crisis intervention kieran mundy
Tokiwa University, Mito, Japan
Principles and Strateg
of Crisis Intervention
Prof. Kieran Graham Mundy Ph.D.
Principles & Strategies of Crisis
Intervention
BACKGROUND
Topic 1
Reduce the Impact of Vf by raising the coping level threshold
of the victim in the victimizing habitus
Topic 2
General Principles of Crisis Intervention
Universal Concepts
Topic 3
INTERVENTION STRATEGIES
Intervention varies with phase of the crisis
Background
To reduce the
Impact of Vf
increase the coping
level threshold of
the affected person
in the Victimizing
Habitus
Background
To bridge the gap between the real needs of people exposed to SEAs and the
resources to reduce the risk of mental health and social problems.
In resource-poor countries far
more people die as a result of
natural disasters than in
resource-rich countries – the
ratio is 9:1.
Social intervention primarily
aims to have social effects–
but it also has secondary
psychological effects.
Psychological intervention
primarily aims to have
psychological effects –but it
also has secondary social
effects.
General Principles
An Overview
Prepare before the Crisis
Plan before the crisis to reduce the impact of the
victimizing habitus
Develop a
coordinated &
effective system of
help.
Identify (and name)
people responsible
for specific tasks.
Make plans to meet
social and mental
health needs.
Train people for social
and psychological
crisis intervention.
Assessment
Make a general assessment of the victimizing
habitus. Use statistics, written information, and
reliable anecdotal evidence.
•
Setting (the affected
area)
•
Culture (the Tohoku
region)
•
History and nature of
problems
•
Local perceptions of
stress & illness
•
Local ways of coping
•
Community resources
Working Together
Government and nongovernmental organizations (NGOs)
working in the disaster area must consult and collaborate.
Ongoing involvement
is basic to ensure
sustainability.
If many agencies work
independently without
co-ordination there is
wastage of valuable
resources.
If possible, staff,
including management
staff, should be hired
from the local
community.
Integrate mental health care into
Primary Health Care (PHC)
Maximize care by
families and loved
ones.
Make active use of
resources in the
community.
Use mental health
specialists to do
on-the-job
training,
supervision, and
support for people
wanting to
work/working with
disaster survivors
and victims.
Access to services for all
Access to services
should be for the
whole community.
Access should not be
restricted to
subpopulations
identified on the basis
of exposure to certain
stressors.
Outreach awareness
programs to ensure
the treatment of
vulnerable or minority
groups within PHC
should be established.
You can get help here!
Training and Supervision
Training and
supervision for aid
workers should be
done by mental
health specialists or under their
guidance - for a
substantial amount
of time to ensure
lasting effects of
training and
responsible care.
Short one-week or
two-week skills
training without
thorough follow-up
supervision are not
the best way to go.
Long term Perspectives
Focus should be on
long-term development
of community-based
mental health care
services and social
interventions rather
than short-term relief of
psychological stress
during the acute phase
of the crisis.
Impetus and funding for
mental health programs
is highest during or
immediately after the
crisis – people forget!
Mental health programs
should be designed to
give help for many
years(e.g. HIBAKUSHA –
Atomic Bomb Survivors).
Intervention Strategies
for Populations Exposed
to SEAs
The choice of
intervention
varies with the
phase of the
emergency /
harm reduction
Social Intervention in AE phase
(1) Give ongoing trustworthy information about:
•
the emergency (e.g., Fukushima Daiichi Nuclear incident)
•
What “the authorities” are doing to make people safe
•
Relief - what each aid organization is doing and where it is
located
•
Where absent relatives are and how to communicate with
them
Information should be given according to principles of risk
communication: that is, understandable to a local 12-year old child
and showing understanding of the situation of the SEA survivor.
(2) Trace family members (in particular) for:
•
Unaccompanied minors
•
Elders
•
Other vulnerable groups
(3) Make volunteers aware of:
•
The nature of normal grief
•
That many people will be disorientated
•
The need for active participation by all able-bodied
survivors
(4) Organize emergency accommodation for survivors:
Aim to keep
family members
and local
communities
together as
much as possible
After the Higashi Nihon Daishinsai, in Iwate
Prefecture the local government adopted a
policy of equality ignoring village social
structures (IDPs were allocated temporary
housing by lottery).
