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Mental Health Response to Mass Violence and Terrorism Example
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Dimensions of Traumatic Exposure Threat to life and limb
Severe physical harm or injury
Receipt of intentional harm or injury
Exposure to the grotesque
Violent/sudden loss of a loved one
Witnessing or learning of violence to a loved one Comparing Criminally Human-Caused and Natural Disasters Causation
Appraisal of Event
Psychological Impact
Subjective Experience
Worldview/Basic Assumptions
Stigmatization of Victims
Phases of Recovery
Media
Secondary Injury Survivor Risk and Resiliency Factors Psychological
Capacity to tolerate stress
Prior trauma history
Socioeconomic and educational level
Family stability
Social support
Female gender Community Response Phases Impact
Heroic
Honeymoon
Disillusionment
Reconstruction Physical Reactions Agitation, hyper-arousal
Fatigue, exhaustion
Hot or cold sensations
Gastrointestinal distress
Tightness in throat, chest
Appetite change
Worsening of health conditions Behavioral Reactions Sleep problems, nightmares
Jumpiness, easily startled
Hyper-vigilance
Crying and tearfulness
Avoidance of reminders
Increased family conflicts
Isolation, social withdrawal Emotional Reactions Shock, disbelief
Anxiety, fear about safety
Irritability, anger, rage
Sadness, grief, depression
Numbness, disconnection
Hopelessness and despair
Survivor guilt, self-doubt Cognitive Reactions Confusion, disorientation
Intrusive thoughts, images
Recurring dreams, nightmares
Memory and concentration difficulties
Difficulty making decisions
Focus on protecting loved ones
Questioning spiritual beliefs Considerations with Older Adults Physical vulnerability
Chronic health conditions
Medication needs
Auditory, visual, mobility, or cognitive impairment
Increased anxiety, confusion
Loss of home health support Mental Health Roles in Crisis Response Mental health consultation
Liaison with key agencies
Psycho-education through media
Mental health services with survivors, families
Mental health services with responders
Stress management support Key Concepts Normal reactions to an abnormal situation
Avoid "mental health" terms and labels
Assume competence and capability
All who witness are affected
Respect differences in coping
First, do no harm
Assistance is practical and flexible
Focus on strengths and potential
Encourage use of support network
Tailor for active, community fit
Be innovative in helping On-Scene Interventions Direct to medical care, safety, shelter
Protect from trauma, media, onlookers
Connect to family, information,
comfort Immediate Interventions Rapid assessment and triage
Psychological first-aid
Crisis intervention
Crime victim assistance
Psycho-education
Informational briefings
Community outreach
Participation in death notifications
Mental health consultation
Debriefing and community meetings
Information and referral Psychological First-Aid Provide comfort, empathy, an "ear"
Address physical needs
Provide concrete information about what will happen next
Link to support systems
Reinforce coping strengths Crisis Intervention Promote safety and security
Gently explore trauma experience
Identify priority needs and solutions
Assess functioning and coping
Provide: Reassurance
Psycho-education
Practical assistance Crime Victim Assistance Protect victims' rights
Ensure control over media contacts
Provide criminal justice information
Facilitate access to compensation
Streamline bureaucratic procedures Community Outreach Initiate contact at gathering sites
Set up 24-hour telephone hotlines
Outreach to survivors through media, Internet
Educate service providers
Use bilingual and bicultural workers Participation in Death Notification Responsible notifier:
Obtains critical information
Notifies next-of-kin directly, simply, in person
Expects intense reactions
Provides practical assistance
Mental health participates on team, provides support and information Brief Trauma Intervention Factual information
Thoughts during event
Reactions and feelings
Problem-solving and action Long-Term Interventions Community outreach
Brief counseling
Support and therapy groups
Psycho-education Beware! Common Pitfalls And Risks Over-involvement, doing too much
Confusing friend and counselor roles
Becoming lax about confidentiality
Providing services beyond competency
"I'm the only one who can..." syndrome
Disengaging from family and own life Key Events with Mental Health Implications Death notification
Ending rescue and recovery
Applying for death certificates
Criminal justice proceedings
Returning to impacted areas
Funerals and memorials Community Interventions Memorials and rituals
Usual community gatherings
Anniversary commemorations
Symbolic gestures Preschool-Age Children’s Reactions Sleep problems, nightmares
Clinging, separation anxiety
Helplessness, passivity
Death not permanent
Fearfulness
Regression
Repetitive play Cultural Group Information Meanings associated with the event
Experience with emergency response
Trauma and violence in country of origin
Signs and symptoms of trauma, grief
View about mental health, providers
Tips for professional courtesy Basic Cultural Sensitivity Convey respect, good will, courtesy
Ask permission to speak with people
Explain role of mental health worker
Acknowledge differences in behavior due to culture
Respond to concrete needs Sources of Stress Exposure to trauma
