National Consensus Statement on Mental Health Recovery

Our approach to mental health recovery is consistent with the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration (SAMHSA) which has developed the following guidelines:

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

The 10 Fundamental Components of Recovery

Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.

Non-Linear: Recovery is not a step-bystep process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). Th e process of recovery moves forward through interaction with others in supportive, trust-based relationships.

Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.

Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.

Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

Hope: Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefi ts individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefi ts of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.

Resources
www.samhsa.gov
National Mental Health Information Center
1-800-789-2647, 1-866-889-2647 (TDD)
Original Link

Public Safety Overview

There are things that everyone can do before a disaster strikes to better prepare themselves for the psychological impact of a catastrophic event. The array of additional challenges that you, as public safety personnel, face as a result of the unique role you fulfill in times of crisis necessitates a discussion of planning and preparedness that focuses on things that you should be mindful of in making preparations. We hope that by taking up such a discussion, we can strengthen your ability to be ready to respond to a disaster by equipping you in the following ways:

1) Educating you about the potential psychological consequences of disasters.
2) Highlighting some of the concerns that public safety personnel face in the event of a disaster, and by pointing to some ways in which they can be addressed beforehand.
3) Directing you to additional resources that can help in preparing for disaster relief operations.

This site seeks to achieve the above stated measures by emphasizing disaster preparation and planning in a number of ways:

• Suggesting ways in which you and your family can prepare in case you have to deploy for disaster relief operations.
• Familiarizing you with some of the psychological risks that public safety personnel face. Forewarned is forearmed!
• Discussing how you can prepare a disaster deployment kit to have nearby in case you are summoned to help.
• Acquainting you with the training facilities and institutions that offer disaster preparedness training to individuals and agencies.

We are glad to see that you have visited our site, and we hope that you will take advantage of what it has to offer. Please take some time to explore the resources offered here. You may also want to have a look at some of the external links listed below.

Tips for ER Workers - This 3 page pdf by SAMHSA focuses mostly on stress prevention and management for individual public safety workers, as well as the role of the agency or organization in accomplishing the two aforementioned goals.

This article from www.policeOne.com is titled Critical incidents: Myths and realities. The article does a nice job of dispelling some of the more common misconceptions about the psychological impact of disasters.

Preparation and Planning

A disaster may strike at any time and at any place. When it does, you will be needed by the community that you serve to provide urgently needed rescue and relief. Because of this, it is important that you make sure your family is prepared for your absence in the event of a disaster. Here are some of the underlying reasons for the need to include all members of your household in planning and preparing:

• Being able to deploy knowing that your loved ones are prepared reduces stress and increases your ability to do your job and stay safe. Public safety personnel oftentimes live in or near the area in which they are employed. In the event of a disaster at or around the vicinity in which you work, your loved ones may be impacted by the very event to which you are responding. Taking steps toward readiness as a family will mediate this source of potentially debilitating stress at a time when you need to be at your best.
• You may have to be away from home for a while. This ties in with the previous point. Chances are quite high that you will be summoned almost immediately. Once you’re at the scene, opportunities for heading home to check on things will probably be scarce; the people in the community you protect and serve will be relying on you and your colleagues for help and trained personnel will probably be in short supply. If disaster strikes while you’re at work (an excellent possibility), you may have to respond immediately, without any chance to check on things at home.
• Being prepared will ease the long-term impact of the event. It will reduce the disaster’s psychological impact on everyone in your home if they know you’re prepared. Thorough preparation and planning can also reduce the degree of financial devastation (pdf version) your household faces. All these things will collectively contribute to a quicker recovery for all of you.

By enacting steps as a family to be ready in case disaster strikes, you can help your loved ones and the community you are sworn to serve, as well as yourself. The steps you will take are very much the same as those taken by the public. However, given the unique role that public safety personnel perform, there are some things that deserve additional emphasis:

