1.  
Chapter Seventeen

2.  Women’s movement in the 1960s and 1970s
 Community Mental Health Act, 1963
 Disaster Relief Act, 1974
• Section 413
 Federal Emergency Management Agency (1978)
 Classification of PTSD as a personality disorder in
the DSM-III (1980)
 American Red Cross establishes a mental health
certification program (1990s)
• Hurricane Hugo
• Loma Prieta earthquake

3.  San Fernando, CA, earthquake of 1971
• “Quake-proofing kids”
 Severe Flooding in 1972:
• Rapid City, South Dakota
• Wilkes-Barre, Pennsylvania
• Operation Outreach
• Logan County, West Virginia
 Hurricane Katrina, 2005
• FEMA

4.  The European Network for Traumatic Stress (TENTS)
• Funded by the European Union
• Provides services, expertise, and support to areas of the
Union that lack resources and availability of trained
personnel
 United Nations’ Inter-Agency Standing Committee
(IASC)
• Published IASC Guidelines on Mental Health and
Psychosocial Input Support in Emergency Situations

5.  September 11, 2001
• Homeland Security Act
 Murrah Federal Building in Oklahoma City
 Violence in Schools:
• Columbine, CO
• Virginia Tech University
 International Events:
• Suicide bombs in Israel
• Hostage situation in a Russian theatre and school
• Drug related guerrilla warfare in Mexico
 Hyper-vigilance
 Repetitive and Graphic Media Coverage

6.  An ecosystemic crisis is any disruptive or destructive
event that occurs at a rate and magnitude beyond the
ability of the normal social process to control it.
• Impacts an entire community, region, nation, or the entire world
• Sudden
• Slow buildup
• Human-made
• Natural disaster
• One intense episode
• Several compounding incidents

7.  Types of Ecosystemic crises:
• Metastisizing Crises
• Start small but, if not contained both physically and
psychologically, can quickly turn into large-scale
crises
• Large-Scale Crises
• At a minimum affect whole communities or regions
either directly or vicariously
• Mega-crises
• Affect entire countries or the world, either directly or
vicariously

8.  Microsystem
 Mesosystem
• Primary Mesosystem
• Super Mesosystem
 Exosystem
 Macrosystem
 Chronosystem
• The Individual
• The Society

9.  Systems must be interdisciplinary
 The system must be multitheoretical
 Individuals are part of the ecosystem
 Multiple contexts must be considered
 Time is of the essence
 Meaning is important

10.  Parsimonious interventions are needed
 The process is cooperative, collaborative, and
consultative
 There is a full range of targeted interventions aimed at
individuals, institutions, communities, and nationals
 The service characteristics of credibility, acceptability,
accessibility, proactivity, continuance, and confidentiality
should be adopted as “cast in stone” goals for service
delivery in disaster-stricken areas

11.  National Crisis Response Teams
• Development of Crisis Response Teams (CRTs)
• National Organization for Victim Assistance (NOVA) CRTs
• The Red Cross
• Federal Emergency Management Agency (FEMA)
• National Institute of Mental Health (NIMH)
 Professional Organizations
 Constructing an Outreach Team

12.  Vertically and Horizontally Integrated Local Emergency
Management Systems
• Role of Local EMA Directors
• Background and Training
• What Do Emergency Managers Do?
• Planning for Disasters
 Mental Health Components of Local EMAs
• Personnel
• Transdisaster (0–14 Days)
• Postdisaster (15–365 Days)

13.  Lack of efficient communication
 Poor coordination plans
 Ambiguous authority relationships
 Who’s in charge? Everyone shifts the blame
 Counterterrorism versus all-hazards response
 Ambiguous training standards and lack of preparation
 Where is the “learning” in lessons learned?
 Performance assessment was not integrated into the process
 The geography of poverty
 Rumor and chaos
 Personal and community preparedness
 Disaster mental health and the role of mental health
professionals

14.  Psychological First Aid and Psychosocial Support as Applied
to Disaster Survivors
• Make initial contact in a respectful manner
• Gather and provide information regarding immediate physical and
safety concerns
• Provide and direct people in regard to practical assistance needed
• Provide for their safety and comfort by linking them with social
services
• Teach them basic coping skills if requested
• Get information and help that will connect them to social supports
 When More Than PFA Is Needed
 The Current State of Affairs

15.  Debriefing
• An intervention designed to assist workers and survivors in dealing
with intense thoughts, feelings, and reactions that occur after a
traumatic event, and to decrease their impact and facilitate the
recovery of normal people having normal reactions to abnormal
events
 Debriefing Emergency Workers
• Critical Incident Stress Debriefing (CISD)
• Informal Defusing
• Formal Debriefing
 Debriefing Crisis Workers
• The Need for Debriefing
• Precautions
• Dynamics of Debriefing
• Confidentiality
• Understanding