IDPs were also secondarily victimized in the
aftermath of the Great Hanshin-Awaji
Earthquake when ~5000 people in Kobe were
relocated to temporary housing in a different
part of the Kansai Region; many committed
suicide due to loneliness or died of illness
resulting from alcoholic abuse.
In contrast, Miyagi Prefecture applied a policy
to maintain vertical communities as much as
possible in evacuation centers and temporary
housing (IDPs live basically with same families
of their original villages/communities).
(5) Arrange meetings to brainstorm all
community decisions:
•
About where to locate religious places, schools, and water
supply in emergency housing arrangements
•
About how to provide religious, recreational and cultural
space in the design of emergency housing.
(6) Discourage unceremonious disposal of
corpses to control communicable diseases:
•
Dead bodies carry no or extremely limited risk for
communicable diseases disorientation
(7) Encourage normal cultural and religious
events:
•
including grieving rituals in collaboration with
spiritual and religious practitioners
(8) Encourage activities that facilitate the inclusion
of:
•
orphans, widows, widowers, or those without their families into
social networks.
(9) Encourage normal recreational activities for
children:
•
Do not give out items like football jerseys, modern toys. These
may have been considered luxury items in the local context
before the crisis.
(10) Encourage children to go back to school:
•
Even if this Is only a symbolic gathering at first
(11) Involve adults in purposeful activities:
•
constructing/organizing accommodation, organizing family
tracing, collecting photographs, distributing food, organizing
vaccinations, supervising children
(12) Community awareness about normal
stress reactions:
Provide nonsensationalistic press
releases, radio programs,
posters and leaflets to
reassure people.
Focus of public education
about normal stress
reactions widespread.
Focus on
psychopathology during
AE phase may potentially
lead to unintentional
harm.
Expect natural recovery.
Psychological Intervention in AE
phase
(1) Establish contact with local PHC/emergency
care:
•
Manage urgent problems (e.g., danger to self or others,
psychoses, severe depression, mania, epilepsy) within PHC
system run by local government or NGOs
•
Meet the needs of survivors who use psychotropic
medication. Sudden discontinuation of (any) medication
could be fatal.
•
Most survivors (about 80%) will not ask for counseling even
if they have no other options. Don’t expect to be asked.
Don’t interfere but just make yourself available.
(2) What you can do:
•
Most acute mental health problems during the AE phase
are best managed without medication following the
principles of PSYCHOLOGICAL FIRST AID.
1.
Listen
2.
Convey Compassion
3.
Assess Needs
4.
Ensure Basic Physical Needs Are Met,
5.
Do Not Force Talking
6.
Provide Or Mobilize Company From Preferably
Family Or Significant Others
7.
Encourage But Do Not Force Social Support
8.
Protect From Further Harm
Social Intervention in
Reconsolidation Phase
(2) Organize outreach and psycho-education:
•
Educate survivors on availability or choices of mental health
care.
•
Commencing no earlier than four weeks after the AE phase,
carefully educate survivors on the difference between
psychopathology and normal psychological distress.
•
Avoid suggestions of wide-scale presence of psychopathology.
•
Avoid jargon and idioms that carry stigma (e.g. victims of 3/11
cf. 9/11 victims in the USA, the triple disaster, nuclear ‘ground
zero’.
Ψ Intervention in Reconsolidation
Phase
(1 & 2) Educate other humanitarian aid workers and
community leaders (how to identify?) in core
psychological care skills to raise awareness and
encourage community support:
•Core
psychological care skills
•
“PSYCHOLOGICAL FIRST AID”
•
EMOTIONAL SUPPORT
•
PROVIDING INFORMATION
•
SYMPATHETIC REASSURANCE
•
RECOGNITION OF CORE MENTAL HEALTH
PROBLEMS
(3) Train and supervise PHC workers in basic mental
health knowledge and skills (based on the curriculum in WHO/UNHCR’s
(1996) Mental Health of Refugees):
•
Provision of appropriate psychotropic
medication
•
“Psychological first aid”
•
Supportive counseling
•
Working with families
•
Suicide prevention
•
Management of psychosomatic complaints
•
Substance use issues
(4) Collaborate with traditional healers if
feasible:
•
Try to establish a working alliance between
traditional and allopathic practitioners – it may be
possible in certain contexts
(5) Ensure continuation of medication for
psychiatric patients:
•
Some survivors may not have had access to
medication during the acute phase of the crisis.
