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MENTAL HEALTH IN TIME OF CRISIS

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Allow yourself and other family members to feel sadness and grief over what happened. ... Helping other individuals requires empathy and compassion. Caring too ... – PowerPoint PPT presentation

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Title: MENTAL HEALTH IN TIME OF CRISIS


1
MENTAL HEALTH IN TIME OF CRISIS
  • Francisco I Perez, Ph.D., ABPP
  • UT School of Public Health
  • Houston, Texas

2
INTRODUCTION
  • The effect of a disaster or traumatic event goes
    far beyond its immediate devastation.
  • Just as it takes time to reconstruct damaged
    buildings, it takes time to grieve and rebuild
    our lives.
  • Life may not return to normal for months, or even
    years, following a disaster or traumatic event.

3
  • There may be changes in living conditions that
    cause changes in day-to-day activities, leading
    to strains in relationships, changes in
    expectations, and shifts in responsibility.
  • These disruptions in relationships, roles, and
    routines can make life unfamiliar and
    unpredictable.

4
UNDERSTANDING REACTIONS TO DISASTER EVENTS
  • No one who experiences a disaster is untouched by
    it.
  • It is normal to feel anxious about you and your
    familys safety.
  • Profound sadness, grief, and anger are normal
    reactions to an abnormal event.
  • Acknowledging our feelings helps us recover.
  • Focusing on you strengths and abilities will help
    you heal.

5
  • Accepting help from community programs and
    resources is healthy.
  • We each have different needs and different ways
    of coping.
  • It is common to want to strike back at people who
    have caused great pain.
  • However, nothing good is accomplished by hateful
    language and actions.

6
SIGNS THAT STRESS MANAGEMENT IS NEEDED
  • Disorientation or confusion and difficulty
    communicating thoughts.
  • Limited attention span and difficulty
    concentrating.
  • Becoming easily frustrated.
  • Overwhelming guilt and self-doubts.
  • Depression, sadness, and feelings of
    hopelessness.
  • Mood swings and crying easily.
  • Difficulty maintaining balance
  • Headaches/stomach problems.

7
  • Tunnel vision/muffled hearing.
  • Colds or flu-like symptoms.
  • Difficulty sleeping.
  • Poor work performance.
  • Reluctance to leave home.
  • Fear of crowds, strangers, or being alone.
  • Increased use of drugs/alcohol.

8
WAYS TO EASE THE STRESS
  • Talk with someone about your feelings even though
    it may be difficult.
  • Dont hold yourself responsible for the
    disastrous event.
  • Dont become frustrated because you feel that you
    cant help directly in the rescue work.
  • Take steps to promote your own physical and
    emotional healing by staying active in your daily
    life patterns or by adjusting them.

9
  • A healthy approach to life will help both you and
    your family.
  • Maintain a normal household and daily routine,
    limiting demanding responsibilities of yourself
    and your family.
  • Spend time with family and friends.
  • Participate in memorials, rituals, and the use of
    symbols as a way to express feelings.

10
  • Use existing supports groups of family, friends,
    and spiritual/religious outlets.
  • Establish a family emergency plan. It can be
    comforting to know that there is something you
    can do.
  • Knowing what to expect can help ease the
    transition back to a normal life.

11
FACING PERSONAL UNCERTAINTIES
  • Feeling mentally drained and physically exhausted
    is normal and common.
  • The loss of a home, business, or income may
    result in displacement and confusion about the
    future.
  • Unresolved emotional issues or pre-existing
    problems may resurface.
  • Anniversaries of the disaster remind us of our
    losses.

12
FACING FAMILY RELATIONSHIPS CHANGES
  • Relationships may become stressed when everyones
    emotions are heightened, and conflicts with
    spouses and other family members may increase.
  • When homes are destroyed or damaged, families may
    have to live in temporary housing or with
    relatives and friends, leading to overcrowding
    and added tension.
  • Family members or friends may be forced to move
    out of the area, disrupting relationships and
    usual support systems.

13
  • Parents may be physically or emotionally
    unavailable to their children, because they are
    busy cleaning up or are preoccupied, distracted,
    or stressed by difficulties related to the event.
  • Parents may become overprotective of their
    children and their childrens safety.
  • Children may be expected to take more adult
    roles, leaving less time to spend with friends or
    participate in routine activities.