• Communication: How will you communicate with one another? Plan for this now, because it may be an issue during a catastrophic event. Think about having a primary means of communication, as well as a backup in case the primary one fails. Also, discuss the fact that you may be temporarily unable to contact one another. As an example, during Hurricane Katrina, the internet, landline telephones, and cellular phones were all incapacitated. 
• Evacuation: Establish beforehand some guidelines for when and how your family will evacuate. For help with this, you can take a look at GEMA's Evacution Guildlines (pdf version). You may also want to consider where everyone will go in the event that evacuation does become necessary. For help with this see GEMA Shelter Information (pdf version).
• Location and Status: How will they know you’re okay? Does your agency have a plan for letting personnel’s families know that their people are okay? Be familiar with locator services like SATERN (pdf version).
• Basic life support skills: Most of you have had at least some training on what to do if someone becomes critically ill or injured. Even if you haven’t, you have access to places that provide such training through your agency. Take advantage of this benefit! At a minimum, make sure everyone is certified in CPR and acquainted with basic trauma care.
• Talk to young children: It’s important to familiarize yourself with how children and adolescents at various levels experience and respond to disasters and to talk to them about it beforehand. In the event that you must respond to a disaster, your absence may intensify the fears they experience. Talk to them about your role during a disaster in a way that is appropriate to their age. (pdf version)

 

Additional Resources

How traumatic stress impacts children (pdf version)

Information from the American Red Cross on disasters and financial recovery (pdf version)

The American Red Cross site allows access to a wide range of preparedness information (pdf version)

GEMA's (Georgia Emergency Management Agency) homepage (pdf version)

Training and Education

Public safety personnel are among those most likely to contend with potentially dangerous levels of traumatic stress (pdf version) in the wake of a disaster. The degree to which disaster-related stress is experienced as a harmful influence varies according to a number of individual and situational factors (pdf version). Included among these determinants is the extent to which the individual is prepared for the event. Although each disaster unfolds differently, there are some generalizable ways in which public safety personnel can help to minimize their psychological impact. One of the ways in which they can prepare (pdf version) is by attending disaster-related training and coursework. Here are some facts about disaster preparedness training;

• The psychological impact of ANY stressful event (like a disaster) is reduced if you are trained and educated to react to it.
• Disaster preparedness training often combines an array of topics and methods to prepare you cognitively, emotionally, and physically for disasters.
• Physical and cognitive response preparedness can increase emotional preparedness through the proficiency they enable (and vice-versa). For example --if, enabled by preemptive classroom and field training, you rescue people from waterborne risks when flooding occurs, you will experience less total subsequent emotional traumatization than if you had been able to rescue no one.
• Disaster training is available from a variety of training facilities, institutions, and agencies. Online coursework is also offered.
• Your family and loved ones will worry less if they know that you are trained to stay safe during disasters.
• Attention Administrators & Supervisors! Disaster preparedness exercises and information (pdf version) involving coordination of different agencies can make your agency better able to contend with this inevitable aspect of disaster relief operations (a phenomenon known in some fields as ‘the second disaster’).
• Attention Administrators & Supervisors! Having trained personnel at ALL levels of your department can reduce the stress YOU encounter during and after a disaster. 

 

A diverse array of training is offered at the federal and state level to help prepare public safety personnel for disasters. Some resources are listed below. Be sure to also check with your agency's designated training coordinator for places where training and coursework can be found.

• The Georgia Public Safety Training Center (pdf version) offers classes to prepare public safety responders, supervisors, and administrators for disaster operations..
• The National Incident Management System Incident Command System (NIMS ICS) (pdf version) conducts training that emphasizes coordination among agencies.
• The Federal Emergency Management Agency's Emergency Management Institute (FEMA EMI) (pdf version) offers disaster training, both online (pdf version) and at their facility (pdf version).

 

For anyone interested in pursuing accredited/certified education and training from places other than those traditionally used by public safety in Georgia, a number of colleges, universities, and institutions (pdf version) offer various courses and programs.  

Proactive Means

In a perfect world, all public safety personnel would receive extensive disaster training with full support (e.g. pay) from the agencies they serve under; but then again, in a perfect world, disasters would never happen, and this conversation would be pointless. As things are, it sometimes seems impossible to get the disaster-related training you need, for a variety of reasons. These include;

• Lack of support from your agency -- this can be due to manpower shortages, budgetary constraints, or sheer indifference on the part of administrators.
• Time -- your routine duties may require you to expend your time for training on vital coursework not related to disaster.
• Geographic constraints -- facilities where training is offered may be far away or inconveniently located.

It is important that you know that even though your attendance of disaster-related coursework may be limited due to practical considerations such as those listed above, there are some PROACTIVE measures you can take to become better trained (and thus prepared) for disaster response:

• FEMA (pdf versionPS06FEMA) offers an extensive array of online courses.
• The National Disaster Life Support Foundation (pdf version) offers an online course covering an overview of mass casualty care. 
• Local chapters of the American Red Cross (pdf version) routinely offer a variety of classes. The selection of available classes may vary by region. Many classes are available online.

