Mental Hospital and Disaster Stress
Raquel Cohen
Biscaya Avenue 1385, Surfside, Florida, USA, 33 154.
(Translation: Tan Shuping Proofreading: Zhou Dongfeng)
Disasters, whether natural or man-made, may cause losses to people's lives and property, and seriously damage our lives and restrict social and economic development through a series of chain reactions. Disasters are usually difficult to predict, prevent and control. In the disaster, survivors have to face physical trauma, spiritual loss and various crises. Therefore, for our mental health professionals, disaster means challenges, and we must provide assistance to people in the disaster area, because many people in the disaster area need our help, whether they are survivors or rescuers.
In order to better plan, organize and implement post-disaster crisis intervention, it is imperative to establish a complete, interactive and flexible linkage system between mental health institutions and disaster emergency rescue institutions. At the same time, while organizing mental health professionals to provide corresponding relief for the victims, the government or other public institutions must participate in relief activities, because many decisions such as "living arrangements for survivors after the disaster" are made by other departments.
According to whether people are directly or indirectly affected by disasters, the affected people can be roughly divided into the following categories, so as to treat them differently [1]: (1) First-class victims: people who have personally experienced disaster events at the first site; (2) Secondary victims: people whose relatives were killed or injured in disasters; (3) Third-level victims: refers to the personnel involved in emergency rescue, mainly including doctors, nurses, mental health personnel, Red Cross staff, priests, emergency personnel, soldiers, police, etc. (4) Fourth-degree victims: refer to other people in the affected areas, such as civil servants and journalists; (5) Level 5 victim: refers to the person who saw or heard the report about the disaster through the media (for example, saw or heard the report that someone fell from the Twin Towers in the terrorist attack in new york in September 2006, 5438+0).
The response at different times after the disaster will be divided into different stages according to the passage of time, so as to identify a series of responses after the disaster, which will help to understand the responses of the victims more accurately and provide help more effectively. Usually, we divide the post-disaster response into several stages: panic/shock, short-term response and long-term response [2]. Post-disaster response includes a series of emotions, thoughts and behaviors in loss and mourning. Although the duration of each reaction stage is not fixed, it is generally a gradual development process, which has been recorded in relevant literature. At first, the physical and psychological changes after the disaster are often manifested as the main psychological defense means such as doubt, confusion, inattention and denial. At the same time, after anxiety and fear, they will eventually show different degrees of depression and sadness. If a secondary stress event occurs at this stage, it may promote the recovery of the victim, but it may also aggravate his reaction and even appear various pathological symptoms. In addition, the intensity, scope and speed of emergency rescue of disasters also affect the response of victims to disasters. After the terrorists hit the World Trade Center in New York with commercial planes, many people failed to face up to this catastrophic reality, leading to the emergence of various mental disorders. At that time, the media reported a lot about these reactions.
After the disaster in the shocking stage, people's situation will change greatly. At this time, the people in the disaster area will quickly and spontaneously mobilize to participate in the actions of helping the suffering compatriots, building shelters and ensuring public safety. In these self-help activities, people will devote themselves to burying the victims, saving the wounded and dying, helping the sick and helping the disabled, and at the same time, use their existing knowledge to start self-help at the first scene [3].
In the first few days, when the wounded were treated, the shelter was built and the problems of food and drinking water were initially solved, the mental health problems caused by the disaster began to appear. These problems should attract our attention, because they usually last until the physical trauma is healed. The following contents of this paper will outline the important activities needed to formulate, organize and implement mental health assistance programs to alleviate mental disorders of susceptible people.
