family and friends: Share your thoughts and talk about your feelings when you are able. Realizing that the people around you are experiencing similar feelings may provide comfort and support.

Don’t neglect your health: You can better cope with the stress of the situation if you are healthy. Take care of your body by getting enough sleep, eating well and exercising. Do not smoke, drink excessively or use drugs to cope – these will cause only more problems in the long run.

The Klaxon: When should someone seek help to cope with stress?

Cohen: People should consider seeking help whenever they feel the need and especially if their symptoms or reactions to a disaster persist more than a few weeks, are getting worse, or are interfering with their home, work or other areas of functioning.

The Klaxon: Where can the affected person find professional mental health help?

Cohen: Individuals can find help by speaking with their primary care physician about a referral for mental health services or in New York City by calling 1-800-LIFENET, a 24-hour, free and confidential hotline that provides mental health information and referral. LIFENET is multilingual and multicultural.