Disasters and traumatic events are part of human life.  1 in 5 individuals will face a traumatic event (Webber, et al., 2018).  Responses to traumatic events and disasters are a critical element of crisis intervention.  Crisis intervention helps stabilize a person by restoring equilibrium and mobility (James & Gilliland, 2013).  When one thinks of trauma and PTSD, the reality is most individuals who face disastrous events do not develop PTSD.  Human beings once stabilized are far more resilient than sometimes portrayed but without professional and on spot Disaster Mental Health support, as well as communal aid and support, then many individuals cannot foster that inner resiliency to recover. This short blog will look at Disaster Mental Health and the crucial role C Crisis Intervention plays in helping individuals return to a healthy mental baseline.

If you would like to learn more Crisis Intervention, as well as Trauma Informed Care, then please review AIHCP’s Crisis Intervention Counseling Certification, as well as AIHCP’s Trauma Informed Care Specialist Certification.

What Constitutes a Disaster?

A disaster according to The World Health Organization involves a complex humanitarian emergency in which a region, country or society experiences a total breakdown of authority resulting from external or internal conflict which requires an international response due to the inability of the locality’s capacity to face the problem (Webber, et al., 2018).   Disasters can be due to nature, human caused or with human influence.  Examples of natural disasters include hurricanes, tornadoes, floods, and earth quakes, while human caused disasters include war, terrorism, or even riots.  With human influence includes pollution, global warming, fire, gas leaks, displacements, or even hazardous waste (Webber, et al., 2018).  While this is a modest list to many possible scenarios, it encompasses what the U.N describes within a disaster as something that causes a massive disruption in the functioning of society that causes widespread human, material and environmental losses beyond the ability of the locality to manage with its resources (Webber, et al., 2018).

Disaster Response

Disaster response while not within the immediate topic of Disaster Mental Health represents the broader band in which Disaster Mental Health falls within.  Disaster response involves coordination between local, state, federal and sometimes international resources.  It involves working with religious, as well as non-profit organizations such as the Red Cross.  Within the United States, local government has limited resources.  The acting EMA Director, or director of the Emergency Management Agency reaches out to the state for assistance.  The state when overwhelmed then can reach out to FEMA or the Federal Emergency Management Agency which then coordinates the issue under the National Incident Management System (NIMS). (Webber, et al., 2018).  Various commanders are assigned within the NIMS with various officers who serve various capacities that meet the vast needs of the situation.  This ranges from needed resources, communication, coordination, physical and mental health care, shelter, food, medical, as well as helping others apply for necessary federal assistance.   Mental Health Professionals and Crisis Counselors are deployed under this leadership work within this framework.

From a mental health perspective, it is important to understand the phases of a disaster and its recovery and the corresponding emotional responses to each.  Pending on the phase of the disaster and its recovery has a huge impact on where the survivor is mentally and how well they are coping.  It is also can determine, if well after the disaster, if the person is suffering from any pathological reactions.

The first phase is the Impact Phase which follows the pre disaster.  Whether the impact is sudden or following multiple warnings and threats, an person will experience multiple emotional reactions to severe danger and loss.  In addition, their fight or flight responses will engage and different individuals will respond in different ways.  Within this phase shock, panic and overwhelmed feelings can be common as the mind faces traumatic conditions (Webber, et al., 2018).

The second phase is the Rescue Phase.  In this phase also referred to as the Heroic Phase, individuals may witness great acts of courage in helping one’s neighbor. The shift from fear and shock turns to altruism and helping.  Of course, some may be so shocked, inability to act may be perceived as cowardice and lead to later guilt and shame issues (Webber, et al., 2018).

The third phase involves the Remedy Phase or Honeymoon Phase.  Within this phase survivors feel a sense of euphoria and are overwhelmed by the generosity and help from others.  The public and communal support and prayers and good wishes towards a quick fix or repair become center stage to the survivor (Webber, et al., 2018).

The fourth phase is the Disillusionment Phase.  This period lasts from week 8 to year 1 and involves the realities of the loss, the lack of interest nationally, the bureaucratic halts, paperwork, lack of funding and triggering events from the initial disaster.  For many, this is the second disaster from a mental perspective (Webber. et al., 2018).

The final phase involves the Recovery Phase or Reconstruction Phase.  Following the anniversary, the locality rebuilds.  Some individuals rebuild, others move, but there is a return a new normal.  Memorials and healing also accompany the financial and physical rebuilding (Webber, et al. 2018).

Of course there are numerous variables to this.  Survivors differ in resiliency from a mental standpoint.  Others experience the disaster differently.  Others consist of more at risk communities due to age, capability, race, or income.  Others may face various other secondary issues in all aspects of life (Webber, et al., 2018).

What a Crisis Counselor Does and Does not Do

Crisis Counselors need to understand the paradigm shift of their purpose.  While some may be licensed counselors other may also be non-licensed professionals performing psychological first aid where needed.  Crisis Counselors are not on scene to offer diagnosis of clients.  The reality is most individuals who suffer a disaster will recover.  It is far to premature to diagnosis pathology when normal human reactions are responding to stress and loss.  Crisis counselors are meant to stabilize the situation for the person.  They are not there to diagnosis potential trauma or discuss the financial loss and procedures.  They can direct victims to resources but they are not there to advocate.  This takes time away from dealing with the primary goal of helping individuals stabilize mentally.  It is critical to also point, the purpose of crisis counseling is NOT TO DEBRIEF but to stabilize.  Studies have shown more emotional trauma occurs during the event when counselors attempt to debrief what occurred.  Finally, crisis counseling is anonymous for individuals needing it.  This is a key element of it.  It does not require records for mental health issues.

