Introduction to Preparedness and Planning
Although outbreaks of disease, natural disaster, and human-caused disaster are relatively rare, we know that they do occur. It is, therefore, important that we all take steps to be informed, write a disaster plan, put together a disaster supply kit, and be prepared in other physical ways for a disaster. Another important component of preparedness and planning is mental health. How can you prepare and plan for a disaster so that you may experience it and recover from it in a way that promotes your growth and that of others? Preparedness includes not only the essential actions and information-gathering referenced above, but mental health as well. Being prepared can reduce fear, anxiety, and losses that accompany disasters.
SAMHSA, the U.S. Substance Abuse and Mental Health Services Administration,assembled a group of experts to study what helps people through disaster, and they suggested based on these studies ten common features of a mentally healthy response to these events. These responses include:
- An individualized and person-centered approach: Each of us must prepare and plan for disasters in a way that "fits" with how we are human. For example, a disaster such as some hurricanes that involves relocation will be experienced differently for someone who has recently moved to a city compared to someone living there all of her life
- Self-direction: Although other people can influence and assist with our response to life events such as disasters, we each must take our human trip for ourselves, and each person's experience of a disaster is unique.
- Hope: Psychologists have found that hope, something that other traditions might refer to as positive outlook or even faith, can help people to prepare for and experience disasters in a mentally healthy fashion.
- Responsibility: Although resources including websites such as this one can help in preparation, ultimately disasters demand that we respond in a way that takes responsibility, that is ours.
- Empowerment: The essence of preparedness is to be empowered, to be able to not be merely a victim of disasters but a participant in their process. Additional information about empowerment is located throughout our website.
- Respect: People experiencing disasters are still first and foremost people. A mentally healthy approach to disasters would respect and honor personal experience and meaning-making.
- Peer-support: Although each of us experiences a disaster in ways that are unique to us and to our experience, and although we can count on governmental and other agencies to assist us through these experiences, reliance on those around us and similar to us is also an important feature of a mentally healthy response to disasters.
- Strengths-based: Our approach to mental health in disaster is founded on the idea that people are fundamentally strong, and that rather than speaking to deficits or shortcomings, we build our response to disasters on these strengths.
- Non-linear: Although some elements of disasters and our responses to them are predictable in terms of progressing through phases to a defined outcome, a mentally healthy response to disaster takes its own journey, sometimes with twists and turns and according to its own timetable. Responding to and recovering from disaster is a personal and somewhat unique experience.
- Holistic: This element of preparedness, response, and recovery emphasizes how disasters are part of a whole life and culture and time, and although having some special features, they are not separate from other human experience.
In this section of the website, which we have prepared specifically for the general Georgia public, you will find much more information about disaster preparedness and mental health.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Readiness can be critical in reducing the stress of disasters and emergencies. Here are some additional resources to help you prepare and plan for an emergency or disaster:
From Ready.georgia:
Children's Developmental Level
Preparing Children and Teens
Child Responses
Reassuring Children
Supporting Children
How do children and adolescents at various levels experience and respond to disasters?
People of all ages share some feelings and reactions in response to disaster. Special attention, though, is required to meet the needs of children and adolescents and understanding these needs can help us help them through these difficult times.
Typical reactions for children and adolescents of all ages include:
- Fears of future disasters
- Loss of interest in school, work, or hobbies
- Regressive behavior such as thumb-sucking and toilet-training accidents
- Sleep disturbances and night terrors
- Fears of events associated with the disaster
Here are some responses of people of various ages, and some suggestions for being helpful to those in these developmental levels.
Preschool (ages 1-5): Children in this age group are particularly vulnerable to disruption of their previously secure world, and need others to help them cope with stress and disruption. Abandonment is a major fear in this age group, and children who have lost family members and even pets or toys will need special reassurance. Typical responses include:
- Thumb sucking
- Bed-wetting
- Fears of the darkness or of animals
- Physical and emotional "clinginess " to parents and teachers
- Night terrors (PDF)
- Loss of bladder or bowel control, constipation
- Speech difficulties (e.g., stammering)
- Loss or increase of appetite
We can respond helpfully to these difficulties by:
- Encourage expression through play or other symbolic creative activities such as coloring or clay sculpting.
- Children of this age often express their feelings of grief and loss mostly clearly through non-verbal methods.
- Provide verbal reassurance and physical comforting
- Give frequent and extra attention
- Plan calming, comforting pre-bedtime activities
- Allow short term changes in sleep arrangements such as allowing children to sleep with a light on or with the door open, or on a mattress in the parents' or another child's room, or remaining with the child while the child falls asleep.
Early childhood (ages 5-11) Regressive behavior in which children slip back to previous developmental levels, is most typical of children this age. In part this is because they experience loss more intensely, and often in ways that are difficult for them to manage. Some typical forms taken by regression include:
- Irritability
- Whining
- Clinging
- Aggressive behavior at home or school
- Open competition with younger siblings for parents attention
- Night terrors, nightmares, fear of darkness
- School avoidance or other problems
- Withdrawal from peers
- Loss of interest and poor concentration in school
Some things that are helpful are:
- Patience and tolerance
- Play sessions with adults and peers
- Discussions with adults and peers
- Relaxation of expectation at school or at home (with a clear understanding that this is temporary and the normal routine will be resumed after a suitable period).
- Opportunities for structures but not demanding chores and responsibilities at home
- Rehearsal of safety measures to be taken in future disasters
Pre-adolescent (ages 11-14): Peer reactions are especially significant in this age group. The child needs to feel that his/her fears are both appropriate and shared by others. Responses should be aimed at lessening tensions and anxieties and possible guilt feelings.
Typical responses include:
- Sleep disturbance, appetite disturbance
- Rebellion in the home
- Refusal to do chores
- School problems (e.g., fighting, withdraw, loss of interest, attention seeking behavior)
- Physical problems (e.g., headaches, vague aches and pains, skin eruptions, bowel problems, psychosomatic complaints)
- Loss of interest in peer social activities
Some things that may be helpful are:
- Group activities geared toward the resumption of routines
- Involvement with same age group activity
- Group discussions geared toward relieving the disaster and rehearsing appropriate behavior for future disasters
- Structured but undemanding responsibilities
- Temporary relaxed expectations of performance at school or at home
- Additional individual attention and consideration
Adolescent (ages 14-18): Most of the activities and interest of the adolescent are focused in his/her own age group peers. They tend to be especially distressed by the disruption of their peer group activities and the lack of access to full adult responsibilities in community efforts.
Typical responses include:
- Psychosomatic symptoms (e.g., rashes, bowel problems, asthma)
- Headaches and tension
- Appetite and sleep disturbance
- Hypochondriasis
- Amenorrhea or dysmenorrhea
- Agitation or decrease in energy level
- Apathy
- Irresponsible and/or delinquent behavior
- Decline in emancipatory struggles over parental control
- Poor concentration
Some things that might be helpful are:
- Encourage participation in the community rehabilitation or reclamation work
- Encourage resumption of social activities, athletics, clubs, etc.
- Encourage discussion of disaster experiences with peers, extended family members, significant others
- Temporarily reduce expectations for level of school and general performance
- Encourage, but do not insist upon, discussion of disaster fears within the family setting.
Web Links
This excellent resource from SAMHSA explains developmental reactions to trauma by grade level. (PDF)
This document from APA Online, entitled "Reactions and Guidelines for Children Following Trauma/Disaster," contains some very helpful and specific information based on a child's school level. (PDF)
How to Prepare Children and Teenagers for Disasters
Part of disaster preparedness involves helping children and adolescents recognize the possibility of disasters and begin to be aware of possible responses to them. Although you may think that avoiding these topics would be a gift to your children, we know that preparedness is enhanced by giving children information in a way that is appropriate to their age and developmental level. What is always appropriate is reassuring them of our companionship to them in even the most difficult circumstances.
Of course, disaster preparedness is different for children of different age groups. Here are some tips for preparing children and teenagers of various ages:
- Preschool (ages 1-5): Children of this age lack the verbal and conceptual skills to discuss something as abstract as a disaster. So rather than presenting to them various disaster possibilities, a general discussion of “bad things” happening, along with reassurance that they will not be left alone, is what is required. Be sensitive so as not to raise fears of young children through detailed discussion of disasters, and tailor the information to their level of understanding.
- Early childhood (ages 5-11): As they begin their school experience, children have more ability to imagine different possibilities. Go to this FEMA website (PDF) for suggestions and to consider their responses to them. Discussing various disasters such as fires and storms can help children begin to prepare for their possibility. Again, fear of abandonment is a major theme of this age group, and reassurance (“whatever happens, we are in it together”) is always appropriate.