Online courses offer the chance for you to receive structured training by qualified professionals at the time and place of your choosing. Even though learning styles vary according to the individual, everyone can benefit from the opportunities afforded by online learning.

 

Additional resources

Comprehensive list of FEMA online courses (pdf version)

Brochure with information about FEMA’s independent study program (pdf version)

Psychological Health

Education is a critical part of disaster preparedness. One aspect of disaster education for public safety personnel that is sometimes overlooked is mental health. It is a topic that agencies and individuals tend to overlook until after a traumatic event, by which time it has already arisen as a threat to the psychological well-being of rescuers.
Here is some information about disaster mental health that public safety personnel should be aware of:

• No two individuals will have identical reactions to a traumatic event (pdf version). The number of factors that influence each person’s ways of responding are countless, but a person’s prior training and education have been identified as having a significant determining effect.
• Public safety personnel are among those most at risk of experiencing pathological reactions to stress (pdf version) following a disaster. Severe reactions, including suicide and substance abuse, have been documented among those who responded to Hurricane Katrina (pdf version) and the World Trade Center (pdf version).
• If they go untreated, disaster-related psychological difficulties can have a real and significant negative impact on any and all aspects of one’s life, to include;
  • 1) Ability to be alert and safe while on duty. 
  • 2) Physical health and fitness. 
  • 3) Relationships with family, friends, and colleagues.

There exists among public safety personnel a reluctance to seek psychological help during times of personal crisis. One reason for this atmosphere of reticence is the stigma that is oftentimes associated with mental health. Here are four common myths that can keep public safety personnel from seeking help when they need it, along with the truth about what they say:

Myth #1
Everyone goes through tough times, but psychological counseling is for those who are too weak or too crazy to adjust to everyday difficulties.

Reality: Everyone DOES go through tough times, and everyone, no matter who they may be, is susceptible to the debilitating effects of the disaster environment (pdf version).
 
Myth #2
If my agency finds out that I am seeing a ‘shrink’, my career will be over.

Reality: These days, most administrators realize the importance of ensuring the psychological well being of their personnel as part of maintaining an effective       organization. It is also important to know that if you feel the need to seek help, you are afforded legal protections from being harassed or unfairly stigmatized (pdf version)
  
Myth #3
Counseling is ineffective.

Reality: Treatment with a licensed counselor/psychologist allows you to capitalize        on the therapeutic value of talking with others about your experiences, concerns, and fears. Professionally trained mental health professionals can further facilitate your recovery by providing a safe, empathetic atmosphere and by effectively identifying and treating the causes of psychological struggle. 

Myth #4
If I give it time, the emotional difficulties I am experiencing will pass.

Reality: For some people this may be the case; however, for many others these            difficulties will simply appear in the form of seemingly unrelated struggles, such as substance abuse, relationship problems, and even physical symptoms. For others, a lengthy period of apparently good health may pass following the cessation of disaster operations before symptoms even appear.  

 

Additional Resources and Publications

List of articles on dispatcher stress from Headsets911.com (pdf version)

Article from the American Psychological Association called Mind/Body/Health; The Effects of Traumatic Stress. It discusses how stress can impact all facets of one's existence. (pdf version)

Article called Incidents Most Likely to Traumatize Rescue Workers. It discusses the issue in a way that is specific to public safety personnel (pdf version).

PoliceOne.com’s list of physical and mental fitness articles (pdf version)

Article from Firehouse.com called Firefighter’s Mental Health (pdf version)

Disaster-related stress: A primer for public safety personnel

The immediate response to events such as disasters is stress. Stress is an elevation in a person's state of arousal or readiness, caused by some stimulus or demand. As stress arousal increases, health and performance actually improve. Within manageable levels, stress can help sharpen our attention and mobilize our bodies to cope with threatening situations.  As the following graph illustrates, “optimal” stress involving functional amounts of arousal contributes to effective task performance, including response to disaster.

 

 

 

 

 

 

 

 

But beyond that optimal level there is deterioration of health and performance begins to lessen, so it is important to manage stress in order to keep it in the “good” range.