The scope of psychological intervention
Activities to provide spiritual assistance to the affected people can be carried out in temporary shelters, mass gathering places and victims' homes in the affected areas, with the main purpose of providing emotional and emotional support to the victims in the acute stage after the disaster. The contents of providing spiritual assistance to the victims mainly include helping them correctly express and understand the stress, sleep disorder, thinking difficulties and sad reactions caused by the disaster, so as to help them restore a stable and peaceful state as soon as possible and maintain good social functions. We should tell people that all kinds of reactions and behavior changes after the disaster are normal, and these changes are caused by our sudden exposure to a rapidly changing abnormal environment, which is understandable [4]. 1988, a major earthquake struck Armenia in the former Soviet Union, killing 250,000 people. At that time, relevant international organizations launched a mental health rescue plan. Later, Sanentz, A[5] also compared this rescue operation with the rescue operation in the earthquakes in San Francisco and Hanikai Andrew in southern Florida, and described the rescue preparation and resource allocation in these two earthquakes.
In recent years, the practical experience of disaster relief has enabled professionals to adjust and rebuild the mode of psychological intervention after the disaster. The new intervention model mainly focuses on "individual situation configuration" and takes it as the goal of post-disaster psychotherapy. Now this kind of post-disaster psychological intervention has been widely known. At present, the definition of post-disaster psychological stress intervention is: an effective mental health intervention technology to help people maintain good ability to deal with emergencies after the disaster and stay awake in the disaster. The goal of post-disaster psychological intervention mainly includes the following three aspects: a) restoring the individual function of the victims; Help victims adapt to the new post-disaster environment; And 3) helping the victims to cooperate with the official emergency disaster reduction procedures [6]. In the methodology of psychological intervention, due to the different theories used by various professionals, the methods adopted to achieve the above goals may also be different. However, the cruel reality after the disaster requires us to replace the usual structured and systematic clinical methods with a set of concise, flexible, creative and practical intervention methods. At present, professionals are gradually applying and perfecting corresponding clinical skills and methods in post-disaster intervention practice, and constantly improving psychological intervention methods. In specific psychological intervention, children, adults and the elderly with different cultural backgrounds, traditions and beliefs have different post-disaster responses due to differences in age, gender and cultural background. Therefore, in order to successfully carry out post-disaster psychological intervention, the measures taken should also be different.
Family psychological assistance
When someone in the family is killed in a disaster, other members will become a high-risk group with psychological problems after the disaster, so the help of mental health prevention and control institutions is urgently needed [7]. For them, the departure of relatives, the loss of property, the loss of work, the disappearance of residence, unfamiliar environment and so on may destroy their will and make them unable to cope with the immediate difficulties.
Morgues and public burial places (the remains of victims may be burned centrally to prevent the spread of infectious diseases) may be the places where mental health workers need psychological intervention most. At the same time, in psychological intervention, it is very important to strengthen cooperation with people in the spiritual and religious circles, especially in some accidents where no victims can be found, such as air crashes or fires, and the rescue or cremation of the remains of the victims cannot be carried out, which is particularly painful. At this time, it is even more necessary to strengthen cooperation with these people.
Psychological intervention in shelters
The formulation of psychological intervention procedures is closely related to the specific situation of survivors in shelters. When survivors stay in shelters for more than a few weeks, their frustration in the disaster may turn into violence, anger, depression and other emotions. Therefore, when carrying out psychological intervention in shelters, professionals will have to assess the environment of shelters to judge how this environment affects the victims' ability to solve problems and adapt to the environment of shelters, because national resources are limited and shelters are often crowded. At the same time, there should be a set of optimized allocation methods of health resources during intervention. Among them, the proportion of people who need psychological intervention and the number of professionals who can provide psychological help are important references to guide the allocation of mental health resources. The purpose of crisis intervention in shelters includes helping the victims to recover their health, enhancing their self-help ability and helping to solve some practical difficulties. In the actual process of psychological intervention, well-trained professionals should first integrate themselves into the rescue team and become a truly recognized rescue worker. Only in this way can we contact the victims naturally and casually, and guide and respect their thoughts and emotional expressions. At the same time, when the victims talk to each other about what happened in the disaster, professionals should record these materials in order to make a preliminary diagnosis and evaluation of the stress they suffered. Subsequently, professionals will gradually use crisis intervention skills such as emotional support and empathy, and understand and accept psychological defense methods such as negation and distortion to conduct standardized post-disaster psychological intervention. In the first time after the disaster, the cognitive system of the victims will be confused, so that they can "filter out" those painful thoughts. At this moment, while they get material relief, they also need spiritual help to guide them to obtain information, make plans and get out of the predicament. As time goes by, the victims will move out of the shelter and enter the temporary residence. At this time, mental health workers or other rescue teams will accompany them into the temporary residence to continue their assistance activities. At this stage, all kinds of problems will appear, which is very difficult for victims who are tortured both physically and mentally.