- Preadolescence (ages 11-14): Children of this age are beginning to be very aware of how they relate to others, and need reassurance mostly that their fears and concerns are normal, and are shared by others of their age. Materials can help preadolescents start to imagine how they might respond to various disasters. Always it is important to follow children’s lead in responding to questions maybe stirred by news events or television shows.
- Adolescence (ages 14-18): Teenagers of this age are increasingly capable of abstraction and empathy, and of “feeling their way into” various possibilities. They are able to consider specific disasters and their implications. Given the emerging sense of service and social commitment in adolescence, volunteering to help with disasters (PDF) may also be a helpful preparedness strategy for this age group.
- Always start with reassuring children and teenagers of your commitment to keeping them safe.
- Be aware that children and adolescents respond to the possibility of disasters at their own developmental level. Don't get too technical or complicated, and talk on their level.
- Encourage children to ask questions. Listen to what they say. Provide comfort and assurance that address their specific fears. It's okay to admit that you can't answer all of their questions.
- Find out what frightens them. Encourage your children to talk about fears they may have. They may worry that someone will harm them at school or that someone will try to hurt you.
- Focus on the positive. Reinforce the fact that most people are kind and caring. Remind your child of the heroic actions taken by ordinary people to help people in disaster, and of the heroism of people responding to disasters.
- Pay attention. Your children's play and drawings may give you a glimpse into their questions or concerns. Ask them to tell you what is going on in their play, or in the pictures they draw. These conversations are a great opportunity to clarify their misconceptions, answer questions, and give reassurance.
- Develop a plan. Establish a family emergency plan for the future, such as a meeting place where everyone should gather if something unexpected happens in your family or neighborhood. Planning can help you and your children feel safer.
Web Links
This FEMA website contains some very helpful information and activities for parents and teachers, including materials in Spanish. (PDF)
This game, in Spanish, focuses on enhancing disaster preparedness. (PDF)
Here are some very informative video clips from FEMA of various disasters, geared to the understanding level of children and preadolescents. (PDF)
This is a comprehensive curriculum prepared by the Red Cross that involves an approach to disaster preparedness emphasizing “feelings, facts, and future.” (PDF)
These coloring books, available for download in English and Spanish, are from the American Red Cross and assist in helping children understand disaster preparedness.
Coloring Book 1 (PDF)
Coloring Book 2 (PDF)
How do children and adolescents at various levels experience and respond to disasters?
People of all ages share some feelings and reactions in response to disaster. Special attention, though, is required to meet the needs of children and adolescents (PDF), and understanding these needs can help us help them through these difficult times.
Reactions to disasters may appear immediately after the disaster or after several days or weeks. Most of the time the initial stressful response phase will pass as the child or teenager adjusts. When symptoms do continue, sometimes a more serious emotional problem has developed. In this case, referring the child to a mental health worker who is experienced in working with children and trauma would be necessary.
Typical reactions for children and adolescents of all ages include:
- Fears of future disasters
- Loss of interest in school, work, or hobbies
- Regressive behavior such as thumb-sucking and toilet-training accidents
- Sleep disturbances and night terrors
- Fears of events associated with the disaster
Here are some responses of people of various ages, and some suggestions for being helpful to those in these developmental levels.
Preschool (ages 1-5): Children in this age group are particularly vulnerable to disruption of their previously secure world, and need others to help them cope with stress and disruption. Abandonment is a major fear in this age group, and children who have lost family members and even pets or toys will need special reassurance. Typical responses include:
- Thumb sucking
- Bed-wetting
- Fears of the darkness or of animals
- Physical and emotional “clinginess” to parents and teachers
- Night terrors (PDF)
- Loss of bladder or bowel control, constipation
- Speech difficulties (e.g., stammering)
- Loss or increase of appetite
We can respond helpfully to these difficulties by:
- Encourage expression through play or other symbolic creative activities such as coloring or clay sculpting. Children of this age often express their feelings of grief and loss mostly clearly through non-verbal methods.
- Provide verbal reassurance and physical comforting
- Give frequent and extra attention
- Plan calming, comforting pre-bedtime activities
- Allow short term changes in sleep arrangements such as allowing children to sleep with a light on or with the door open, or on a mattress in the parents' or another child's room, or remaining with the child while the child falls asleep.
Early childhood (ages 5-11): Regressive behavior, in which children “slip back” to previous developmental levels, is most typical of children this age. In part this is because they experience loss more intensely, and often in ways that are difficult for them to manage. Some typical forms taken by regression include:
- Irritability
- Whining
- Clinging
- Aggressive behavior at home or school
- Open competition with younger siblings for parents attention
- Night terrors, nightmares, fear of darkness
- School avoidance or other problems
- Withdrawal from peers
- Loss of interest and poor concentration in school
Some things that are helpful are:
- Patience and tolerance
- Play and discussion sessions with adults and peers
- Relaxation of expectation at school or at home (with a clear understanding that this is temporary and the normal routine will be resumed after a suitable period).
Pre-adolescent (ages 11-14): Peer reactions are especially significant in this age group. The child needs to feel that his/her fears are both appropriate and shared by others. Responses should be aimed at lessening tensions and anxieties and possible guilt feelings.
Typical responses include:
- Sleep disturbance, appetite disturbance
- Rebellion in the home
- Refusal to do chores
- School problems (e.g., fighting, withdraw, loss of interest, attention seeking behavior)
- Physical problems (e.g., headaches, vague aches and pains, skin eruptions, bowel problems, psychosomatic complaints)
- Loss of interest in peers and social activities
Some things that may be helpful are:
- Group activities geared toward the resumption of routines
- Involvement with same age group activity
- Group discussions (PDF) geared toward relieving the disaster and rehearsing appropriate behavior for future disasters
- Structured but undemanding responsibilities
- Temporary relaxed expectations of performance at school or at home. Additional individual attention and consideration
Adolescent (ages 14-18): Most of the activities and interest of the adolescent are focused in his/her own age group peers. They tend to be especially distressed by the disruption of their peer group activities and the lack of access to community, all common features of disasters
Typical responses of this age group include:
- Psychosomatic symptoms (e.g., rashes, bowel problems, asthma)
- Headaches and tension
- Appetite and sleep disturbance
- Amenorrhea or dysmenorrhea (changes in menstrual cycles)
- Agitation or decrease in energy level
- Apathy
- Irresponsible and/or delinquent behavior
- Poor concentration
Some things that might be helpful are:
- Encourage volunteer participation (PDF) in the community rehabilitation or reclamation work
- Encourage resumption of social activities, athletics, clubs, etc.
- Encourage discussion of disaster experiences with peers, extended family members, significant others
- Temporarily reduce expectations for level of school and general performance
- Encourage, but do not insist upon, discussion of disaster fears within the family setting
Some of this information is excerpted and modified from a SAMSHA publication. (PDF)
Web Links
This web page, entitled “Reactions and Guidelines for Children Following Trauma/Disaster,” contains some very helpful and specific information tailored for the most part to various school levels. (PDF)
The National Association of School Psychologists has a very nice website on how to work with school children during and after disasters. (PDF)
This is comprehensive summary page from the United Methodist Committee on Relief entitled, “How Can I Expect My Child to React to Disasters?” lists physiological, emotional, and behavioral reactions by age group. (PDF)
How do I reassure children after a disaster?
The most important job we have as parents and teachers is to accompany children in ways that keep them safe and contribute to their development. This role becomes even more essential following disasters, when children are vulnerable and concerned. Here are some things to keep in mind following disasters in your response to children:
- Children need to hear that family and friends who love them are still there to protect and take care of them. When children feel scared or confused, they often feel alone and vulnerable, and a parent leaving, even for a short time, can be very frightening. This is a time for extra intimacy with your child, lots of physical affection and patience, and respect for the fears and concerns that surface. Children need to hear that it is all right to be afraid and confused at times, and that grown-ups feel that way too. But follow up with assurances that you will be there to help them understand their feelings and thoughts. As always, try to be with children in a way that fits with their developmental level.
- Children are naturally curious, and disasters stir new concerns and curiosities. They need to know that it is all right to ask questions as part of their meaning-making and sense-making and recovery. You should encourage questions and opinions from children and respond to them as legitimate and important. It is also natural for children to express some of their concerns through humor or jokes. You can help them find more constructive ways to express their feelings and concerns.
- Answer children’s questions with accurate information and honest expressions of opinion. The amount and complexity of information should be geared to the child’s age and interest (PDF), but every child, no matter what age, needs honest answers. If you do not know how to answer a question, tell your child that you do not know the answer, but that you will try to find one as soon as you learn more about what is going on. Questions on death need to be answered with support and simple directness as they arise. Children need the reassurance that loss by death does not mean that they are being punished or that they will be abandoned by others close to them. Children’s grief (PDF) tends to take place along different, but similar, pathways to that of adults.