14
FACING WORK DISRUPTIONS
  • Fatigue and increased stress from preoccupations
    with personal issues can lead to poor work
    performance.
  • Conflicts with co-workers may increase, because
    of the added stress.
  • Business may be forced to lay off employees, or
    company work hours and wages may be cut.
  • Reduced income may require taking a second job.
  • Daily travel and commute patterns may be
    disrupted.

15
FACING FINANCIAL WORRIES
  • Those who experience work disruptions may be
    unable to regain their previous standard of
    living, leading to financial concerns and unpaid
    bills.
  • Seeking financial assistance to rebuild and
    repair damages adds to the already high levels of
    stress caused by the disaster or traumatic event,
    and the hassles of dealing with a bureaucracy can
    add to the frustration.

16
TIPS ON HOW TO BE A SURVIVOR
  • Accept the reality of the loss.
  • Allow yourself and other family members to feel
    sadness and grief over what happened.
  • Adjust to a new environment.
  • Acknowledge that the person or possessions lost
    are gone forever.
  • Put closure on the situation and move on.
  • Have faith in better times to come.
  • Return to doing things you enjoy.

17
  • Reestablish the routines of your life.
  • Make commitments and keep them.
  • Ask for help.

18
POSTTRAUMATIC STRESS DISORDER
  • Background
  • 1. PTSD is a pathological anxiety that usually
    occurs after an individual experiences or
    witnesses severe trauma or events that constitute
    a threat to the physical integrity or life of the
    individual or of another person.
  • 2. The individual initially responds with
    intense fear, helplessness, or horror.
  • 3. The person later develops episodes of
    re-experiencing the event (flashbacks).

19
  • 4. Symptoms of numbness, avoidance, and
    hyper-arousal develop.
  • 5. These symptoms result in clinically
    significant distress or functional impairment.
  • 6. The symptoms should be present for at least
    one month.
  • 7. PTSD can be acute (lt 3 months), chronic (gt 3
    months), or delayed of delayed onset (6 months
    after the event).

20
  • Pathophysiology
  • The amygdala is a key brain structure implicated
    in PTSD. Research has shown that exposure to
    traumatic stimuli can lead to fear conditioning.
    Flashbulb memories are common in PTSD.
  • Prevalence
  • PTSD has a lifetime prevalence of 8 10
    accounts for considerable disability and
    morbidity.

21
  • Mortality/Morbidity
  • Increased risk of impulsive behavior, suicide,
    and homicide.
  • A direct relationship is observed between the
    severity of the trauma and the risk for PTSD.
  • There is a strong correlation between early
    trauma exposure and subsequent re-traumatization.

22
  • Sex
  • Females may be at a higher risk that males.
  • Age
  • PTSD can occur in persons of any age, including
    children.
  • Children may have different reactions to trauma
    than adults.
  • Children tend to be strongly affected by their
    parents reactions to the traumatic event.

23
  • Factors that interact to influence vulnerability
    to developing PTSD
  • Characteristics of the trauma exposure itself
    Proximity to, severity of, and duration of
    exposure to the trauma.
  • Characteristics of the individual prior trauma
    exposure, history of mental health problems, sex.
  • Post-trauma factors social support.

24
TIPS FOR EMERGENCY RESPONSE AND PUBLIC SAFETY
WOEKERS
  • Stress prevention and management should be
    addressed in two critical contexts the
    organization and the individual.
  • Adopting a preventive perspective allows both
    workers and organizations to anticipate stressors
    and shape responses, rather that simply reacting
    to a crisis when it occurs.
  • Tips for organizational and individual stress
    prevention and management follow.

25
Organizational approaches
  • 1. Provide effective management structure and
    leadership. Elements include
  • Clear chain of command and reporting
    relationships.
  • Available and accessible supervisors.
  • Disaster orientation for all workers.
  • Shifts no longer that 12 hours, followed by 12
    hours off.
  • Briefings at the beginning of shifts as workers
    enter the operation.

