Coping with mental health needs following a disaster

The elderly and children are particularly at risk

Even now, more than a month after the terrorist attacks on the World Trade Center and the Pentagon, the psychological effects of the disaster still are being seen, and experts warn they will continue to manifest themselves for some time to come.

Within days of the disaster, New York City and Washington, DC, hospitals and clinics opened their doors, offering free psychological counseling to those in need. Some hospitals formed therapy groups, and many mental health professionals volunteered their services to help the friends and families of those missing or lost. Still, health care professionals found that, initially, few people came to make use of their services possibly because for many the shock was still too great and others hoped to cope with their grief and loss by getting involved in rescue and clean-up efforts.

Now with little left to do but mourn and with the holidays approaching, many might find themselves suffering from symptoms of post-traumatic stress disorder (PTSD) and similar syndromes.

Unlike in times of war, the recent terrorist attacks were particularly devastating because of their unexpected nature. People’s sense of personal security was shattered, and the sense that a similar event may occur at any moment pervades. War, on the other hand, is usually foreseen and premeditated, giving people some chance to put it into context.

Mental health professionals note that these symptoms are not only showing up in the survivors and direct witnesses to the attack but in those who perhaps only saw the vivid images on television. Especially at risk are the elderly and children.

Those most at risk

Judi Graser, EdD, a clinical psychologist and neuropsychologist in Burke, VA, points out that children are especially vulnerable in these situations because of their inability to vocalize their fears and accompanying inability to put it in perspective. "Every child will respond differently to stress and anxiety, in part because of their personalities but also because of different levels of maturity and their ability to understand what is happening, she explains. This often makes it more difficult for health care providers and parents to help children cope with their worries and concerns in the aftermath of something catastrophic. That’s why it’s so important that families sit down together and talk about what is worrying the child."

While Graser points to the importance of comforting children and assuring them that they are being kept safe, she cautions against making false promises. "If something bad does happen," she says, "the child will lose a sense of trust in that adult. Instead of saying that a particular event will never happen again, the adult should say that it’s very unlikely it will happen, and if something does, they will keep the child from harm." (See "Helping Children Cope with Disaster-Related Anxiety," in this issue.)

The elderly, too, are at risk when it comes to suffering from stress and anxiety. Typically they are well aware of the events but unlike younger, healthier adults are often times incapable of taking an active role in working through their stress and grief.

Says Mike Ferris, president of Access Health Education in Chapel Hill, NC: "We need to remember that [these situations are] also very difficult for our elderly patients and clients. They tend to take things very hard and depending upon their health status may be subject to great mood swings and severe bouts with depression. All ages are dealing with tremendous emotions dealing with loss and all of the other issues related to this tragic event.

"We must remember that every generation will respond differently to this tragic situation. The senior population has a totally different vantage point having experienced World War II and everything that followed. One 82-year-old told me that she felt that it was her generation’s fault for letting the country get soft. All I know is that none of our most senior citizens should suffer any more than is necessary to grieve properly. The economic uncertainties become more difficult to understand and seniors typically create additional worries related to recessions. That may show up as concern for their family or even concern that they will not have the means to stay at home under your care. [Home care] staff should be ready to discuss and assist with these concerns."

Those who lived through the disaster will surely never be the same emotionally; the same can be said for those who witnessed the attack on television for they too will have horrifying images burned into their memories. Thanks to television, the Internet, and host of other electronic media, people across the world were exposed to graphic details and images that may in some cases cause severe stress reactions in some individuals. These reactions may have lasted only a short time in some people, but for others they may be more long-lasting.

Stress reactions refer to a host of emotional and behavioral responses occurring when a person’s normal functioning is disrupted or challenged. It’s important, from the perspective of a health care provider as well as friend and family member, that home health staff recognize the symptoms of stress disorders.

Among the ways in which stress may manifest itself are through somatic complaints which may include an array of nonspecific aches and pains: headaches, backaches, abdominal cramping, chest pain, sleep disruptions, or changes in appetite, as well as a heightened startle response and/or lowered immunity to infections. Some people may experience more emotional reactions. In these cases, individuals actually may be experiencing anxiety, dysphoria, anger, shock or disbelief, grief, irritability, and restlessness, not to mention a sense of denial and/or numbing. For some, a sense of survivor guilt may exist, and in extreme cases, nightmares and flashbacks may indicate the onset of a PTSD. Substance abuse, too, may begin to manifest itself in those who are unable to cope through constructive means.

Just as there are a range of symptoms, there is a wide variety of coping mechanisms that your agency and staff can implement. For example, says Ferris, it’s often "helpful to find initiatives to help [the elderly] deal with their emotions and feel that they are making a difference.

"Blood drives and supplies, food, clothing, and money raising for the victims and to support those working to resolve the myriad of issues are all very beneficial activities," he adds.

Key to this, he says, is to "make it an agency-wide initiative to help your patients understand what has happened and deal with their special grief. Maybe you can also let your patients know what you are doing as an agency to help."

Graser suggests allowing patients, be they children, the elderly, or anywhere in between, talk through their fears — but only if they want to. "Give them the chance to talk, but never force a person to do so. For some people, denial is their most effective means of coping," she says. Whether someone wants to talk, friends and family support can make a critical difference. In lieu of this — and sometimes, in addition to — professional counseling groups can be helpful.

Home care professionals should remember that there is no set timetable for getting over a shock or traumatic event — people cope in their own ways and on their own schedules, Graser says. "When [people] experience such a traumatic event, the best thing others can do . . . is to be there, to be accepting of their pain, and to help them work through it."

[For more information, contact:

  • Judi Graser, EdD, Burke Professional Center, 5203 Lyngate Court, Burke, VA 22015. Telephone: (703) 866-0615.
  • Mike Ferris, President, Access Health Education, 103 Dorset Point, Chapel Hill, NC 27514. Telephone: (919) 933-6026.] 

How to Help Others Cope

Sometimes the best way to help others, and yourself, is simply to be there for other people. Whether it’s running errands, preparing a meal or listening to their fears, sometimes the best cures are the simplest ones. Here are a few suggestions for helping your friends, families, and patients deal in the wake of a disaster.

  • Provide practical help in dealing with the disaster. Furnish meals if someone is incapacitated, either physically or emotionally. Provide a place to stay.
  • Listen. When others talk about their experiences and feelings, their emotional load seems lighter to bear. One of the best ways you can help is to just listen. You don’t have to come up with solutions or answers.
  • Show by words and actions that you care. Go ahead and act. Don’t be afraid of saying or doing the wrong thing. A friendly arm around troubled shoulders or a few words of support and encouragement can help in times of crisis. Small, kind deeds and sincere expressions of affection or admiration mean a lot.
  • Care for the kids. If affected friends or loved ones are parents, offer to spend some time with the children to play and to listen to their concerns.
  • Keep helping. The disruptions caused by a traumatic event may continue for some time. Recovery may take even longer. Your friends or family members will need regular, small acts of kindness to maintain their morale and to put their lives back together.

Source: Kansas State Cooperative Extension Service, Manhattan. University of Illinois, Urbana.