- Try to return to a normal daily routine, including school and community-based activities, as soon as possible to further your children’s feeling of security and stability. Children will also feel that their world has become safe again if they can visit their favorite playground, park, or museum, or to see a favorite movie.
- Monitor and interpret children’s exposure to media (PDF) following a disaster. Children’s fertile imagination can distort and magnify events portrayed on the television and radio, in the newspaper, in the classroom or play yard, or right around your dinner table in a way that threatens their sense of security and stability. To complicate things, for young children, "seeing is believing." It's hard for them to separate fact from fantasy. With instant replays of news reporting video coverage, children form terrifying misperceptions. If not told otherwise, they can think multiple disasters are continuously happening for days on end! Plan enjoyable activities to distract children's attention from media coverage of disasters. Turn off the television and radio when young kids are present. To help children maintain perspective, we have to limit the re-hashing of crisis.
- Some of the stress management techniques presented elsewhere in this website can help not only adults but children as well. Some specific things you can do to help manage children’s stress include:
- Providing a physical outlet through play and exercise
- Treat aggressive behavior, bed-wetting, and sleep and eating changes as symptoms, not problems. These are normal responses of children to stress (PDF)
- Children experiencing nightmares or feeling fearful at night may be comforted by a night light, stuffed animal or doll, or music from a bedside radio. Some children may feel less vulnerable if they have a flashlight by their bed or a whistle to call a parent. If they do awake with fears during the night, sitting with them provides comfort and support and helps to lessen their frightening feelings.
- Children, like adults, feel better about overwhelming events when they can do something to help. It is important to give children opportunities to help or volunteer even if it is only a small task of short duration. Being able to join with others increases a child’s awareness that they are not alone and helpless and that there is strength through family and community cooperation.
Some of this material is adapted from “Helping Young Children Respond to War,” by Marzy Sykes, Ph.D.
Books for Parents and Others Helping Children
What Happened to the World? Helping children cope in turbulent times by Jim Greenman. Published by Bright Horizons Family Solutions, JPMorgan Chase, Mercy Corps, and The Dougy Center, 2001.
Bad Stuff in the News: A guide to handling the headlines by Marc Gellman and Thomas Hartman. New York,NY: Sea Star Books, 2002.
The Place I Know: Poems of Comfort selected by Georgia Heard. Cambridge, MA: Candlewick Press, 2002.
Web Links
This very helpful website from Illinois University Extension for teachers working with children following disasters. (PDF)
For those who are uncertain about how to talk with children about disasters (and other experiences), this is a wonderful resource from Michigan State University Extension’s Children, Youth, & Family Programs. (PDF)
This is an American Psychiatric Association website for “helping children after a disaster” that has a lot of well-organized information. (PDF)
How can you support children during a disaster?
Disasters may strike quickly and without warning. As frightening as they can be for adults, disasters can be even more traumatic for children if they lack kind and clear companionship to find their way through. There are some things that you can do to keep children company during these difficult times, and to help them manage their fear and anxiety.
- Understand that children of various ages will respond differently to disasters. Find ways to connect with children’s experience that are appropriate to their level of understanding and being in relationship with their feelings.
- During disasters, as during other difficult life events, children will look to you and other adults for help. How you react to an emergency gives them clues on how to act. If you react with alarm, a child may become more scared. They see our fear as proof that the danger is real. If you seem overcome with a sense of loss, a child may feel their losses more strongly. Use stress management (PDF) principles and techniques so that you may be a source of guidance and stability for those around you.
- Touch or cuddle with your children. Physical touch reassures your child and makes them feel safe. Look into the eyes of your child with your touch. Touching is important for children during disasters. Close contact helps assure children that you are there and will not abandon them, and will help them feel safe. As you touch them, look into their eyes, and say “We are together. We are safe. We will survive.”
- Get your child something to cuddle, a transitional object (PDF) such as a toy, blanket, or teddy bear, to serve as a bridge between their disaster experience and their ordinary experience.
- Focus on listening. Get down to the child’s eye level and talk to him or her. Try to understand, then to be understood. When you're sure that danger has passed, concentrate on your child's emotional needs by asking the child what's uppermost in his or her mind. Give children simple and accurate information about what has happened. Then listen to what your child says and their questions. Mirror the child’s question through reflective listening (PDF) so that your child feels assured of your presence, and feels understood.
- Keep in mind that children’s understandings and fears are different from yours.
- The event will happen again.
- Someone will be injured or killed.
- They will be separated from the family.
- They will be left alone.
- You can respond to these fears with simple, clear information that is both accurate and reassuring, and again appropriate to the child’s level of understanding.
- Children depend on daily routines to organize and regulate their lives: They wake up, eat breakfast, go to school, and play with friends. When emergencies or disasters interrupt this routine, children may become anxious. Try to do what you can to maintain structure and routine during a disaster, even if you and your family have to leave your home to go to a shelter. Having children participate in the family's recovery activities in a way that is appropriate to their developmental level will help them feel that their life will return to "normal."
- Include children in recovery activities. Give children chores that are their responsibility. This will help children feel they are part of the recovery. Having a task will help them understand that everything will be all right.
- Understand that recovery is a process, not an event. Helping children through the journey of disaster recovery is a difficult but worthwhile effort.
Some of the material on this page is from “Helping Children Cope With Disaster,” developed by the Federal Emergency Management Agency (PDF) and the American Red Cross.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
What to Do Immediately Following a Disaster
The time immediately following a disaster, whether human-caused or natural, is critical to mental health. This is a time and space in which our preparedness can pay off, in reducing paralyzing anxiety, uncertainty, and isolation. This is a time when we are faced with what is sometimes impossible to “fix,” and so it is important to do what we can, to remind ourselves that we have some control and responsibility, and to stay focused on meaningful work and activity. There will be time for analysis (“Why did this happen to me?”) and sense-making later: now is the time because we can’t do everything, to do what we can. Here are some helpful suggestions borrowed and modified from the prepare.org website (PDF):
- Check the area around you for safety. In the case of hurricanes or tornados or of biological, chemical or radiological threats, listen for instructions on local radio or television stations about safe places to go. Georgia911.org maintains information on state disaster status and this GEMA site (PDF) has up-to-the-minute situation reports (PDF)
- Do what you can to treat your injuries and those of others. Wash small wounds with soap and water. To help prevent infection of small wounds, use bandages and replace them if they become soiled, damaged or waterlogged. There is some helpful information on family first-aid after a disaster at disasterfirstaid.com (PDF)
- Seek appropriate medical care for more severe injuries, to the extent that you can. Access to medical professionals is often affected by disasters, but relief agencies such as the Red Cross have authorized providers (PDF) to furnish care during and after disasters.
- Be prepared for some “ripples” of disasters, in that some natural hazards, like severe storms or earthquakes, may recur in the form of new storms or aftershocks over the next several days. Part of your mental health preparedness should involve acquainting yourself with common or possible disasters in the Georgia area (PDF) and knowing the different consequences of each.
- Avoid using the telephone (either cellular or landlines) if a large number of homes in your area have been affected by a disaster. Emergency responders need to have the telephone lines available to coordinate their response. During the immediate post-disaster time period, only use the telephone to report life-threatening conditions and call your out-of-town emergency contact (PDF)
- Remain calm. Pace yourself. You may find yourself in the position of taking charge of other people. Listen carefully to what people are telling you, and deal patiently with urgent situations first. This is a time for focusing on the large questions (how to secure food, clothing, and shelter) but also doing what you can to be patient and trusting. People of faith may find it helpful to pray or meditate (PDF) but stress management of whatever form is important.
- If the disaster was widespread, listen to your radio or television station for instructions from local authorities. Information may change rapidly after a widespread disaster, so continue to listen regularly for updates. If the power is still out, listen to a battery-powered radio, television or car radio. Research shows that mental health during disasters is enhanced by the experience of connection and control, and diminished by isolation and retreat. Try to stay connected with others by whatever means possible. Even if you do not need to go to a shelter (PDF) it is helpful to remain in contact with and to be around others.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Disasterassistance.gov also contains this list of links to contact federal, local, and state agencies for assistance after a disaster
Disaster preparedness and response for people with disabilities or special needs
In some ways, disaster preparedness and immediate response are the same for all people, regardless of special needs. Please review the materials elsewhere on this website about general preparedness and response.