Cooperation, education and consultation with medical emergency personnel who deal with the injured or burn victims will help the victims recover soon. It is important for us to find out whether the victims left a lot of physical and mental health problems after the disaster. At the same time, it is necessary to classify the psychological state of the victims, which will help the smooth progress of crisis intervention and help to judge whether the victims need long-term and professional psychological counseling.
The contents of short-term consultation, education and assistance to the victims will change in the weeks and months after the disaster. After the acute phase, the victims will immediately enter a new post-disaster response stage, which may last for several months, and the victims will face various problems. Through training, people engaged in post-disaster mental health work can find new problems of victims, including depression, anxiety and post-traumatic stress disorder (PTSD) in different degrees. In view of these problems, in recent years, by combining psychological and drug treatment methods, a variety of treatment methods have been developed. The traumatic experiences of many victims are not only stress-related syndrome, but also depression, alcohol and drug dependence and personality disorder. If the disaster leads to the breakdown of a happy family-some family members are killed, then it is extremely important to find ways to get other family members out of the grief of losing their loved ones as soon as possible. Usually, psychological treatment for most victims focuses on two aspects: traumatic memory and various physiological reactions in dangerous situations. Both situations will last for a long time after the disaster. In psychotherapy, professionals usually adopt cognitive therapy, exposure therapy and behavioral therapy, the main purpose of which is to let the victims recuperate physically and mentally in a safe environment and get rid of traumatic memories, fantasies, fears and sadness caused by disasters as soon as possible. Memories of disasters often recur in the victims' minds. Slowly, they gradually lost their perception of anxiety and pain, and their spirit became numb. Drug therapy is mainly aimed at various physiological disorders. Antidepressants can relieve anxiety symptoms, improve sleep disorders, relieve panic reaction and promote physical recovery. At present, a large number of drug experiments of selective serotonin reuptake inhibitors are being conducted to evaluate the efficacy of these drugs on these symptoms. In addition, where conditions permit, group psychotherapy, family psychotherapy and psychotherapy specifically for children after disasters are also selectively carried out.
If appropriate preventive measures are taken at this stage, the victim's further functional decline in the future can be prevented. One of the important measures is the school education plan for students, parents, teachers and school administrators. This plan is based on the fact that all these people can gather together for children's education, so that they have the opportunity to become an organic core group and receive education to prevent mental disorders very effectively [8]. Women living in developing countries are the main undertakers of housework and an important group in urgent need of help. They need help to take care of their families as soon as possible and have the courage to start a new life.
Another group that needs attention is those who lost their homes and became homeless in the disaster. While waiting for the government's reconstruction plan, they gradually became depressed. Among these people, the number of patients with pathological symptoms who can be diagnosed clearly has increased obviously, which needs the attention of professionals.
At this stage, if professionals have not received good training on mental health problems caused by disasters, they may ignore, misdiagnose and mistreat those severe acute stress reactions, post-traumatic stress disorder (PTSD), anxiety and depression syndrome and other symptoms that may worsen gradually in the acute phase.
The time limit of the long-term assistance plan for the affected people is longer than we usually expect. When relief agencies realize that a considerable proportion of victims are trapped in food and clothing difficulties for various reasons, the contents of relief should include helping them find shelter, employment and health resources. Due to the shortage of resources, such relief will be difficult to implement in some countries.