26
  • Shifts should overlap so the outgoing workers
    brief incoming workers.
  • Necessary supplies and communication tools should
    be readily available.
  • 2. Define a clear purpose and goals.
  • 3. Define clear intervention goals and strategies
  • appropriate to the assignment setting.
  • 4. Define roles by function.

27
  • 5. Orient and train staff with written role
    descriptions for each assignment setting.
  • 6. When the setting is under the jurisdiction of
    another agency, inform workers of each agencys
    role, contact person, and expectation.
  • 7. Nurture team support.
  • 8. Create a buddy system for support and
    monitoring.
  • 9. Promote a positive atmosphere of support and
    tolerance with frequent praise.

28
  • 10. Develop a plan for stress management
  • Assess workers functioning regularly.
  • Rotate workers among low-, mid-, and high-stress
    tasks.
  • Encourage breaks and time away from assignment.
  • Educate about signs and symptoms of worker stress
    and coping strategies.
  • Provide individual and group defusing and
    debriefing.

29
  • Develop an exit plan for workers leaving the
    operation, including a debriefing, reentry
    information, opportunity to critique, and formal
    recognition for service.

30
Individual approaches for stress prevention and
management
  • 1. Manage workload.
  • Set priority levels for tasks with a realistic
    work plan.
  • Delegate existing workloads so workers are not
    attempting disaster response in addition to their
    usual job.
  • 2. Balance lifestyle.
  • Get physical exercise, and stretch muscles when
    possible.
  • Eat healthy.

31
  • Get adequate sleep and rest.
  • Maintain contact and connections with family and
    friends.
  • 3. Apply stress reduction techniques.
  • Reduce physical tension by activities such as
    taking deep breaths, meditating, and walking
    mindfully.
  • Use time off for exercise, reading, listening for
    music, taking a bath, talking to family, or
    getting a special meal.

32
  • Talk about emotions and reactions with coworkers
    during appropriate times.
  • 4. Practice self awarenessgt
  • Learn to recognize and heed early warning signs
    for stress reaction.
  • Accept that you may need help to assess
    problematic stress reactions.
  • Avoid overly identifying with survivors and
    victims grief and trauma, which may interfere
    with discussing painful material.

33
  • Understand differences between professional
    helping relationships and friendships.
  • Examine personal prejudices and cultural
    stereotypes.
  • Be mindful that vicarious traumatization or
    compassion fatigue may develop.
  • Recognize when personal disaster experience or
    loss interferes with effectiveness.

34
Normal reactions to a traumatic event
  • No one who responds to a traumatic event is
    untouched by it.
  • Profound sadness, grief, and anger are normal
    reactions to an abnormal event.
  • You may not want to leave the scene until the
    work is finished.
  • You likely will try to override stress and
    fatigue with dedication and commitment.
  • You may deny the need for rest and recovery time.

35
Signs that you may need stress management
assistance
  • Disorientation or confusion, and difficulty
    communicating thoughts.
  • Difficulty remembering instructions and remaining
    focused.
  • Difficulty maintaining balance
  • Becoming easily frustrated and increasingly
    irritable.
  • Inability to engage in problem solving and making
    decisions.
  • Unnecessary risk taking.

36
  • Physical symptoms of stress including tremors,
    headaches and nausea.
  • Loss of objectivity.
  • Inability to relax off duty.
  • Refusal to follow orders or leave the scene.
  • Increased use of drugs or alcohol.
  • Unusual clumsiness.
  • Problems sleeping.

37
Ways to manage stress
  • Limit on-duty-work hours to no more than 12 hours
    per day.
  • Rotate work from high-stress to lower stress
    functions.
  • Rotate work from the scene to routine assignments
    as practicable.
  • Use employee assistance programs as needed.
  • Drink plenty of water and eat healthy.
  • Take frequent, brief breaks from the scene.

38
  • Talk about your emotions to process what you have
    seen and done.
  • Stay in touch with your family and friends.
  • Participate in memorials and rituals.
  • Pair up with another responder so that you may
    monitor one anothers stress.

39
DISASTER COUNSELING
  • Disaster counseling involves both listening and
    guiding.
  • Survivors typically benefit from both talking
    about their disaster experiences and being
    assisted with problem-solving and referral to
    resources.