There are some special considerations, though, in preparedness for persons with disabilities or other special needs (PDF). Persons and caregivers of these persons should:
- Identify a personal support network. Organize a network that includes your home, school, workplace, volunteer site, and any other places where you spend a lot of time. Members of your network can be roommates, relatives, neighbors, friends, and co-workers. They should be people you trust and who can check to see if you need assistance. They should know your capabilities and needs, and be able to provide help within minutes. Include a minimum of three people in your network for each location where you regularly spend a lot of time since people work different shifts, take vacations and are not always available.
- Make a personal disaster preparedness assessment. Decide what you will be able to do for yourself and what assistance you may need before, during and after a disaster. Make a list of your personal needs and your resources for meeting them in a disaster environment. Consider personal care and equipment, transportation and mobility and evacuation needs, and needs of service animals.
- Get informed by contacting your local emergency management office or American Red Cross Chapter to gather information about community hazards, disaster plans, and warning systems. Ask about special assistance programs available in the event of an emergency. Many communities ask people with a disability to register, usually with the local fire or police department, or the local emergency management office so needed help can be provided quickly in an emergency. Let your personal care attendant know you have registered, and with whom. If you are electric-dependent, be sure to register with your local utility company.
- Make a personal disaster plan(PDF) that includes information about your special needs and how they would relate to your ability to respond to a disaster. Consult with caregivers and with disability-specific agencies (see “additional resources” below) as necessary in your planning.
- Maintain and update your plan every six months
Disaster Response
In the event of a disaster, you may have to take additional steps to protect yourself and your family in an emergency. Here are some specific disaster response considerations for persons with various disabilities and special needs, excerpted from this website (PDF):
| Disability/Special Need | Additional Steps |
| Visually impaired | May be extremely reluctant to leave familiar surroundings when the request for evacuation comes from a stranger. A guide dog could become confused or disoriented in a disaster. People who are blind or partially sighted may have to depend on others to lead them, as well as their dog, to safety during a disaster. |
| Hearing impaired | May need to make special arrangements to receive warnings. |
| Mobility impaired | May need special assistance to get to a shelter. |
| Non-English speaking persons | May need assistance planning for and responding to emergencies. Community and cultural groups may be able to help keep people informed. |
| People without vehicles | May need to make arrangements for transportation. |
| People with special dietary needs | Should take special precautions to have an adequate emergency food supply. |
| People with medical conditions | Should know the location and availability of more than one facility if dependent on a dialysis machine or other life-sustaining equipment or treatment. |
| People with mental retardation | May need help responding to emergencies and getting to a shelter. |
| People with dementia (PDF) | Should be registered in the Alzheimer’s Association Safe Return Program (PDF) |
If you have special needs: Find out about special assistance that may be available in your community. Register with the office of emergency services or the local fire department for assistance so needed help can be provided.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How can I, as a senior citizen, plan for disasters?
Everyone shares some common ways we can prepare for disasters. Because of some physical, demographic, and other considerations, there are some special things to keep in mind for senior citizens. Here are some tips:
- Store plenty of water, at least 1 gallon per person per day, because dehydration is a serious health problem for older adults. Store at least 3 days worth. Use small containers with easily removable caps. Water in swimming pools and spas can be used for sanitation and personal hygiene.
- Have a three-day supply of nonperishable food, with consideration to your special dietary needs.
- Assemble a disaster first aid kit, being certain to include nonprescription medications that you use on an ongoing basis. Include a thorough personal medical history (PDF) or invest in some sort of electronic medical history device (PDF). If possible keep an extra pair of eyeglasses, hearing aid batteries and if you are in an electric wheelchair have a manual wheelchair available or extra batteries on hand.
- Have an emergency contact person (PDF) who lives in a different geographic area. Give that person a list of names, phone numbers / email addresses of people who should be contacted; or you can give your friends and family the name and phone number / email address of your contact person.
- Put your important papers in a safe place. These should include insurance policies, bank account and credit card information, Medicare and/or Medicaid cards, and living wills and powers of attorney.
- Include in your disaster kit (PDF) some time passers such as board games, puzzles, books, paper and pens for letters and notes, envelopes and stamps, playing cards and some paperback books
Use the following checklist to get started:
- Assemble a disaster supplies kit (PDF).
- Arrange for someone to check on you.
- Plan and practice the best escape routes from your home.
- Plan for transportation if you need to evacuate to a Red Cross shelter.
- Find the safe places in your home for each type of emergency.
- Have a plan to signal the need for help.
- Post emergency phone numbers near the phone.
- If you have home health care service, plan ahead with your agency for emergency procedures.
- Teach those who may need to assist you in an emergency how to operate necessary equipment. Be sure they will be able to reach you.
Seniors with Alzheimer’s Disease have some special disaster-related needs, and this is a very helpful guide for helping them prepare and respond to disasters.
Seniors with diabetes, bed-bound persons, and oxygen dependent persons need to assure that they have sufficient emergency supplies on-hand.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How do I prepare to care for my pets during disasters?
Our pets enrich our lives in more ways than we can count and make important contributions to mental health. In turn, they depend on us for their safety and well-being. Here's how you can be prepared to protect your pets when disaster strikes.
Be Prepared with a Disaster Plan
The best way to protect your family from the effects of a disaster is to have a disaster plan (PDF). If you are a pet owner, that plan must include your pets. Being prepared can save their lives. Different disasters require different responses. Certain disasters may require you to evacuate (PDF) your home. If you must evacuate, the most important thing you can do to protect your pets is to evacuate them, too. Leaving them behind, even if you try to create a safe place, is likely to result in their being injured, lost, or worse. So prepare now.
Have a Safe Place to Take Your Pets
Red Cross disaster shelters cannot accept pets, except for service animals that assist people with disabilities, because of states' health and safety regulations and other considerations. Although there are some emergency animal rescue services, it may be difficult, if not impossible, to find shelter for your animals in the midst of a disaster, so plan ahead. Do not wait until disaster strikes to do your research.
- Contact hotels and motels outside your immediate area to check policies on accepting pets and restrictions on number, size and species. You can find a list of pet-friendly hotels in Georgia here (PDF), although this information may change over time. Ask if "no pet" policies could be waived in an emergency. Keep a list of "pet friendly" places, including phone numbers, with your other disaster information and supplies. If you have notice of an impending disaster, call ahead for reservations.
- Ask friends, relatives or others outside the affected area, including maybe your emergency contact person (PDF) whether they could shelter your animals. If you have more than one pet, they may be more comfortable if kept together, but be prepared to house them separately.
- Prepare a list of boarding facilities and veterinarians who could shelter animals in an emergency; include 24-hour phone numbers. Georgia has a state animal response team devoted to care for animals during disasters, but they will probably be overburdened in the event of a local large-scale disaster.
- Ask local animal shelters if they provide emergency shelter or foster care for pets in a disaster. They may be overburdened caring for the animals they already have as well as those displaced by a disaster, so this should be your last resort.
Assemble a Portable Pet Disaster Supplies Kit
Whether you are away from home for a day or a week, you will need essential supplies for your pets. Keep these items in an accessible place and store them in sturdy containers that can be carried easily (duffel bags, covered trash containers). Your pet disaster supplies kit should include:
- Medications and medical records (stored in a waterproof container) and an animal first aid kit (PDF)
- Sturdy leashes, harnesses, and/or carriers to transport pets safely and ensure that your animals can't escape.
- Current photos of your pets in case they get lost.
- Food, potable water, bowls, cat litter and pan, and can opener.
- Information on feeding schedules, medical conditions, behavior problems and the name and number of your veterinarian in case you have to foster or board your pets.
- Pet beds and toys, if easily transportable.
Know What To Do as a Disaster Approaches
- Often warnings are issued hours, even days, in advance, and are posted for Georgia residents here. At the first hint of disaster, act to protect your pet.
- Call ahead to confirm emergency shelter arrangements for you and your pets.
- Check to be sure your pet disaster supplies are ready to take at a moment's notice.
- Bring all pets into the house so that you won't have to search for them if you have to leave in a hurry.
- Make sure all dogs and cats are wearing collars and securely fastened, up-to-date identification. Attach the phone number and address of your temporary shelter, if you know it, or of a friend or relative outside the disaster area. You can buy temporary tags or put adhesive tape on the back of your pet's ID tag, adding information with an indelible pen.
Planning and preparation will enable you to evacuate with your pets quickly and safely. But bear in mind that animals react differently under stress. Outside your home and in the car, keep dogs securely leashed. Transport cats in carriers. Don't leave animals unattended anywhere, as they can run off. The most trustworthy pets may panic, hide, try to escape or even bite or scratch. When you return home, give your pets time to settle back into their routines. Consult your veterinarian if any behavioral problems persist.