Rescuers "exhaustion syndrome" mental health professionals are an important force in the professional team involved in emergency rescue after the disaster [9]. The nature of their work determines that they will hear and witness the most tragic scenes to the greatest extent. Therefore, even if they are fully prepared psychologically, they work like policemen, firefighters and ambulance drivers every day, which also makes them feel all kinds of painful experiences. When this experience is repeated among thousands of victims, it will be a huge physical and mental blow to the professionals who carry out rescue. No one can be fully prepared for the destructive impact of this experience, or have natural immunity to this impact. In addition, we should also understand why many rescuers are selfless in their work, even if they are extremely tired, they are unwilling to leave their jobs, even if they have a short rest. This is a good example of firefighters who participated in the 9 1 1 rescue. When they were ordered to stop working, they showed anger because they fought side by side with the police on the ruins of the World Trade Center. The basic contents of psychological intervention for these rescuers include: task report, emergency identification, helping them to examine the situation from a global perspective, supplementing the physical strength of the staff and enhancing their skills [10]. The specific step-by-step implementation procedures are as follows:
1. Introduce formal, scheduled and confidential task reports to employees.
2. Let the rescuers tell their feelings.
3. Communicate each other's reactions and reactions.
4. Explain and understand the various reactions that have occurred.
5. Identify ways to deal with various reactions through cognitive and educational means.
6. If necessary, let the rescuers stop working and give them further psychological intervention.
Using auxiliary professionals to carry out work in some areas, it is necessary to establish a rescue team with professionals and auxiliary professionals. Based on the theory and technology of crisis intervention, professionals and auxiliary professionals can work together to successfully provide rehabilitation assistance to victims. According to the local human resources situation, professionals have made various attempts to use others to intervene in related crises. Of course, to become a qualified auxiliary professional, you should have certain qualities, including:
1. Have certain consulting service experience;
2. Have good communication skills and be sensitive to the racial, social and religious characteristics of the victims.
3. In the whole intervention process, we should continue to receive training and keep close contact with management personnel.
In recent years, after urban residents suffered disasters, private volunteer activities in the field of mental health services have gradually increased. Of course, private participation in post-disaster mental health services requires certain conditions:
1. Understand the local post-disaster relief plan and various organizations engaged in post-disaster relief (such as the Red Cross, government agencies, clergy, etc.). ).
2. Have certain crisis intervention skills, consulting skills and task skills.
Cross-cultural issues of post-disaster assistance Usually, government agencies will intervene in post-disaster assistance, and sometimes this intervention is quite extensive. In different societies, the degree of government participation in disasters and accidents is obviously different. In the United States, unless the local self-help ability is greatly weakened by the direct impact of disasters, disaster relief will first be considered as the responsibility of the local government. In other countries, disaster self-help is first considered as the responsibility of the whole country. In these places, the army not only plays the role of the main post-disaster rescuer, but also usually plays the role of the controller of various post-disaster rescue activities.
Religious institutions participate in post-disaster relief work in different ways. Part of the reason is that they have different degrees of differentiation and institutionalization, on the other hand, it is also related to their secularization and the scope of activities in peacetime to some extent. Clerics play an important role in people's mental health after disasters, especially in major disasters involving a large number of casualties, such as the Armenian earthquake and landslides in Honduras [1 1].
After the mission, the information about mental health reported by the media provided people with an opportunity to understand the knowledge of mental health after the disaster. People's stories in disasters often attract people's attention, and at the same time, professional media will invite some psychiatrists to interview related issues in due course. In the middle of post-disaster community crisis, this information will have a great impact on people. Through publicity and education, two aspects of information can be made clear to the public: on the one hand, how disasters affect mental health and a series of stress reactions after disasters; On the other hand, what measures will mental health institutions take after the disaster and what kind of professionals can help people after the disaster. Every aspect of information should include: a) methods; B) catalogue; C) knowledge structure. In addition, information about mental health institutions should include: consulting services, popular science education, and how to get practical help more conveniently.
(Translation: Tan Shuping Proofreading: Zhou Dongfeng)
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