Texas Department of State Health Services DSHS

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Behavioral Health In a Disaster

• Texas Department of State Health Services (DSHS)
• Disaster Mental Health Services (DMHS)
• Program

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Scenarios

• A young woman with two young children is crying,
  her children appear scared
• A middle aged man has liquor on his breath and
  appears a bit unruly.
• An elderly hispanic couple refuses medication
  stating the curandero has not approved.
• Several individuals in a shelter have come down
  with a debilitating illness of unknown origin

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GOAL

• The goal of this training is to provide an
  overview of Disaster Mental Health.

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ObjectivesParticipates will be able to

• Define Psychological First Aid (PFA) and Identify
  who can provide PFA
• Identify duties and responsibilities of DMHS)
• Differentiate between crisis counseling and
  traditional counseling

• Identify the phases of a disaster
• Identify six emotional concepts of a disaster
• Define traumatic stress
• Identify common stress reactions ways to cope
  with these reactions

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Phases of Disaster
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Traumatic Stress

• Traumatic stress refers to the emotional,
  cognitive, behavioral and physiological
  experiences of individuals who are exposed to, or
  who witness, events that overwhelm their coping
  and problem solving abilities
• (Lerner Shelton, 2001)

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Emotional Concepts of a Disaster

• No one who sees a disaster is untouched by it
• Stress and grief are normal reactions to an
  abnormal situation
• Emotional reactions relate to the problems of
  living and recovery
• People do not seek out mental health services
• Services are practical rather than psychological
• Support systems are crucial to recovery

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Common Reactions to Disaster

• Trouble concentrating or remembering things
• Difficulty making decisions
• Preoccupation with the event
• Recurring dreams or nightmares
• Increased alcohol/drug use
• Feeling depressed or sad
• Feeling irritable, angry or resentful
• Crying easily
• Fatigue
• Increase or decrease in appetite

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Coping with Post-Disaster Stress

• Sharing experiences helps decrease anxiety and
  feelings of helplessness
• Get back into daily routines as soon as possible
• Maintain a healthy diet and get plenty of sleep
• Do some physical exercise every day
• Children are particularly vulnerable to emotional
  stress. Spend time each day giving your child
  your undivided attention and reassure them that
  they are safe.

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Managing Stress Fatigue

• Understand and set limits
• Seek social support develop a buddy system
• Take breaks
• Eat well sleep well
• Be active and exercise
• Drink plenty of fluids
• Read for pleasure
• Smile! Use humor

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Psychological First Aid (PFA)

• An evidence based approach designed to reduce the
  initial stress caused by traumatic events and to
  foster short and long term adaptive functioning.

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Psychological First AidWho? When? Where?

• May be used for everyone
• PFA is a useful tool for non-clinicians
• Used during and immediately after trauma/disaster
• May be used anywhere

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Psychological First AidBasic Objectives

• Contact and Engagement
• Safety and comfort
• Help survivors discuss needs and concerns
• Calm distraught survivors
• Offer practical assistance and information
• Connect to social supports
• Provide information on stress and coping

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Psychological First Aid Delivery

• Operate within the Response frame work
• Be calm, courteous, organized and helpful
• Be visible and available
• Maintain confidentiality
• Operate within expertise and designated role
• Be sensitive to cultural, ethnic and community
  concerns

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Psychological First AidBehaviors To Avoid

• Do not presume to know what the person is
  experiencing
• Do not assume that everyone is traumatized
• Do not label/diagnose or patronize
• Do not debrief

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Psychological First AidIndividuals Who May Need
Services

• Those showing signs of acute distress
• Disoriented
• Confused
• Frantic
• Panicky
• Extremely withdrawn
• Extremely irritable

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Psychological First AidAt Risk Populations

• Responders/volunteers who participated in
  response efforts
• Children, especially whose parent(s) are missing
  or have died
• Those with multiple displacements
• The medically frail
• The elderly
• Those with serious mental illness
• Adolescent and adult substance abusers
• Mothers with babies/small children
• Very-low income

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Disaster Mental Health Services Mission Statement

• The mission of DMHS is to decrease the adverse
  mental health effects of trauma for victims,
  survivors and responders of traumatic events.
  DMHS provides immediate response capability.

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Disaster Mental Health ServicesResponsibilities
During a Disaster

• Provide situational awareness for Service
  Providers
• Coordinate emergency response stress management
  and crisis counseling services in Texas
• Coordinate with DSHS response components as well
  as State and Federal partners
• May provide staffing at the State Operations
  Center (SOC), DSHS Multi Agency Coordination
  Center (MACC), or FEMA Joint Field Office (JFO)

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The Purpose of Crisis Counseling

• Normalize and validate feelings and reactions
• Help define and prioritize needs
• Help design strategies for addressing needs
• Help to adapt/reestablish coping skills
• Offer practical assistance and referral(s)
• Prevent future emotional and psychological
  problems

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Crisis Counseling Strategies

• Provide opportunities to share experiences,
  reactions, problems and solutions
• Provide information addressing common physical
  and psychological reactions to crisis
• Reestablish coping skills that worked in the past
• Provide education about substance use as coping
  tool
• Restore the individuals sense of control
• Discuss the impact that the disaster has on
  children and the family
• Encourage networking with support groups,
  providers, and the clergy

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Crisis Counseling Program Services

• Outreach-Primarily in the home or business
• Screening and Assessment for referral to formal
  mental health, public health, physician, etc
• Counseling-Individual and Group
• Information and Referral to disaster assistance
  organizations
• Public Education about the effects and means to
  manage stress

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Crisis Counseling vs. Traditional Counseling
Traditional
Crisis Counseling

• Office Based
• Focus Diagnosis Treatment
• Attempts to impact functioning
• Examines content
• Psychotherapeutic focus

• Home community based
• Assesses strengths, adaptation coping skills
• Seeks to restore pre-disaster functioning
• Accepts content at face value
• Validates appropriateness of reactions and
  normalizes the experience
• Psycho-educational focus

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Contact Information

• Community Preparedness Section
• Community Regional Coordination Branch
• Disaster Mental Health Services
• Ed Maldonado - Ext. 6936
• Melva Richardson - Ext. 3093
• 1100 W. 49th Street, T306
• Austin, TX 78756
• Office [phone], extension Fax (512)
  458-7231
• For more complete information and printable
  brochures, forms, etc
• http//www.dshs.state.tx.us/comprep/dmh/default.sh
  tm