(7) Train and supervise volunteer,
paraprofessional /professional community
workers (i.e., support workers, counselors) to
assist PHC workers with heavy case loads:
•
•
•
•
•
•
•
•
•
•
Provide training in core skills
Assessment of individual needs
Families’ and groups’ perceptions of problems
‘Psychological first aid
Providing emotional support
Grief counseling
Stress management
‘Problem-solving counseling’
Mobilizing family and community resources
Referral
(8) Facilitate creation of community-based
self-help support groups:
•
Focus of self-help groups is typically:
•
problem sharing
•
brainstorming for solutions or more effective ways
of coping (including traditional ways)
•
generation of mutual emotional support
•
generation of community- level initiatives
Tokiwa
University,
Mito,
Japan
Kieran G. Mundy
Principles and Strateg
of Crisis Intervention
Prof. Kieran Graham Mundy Ph.D.
Principles & Strategies of Crisis
Intervention
BACKGROUND
Topic 1
Reduce the Impact of Vf by raising the coping level threshold
of the victim in the victimizing habitus
Topic 2
General Principles of Crisis Intervention
Universal Concepts
Topic 3
INTERVENTION STRATEGIES
Intervention varies with phase of the crisis
Background
To reduce the
Impact of Vf
increase the coping
level threshold of
the affected person
in the Victimizing
Habitus
Background
To bridge the gap between the real needs of people exposed to SEAs and the
resources to reduce the risk of mental health and social problems.
In resource-poor countries far
more people die as a result of
natural disasters than in
resource-rich countries – the
ratio is 9:1.
Social intervention primarily
aims to have social effects–
but it also has secondary
psychological effects.
Psychological intervention
primarily aims to have
psychological effects –but it
also has secondary social
effects.
General Principles
An Overview
Prepare before the Crisis
Plan before the crisis to reduce the impact of the
victimizing habitus
Develop a
coordinated &
effective system of
help.
Identify (and name)
people responsible
for specific tasks.
Make plans to meet
social and mental
health needs.
Train people for social
and psychological
crisis intervention.
Assessment
Make a general assessment of the victimizing
habitus. Use statistics, written information, and
reliable anecdotal evidence.
•
Setting (the affected
area)
•
Culture (the Tohoku
region)
•
History and nature of
problems
•
Local perceptions of
stress & illness
•
Local ways of coping
•
Community resources
Working Together
Government and nongovernmental organizations (NGOs)
working in the disaster area must consult and collaborate.
Ongoing involvement
is basic to ensure
sustainability.
If many agencies work
independently without
co-ordination there is
wastage of valuable
resources.
If possible, staff,
including management
staff, should be hired
from the local
community.
Integrate mental health care into
Primary Health Care (PHC)
Maximize care by
families and loved
ones.
Make active use of
resources in the
community.
Use mental health
specialists to do
on-the-job
training,
supervision, and
support for people
wanting to
work/working with
disaster survivors
and victims.
Access to services for all
Access to services
should be for the
whole community.
Access should not be
restricted to
subpopulations
identified on the basis
of exposure to certain
stressors.
Outreach awareness
programs to ensure
the treatment of
vulnerable or minority
groups within PHC
should be established.
You can get help here!
Training and Supervision
Training and
supervision for aid
workers should be
done by mental
health specialists or under their
guidance - for a
substantial amount
of time to ensure
lasting effects of
training and
responsible care.
Short one-week or
two-week skills
training without
thorough follow-up
supervision are not
the best way to go.
Long term Perspectives
Focus should be on
long-term development
of community-based
mental health care
services and social
interventions rather
than short-term relief of
psychological stress
during the acute phase
of the crisis.
Impetus and funding for
mental health programs
is highest during or
immediately after the
crisis – people forget!
Mental health programs
should be designed to
give help for many
years(e.g. HIBAKUSHA –
Atomic Bomb Survivors).
Intervention Strategies
for Populations Exposed
to SEAs
The choice of
intervention
varies with the
phase of the
emergency /
harm reduction
Social Intervention in AE phase
(1) Give ongoing trustworthy information about:
•
the emergency (e.g., Fukushima Daiichi Nuclear incident)
•
What “the authorities” are doing to make people safe
•
Relief - what each aid organization is doing and where it is
located
•
Where absent relatives are and how to communicate with
them
Information should be given according to principles of risk
communication: that is, understandable to a local 12-year old child
and showing understanding of the situation of the SEA survivor.