Stress is mediated by appraisal (pdf version) which is the process of threat-assessment and response-formulation that your brain carries out when you are confronted with potentially harmful environmental challenges: “Have I had this experience before? If so, how did I respond? What was the outcome? Can I cope with the situation now?” If there's doubt as to any of these questions, the stress response elevates.

Here are some common stress reactions in response to disasters, experienced to varying degrees by everyone involved with them, and which you will experience as well.

 

•Monitor yourself and others for signs (pdf version) that you may need stress management assistance, if any of the following become persistent and extreme:

• Difficulty communicating thoughts
• Difficulty remembering instructions
• Difficulty maintaining balance
• Uncharacteristically argumentative
• Difficulty making decisions
• Limited attention span
• Unnecessary risk-taking
• Tremors/headaches/nausea
• Tunnel vision/muffled hearing
• Colds or flu-like symptoms.
• Disorientation or confusion
• Difficulty concentrating
• Loss of objectivity
• Easily frustrated
• Unable to engage in problem-solving
• Unable to let down when off duty
• Refusal to follow orders
• Refusal to leave the scene
• Increased use of drugs/alcohol
• Unusual clumsiness
• Practice self-care and coping for yourself.

 

• Be aware of more serious signs of stress in yourself and in your coworkers as they may indicate Post-Traumatic Stress Disorder (pdf version):
  • Intrusions, such as flashbacks or nightmares, where the traumatic event is re-experienced.
  • Avoidance, when the person tries to reduce exposure to people or things that might bring on their intrusive symptoms.
  • Physical signs of increased arousal, such as excessive/inappropriate vigilance (such as when there is clearly no need to be on your guard) or increased startle response.

  Although the effects of PTSD are serious and difficult to deal with, it can be treated (pdf version) by a variety of forms of psychotherapy and medication.

   

Additional Resources

The homepage of the National Center for Posttraumatic Stress Disorder offers an abundance of educative resources that address some of the mental health concerns faced by public safety personnel. (pdf version)

This resource is titled "A Guide to Managing Stress in Crisis Response Professions". It gives guidance for how to recognize common stress reactions as well as symptomatic ones. (pdf version)

Here are some specific techniques for individual stress management (pdf version)

This gives some of FEMA’s reccomendations for coping with disaster stress (pdf version)

Self Care for Personnel

It is a sadly ironic fact that the first ones to help others are often the last to help themselves; a fact that is all too descriptive of the public safety community as a whole. Experience has shown us that when a community is stricken by a disaster, there is no shortage of qualified men and women willing to spend long hours working at providing much-needed rescue and relief to the citizens they are sworn to serve. Past lessons also show that their willingness is often so unquenchable as to exceed their physical and mental capacities. The disaster environment is an inherently dangerous place, so dangerous that vigilance is required to preempt the additional hazards that are posed when we try to exceed our own human limitations. This site will help with managing such tendencies in two ways:

1) By offering some established guidelines for self-care;
2) By discussing what individuals and organizations can do to minimize debilitating          problems among personnel;

It’s called ‘self-care’ because ultimately, it boils down to YOU. By being attentive to your own needs, you can minimize the dangers you face in the disaster environment. By ignoring them, you put yourself and others at risk.

• Pace Yourself. The natural tendency to charge headlong into the mission before you will be particularly strong. This is especially true during the period during and immediately after the onset of relief operations. (pdf version)
• Remember your basic needs. Your participation in the mission doesn’t relieve you of your need for food, water, proper clothing, and sleep.
• If a particular job requires more personnel or equipment than is immediately available, wait. If you need help, ask for it. The road to ruin is devoid of proper backup and equipment.
• If you need time off the line, just ask. Your sense of mission and duty will make this a tough thing to do, but in times like this, it’s best to think long-term:

Question-to-self: How can I keep myself in the game? 
Answer-to-self: By taking breaks from the action as needed.

• Ignore the ‘rumor-mill’. Oftentimes, the stuff you hear is based on the fears, hopes, or unfounded expectations of someone who talks too much. Listening to false rumors inevitably aggravates an already difficult situation.
• Know measures you can take to de-stress. Stuff like talking, expressing your emotions through symbols and rituals, and rotating between more demanding duties and easier ones.   

Leadership; it’s more than just a bigger paycheck and increased civil liability. If ever there was a time when strong, competent leadership was needed, it’s during disaster operations. Here are some tips for supervisors and administrators.