High-intensity assignments
Environmental factors
Organizational factors
Individual factors Stress Is: Normal
Necessary
Productive and destructive
Acute and delayed
Cumulative
Identifiable
Preventable and manageable Organizational Approaches Effective management structure
Effective managers and supervisors
Clear purpose and goals
Functionally defined roles
Team support
Plan for stress management Individual Approaches Management of workload
Balanced lifestyle
Stress reduction strategies
Self-awareness Compassion Fatigue “The natural consequent
behaviors and emotions resulting
from knowing about a traumatic
event experienced by a significant
other—the stress resulting from
helping or wanting to help a
traumatized or suffering person.” School-Age Children’s Reactions Sleep problems, nightmares
Preoccupation with disaster, death
Fears about safety
Self blame, guilt, responsibility
Angry outbursts
Retelling and repetitious play
Social withdrawal
Somatic complaints
School performance problems Pre-Adolescents and Adolescents Sleep problems and nightmares
Self blame, guilt, shame
Self-consciousness
Depression, social withdrawal
Desire for revenge
Aggressive and risk-taking behavior
School performance problems Risk Factors for Children Exposure to direct life threat and injury
Witnessing mutilating injuries
Hearing unanswered cries for help
Degree of brutality and violence
Unexpectedness and duration
Separation from family Screening Checklist Trauma and loss exposure
Current level of distress
Social, academic, emotional, and behavioral changes
Traumatic reminders at home and school
Ongoing stressors at home and school
Other trauma in the past year Tasks for Psychological Recovery Regain a sense of safety and security
Gain understanding of child's unique experience of the trauma
Gain understanding of actual events that have occurred
Identify and express reactions and emotions
Grieve and cope with traumatic stress
Resume age-appropriate roles and activities Cultural Competence Recognize the importance of culture and respect diversity
Maintain a current profile of the cultural composition of the community
Recruit disaster workers who are representative of the community or service area
Provide ongoing cultural competence training to disaster mental health staff
Ensure that services are accessible, appropriate, and equitable
Recognize the role of help-seeking behaviors, customs and traditions, and natural support networks
Involve as "cultural brokers" community leaders and organizations representing diverse cultural groups
Ensure that services and information are culturally and linguistically competent
Assess and evaluate the program's level of cultural competence MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Mental Health Response to Mass Violence and Terrorism, 2004
Severe physical harm or injury
Receipt of intentional harm or injury
Exposure to the grotesque
Violent/sudden loss of a loved one
Witnessing or learning of violence to a loved one Comparing Criminally Human-Caused and Natural Disasters Causation
Appraisal of Event
Psychological Impact
Subjective Experience
Worldview/Basic Assumptions
Stigmatization of Victims
Phases of Recovery
Media
Secondary Injury Survivor Risk and Resiliency Factors Psychological
Capacity to tolerate stress
Prior trauma history
Socioeconomic and educational level
Family stability
Social support
Female gender Community Response Phases Impact
Heroic
Honeymoon
Disillusionment
Reconstruction Physical Reactions Agitation, hyper-arousal
Fatigue, exhaustion
Hot or cold sensations
Gastrointestinal distress
Tightness in throat, chest
Appetite change
Worsening of health conditions Behavioral Reactions Sleep problems, nightmares
Jumpiness, easily startled
Hyper-vigilance
Crying and tearfulness
Avoidance of reminders
Increased family conflicts
Isolation, social withdrawal Emotional Reactions Shock, disbelief
Anxiety, fear about safety
Irritability, anger, rage
Sadness, grief, depression
Numbness, disconnection
Hopelessness and despair
Survivor guilt, self-doubt Cognitive Reactions Confusion, disorientation
Intrusive thoughts, images
Recurring dreams, nightmares
Memory and concentration difficulties
Difficulty making decisions
Focus on protecting loved ones
Questioning spiritual beliefs Considerations with Older Adults Physical vulnerability
Chronic health conditions
Medication needs
Auditory, visual, mobility, or cognitive impairment
Increased anxiety, confusion
Loss of home health support Mental Health Roles in Crisis Response Mental health consultation
Liaison with key agencies
Psycho-education through media
Mental health services with survivors, families
Mental health services with responders
Stress management support Key Concepts Normal reactions to an abnormal situation
Avoid "mental health" terms and labels
Assume competence and capability
All who witness are affected
Respect differences in coping
First, do no harm
Assistance is practical and flexible
Focus on strengths and potential
Encourage use of support network
Tailor for active, community fit
Be innovative in helping On-Scene Interventions Direct to medical care, safety, shelter
Protect from trauma, media, onlookers
Connect to family, information,
comfort Immediate Interventions Rapid assessment and triage
Psychological first-aid
Crisis intervention
Crime victim assistance
Psycho-education
Informational briefings
Community outreach