40
Disaster counseling skills
  • Establishing rapport.
  • Active listening
  • Allow silence
  • Attend nonverbally
  • Paraphrase
  • Reflect feelings
  • Allow expression of emotions

41
Some dos and don'ts
  • Do say
  • These are normal reactions to a disaster.
  • It is understandable that you feel this way.
  • You are not going crazy.
  • It wasnt your fault, you did the best you could.
  • Things may never be the same, but they will get
    better and you will feel better.

42
  • Dont say
  • It could have been worse.
  • You can always get another pet/car/house.
  • Its best if you just stay busy.
  • I know just how you feel.
  • You need to get on with your life.

43
COMPASSION FATIGUE
  • Compassion fatigue is a state experienced by
    those helping people in distress.
  • It is an extreme state of tension and
    preoccupation with the suffering of those being
    helped to the degree that it is traumatizing for
    the helper.
  • The helper, in contrast to the person(s) being
    helped, is traumatized or suffers through the
    helpers own efforts to empathize and be
    compassionate.
  • Often this leads to poor self care and extreme
    sacrifice in the process of helping.

44
  • Together, this leads to compassion fatigue and
    symptoms similar to PTSD.
  • Helping other individuals requires empathy and
    compassion.
  • Caring too much can hurt.
  • When caregivers focus on others without
    practicing self-care, destructive behaviors can
    surface.
  • Those who are selfless and compassionate have an
    Achilles heel they dont pay enough attention
    to themselves.

45
  • It is important to set boundaries.
  • It is important to strike a balance.

46
COMPASSION FATIGUE AWARENESS PROJECT
  • Denial is one of the most detrimental symptoms of
    Compassion fatigue and Life Stress.
  • It can hinder the ability to assess the level of
    fatigue and stress in your life as well as thwart
    your efforts to begin the healing process.
  • Once you realize that you are experiencing
    compassion fatigue, exploring this new awareness
    can lead to insights about your behavior patterns
    and approach to life.

47
  • A common coping mechanism in care giving is to
    simply stuff your emotions that surface
    repeatedly in your work.
  • Eventually, those emotions refuse to be ignored.
  • Psychological and physical symptoms develop.
  • With support, insightful information, and
    authentic self-care, you can begin to understand
    the complexity of the emotions youve been
    juggling and, most likely suppressing.

48
  • Most people never take the time to understand how
    their jobs affect them emotionally.
  • Give yourself credit for moving forward and
    affecting change.
  • Your hard work will pay off.

49
Authentic and Sustainable self-care begins with
you
  • Be kind to yourself
  • Enhance your awareness with education
  • Accept where you are on your path at all times
  • Understand that those close to you may not be
    there when you need them most
  • Exchange information and feelings with people who
    can validate you
  • Listen to others that are suffering

50
  • Clarify your personal boundaries
  • Express your needs verbally
  • Take positive action to change your environment

51
Your continuing journey
  • Helping the symptoms of compassion fatigue is a
    personal ongoing inside job.
  • Youve been loyal to your self-care plan,
    clarified personal boundaries in both your
    personal and professional life, and now
    understand your negative behaviors and their
    origin.
  • As you continue to do the necessary internal
    work, you will reap the benefits.
  • Your life will begin to change for the better.

52
  • In order to move forward on your path to
    wellness, you must continually commit to
    authentic self-care that includes
  • Health-building activities such as exercise,
    massage, yoga, meditation
  • Eating healthy foods.
  • Drinking plenty of water
  • Use natural healing products to care for and heal
    your body

53
  • Practicing the art of self management learn to
    say no
  • Developing a healthy support system people who
    contribute to your self esteem, people who listen
    well, people who care.
  • Organizing your life so you become proactive as
    opposed to reactive.
  • Reserving your life energies for worthy causes.
    Choose your battles.
  • Living a balanced life. Sing, dance, sit with
    silence.

54
  • Francisco I Perez, Ph.D., ABPP
  • 6560 Fannin Suite 1810
  • Houston, Texas 77030
  • 713 790 1225
  • fperez3_at_sbcglobal.net
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