• Reduce the danger of exhaustion by implementing shift schedules. Personnel should not exceed 12 hours at work, and the length of time they have off should at least equal the time spent on-duty. Also, allot time for rest periods during shifts.
• Cultivate a supportive environment. Be approachable. Have a plan in place for stress management. Make sure logistical needs are met.
• Find a place away from the scene where your people can go. Give them places to eat and rest that remove them from the disaster environment as much as possible.  
•  Emphasize top-down vigilance, starting with you. Administrators should disseminate guidelines to supervisors for combating stress, exhaustion, and fatigue. First-line supervisors should establish a system whereby personnel monitor one another for signs of problems. (pdf version)
• Enact good communication at all levels. A lot of the stress that responders face during disaster operations results from poor communication. This is also how rumors get started (see “Ignore the Rumor Mill” above). One way of facilitating this is establishing times and locations for ‘roll call’ meetings for on-going and off-going shifts. Be sure that everyone is briefed on group and individual missions, goals and responsibilities, disaster news, and relevant operational information.

Watch each others’ backs. Sometimes, your colleagues will be so immersed in the disaster mission that they temporarily lose self-awareness.

• Know the signs of stress; the normal ones as well as ones that indicate help is needed (pdf version)
• Pair up. Find someone you will be working with or near throughout the mission. Agree amongst yourselves to monitor each other for signs that a break is needed.
• Know the people you work with everyday. You are in a better position than anyone to know what is normal behavior for those you work with, and to watch for changes.
• Be receptive. Some of the stress for individuals that accumulates during disaster operations may be able to be relieved by simply having someone to talk to. Be present, be attentive, and let them know you’re listening. 

 

Additional resources

This site offers information on disaster stress in a way that is specific to public safety personnel. (pdf version)

Here are some recommendations from FEMA on how public safety personnel can minimize the harmful effects of stress. It's called Tips for Managing and Preventing Stress: A Guide for Emergency and Disaster Response Workers. (pdf version)

http://www.bt.cdc.gov/mentalhealth/pdf/primer.pdf (PS09additional_resources3a.pdf)

The Center for Disease Control offers their Disaster Mental Health Primer as an excellent guide for understanding how disasters impact individuals and communities.(PS09additional_resources3b.pdf)

This resource has some good self-care recommendations for public safety personnel. It's called Self Care for Crisis Response Professions. (pdf version)

 

 

Secondary stress and public safety personnel

Public safety personnel who interact with trauma survivors are themselves exposed to a form of traumatic stress.  More recent diagnostic formulations of Post-traumatic Stress Disorder such as those in DSM-IV have broadened the definition of trauma to include participation in others’ traumatic response.  As you encounter and provide rescue and relief to those who have experienced disaster, you will be exposed to secondary stress and traumatization, the focus of this fact sheet. 

• Secondary stress has also been termed Secondary Traumatic Stress Disorder (STSD), vicarious traumatization (pdf version), compassion fatigue (pdf version) or empathic strain.
• Some responders exposed to stress develop PTSD, but the experience of the full syndrome is only one of the ways in which public safety are affected by their exposure to secondary traumatic stress (pdf version)
• Your vulnerability to secondary stress (pdf version)is influenced by:
• personal history, current life circumstances, as well as proximity and personal connection to the events and people involved in the disaster
• your level of empathic engagement with victims’ experience of the disaster
• your perceived similarity to the victims of the disaster
• Secondary stress involves the following features:
• A broadened sense of “what can happen” sometimes experienced as a “loss of innocence” or as cynical detachment influencing your frame of reference and identity, worldview, and spirituality.
• Cognitive distortion around normalcy and baseline rates.  Our awareness that planes actually do crash and innocent appearing adults actually do molest children can transform into an expectation that every plane is likely to crash and every adult is likely to hurt our child. When we lose our sense of perspective in this way, we enter the world of the traumatized.
• Heightened arousal and vigilance, a way of being human in which we are characteristically aroused and remain constantly on our guard because we anticipate danger at every turn. At work, this can be a very desirable thing, but you must be able to ‘turn it off’ when you go home.  
• Avoidance, as we find ourselves organizing our lives around what might happen, rather than what is happening.
• Emotional consequences of involvement, experienced as:
• Threats to Self-Capacities of emotional management, self-worth
• Changes in basic beliefs about psychological needs: Safety, trust, esteem, intimacy, and control
• Loss of hope and meaning: Increased cynicism and pessimism; nihilism, existential despair (pdf version)
• Anger at the disaster or the perceived causes
• Symptoms similar to those of the people you help: a blurringof what experiences are “ours” and what belongs to the victims (a process involving dissociation)
• a sense of unworthiness and survival guilt (pdf version)
• a persistent and extreme sadness, or dysphoria
• a sense of mourning and grief (pdf version)

