Responding to disasters: the psychological dimension

Citation

(1999), "Responding to disasters: the psychological dimension", Disaster Prevention and Management, Vol. 8 No. 3. https://doi.org/10.1108/dpm.1999.07308cac.001

Responding to disasters: the psychological dimension

Responding to disasters: the psychological dimension

Keywords Counselling, Disaster management

"We need to focus on survivors to make us more effective in our work in responding to people", so spoke James Horn, ex-FBI special agent in addressing the annual conference on the Association of Traumatic Stress Specialists in Charleston, South Carolina, in February. This 8th annual conference, which had as its theme "Responding to Trauma and Victimisation", was sponsored by organisations such as South Carolina's Victim Assistance Network, the Law Enforcement Victim Advocates' Association and the international Critical Incident Stress Foundation. Many of the workshops dealt with issues directly relating to mental health intervention following disaster and other major incidents including school shootings, wind and water disasters, the Oklahoma bombing disaster and other crime-related incidents. So what is Association of Traumatic Stress Specialists and what can we in the UK learn from such organizations set up in response to the range of disaster and other incidents in the USA and further afield?

ATSS is a non-profit organization founded in 1989 to provide professional education and certification to those actively involved in response, management and treatment of those affected by traumatic stress, and to help in their recovery. The conferences are active forums to learn how to effectively communicate with, respond to, manage and treat individual victims and groups of victims experiencing critical incident stress and long-term traumatic reactions to disasters, industrial accidents, violence and victimisation. This often includes emergency service personnel and other professionals and volunteers responding to incidents as well as relatives and survivors. Membership of ATSS includes representatives from the medical and legal professions as well as researchers, clergy and administrators, all of whom are encouraged to attend the trauma training. Such multi-agency and interdisciplinary dialogue is important for understanding the respective roles, responsibilities and challenges facing the different responders to traumatic incidents, a fundamental principle for improving disaster management and response.

This was illustrated in a presentation on co-ordinating mental health responses to disasters by Dusty Bowenkamp of the American Red Cross and Diane Myers, both of whom have extensive experience in responding to incidents including the Oklahoma bombing. They discussed the difficulties facing local mental health organizations initiating and maintaining a response, including limited staff and funding as well as poor understanding of the short- and long-term needs of victims. Political problems relating to, for example, responsibility of mental health programmes can also beset mental health responses. Many of these difficulties not only apply also to those involved either professionally or on a voluntary basis in the UK, but are exacerbated by lesser understanding of critical incident stress and lower frequency of major disasters than is the case in the USA. The presentation discussed the benefits of community collaboration in developing disaster mental health plans and response, highlighting important lessons learned as well as training, support systems and longer-term planning implications for disaster workers.

Another enlightening workshop was presented by Barbara Ertl, a member of the crisis team which responded to a fatal shooting incident at a school dance in 1998. There was a crisis plan in place for the school district (this not always being so); however, some members of the crisis team had been directly involved in the incident and therefore were not in a position to respond effectively. The lesson from this is that it is important to have a back-up plan which can draw on external resources in the event of an incident such as this which has a community-wide impact. Following the shooting incident, community meetings were held which explained the normal reactions that might be experienced. The most directly affected victims were each assigned a support worker and debriefing teams worked with various groups within the community identified as at risk from psychological stress. Another lesson learned was the importance of supporting the variety of individuals and groups involved in school communities. In this incident the kitchen staff at the location of the shooting and the bus drivers were forgotten about, resulting in much resentment and determination on the part of the crisis team to remember to include such personnel in future responses.

Crisis teams can provide important practical as well as emotional support in the aftermath of disaster. An example of this is advising relatives and victims that they are under no obligation to speak to anyone, including the media who frequently hound the vulnerable in seeking a personal angle for their reports. Indeed, treatment by the media as well as the authorities are often themselves sources of stress for relatives and victims, a factor further reinforcing the importance of mental health teams whose remit is first and foremost their emotional care and support. These issues in disaster response apply universally; hence there is much for researchers and practitioners involved in disaster management in the UK to learn from the experiences of those who have developed and refined traumatic stress responses in the context of natural and technological disasters internationally.

As illustrated in the above examples, this applies to the caregivers as well as relatives and survivors. Kent Laidlaw, a retired Canadian senior police officer who specialises in trauma management, presented a workshop on giving death notification with professionalism and compassion. He believes police officers and others involved in informing about deaths frequently lack training, fear this important dimension of their job for which they have little practice and are unaware of available resources. He highlighted the importance of a supportive attitude and good communication skills in delivering such news which, if done inappropriately, can have detrimental impacts on the deliverer as well as the bereaved. This is an area of training which also needs to be addressed in the UK, particularly for those in the position of having to deliver news of sudden death, whether it be through natural causes, accidents or disasters.

Being the only delegate from the UK at the Conference reinforced for me the contrast between the developments in the USA and the fragmented picture of disaster mental health in Britain. As stated earlier, this is partly due to the lower frequency of and vulnerability to the types and scale of natural hazards and disasters experienced in the USA such as flooding, hurricane, earthquakes and tornadoes. However, the emotional impacts associated with disaster also apply to man-made events, of which we became only too aware during the spate of disasters ten years ago, including Lockerbie, the Marchioness, Hillsborough, Zeebrugge, King's Cross and Clapham disasters and, more recently Dunblane. Elsewhere I have discussed the role and function of survivor self-help groups in dealing with the longer-term issues and impacts of disasters. It is also important to readdress, research and consolidate plans for dealing with mental health needs following major incidents, their relationship to and role within focal emergency planning and the coordination of community-based support systems. My impression is that much of the impetus for this, as highlighted by the Disasters Working Party Report (1990), has waned in the years since the "decade of disasters". Key questions include the following: How far is critical incident debriefing integrated into today's emergency management and response? Are there disaster debriefing teams in every local authority and how far are they adequately trained and supported? How frequently do disaster debriefing teams meet and update their plans? Are they involved in regular exercises which address the issue beyond the first few hours or days of an incident?

At Coventry University, an integrated and multidisciplinary approach to disaster management training and education includes modules focusing on the psychological and social dimensions of disasters. These specialisms complement important engineering and field skills by highlighting the importance of responding to the human aspect of disasters. Clearly these are areas deserving further research and development. Without the human element an earthquake in the desert is not a disaster; without attending to the human aspect, many forms of disaster response, whether by commission or omission, can themselves become secondary disasters.

For further details of ATSS and Coventry's programmes please contact Dr Anne Eyre, Centre for Disaster Management, Priory Street, Coventry CV1 5FB, UK. Tel/Fax: +44 (0)1203 838485.