Participation in death notifications
Mental health consultation
Debriefing and community meetings
Information and referral Psychological First-Aid Provide comfort, empathy, an "ear"
Address physical needs
Provide concrete information about what will happen next
Link to support systems
Reinforce coping strengths Crisis Intervention Promote safety and security
Gently explore trauma experience
Identify priority needs and solutions
Assess functioning and coping
Provide: Reassurance
Psycho-education
Practical assistance Crime Victim Assistance Protect victims' rights
Ensure control over media contacts
Provide criminal justice information
Facilitate access to compensation
Streamline bureaucratic procedures Community Outreach Initiate contact at gathering sites
Set up 24-hour telephone hotlines
Outreach to survivors through media, Internet
Educate service providers
Use bilingual and bicultural workers Participation in Death Notification Responsible notifier:
Obtains critical information
Notifies next-of-kin directly, simply, in person
Expects intense reactions
Provides practical assistance
Mental health participates on team, provides support and information Brief Trauma Intervention Factual information
Thoughts during event
Reactions and feelings
Problem-solving and action Long-Term Interventions Community outreach
Brief counseling
Support and therapy groups
Psycho-education Beware! Common Pitfalls And Risks Over-involvement, doing too much
Confusing friend and counselor roles
Becoming lax about confidentiality
Providing services beyond competency
"I'm the only one who can..." syndrome
Disengaging from family and own life Key Events with Mental Health Implications Death notification
Ending rescue and recovery
Applying for death certificates
Criminal justice proceedings
Returning to impacted areas
Funerals and memorials Community Interventions Memorials and rituals
Usual community gatherings
Anniversary commemorations
Symbolic gestures Preschool-Age Children’s Reactions Sleep problems, nightmares
Clinging, separation anxiety
Helplessness, passivity
Death not permanent
Fearfulness
Regression
Repetitive play Cultural Group Information Meanings associated with the event
Experience with emergency response
Trauma and violence in country of origin
Signs and symptoms of trauma, grief
View about mental health, providers
Tips for professional courtesy Basic Cultural Sensitivity Convey respect, good will, courtesy
Ask permission to speak with people
Explain role of mental health worker
Acknowledge differences in behavior due to culture
Respond to concrete needs Sources of Stress Exposure to trauma
High-intensity assignments
Environmental factors
Organizational factors
Individual factors Stress Is: Normal
Necessary
Productive and destructive
Acute and delayed
Cumulative
Identifiable
Preventable and manageable Organizational Approaches Effective management structure
Effective managers and supervisors
Clear purpose and goals
Functionally defined roles
Team support
Plan for stress management Individual Approaches Management of workload
Balanced lifestyle
Stress reduction strategies
Self-awareness Compassion Fatigue “The natural consequent
behaviors and emotions resulting
from knowing about a traumatic
event experienced by a significant
other—the stress resulting from
helping or wanting to help a
traumatized or suffering person.” School-Age Children’s Reactions Sleep problems, nightmares
Preoccupation with disaster, death
Fears about safety
Self blame, guilt, responsibility
Angry outbursts
Retelling and repetitious play
Social withdrawal
Somatic complaints
School performance problems Pre-Adolescents and Adolescents Sleep problems and nightmares
Self blame, guilt, shame
Self-consciousness
Depression, social withdrawal
Desire for revenge
Aggressive and risk-taking behavior
School performance problems Risk Factors for Children Exposure to direct life threat and injury
Witnessing mutilating injuries
Hearing unanswered cries for help
Degree of brutality and violence
Unexpectedness and duration
Separation from family Screening Checklist Trauma and loss exposure
Current level of distress
Social, academic, emotional, and behavioral changes
Traumatic reminders at home and school
Ongoing stressors at home and school
Other trauma in the past year Tasks for Psychological Recovery Regain a sense of safety and security
Gain understanding of child's unique experience of the trauma
Gain understanding of actual events that have occurred
Identify and express reactions and emotions
Grieve and cope with traumatic stress
Resume age-appropriate roles and activities Cultural Competence Recognize the importance of culture and respect diversity
Maintain a current profile of the cultural composition of the community
Recruit disaster workers who are representative of the community or service area
Provide ongoing cultural competence training to disaster mental health staff
Ensure that services are accessible, appropriate, and equitable
Recognize the role of help-seeking behaviors, customs and traditions, and natural support networks
Involve as "cultural brokers" community leaders and organizations representing diverse cultural groups
Ensure that services and information are culturally and linguistically competent
Assess and evaluate the program's level of cultural competence MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Mental Health Response to Mass Violence and Terrorism, 2004