• Behavioral changes such as:
• Becoming judgmental of others
• Tuning out
• Having a reduced sense of connection with loved ones and colleagues
• Becoming cynical or angry and losing hope or a sense of meaning
• Developing rescue fantasies, becoming overly involved, taking on others' problems
• Developing overly rigid, strict boundaries
• Feeling heightened protectiveness as a result of a decreased sense of the safety of loved ones
• Avoiding social contact
• Avoiding work contact

• Secondary stress can affect your:
• Relationship with meaning and hope
• Ability to get your psychological needs met
• Intelligence
• Willpower
• Sense of humor
• Ability to protect oneself
• Memory/Imagery
• Existential sense of connection to others

 

• Dangers of secondary stress lie in both direct negative effects (intrusive imagery, disrupted beliefs) and in our way of responding to it (numbing, overgeneralized negative expectations, and cynicism).

Coping with secondary stress:

• Self-assessment: Ask yourself, "How am I doing?" What do I need? How have I changed? Discuss the questions and answers with a colleague, friend, or therapist.
• Protect yourself through awareness of your vulnerability and recognition of the negative consequences of your work as echoed in the voices of others (PS11voices-of-others.pdf)
• Work to cultivate a:

• Sense of strength
• Self-knowledge
• Confidence
• Sense of meaning
• Spiritual connection
• Respect for human resiliency

• Address the stress of your work through practicing self-care--Nurture yourself by focusing on sources of pleasure and joy, and allow yourself to escape when necessary.

Fortunately, public safety personnel have tools to manage secondary stress: we have knowledge of the ways in which trauma affects people, we have skills for soothing arousal and processing states of distress, and most importantly, we have each other, a support system with the potential to help each of us maintain perspective and find understanding during those times when we get caught in the web of secondary traumatic stress. We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be resilient.

Additional Resources

Discussion of secondary stress, titled Secondary stress and the professional helper is wonderfully comprehensive and informative. (pdf version)

Discussion of compassion fatigue, which is a potential problem for anyone working with disaster victims. (pdf version)

Resource is titled Working with Trauma Survivors: What Workers Need to Know. It has lots of good information for anyone working in the impacted environment. (pdf version)

 

Psychological First Aid as a Means of Crisis Resolution

SOME DISASTER VICTIMS MAY PRESENT SOME OF THE SAME CHALLENGES TO PUBLIC SAFETY AS THOSE POSED BY EMOTIONALLY DISTURBED PERSONS.
Past disaster relief operations have shown people who have been impacted by catastrophic events may exhibit behaviors and attitudes that, under normal circumstances, are associated with the mentally ill. Here are some things to keep in mind whenever you interact with people during disaster relief operations:

• Intense, oftentimes irrational emotions are ENTIRELY NATURAL amidst the kind of life altering devastation that disasters bring.
• As public safety, you may become the object of people’s rage and frustration at what they perceive to be an unwillingness or inability on the part of government authorities to help them.
• It’s not about you! It’s about the disaster!

In times of disaster, you can provide a critical service by providing support in the form of psychological first aid. The following is a list of things to do, as well as what you should avoid doing:
DO:
Promote Safety:

• Help people meet basic needs by directing them to food and shelter, and by obtaining emergency medical attention as needed.
• Provide repeated, simple, and accurate information onhow to get these basic needs.

Promote Calm:

• Listen to people who wish to share their stories and emotions, and remember that there is no right or wrong way to feel.
• Display sincere kindness in your demeanor toward them. Treat them as you would want your loved ones to be treated if they were in the same situation.
• Be friendly and compassionate even if people are being difficult.
• Offer accurate information about the disaster or trauma and the relief efforts underway to help victims understand the situation.