Know the Special Needs of Your Pets
Exotic pets, such as birds and reptiles, often have special care needs that influence their response to disaster. Be educated about your pets’ needs as part of your disaster preparation.
In Summary
If you must evacuate, do not leave your animals behind. Take them to a prearranged safe location if they cannot stay with your during the evacuation period. Remember, pets are not allowed in Red Cross shelters. If there is a possibility that disaster may strike while you are out of the house, there are precautions you can take to increase your pets' chances of survival, but they are not a substitute for evacuating with your pets. For more information, contact the Humane Society of the United States (PDF).
Much of this information is based on a website prepared by the Red Cross (PDF) in cooperation with the Human Society of the United States (PDF).
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Coping Strategies
During the recovery phase following the disaster, people continue to experience stress, grief, and perhaps even some symptoms of depression and anxiety (PDF). During this period there are some helpful coping strategies to assist you in disaster recovery.
Helpful Coping Strategies
- mobilize a support system to reach out and connect with others, especially those who may have shared the stressful event
- talk about the traumatic experience with empathic listeners
- cry
- hard exercise like jogging, aerobics, bicycling, walking
- relaxation exercise like yoga, stretching, massage
- humor
- prayer and/or meditation; listening to relaxing guided imagery; progressive deep muscle relaxation
- hot baths
- music and art
- maintain balanced diet and sleep cycle as much as possible
- avoid over-using stimulants like caffeine, sugar, or nicotine
- commitment to something personally meaningful and important every day
- hug those you love, pets included
- eat warm turkey, boiled onions, baked potatoes, cream-based soups n these are tryptophan activators, which help you feel tired but good (like after Thanksgiving dinner)
- proactive responses toward personal and community safety n organize or do something socially active
- write about your experience n in detail, just for yourself or to share with others
People are usually surprised that reactions to trauma can last longer than they expected. It may take weeks, months, and in some cases, many years to fully regain equilibrium. Many people will get through this period with the help and support of family and friends. But sometimes friends and family may push people to "get over it" before they're ready. Let them know that such responses are not helpful for you right now, though you appreciate that they are trying to help. Many people find that individual, group, or family counseling is helpful. The key word is CONNECTION; ask for help, support, understanding, and opportunities to talk.
The Chinese character for crisis is a combination of two words -- danger and opportunity. People who fully engage in recovery from trauma discover unexpected benefits. As they gradually heal their wounds, survivors find that they are also developing inner strength, compassion for others, increasing self-awareness, and often the most surprising -- a greater ability to experience joy and serenity than ever before.
Coping Skills
What can we do to cope with stress in our lives? "Coping reflects thinking, feeling, or acting so as to preserve a satisfied psychological state when it is threatened. Coping is typically not a single response, but a series of responses, initiated and repeated as necessary to handling the remaining, continuing, or transformed nature of the stressor."
Practical Coping Skills
| Problem-Focused | Environment-Directed | Emotion-Focused | Self-Directed |
| Know Your Enemy-What is causing the stress? | Work to make your home a safe place | Develop and continue friendships/relationships | Do things that help you relax-walk, hike, read a book |
| Develop a stress management plan | Reduce stress in the workplace | Have hope and optimism that things will get better | Breathe |
| Utilize community resources | Breathe clean air and avoid toxins | Keep a sense of humor | Go Outdoors |
| Communicate with your immediate family about what is stressing you | Recognize what you can and cannot change in the environment | Be kind to yourself, and have a positive attitude | Healthy Diet and Reduce sugar and fat |
| Develop a family plan to address the stressor | Accept help from others | Participate in spiritual/faith-based activities | Drink Water |
| Time management | Seek to have a sense of control of your environment | Make time for quiet time each day | Regular aerobic exercise |
| Money management | Communicate your values, goals and action plans | Exercise regularly to build your self-esteem and manage stress | Participate in spiritual activity - get a massage, meditate |
| Reduce the intensity of your emotional reactions to stress | Make a list of things that are important to you that affect your environment | Develop thinking and behavior strategies to deal with your feelings and control your emotions | Get enough sleep |
| Seek professional help | Talk to a close friend about your stress | Join a support group | Avoid nicotine, caffeine, and other stimulants- avoid alcohol and drugs |
| Note: Many of the categories overlap and integrate | Stuart, M.E., adapted from Lazarus |
Much of the information on the fact sheet was adapted from this Arizona-based website.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Mental health: What to expect immediately following a disaster
Everyone who sees a disaster is affected by it in some way, and many may experience some negative reactions. Below are some reactions common to people who experience traumatic stress as a result of witnessing or participating in a major disaster. Such traumatic incidents remind us that we are also vulnerable to tragedy. Our protective belief that "nothing could happen to my family" can be momentarily stripped away, and some have suggested that our psychological world can be affected as much as our physical one. Parents may feel especially protective of their children, and children may feel anxious about their safety and ask difficult questions in their attempts to cope and make sense of their experience.
The following thoughts, feelings and actions are normal responses, and may vary in intensity and duration. Although they can be upsetting, it is important to remember that they are ordinary reactions to a frightening and extraordinary experience. These responses are likely to become less frequent and eventually disappear within the weeks ahead, but if you continue to be concerned, you may want to seek professional assistance.
Thoughts
- Recurring dreams or nightmares about the event and its aftermath.
- Difficulty concentrating or remembering things.
- Questioning your spiritual or religious beliefs.
- Repeated thoughts or memories of loved ones who have died, or of the event itself or
- The damage which resulted from the event that are hard to stop.
Feelings
- Feeling numb, withdrawn, or disconnected.
- Feeling frightened or anxious when things like the sound of a heavy truck or particular smells remind you of the event. Psychologists call this hypervigilance and it can be a sign of post-traumatic stress.
- Feeling a lack of involvement or enjoyment in everyday activities.
- Feeling depressed, blue, or down much of the time.
- Feeling bursts of anger, or intense irritability.
- Feeling a sense of emptiness or hopelessness about the future.
Behaviors
- Being overprotective of your own and your family's safety.
- Isolating yourself from others.
- Becoming very alert at times, and startling easily.
- Having problems getting to sleep or staying asleep.
- Avoiding activities that remind you of the event itself or the damage; avoiding places or people that bring back memories.
- Having increased conflict with family members.
- Keeping excessively busy to avoid thinking about the event and what has happened to you.
- Being tearful or crying for no apparent reason.
Physical Reactions
(If you have any concerns about your physical reactions, please consult with your physician.)
- Stomach upset, nausea
- Diarrhea, intestinal cramps
- Elevated heart rate
- Elevated blood pressure
- Elevated blood sugar
Coping
During this time it is important that you avoid unhealthy or maladaptive ways to manage your stress, such as excessive use of alcohol or other drugs. Focus on eating well and getting enough sleep. Be patient with yourself and with others. Don't let yourself become isolated, and maintain connections with your community friends, relatives, neighbors, co-workers, and church members. Talk about your experiences with them.
Seek mental health services if these responses become worse over time or linger longer than you feel that they should.
Adapted and modified from this University of South Dakota Disaster Mental Health Institute website. (PDF)
The Centers for Disease Control also offers information on what to expect following a disaster.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Managing Stress
Traumatic Stress
Serious Stress
How do I manage stress following a disaster?
Information is available elsewhere on this website on what stress is and how it changes during phases of disaster response. Stress, as we discuss there, is an adaptive and necessary preparation for the work of survival, but becomes a problem when it is excessive in level (that is, too much stress) or when it hangs around past the time when it is needed. In these cases “good stress” turns into “bad stress." Here are some things you can do in conjunction with disasters to lessen stress levels:
- Don’t make sudden or drastic decisions. The period immediately following a disaster is not the time to add additional stressors. For example, if your home was destroyed in a fire, focus on the immediate response, such as contacting your insurance carrier, rather than worry about long-term living arrangements.
- Do make as many daily decisions (about food and clothing choices, about which radio station to listen to) as possible that will give you the feeling of control over your life.
- Structure your time through a routine, to remind yourself that you are normal and having normal stress reactions. Keep your life as normal as possible under the circumstances of the disaster. Routines help both physical and emotional healing. New routines you may want to add (if you haven't already done so) include healthy eating, rest, exercise, and relaxation.
- Talk with others as much as you are comfortable. Talking about what is going on reduces the feelings of anxiety, hopelessness and helplessness. Seek out people who care for your and for whom you care. Community gives you strength, courage, and support.
- As far as possible, do something every day (even if it’s taking a sponge bath) to make yourself feel good and give yourself a small gift.
- Be careful about numbing your immediate experience with overuse of drugs or alcohol. Don’t complicate things further with substance abuse problems.
