Providing Disaster Mental Health Services Through The American Red Cross
By Jane Morgan, R.N.
NCP Clinical Quarterly 4(2): Spring 1994
The fall of 1989 brought two of the largest disaster operations
that the Red Cross had ever encountered: Hurricane Hugo with operations in the
Caribbean and the Carolinas, and the Loma Prieta Earthquake in northern California.
The obvious need for emotional support seen in the victims and the increased
levels of stress experienced by workers throughout Red Cross brought a realization
that an organized method was needed for delivering disaster mental health services
to victims and Red Cross workers. Prior to these disasters, emotional support
was provided by nurses whose primary responsibility was to meet the overall
health needs of disaster victims and workers. Under this system, the magnitude
of physical injuries and illnesses often left little time for providing emotional
support. Furthermore, a standard level of mental health training and or experience
among the nurses did not exist. These two conditions led to inconsistencies
in the extent and quality of emotional support services when they were made
available.
In 1990, American Red Cross National Disaster Services undertook
an extensive evaluation of these relief operations and convened a multi-disciplinary
task force comprised of a psychologist, two psychiatrists, a social worker,
and four nurses. Their purpose was to determine if there was a need for an internal
disaster mental health program, and if the findings warranted, develop the program.
Disaster workers and victims were surveyed and, based on the survey results,
the task force recommended the development of an internal disaster mental health
program. Over the next few months, the American Red Cross Disaster Mental Health
Services (DMHS) was created. Representatives from the National Institute of
Mental Health, the American Psychological Association, the National Association
of Social Workers, and the American Counseling Association provided suggestions
and reviewed materials as they were developed.
Disaster workers who become inordinately stressed during an
assignment are less able to provide quality relief services. Despite the emotional
rewards of helping disaster victims, Red Cross disaster workers are exposed
to a significant amount of suffering and stress and become vulnerable to secondary
traumatization. Even the most experienced workers are at risk for stress reactions.
In an effort to help our workers with stress management and good health practices,
the care of Red Cross disaster workers has been set as the first priority of
DMHS.
The provision of mental health services to disaster victims and the community mental health providers are the second and third priorities. It was determined that the assistance provided by Red Cross DMHS would be restricted to crisis intervention with referrals to local providers for more intensive needs. Only licensed or certified mental health professionals would be utilized in the national program. Volunteers must be currently employed in a mental health field and be license eligible in states requiring licensure. "Disaster Services Regulations and Procedures: Disasters Mental Health Services"1 is the guideline for program development and delivery and contains the above information.
Disaster Mental Health Services I 2 is a two day course intended to help mental health professionals adapt their existing skills to the needs of disaster workers and victims. The course is not crisis intervention training. This two day course plus a four hour orientation to the overall disaster services program and a first aid certificate are the sole requirements for becoming a DMHS volunteer.
The disaster mental health program is being developed at both
the national and local levels. Extensive networking is being conducted with
professional associations to inform their membership of the Red Cross DMHS program
and their opportunity to become involved. National statements of understanding
have been signed with the American Psychological Association and the National
Association of Social Workers. Discussions are underway with other organizations
such as the American Counseling Association, the Association of Marriage and
Family Therapists, the National Association of Mental Health, and several others
which, hopefully, will lead to additional formal agreements. These understandings
will facilitate interagency cooperation and increase the number of available
mental health professionals for local and national assignments. Utilizing Disaster
Services Regulations and Procedures: Disaster Mental Health Services, local
Red Cross chapters are developing and incorporating disaster mental health response
plans in their overall chapter disaster plan. Chapters are encouraged to network
with community agencies and individual providers to coordinate services and
obtain agreements that provide pro bono services to disaster victims
and workers. These services would be then utilized in the chapter's response
to local disasters.
When disasters occur that are beyond the response capabilities
of a local chapter, the national organization provides assistance with personnel,
materials, and financial resources. The Disaster Services Human Resources System
(DSHR) is the national personnel inventory that tracks individual disaster workers.