Promote Rapport:

• Introduce yourself if they do not know you.
• Ask the person what they would like to be called, and do not use nicknames or first names without permission.  With some cultures it is important to always address the person as Mr. or Mrs.
• Use words like please and thank you.
• Do not make general statements about the person’s character; for example, you would not want to say “you’re a brave person” during a time when they may be feeling quite afraid and unsure.
• Avoid flattery and excessive complements.  

Promote Connectedness:

• Help people contact friends and loved ones whenever circumstances allow it.
• Keep families together. Keep children with parents or other close relatives whenever possible, and understand that the way of responding to trauma will vary with levels of development. 

Promote Help:

• Be aware of the types and locations of government and nongovernmental services and direct people to those services that are available.

DO NOT:

• Force people to share their stories with you, especially very personal details.
• Give simple reassurances like “everything will be OK” or “at least you survived.”
• Tell people what you think they should be feeling, thinking, or how they should have acted earlier.
• Tell people why you think they have suffered by alluding to personal behaviors or beliefs of victims.
• Make promises that may not be kept.
• Criticize existing services or relief activities in front of people in need of these services

STAY SAFE!!! The recommendations that follow are intended only as possible suggestions that in no way override your knowledge, training, and experience for how to avoid danger.
Look for signs of agitation and increased stress.  People in such phases of response to disaster may:

• Challenge or question your authority, in which case you might:
• Answer the question calmly
• Repeat your statement calmly
• Refuse to follow directions, which can sometimes be responded to through: 
• not immediately asserting control. Rather, let the person gain control of him or herself
• Remaining professional
• Restructuring your request in another way
• Giving the person time to consider your request and perhaps pose alternatives
• Lose control and become verbally agitated, to which you might,
• Reply calmly.
• State that you may need assistance to help them.
• Become Threatening:
• If the person becomes threatening or intimidating and does not respond to your attempts to calm them, take the appropriate actions to keep yourself and others safe.

Information adapted for public safety from “Nebraska Disaster Behavioral Health Psychological First Aid Curriculum” at (pdf version)

Summary:  People in the midst of disasters, or immediately following, will often have strong feelings of confusion, fear, hopelessness, sleeplessness, anxiety, grief, shock, guilt, shame, and loss of confidence in themselves and others. Your early contacts with them can help to restore some degree of calm and to avoid further risk or traumatization.
Your goal in providing psychological first aid is to promote an environment of safety, calm, and hope.

Post-operational mental health concerns for public safety personnel

THE THREAT TO YOUR WELL-BEING CAN PERSIST AFTER YOUR INVOLVEMENT IN OPERATIONS HAS ENDED!

A number of factors inherent in the disaster environment dictate that you should maintain your vigilance against the emergence of physical and psychological problems, both in yourself and in your fellow public safety workers. Here are some reasons why:

• Symptoms for serious mental health threats, such as depression and PTSD (pdf version) may not show up for months following the end of rescue/relief efforts.

• Physical illnesses (pdf version), to include respiratory and cardiac disease, may emerge as a result of exposure to a variety of pathogens.

• Studies indicate there to be a positive correlation between exposure to disaster and substance abuse (pdf version).

• Many of those deployed will return to their normal duties as public safety personnel once operations have ended. This can be a problem for a couple of reasons:

  1) It’s a transition from one stressful environment to another. Whatever threats exist as a result of the disaster will probably be exacerbated, to varying degrees, by the environmental stressors that public safety    personnel routinely face.

  2) The effects of disaster-related illnesses reduce your ability to perform     your duties safely and effectively.

Some stress-related symptoms are normal, and may dissipate as the weeks and months following the disaster pass; however, there are some things you should be aware of that are indicative of more serious problems (pdf version):

Intrusive Thoughts and Ideas

• Suicidal thoughts.

• Thoughts of injuring others.

• Reliving the event; nightmares or unwanted memories that take you back to the event.

Avoidance; Behaviors Designed To Block or Forget Memories About Your Experiences

• You may go out of your way to avoid places, people, or things that could remind you of the disaster.

• Substance abuse (pdf version) you may begin to use alcohol, pharmaceuticals, or other intoxicants as a way of repressing the pain associated with your experiences.

Numbness

• Loss of loving or positive feelings toward those you used to care about.

• Loss of interest in the things you used to enjoy.

• Feeling unable to feel or express emotions.

Hypervigilance or Increased Arousal

• Irritability or anger.

• Fidgeting or excessive activity.

• Difficulty relaxing when it is okay to relax.