- Within the first 24 to 48 hours, periods of strenuous physical exercise alternated with periods of relaxation will alleviate some of the physical reactions to a stressful situation.
- Remember Your Breath: Take deep cleansing breaths (PDF) and focus on blowing out stress and fear.
- Do a short prayer or meditation. Take a moment, if you are able, close your eyes or focus your eyes on something, take several deep diaphragmatic breaths, and repeat a 1-5 word affirmation with each deep breath like "Keep letting go…"
- Hold on to something familiar. Put something you love in your pocket, around your neck, or on your wrist. This can be a picture, a cross or medallion on your neck or wrist, beads, a rosary, mala beads, or prayer beads. Some of you may choose to keep a sacred book such as the Koran or Bible or other inspirational text with you. When you get stressed and overwhelmed, stop, touch the object; breathe and repeat a word or phrase that comforts you.
- Use progressive relaxation (PDF), a technique in which muscle groups are tightened and released while focusing on breathing.
- Guided Imagery is a helpful and scientifically based way to manage stress through imagination and self-awareness.
- Journaling. Writing down the experience of a disaster can help relieve stress by putting the fear and anxiety out of your body onto paper. People keeping journals (PDF) in the midst of disasters and disaster recovery tend to experience less stress and more meaning-making.
- Soothing and meaningful music and art can lower arousal levels and lessen stress responses.
- Memorials and other healing rituals are one way to express and let go of your feelings. Participate in these if you feel they are helping you.
*Please see stress-related sections of this website for additional information on when to seek help.
Web Links
This site provides information from Dr. Patti Levin regarding what you may experience after a disaster. On the left of the page there is a links section with more detailed information. (PDF)
This Stress Institute site provides advice and tips for reducing stress, such as breath work and prayer. (PDF)
This article is an American Psychological Association website providing useful information about getting help for oneself and one’s family. Also discusses the timeframes that go along with coping after a disaster. (PDF)
What is traumatic stress?
Stress is a typical, and even adaptive, response to traumatic events such as disasters. The arousal, shock, and denial that we feel in the midst of disasters help us accomplish survival tasks, and also help us keep from feeling overwhelmed. What is important, though, is that we recognize the signs of stress and learn to manage it in such a way that we can continue to function. Here are some helpful facts and tips:
- Stress in response to trauma is normal.
- It is felt and experienced as a variety of emotions, including confusion, grief, anger, and sadness.
- Everyone experiences stress differently, and we experience different stress in response to different disasters. Peoples’ way of experiencing stress depends both on what happened to them and on what meaning they give to those events.
- We experience stress differently through different phases of disasters.
This site (PDF) has suggested the following typical stress response to trauma:
- Impact phase
The focus is on survival. Sometimes during this phase people are able to use stress to accomplish meaningful tasks, and other times they respond in a way that is disorganized and stunned. Stressors during this phase include:- Threat to life and encounter with death
- Feelings of helplessness and powerlessness
- Loss (e.g., loved ones, home, possessions)
- Dislocation (i.e., separation from loved ones, home, familiar settings, neighborhood, community)
- Feeling responsible (e.g., feeling as though could have done more)
- Anger at human evil (It is particularly difficult to cope with a disaster if it is seen as the result of deliberate human actions.)
- Immediate post-disaster phase: recoil and rescue
During this phase we begin to recoil from the impact of the disaster, and rescue activities often commence. It is normal to feel stunned, confused, or anxious. Stress responses during this phase may include:- Numbness
- Denial or shock
- Flashbacks (PDF) and nightmares
- Grief reactions to loss
- Anger
- Despair
- Sadness
- Hopelessness
- Recovery phase
This is a sometimes-lengthy period of adjustment in the return to normal that the community and individuals must go through. It begins as rescue is completed and individuals and communities face the task of bringing their lives and activities back to normal. Much will depend on the extent of devastation and destruction that has occurred as well as injuries and lives lost. It is normal for the emotional and physical components of stress to change during the recovery phase, as the immediate threats to survival are no longer the focus and life starts to ask other questions about meaning and values in the midst of disaster. People may also be hesitant to express distress, concern, or dissatisfaction, feeling they should be grateful for the aid given or because they have suffered less than others have. It should be noted that sometimes emotional reactions may present as physical health symptoms, such as sleep disturbance, indigestion, and fatigue, or they may present as social effects such as relationship or work difficulties.
The important thing throughout is to turn stress into work, and give ourselves time to heal. Some more things to keep in mind are:- Stress responses tend to change over time in intensity, frequency, duration, and character.
- The time it takes for emotional “wounds” to heal varies. Much like the flu, traumatic stress reactions must run their course. No one can deny that this is a difficult experience, but it is important to know the reactions are normal and will ease in time.
Web Links
This Department of Veterans Affairs website details the phases of traumatic stress during and after a disaster. (PDF)
Post-Disaster Stress: When is it normal, and when is it more serious?
Just as physical recovery from a disaster takes time, mental health recovery is a process, not an event. As the immediate post-disaster stress response diminishes, here are some principles to keep in mind:
- It is normal to have some intense and unpredictable emotions. You may be more irritable than usual, and your mood may change back and forth dramatically. You might be especially anxious or nervous, or even become depressed (PDF).
- Thoughts and behavior patterns are affected by the trauma. You might have repeated and vivid memories of the event, called “flashbacks.” These flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heart beat or sweating. You may find it difficult to concentrate or make decisions, or become more easily confused. Sleep and eating patterns also may be disrupted.
- Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, can trigger upsetting memories of the traumatic experience. These 'triggers' may be accompanied by fears that the stressful event will be repeated.
- Interpersonal relationships often become strained. Greater conflict, such as more frequent arguments with family members and coworkers, is common. On the other hand, you might become withdrawn and isolated and avoid your usual activities.
- You may have physical symptoms such as headaches, nausea, or chest pain, and some of your pre-existing medical conditions may worsen due to the stress of disaster recovery.
All of us have a different and somewhat unique timetable for disaster recovery, and there is not one “standard” pattern of reaction to the extreme stress of traumatic experiences.
Personal Factors Related to Severe Distress
Personal experiences and characteristics can influence our way of responding to disasters. Some of these influences include:
- Family factors. People who are not living with other family members, who have been exposed to family violence, have a family history of mental illness, and/or have caregivers who are severely distressed by the disaster are more likely themselves to be severely distressed.
- Social factors. People who must face a disaster without supportive and nurturing friends or relatives suffer more than those who have at lease one source of such support.
- Mental health. Those who had mental health problems (such as depression or anxiety disorders) before experiencing a disaster will be more likely to be severely distressed by a traumatic event.
- Developmental level. Although young children, in some respects, may be protected from the emotional impact of traumatic events (because they don’t recognize the threat), once they perceive the situation as dangerous, younger children are more likely to experience severe stress reactions than are older children.
- Previous disaster experience. People who have experienced previous threatening and/or frightening events are more likely to experience severe reactions to a subsequent disaster event severe psychological distress.
Normal post-traumatic responses to disaster include:
- A concern for basic survival
- Grief over loss of loved ones and loss of valued/meaningful possessions
- Fear and anxiety about personal safety and physical safety of loved ones
- Sleep disturbances, often including nightmares and imagery from the disaster
- Concerns about relocation and the related isolation or crowded living conditions
- A need to talk, often repeatedly, about events and feelings associated with the disaster
- A need to feel one is a part of the community and its recovery efforts
Signs that additional help is needed
How do you know when you or a loved one might need help in healing from the disaster? The following symptoms may indicate a deeper stress or more serious reaction than what is considered "normal" stress. These types of reactions may interfere with the person's day-to-day functioning and could continue indefinitely without outside assistance. Difficulties with any or all of the following:- Disorientation (dazed, memory loss, unable to give date/time or recall recent events…)
- Depression (pervasive feeling of hopelessness & despair, withdrawal from others…)
- Anxiety (constantly on edge, restless, obsessive fear of another disaster…)
- Acute psychosis (hearing voices, seeing visions, delusional thinking…)
- Inability to care for self (not eating, bathing, changing clothing or handling daily life)
- Suicidal or homicidal thoughts or plans
- Problematic use of alcohol or drugs
- Domestic violence, child abuse or elder abuse
- Overwhelming guilt and self-doubt
- Fear of crowds, strangers, or being alone
Some traumatic responses are unique to children
Teachers and parents should be alert to these signs of complicated post-disaster response in children:
- Refusal to return to school and "clinging" behavior, including shadowing the mother or father around the house
- Persistent fears related to the disaster (such as fears about being permanently separated from parents)
- Sleep disturbances such as nightmares, screaming during sleep and bedwetting, persisting more than several days after the event
- Loss of concentration and irritability
- Startled easily, jumpy
- Behavior problems, for example, misbehaving in school or at home in ways that are not typical for the child
- Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot be found
- Withdrawal from family and friends, sadness, listlessness, decreased activity, and preoccupation with the events of the disaster
What to do if you are concerned about your or others’ response to a disaster
Here is a Post-traumatic Stress Disorder self-test that you may want to take to get an idea of how your level of stress compares with that of others. If you have any reason to be concerned about your stress following the disaster, please seek appropriate help. Professional companionship for those affected by a disaster--especially those who have witnessed destruction, injury or death--can help prevent or minimize serious post-traumatic stress disorders. You should consult with your family physician for referral to sources of help with these struggles. Parents who are concerned about their children can ask their pediatrician or family doctor to refer them for an evaluation.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How do we start the process of recovery as a family?