Unlike psychotherapy, crisis counseling is facing normal reactions to a horrible event.  There is no goal to fix or change the situation but to stabilize it.  Crisis counseling faces an adaptive response not a pathological response.   Instead of teaching one to learn new behaviors as in psychotherapy, crisis counseling looks to help the person find their original baseline.  Crisis counseling looks to promote self efficacy to the person.  It introduces brief psycho-education when needed and helps present the victim with necessary coping strategies to face the problem in the immediate event (Webber, et al., 2018).   In essence, the crisis counselor helps the person return to a mental baseline by restoring equilibrium and mobility to the person.   This is accomplished through offering protection, direction and connection for the victim (Webber, et. al., 2018).

Crisis Counselors are trained in Psychological First Aid.  This involves:

1. Contact and Engagement
2. Safety and Comfort
3. Stabilization
4. Information Gathering on current needs and concerns
5. Practical Assistance
6. Connection with social supports
7. Information on coping
8. Linkage with collaborative services

(Webber, et al., 2018).

To learn more about Psychological First Aid, please review AIHCP’s Blog on Psychological First Aid.

The Emotional State of a Disaster Victim

A victim of a disaster can be suffering physically, emotionally, cognitively, or behaviorally (Webber, et al., 2018).  It is important to remember how the body responds to traumatic events.  Within the triune brain model, there are survival responses in the lower brain stem, emotional responses within the limbic system, and reasoning processes within the pre-frontal cortex.  Unfortunately, during the autonomous nervous system and its reaction to life threatening events, the survival mode kicks in and the reasoning center is overruled.  In this way, individuals respond via the sympathetic nervous system which incudes fight or flight response, and in parasympathetic responses a freeze, fawn or shutdown response.  Hyperarousal or hypoarousal are the two directions and it is hard to predict how a person will respond.  It is due to this that individuals will exhibit as wide variety of responses from a emotional, cognitive and behavioral fashion.  Some may be numb, while others quite anxious and irritable.   Some may be a danger to themselves or others.  Others may be out of control and angry.

To learn more about trauma responses, please review AIHCP’s video and blog on trauma responses.  Click here

Please also review AIHCP’s Trauma Informed Care Program.

When a disaster strikes and survivors and victims are brought to shelters, crisis counselors should compassionately linger watching for signs of individuals.  Studies show that 1/3 of individuals will not seek any help, while an additional 1/3rd need help but never seek it.  In essence, the crisis counselor initiates contact.  The crisis counselor outreaches to the survivor based on observations of physical, emotional, cognitive and behavioral signs of distress.  The crisis counselor also seeks out those who seem out of place, or disadvantaged such as children, or the elderly, or a person alone.   PsyStart trains crisis counselors with a color coordinated system for this psychological triage.  Within this triage, a purple coding is the highest level of concern which indicates the person is a harm to him/herself or others.  Red coding indicates intermediate intervention of high risk for crisis or long term mental health issues.  This includes extreme panic, witnessed death, awaiting death of a family member, death of a pet, significant injury, trapped or delayed rescue, home destroyed, family member missing or child separated from family.  A yellow coding should be utilized for those who are separated from family, unware of location, prior mental health issues, confirmed exposure to an agent, de-contaminated, received medical treatment, or has health concerns due to the incident.  Finally, a green coding exhibits no triage factors (Webber, et al., 2018).

In these situations, it is important to identify the most vulnerable and help them find the stability, emotional equilibrium,  and re-connection as possible to minimize trauma.

Please also review AIHCP’s Psychological Recovery blog to learn more.

Vicarious Trauma and Compassion Fatigue

It is important to note that healthcare workers and emergency rescue and mental health counselors can also experience trauma via the trauma of others as well as what they witnessed in a disaster site.  Vicarious trauma is the transfer of trauma from one to another.  It can effect the mental health of a counselor or rescue team member.  If symptoms manifest, it is critical to find mental help.  Many times, mental health professionals push themselves too far and ignore the signs of trauma.  It is important to recognize the nature of trauma not only in others but also oneself.  It is also important to recognize compassion fatigue and how it can affect oneself, one’s family and professional performance.

Conclusion

Disasters occur and when a locality is overwhelmed, various levels of assistance are employed.  Disaster Mental Health is an important part of the response team.  Crisis Counselors assist survivors and victims with psychological first aid and help stabilize the individual.  Crisis counseling is far different than psychotherapy and is designed to help the person through moment of crisis and disaster to find stability.  It is important to understand the role of crisis counseling as well as applying essential triage to those emotionally affected by a disaster.  It is also equally important to monitor one’s own emotionally responses to a disaster.

Please also review AIHCP’s Crisis Intervention Program as well as AIHCP’s Trauma Informed Care Program.

Resource

James, R & Gilliland B. (2013). Crisis intervention strategies (Eighth Edition). Cengage

Webber, J. & Mascari, J.B. (Eds) (2018). Disaster mental health counseling : A guide to preparing and responding (Fourth Edition). American Counseling Association.

Additional AIHCP Blogs

Under standing Dissociation.  Click here

Additional Resources

The National Child Traumatic Stress Network.  Access here

Swaim, E (2022). “7 Reminders to Carry with You on Your Trauma Recovery Journey”.  Healthline.  Access here

“Resources on trauma and healing, including a guide inspired by ‘The Color Purple’”. APA.  Access here

“Recovering Emotionally After a Disaster”. American Red Cross.  Access here