• Difficulty falling asleep or staying asleep.

Relations with Others

• Problems with others at home.

• Domestic violence.

• Problems at work with supervisors, coworkers, or the public.

• Isolation or withdrawal.

 Other Signs of Trouble

• A persistent sense of hopelessness or sadness.

• Taking excessive risks or doing unsafe things.

• Sudden problems in your relationships at work or at home.

• Loss of memory or difficulty concentrating.

• Physical symptoms, such as pain or illness.

In the event of physical symptoms, you should seek medical attention. If any of the other problems mentioned here persist, you should seek treatment from a mental health professional.

 

Additional Resources

This article examines some of the difficulties that public safety personnel often face after disasters, and gives some suggestions for alleviating them. (pdf version)

Collection of articles related to police, stress, and suicides. Some were written by mental health professionals who used to be cops.(pdf version)

Cornell University conducted a study on stress and related issues among those NYC firefighters who were present during post-9-11-01 rescue/relief operations. Here is a discussion of the findings. (pdf version)

This site examines stress among the various public safety fields. It does a good job of differentiating among the specific types of stress faced by each of the various public safety fields. (pdf version)

 

 

Building resiliency in yourself and others following disasters

Mental health professionals have spent a long time studying post-traumatic stress disorder (pdf version)as a response to disaster.  But more recently they have focused on resiliency (pdf version), defined professionally as “the ability to spring back from and successfully adapt to adversity,” and by a 15 year-old high school student as, "Bouncing back from problems and stuff with more power and more smarts."  Resiliency is also sometimes referred to as psychological hardiness (pdf version), wellness (pdf version), and positive psychology (pdf version).  Regardless of the name we give it, resiliency and the ability to “bounce back from (disasters) with more power and more smarts” is an important goal to keep in mind following a disaster. There are some things you can do to facilitate resiliency in yourself as well as in others.

Each of us has a built-in capacity for resiliency, "a self-righting tendency" (pdf version) that operates best when we cultivate and practice it.  Here are some suggestions for building resiliency, excerpted and modified from a very comprehensive American Psychological Association website (pdf version).

10 Ways to Build Resilience in yourself and others:

1. Make connections. Good relationships with close family members, friends, colleagues, or others are important, especially following disasters (PS13_1.pdf). Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

2. Avoid seeing crises as insurmountable problems. You can't change the fact that disaster events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.  Punctuate time: keep a journal (pdf version)to remind yourself that time is passing.

3. Accept that change is a part of living. Acceptance of the fact of trauma (pdf version) is an important element of resiliency. Certain ways of being human, for you and for those you work with, may no longer be attainable as a result of the circumstances around the disaster. Accepting circumstances that cannot be changed can help you and those around you to focus on circumstances that you can alter.

4. Move toward small and tangible goals. Develop some realistic goals. Do something regularly -- even if it seems like a small accomplishment -- that enables you to move toward your goals. Instead of focusing on large and abstract tasks, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"  What Bertrand Russell termed “tranquilization by the trivial” is certainly relevant in disaster resiliency.

5. Take decisive actions. Emerging ecological models of trauma recovery (pdf version) emphasize the need for action and empowerment.  Act on, and encourage those with whom you work to act on, the adverse situations associated with the disaster as much as possible.  Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.

6. Look for opportunities for self-discovery.  There is some interesting work on the role of insight in trauma and disaster resiliency (pdf version). Focus on what we can learn about ourselves, and how we have grown in response to loss, is an important feature of resiliency.  Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality, and heightened appreciation for life.

7. Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting in your instincts helps build resilience.

8. Keep things in perspective. One of the effects of trauma is that is shrinks our perspective of time and space. It is helpful to nurture in ourselves and others the ability to keep the disaster in perspective. Try to consider it in a broader context and keep a long-term perspective.

9. Maintain a hopeful outlook. (pdf version) An optimistic outlook enables you and those you work with to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

10. Take care of yourself and encourage self-care in coworkers and loved ones. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

 

The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

 

Additional Resources

This resource from the American Psychological Association gives recommendations for ways to build resilience. (pdf version)

What is resilience? Here's a discussion of that question from the American Psychological Association.  (pdf version)

This is a case example of how psychological hardiness can be an asset during difficult times. (pdf version)

The American Psychological Association talks about what past disasters have taught us about building resilience. (pdf version)