Sometimes following disasters we have the gift of being surrounded by loved ones or family. Under those circumstances the work of grief recovery and recovery can occur within a group of people who love each other (the essence of family, after all). Following disasters we can help each other in families by:
- Encouraging family members to talk in ways that fit for them about their experience of the disaster: what they saw, heard, thought, smelled, and felt. Recovery is facilitated by verbal reliving, making meaning, and putting the event in context as a way of feeling understood, rejoining the human race, and gaining perspective on the experience, in a safe setting.
- Be supportive and non-judgmental, remembering that each person’s experience of the disaster may be different. Use reflective listening (PDF) to test your understanding of others’ experience. At times, a family member in crisis may pull away from you. Part of good communication is the ability to accept temporary withdrawal or silence, as even this silence can be informative to you and helpful to your family member. Likewise, speaking up and clearly stating what you feel and think is an important part of coping with your family's immediate needs in daily life and in a crisis. Communication keeps us connected to family and community.
- Get and give information.
- Discuss factual information about what caused the disaster. Now may be the time, in the safety and stillness following the event, to discuss its factual details using specific information about the disaster. Calmly and firmly explain the situation. As best as you can, tell children what you know about the disaster. Explain what will happen next.
- Share about your experience of stress in response to the disaster, and discuss the specific ways in which your life has changed. This will help others know what is happening.
- Although lots of communication happens informally, you might consider holding family meetings (PDF). Here as a family you can work on goals and problems alike, take turns in sharing your perspectives, make decisions as a group, and most importantly remain connected to one another.
- Maintain crucial standards with children, but adjust your expectations and discipline to meet the needs of your family during this difficult time. Be flexible with family roles.
- Include children in recovery activities. Give children chores (PDF) that are their responsibility. This will help them feel they are part of the recovery. Having a task will help them understand that everything will be all right.
- Laugh. Use humor (PDF) whenever possible to assist in your recovery and meaning-making.
- Be more tolerant. Give each other space.
- Validate each other:
- Give hugs.
- Tell each other how much they are appreciated.
- Offer praise.
- Use rituals to support and aid growth and healing. Rituals can help the family in the healing process and reaffirm family bonds. As an example, one family who lost their home in a fire filled balloons, each representing something they lost in the fire. The family gathered in a circle at the site of their home and said a few words about what each item meant and then released the balloons in the air.
- After some time has passed, review what has happened with your family. Concentrate on how each person has changed or grown. Work on meaning-making of the disaster as you are able.
- Set priorities and problem solve with input from family members.
- Give and ask for support from family members, friends and the community.
- Review emergency preparedness. Improve those areas that need some attention and family practice drills.
Web Links:
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How is resiliency important following a disaster?
Mental health professionals have spent a long time studying post-traumatic stress disorder as a response to disaster. But more recently they have focused on resiliency (PDF), defined as “the ability to spring back from and successfully adapt to adversity,” and defined by a 15 year-old high school student as, "Bouncing back from problems and stuff with more power and more smarts." Resiliency is also sometimes referred to as psychological hardiness (PDF), wellness , and positive psychology. Regardless of the name we give it, resiliency and the ability to “bounce back from (disasters) with more power and more smarts” is an important goal of mental health.
Each of us has a built-in capacity for resiliency, "a self-righting tendency" that operates best when we have resiliency-building conditions in their lives. These resiliency conditions (PDF) take place along three dimensions of our experience: I AM, I CAN, and I HAVE. This fact sheet will discuss each of these as it relates to disaster recovery.
I AM refers to personal characteristics, including
- Self-esteem or the sense that we have of ourselves as capable, loveable, and worthy. Psychological research (PDF) suggests that our beliefs about how we can cope may be as important as coping behavior itself.
- Mastery, confidence, perceived control, hope, and optimism have been shown to relate positively, strongly, and consistently to mental health in both the short-term and long-term recovery from disaster as illustrated in powerful personal stories (PDF) such as this.
- Recognition of personal strengths as well as suffering. Although our suffering in response to disaster must be acknowledged with compassion and empathy and patience for ourselves, we must also remind ourselves of our capacity to master this experience.
I CAN as an element of resiliency refers to recognition of not just self-esteem but self-efficacy, which is different from recognizing our personal strengths: it is the difference between “I am a good reader” (self-esteem) and “I can read” (self-efficacy). In self-efficacy we have a sense of our specific abilities and assets and talents as they relate to recovery. Recognizing our problem-solving skills as they relate to disaster recovery can enhance resiliency, and promote our ability to “bounce back with more power and more smarts.” In building this element of resiliency, you might ask yourself:
- What can I bring to this experience, in terms of talents and skills, that maybe only I can bring? It may be as simple as organizing a reading time for children in a shelter or as complicated as serving as a historian of the disaster.
- What tools do I possess in terms of kindness or gratitude or perspective-taking that I can bring to this experience? How can I bring them courageously and clearly? What gifts do I have, to give?
I HAVE refers to the supports around each of us that promote resilience. These are like the airbags in our cars that even when we crash can keep us from being wounded too seriously: the “I have” of resiliency in disaster recovery might include:
- our access to service agencies that can provide us with basic food, clothing, shelter, and protection during times of disaster
- our financial resources (PDF), even when depleted, help us maintain our basic needs. Careful management of these resources can help promote resiliency.
- our relationships with significant others always influence our mental health, but are particularly important during times of disaster recovery, when relocation and other influences may disrupt our interactions with support systems. An important feature of the “I have” component of resiliency involves maintaining our relationships with family and friends, and when necessary “rebuilding relationships" in the same way that we might rebuild homes or schools.
- our participation with communities such as spiritual or religious groups, schools, and service organizations can remind us that we are not unique, that we are not alone, and that we can survive and even thrive following disasters.
In summary, relatively few of us who experience disasters become depressed or develop PTSD: most of us exhibit resiliency-the ability to deal with adversity without becoming overwhelmed by it. We can learn to respond to adversity with resiliency rather than depression and hopelessness.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How do I do the work of grief following a disaster?
After the immediate response to disasters in which we experience denial, shock, and stress, we begin the work of grief (PDF). This is the process by which we adjust to the various losses associated with disaster. Of course, grief following disasters is complicated because there are always various losses: perhaps of home, workplace, health, pets, and even loved ones. Sometimes grief is also complicated by guilt (known as survivor guilt (PDF) about being alive when someone else has died, or about failure to save the person who died or to make their life or their dying easier.
While grief is not the same for every person, there are some common features and tendencies. Here are some things to keep in mind as you begin to do the work of grief following disasters:
- Grief does require work, and is not automatic. This is why the process of grieving is sometimes known as grief work (PDF)
- Grief has predictable phases but the timetable is intensely personal. For some, it's a relatively quick journey lasting a few months; for others, a journey that may take years to complete. Here is a quick guide to the phases of grief, adapted from this site (PDF):
- Numbness: This is a common reaction and tends to last seven to ten days. A sense of being paralyzed, distant, and removed from one's feelings of grief is present. Some have referred to numbing as the body's mechanism for protecting itself from being overwhelmed by the shock of the loss. We move from this phase to the next when we can no longer be numb.
- Denial and Isolation: In this phase we have difficulty accepting the reality of loss. This may be expressed in more severe forms as a complete denial of the disaster or in less severe forms in confusion and a sense of “sleep-walking” through life. We move from this phase to the next when we start to resume some relatively normal roles and relationships, and then we experience
- Anger, which may be directed at the disaster itself, at the world, fate, God, or other people in their lives. A sense of "Why me?" and/or "Why not someone else?" give a flavor of this phase. Bargaining with God for the return of the dead person may be part of this phase, and we move from this phase to the next when we acknowledge the reality of the loss and give up the idea that we can recover through anger or some other act of our own. Then we tend to experience
- Depression, which in response to disaster may include combinations of hopelessness, helplessness, intense sadness, sleeplessness, anxiousness, physical pain, confusion, fear, anger, grief, shock, guilt, mistrust of others, and loss of confidence in self or others. As acknowledgement and acceptance of the loss and the reality of life after the loss grow, sadness and depression become more present. We move from this phase to the final stage of grief when we start to make meaning of the loss and to experience it fully, gaining some
- Acceptance, in which we come to terms with the loss, and are able to move on or re-invest in the life that lies ahead. We no longer experience extreme emotions, but have a sense of meaning and a new relationship with our loss.