From this system, volunteers are recruited to respond to these large disasters.
To become a DSHR member, licensed mental health professionals must meet the
training requirements listed above and be available for a minimum of a 12 day
operational assignment. Additional experience and training provides further
opportunities for volunteer career advancement.
Late summer of 1992 provided the first opportunity for the
DMHS program to be fully implemented. More than 300 volunteer mental health
professionals were sent to Hurricane Andrew in Florida and Louisiana, Hurricane
Iniki in Hawaii and Typhoon Omar in Guam. Most of these professionals had never
provided disaster relief services nor, due to the newness of the program, had
any formal DMHS training. Brief orientations were provided upon arrival but
most of the training was on the job. Red Cross statistical reports show that
more than 41,000 workers and victims received disaster mental health assistance
from late August 1992 until mid January 1993.
Mental health workers were also assigned to numerous smaller
operations during 1992 and 1993, but it was not until the 1993 floods in the
Midwest that the program was again taxed beyond its current capabilities. The
number of available DMHS members in DSHR was again inadequate to meet the needs
of these operations. As a result, new recruitment and training procedures were
put into place that enabled Red Cross chapters and professional organizations
to register available mental health providers for immediate training in the
two day Red Cross DMHS I course with direct assignment to an operation
for a minimum of 10 days. The course was offered five times during July, August,
and early September. Between the trainings and current DSHR membership, more
than 150 DMHS workers were sent to assist the local mental health providers
in nine different states. This proved to be a much more effective method than
recruiting and assigning untrained volunteers as was done in 1992.
Services provided by Red Cross DMHS workers on all operations
consists of crisis intervention techniques such as defusings, debriefings, crisis
reduction strategies, and referrals. Some of the types of situations encountered
are:
- mediating between workers involved in a work related conflict.
- advocating time off for a stressed worker.
- notifying and providing support to a worker called home due to a death in
the family.
- providing appropriate services for a threatened suicide.
- providing information to victims concerning emotional reactions to disaster.
- working with local community mental health providers on how to provide services
during a disaster.
When Hurricane Andrew hit in August 1992, there were less than
100 DMHS workers in DSHR. By mid November, 1993, there were 470. Clearly, this
growth is phenomenal and reflects both the number of high profile disasters
which have occurred in recent times as well as the tremendous interest and willingness
on the part of mental health professionals to set their personal and professional
lives aside to work on an operational assignment.
Many challenges remain in the continuing development of this
program. We face the prevalent belief among disaster workers, that only the
weak are unable to manage the ongoing stresses of a disaster operation, or that
only "crazy people" talk with mental health professionals. Mental health professionals
require training about the differences between disaster mental health and nondisaster
mental health services. Not the least of the challenges has been finding ways
to mesh the busy schedules of mental health professionals with the immediate
needs of a disaster. Many of the volunteers who have been out on assignment
are now involved in helping to meet these challenges. There is on-going effort
to solidify procedures, expand networking, and increase recruitment. These activities
will help us prepare to meet the needs of future disaster operations and provide
further clarification and resources for new volunteers. Any mental health professional
interested in becoming a volunteer should contact their local chapter of the
American Red Cross.
Related Fact Sheets
Mental
health services for PTSD
Key concepts for the delivery of mental health services to
individuals with PTSD
Natural
disasters
What psychological problems result from disaster experiences? What factors
increase the risk of readjustment problems? What can disaster survivors do to
reduce the risk of negative psychological consequences and to best recover from
disaster stress?
Rescue
workers
Why it is important for those who work with trauma survivors
to know about traumatic stress?
References
1. American Red Cross, (1991), Disaster Services Regulations
and Procedures: Disaster Mental Health Services, ARC 3050M.
2. American Red Cross, (1993), Disaster Mental Health Services
I, ARC 3077.
Jane Morgan is Associate, Disaster Mental Health Services, American Red Cross.
The national office is located in Alexandria, Virginia.
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