Dear CISM Practitioner,

Images broadcast from the areas stricken by Katrina's wrath engender a myriad of reactions such as shock, awe, disbelief, anger, sympathy, fear, and even betrayal. But for those in the helping professions, a visceral urgency to personally respond may be the primary reaction. Experience has taught us well that such urges are to be tempered with a prudent assessment
of need, a realistic assessment of available resources, and a plan for implementing assistance once on site. The following recommendations are offered as an initial set of guidelines for those considering responding to the disaster mental health needs of those affected by Katrina.

1. All intervention is predicated upon an assessment of a need. Need is not only defined as the determination of the necessity for crisis and disaster mental health support, need also means that such support is desired by those at the local/state level and that such support will effectively augment, rather than complicate or disempower local initiatives. Self-deployment based upon an impulsive need to help is never a good idea.

2. Assistance must be coordinated within an integrated response plan. Ideally, such a plan involves local, state, Federal, and NVOAD resources.

3. Once deployed, effective mental health response should follow the hierarchy of needs described by Abraham Maslow:
a. Meet physiological needs for shelter, food, water, clothing.
b. Meet basic needs for safety, security, and medical care.
c. Meet basic needs to re-establish family and other interpersonal connections. Reuniting families must take priority over all other such support. For rescue and recovery personnel, the establishment of "peer" and mental health support should be emphasized.

4. The principles of psychological first aid are useful guidelines for planning support services beyond that mentioned above:
a. Assess need, assess impairment
b. Stabilize (try to prevent further deterioration of psychological/behavioral functioning through meeting basic needs as described above)
c. Assess need for further support
d. Offer information, education, reassurance, as indicated
e. Connect with sources of continued support
f. Diagnostic and traditional "psychotherapy" functions are not included herein, but are considered as later points on an overall continuum of care.

5. Keep in mind that the psychological/behavioral response to mass disasters typically follow a somewhat predictable trajectory. Civilian reactions will follow a very different course than will the reactions of rescue and recovery personnel. Try not to confuse/intermingle the support
services offered to these two groups. The majority of manifest need for rescue and recovery personnel will come weeks post impact...as this is written (09/06/05), we are still in the impact phase where the most basic of all needs are the priorities.

6. Be sure to plan for your own well-being. Prepare yourself mentally and physically. If going to the Gulf Coast on assignment, carefully assess your own health before going. This is an extreme hardship assignment. The history of disaster response is replete with examples of
helpers becoming victims.

7. Plan a time-limited deployment in order to assist in resource planning and in "self-preservation." Plan for some form of "re-entry" or homecoming for interventionists after their deployment. Don't forget the importance of "debriefing the debriefers" when they come back from an assignment. Disaster response work is highly needed and rewarding, but it is highly stressful, as well.

8. If you are not called, or are called and cannot go out to the impacted disaster area, there may be ways to help in your own communities. Many communities around the country are receiving evacuees and can use trained crisis intervention personnel to help them adjust to their new situations. Local Red Cross or other NVOAD agencies may need volunteers locally to answer phones and help out in their offices. Give them a call and see if you can be of assistance.

9. The media is flooding all of our homes with heart wrenching stories and pictures. Be sure to monitor the "dose" of disaster that you, your family, and especially your children are exposed to. Monitor TV watching, and talk about what you are seeing. Reassure your children that you have a family disaster plan. Now is a good time to review your disaster plan as a family
and update the plan and supplies as needed.

This article was a collaborative project contributed by Diane Myers, RN, MSN, Royal Oaks, California and ICISF

 

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Finally, please remember that this will be a long term event, pace yourself. Remember to practice appropriate stress management principles.

Further updates will follow as more information is obtained.

 

Donald Howell, Executive Director
International Critical Incident Stress Foundation, In.
Ellicott City MD 21042-2272
http://www.icisf.org
410/750-9600
Fax: 410/750-9601

KAT-05-02