Following a disaster you can ease your grief work through:
- Seeking out caring people. Find relatives and friends who can understand your feelings of loss. Join support groups with others who are experiencing similar losses.
- Expressing your feelings. Tell others how you are feeling; it will help you to work through the grieving process.
- Taking care of your health. Maintain regular contact with your family physician and be sure to eat well and get plenty of rest. You should not sleep more than 10 hours a day without your doctor’s approval. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief.
- Accepting that life is for the living. It takes effort to begin to live again in the present and not dwell on the past.
- Postponing major life changes. Try to hold off on making any major changes, such as moving, remarrying, changing jobs or having another child, as you respond to the disaster. You should give yourself time to adjust to your loss.
- Being patient. It can take months or even years to absorb a major loss and accept your changed life.
- Seeking outside help (PDF) when necessary. If your grief seems like it is too much to bear, seek professional assistance to help come to terms with your loss and work through your grief. It’s a sign of strength, not weakness, to seek help.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
How do I start recovering emotionally from a disaster?
Although sometimes it gets considerably less focus, you and your family’s mental health and emotional recovery is just as important as rebuilding a home and healing physical injuries. At other places on this website we have talked about stress related to disasters, and how to know the difference between ordinary stress and more serious psychological problems. In the aftermath of disaster there will be many things that happen that tend to make you feel ill, uncomfortable, upset, anxious, or irritated. You will want to do things to help yourself feel better as quickly as possible, without doing anything that has negative consequences such as substance use, hurting yourself, risking your life, or eating lots of junk food.
Here are some basic steps that you can take to start the process of emotional recovery:
- Keep caring for your physical needs: Seek appropriate medical care, get sufficient rest, good food, and drink plenty of water.
- Try to return to as many of your personal and family routines (taking a shower, washing your hair, making yourself a sandwich, calling a friend or family member, making your bed, walking the dog, or getting gas in the car) as possible.
- Limit your exposure to the sights and sounds of disaster, especially on television, the radio and in the newspapers.
- Recognize that recovery is a process, not an event. It takes time.
- Recognize, accept, and try to be patient with your own feelings.
- Stay connected with your family and/or other support systems.
- Reach out and accept help from others. You may have been self-reliant all of your life, but now is a time to reach out and let others reach out to you.
- Do something to bring yourself joy whenever you are having a hard time or as a special treat to yourself. Some of these “gifts to yourself” might include:
- Wear something that makes you feel good. Everybody has certain clothes or jewelry that they enjoy wearing. These are the things to wear when you need to comfort yourself.
- Get some little things done. Survivors of disasters tell powerful stories about how small accomplishments, even little ones, help them start the process of healing. Think of some easy things to do that don't take much time. Then do them. Here are some ideas: clean out one drawer, put five pictures in a photo album, dust a book case, read a page in a favorite book, do a load of laundry, cook yourself something healthful, send someone a card.
- Learn something new. Think about a topic that you are interested in but have never explored. Find some information on it in the library. Check it out on the Internet. Go to a class. Look at something in a new way. Read a favorite saying, poem, or piece of scripture, and see if you can find new meaning in it.
- Practice reframing (PDF), which involves being aware of the stories that you are telling yourself (for example, “Because of this hurricane my life is ruined…”) about your circumstances and trying to tell yourself new stories (such as, “This has been awful, but it also presents me with some new opportunities”).
- Be present in the moment. This is often referred to as mindfulness. It is easy during the time following a disaster to focus on the past or on the future, so that we miss out on experiencing fully what is going on in the present. Making a conscious effort to focus your attention on what you are doing right now and what is happening around you can help you feel better. Look around at nature. Feel the weather. Look at the sky when it is filled with stars.
- Play with children in your family or with a pet. Some people refer to these activities as mental fitness (PDF) in which romping in the grass with a dog, petting a kitten, reading a story to a child, rocking a baby, and similar activities have a calming effect which translates into feeling better.
- Do a relaxation exercise (PDF). There are many sources for these, find the one that works for you.
- Feed your senses through such activities as taking a warm bath, exposing yourself to something that smells good to you, and listening to music.
- Use your spiritual resources. Spiritual resources and making use of these resources varies from person to person. For some people it means praying, going to church, or reaching out to a member of the clergy. For others it is meditating or reading affirmations and other kinds of inspirational materials. It may include rituals and ceremonies—whatever feels right to you. Spiritual work in response to disaster does not necessarily occur within the bounds of an organized religion. Remember, you can be spiritual without being religious.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
Coping and Disaster Recovery
During the recovery phase following the disaster, people continue to experience stress, grief, and perhaps even some symptoms of depression and anxiety. During this recovery phase we may also experience some physical problems such as changes in sleep and appetite, digestive problems, more susceptibility to colds or other illnesses, and increased use of alcohol and other drugs. We may also have emotional responses such as fear, irritability, nightmares, difficulties concentrating, feelings of betrayal, and loss of interest in everyday activities.
What can we do to cope with these stresses as we journey toward recovery from disaster? Here are some helpful suggestions:
- Use grounding (PDF), a technique designed to keep your experience in the “here and now” and remind you that you are alive and present to life.
- Take time every day to focus on your breathing as a calming and centering strategy.
- Experiment with watching your thoughts (PDF) to identify those that may be catastrophic or lead to feelings of hopelessness and helplessness. A healthy outlook on life makes full recovery more achievable.
- Challenge negative beliefs. Replace such thoughts as, "I always have bad luck...nothing will better from now on...everything is going wrong," with, "Is there any real reason to think that...maybe things will change for the better."
- Adjust self-talk. Convert negative messages into positive ones, for example, replace "I’ll never get through this," with "I can do this, but it’s normal and okay to feel scared and overwhelmed."
- Use previous ordeals that have been successfully overcome as a "power base."
- Consider alternative outcomes for worst-case scenarios, for example, "I can still see my friends, I can enjoy the little things in life."
- Imagine how this event will be viewed in the future, remembering how things do change over time.
- Learn to manage anxiety (PDF) through such strategies as guided imagery and relaxation.
- Mobilize a support system or group to reach out and connect with others, especially those who may have shared the stressful event. Although there are professional resources to organize and facilitate disaster groups, there is a lot we can do on our own.
- Talk about the traumatic experience with empathic listeners (PDF) in your circle of friends, family, and spiritual community.
- Cry if that works for you, or laugh or yell, but do something to express yourself emotionally. “Getting things out” helps.
- Exercise (PDF) can contribute to greater well-being following disaster.
- Use prayer, meditation, or other spiritual practices are helpful coping strategies.
- Look for opportunities for service to others (PDF), that even in the midst of our own recovery can help us cope with our struggles in a kinder and clearer way.
- Use creativity to fill your life with “food for your soul.”
- Take planned breaks such as going to the movies or doing some light reading to remind yourself that you are recovering, that you are well.
- Maintain relationships with your pets to give and be given coping gifts.
- Nourish yourself through healthy eating and drinking, and avoid self-medication, alcohol, or other drugs.
- Write about (PDF) your experience in detail, just for yourself or to share with others.
Remember that people who engage fully in recovery from disaster discover unexpected benefits. As they gradually heal their wounds, survivors find that they are also developing inner strength, compassion for others, increasing self-awareness, and often the most surprising -- a greater ability to experience joy and serenity than ever before.
Web Links
CBS News maintains this large database of disaster-related websites.
The Center for Disease Control (CDC) offers this website for emergency preparedness.
The American Red Cross offers this site to help you prepare and get trained for a disaster.
The American Red Cross offers this site to help you get assistance after a disaster.
National Consensus Statement on Mental Health Recovery
Our approach to mental health recovery is consistent with the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration (SAMHSA) which has developed the following guidelines:
The 10 Fundamental Components of Recovery
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.
Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.
Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.
Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.
Non-Linear: Recovery is not a step-bystep process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.
Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). Th e process of recovery moves forward through interaction with others in supportive, trust-based relationships.
Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.
Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.
Hope: Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefits individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefi ts of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.
Resources
www.samhsa.gov
National Mental Health Information Center
1-800-789-2647, 1-866-889-2647 (TDD)
Original Link