(2) Trace family members (in particular) for:
•
Unaccompanied minors
•
Elders
•
Other vulnerable groups
(3) Make volunteers aware of:
•
The nature of normal grief
•
That many people will be disorientated
•
The need for active participation by all able-bodied
survivors
(4) Organize emergency accommodation for survivors:
Aim to keep
family members
and local
communities
together as
much as possible
After the Higashi Nihon Daishinsai, in Iwate
Prefecture the local government adopted a
policy of equality ignoring village social
structures (IDPs were allocated temporary
housing by lottery).
IDPs were also secondarily victimized in the
aftermath of the Great Hanshin-Awaji
Earthquake when ~5000 people in Kobe were
relocated to temporary housing in a different
part of the Kansai Region; many committed
suicide due to loneliness or died of illness
resulting from alcoholic abuse.
In contrast, Miyagi Prefecture applied a policy
to maintain vertical communities as much as
possible in evacuation centers and temporary
housing (IDPs live basically with same families
of their original villages/communities).
(5) Arrange meetings to brainstorm all
community decisions:
•
About where to locate religious places, schools, and water
supply in emergency housing arrangements
•
About how to provide religious, recreational and cultural
space in the design of emergency housing.
(6) Discourage unceremonious disposal of
corpses to control communicable diseases:
•
Dead bodies carry no or extremely limited risk for
communicable diseases disorientation
(7) Encourage normal cultural and religious
events:
•
including grieving rituals in collaboration with
spiritual and religious practitioners
(8) Encourage activities that facilitate the inclusion
of:
•
orphans, widows, widowers, or those without their families into
social networks.
(9) Encourage normal recreational activities for
children:
•
Do not give out items like football jerseys, modern toys. These
may have been considered luxury items in the local context
before the crisis.
(10) Encourage children to go back to school:
•
Even if this Is only a symbolic gathering at first
(11) Involve adults in purposeful activities:
•
constructing/organizing accommodation, organizing family
tracing, collecting photographs, distributing food, organizing
vaccinations, supervising children
(12) Community awareness about normal
stress reactions:
Provide nonsensationalistic press
releases, radio programs,
posters and leaflets to
reassure people.
Focus of public education
about normal stress
reactions widespread.
Focus on
psychopathology during
AE phase may potentially
lead to unintentional
harm.
Expect natural recovery.
Psychological Intervention in AE
phase
(1) Establish contact with local PHC/emergency
care:
•
Manage urgent problems (e.g., danger to self or others,
psychoses, severe depression, mania, epilepsy) within PHC
system run by local government or NGOs
•
Meet the needs of survivors who use psychotropic
medication. Sudden discontinuation of (any) medication
could be fatal.
•
Most survivors (about 80%) will not ask for counseling even
if they have no other options. Don’t expect to be asked.
Don’t interfere but just make yourself available.
(2) What you can do:
•
Most acute mental health problems during the AE phase
are best managed without medication following the
principles of PSYCHOLOGICAL FIRST AID.
1.
Listen
2.
Convey Compassion
3.
Assess Needs
4.
Ensure Basic Physical Needs Are Met,
5.
Do Not Force Talking
6.
Provide Or Mobilize Company From Preferably
Family Or Significant Others
7.
Encourage But Do Not Force Social Support
8.
Protect From Further Harm
Social Intervention in
Reconsolidation Phase
(2) Organize outreach and psycho-education:
•
Educate survivors on availability or choices of mental health
care.
•
Commencing no earlier than four weeks after the AE phase,
carefully educate survivors on the difference between
psychopathology and normal psychological distress.
•
Avoid suggestions of wide-scale presence of psychopathology.
•
Avoid jargon and idioms that carry stigma (e.g. victims of 3/11
cf. 9/11 victims in the USA, the triple disaster, nuclear ‘ground
zero’.
Ψ Intervention in Reconsolidation
Phase
(1 & 2) Educate other humanitarian aid workers and
community leaders (how to identify?) in core
psychological care skills to raise awareness and
encourage community support:
•Core
psychological care skills
•
“PSYCHOLOGICAL FIRST AID”
•
EMOTIONAL SUPPORT
•
PROVIDING INFORMATION
•
SYMPATHETIC REASSURANCE
•
RECOGNITION OF CORE MENTAL HEALTH
PROBLEMS
(3) Train and supervise PHC workers in basic mental
health knowledge and skills (based on the curriculum in WHO/UNHCR’s
(1996) Mental Health of Refugees):
•
Provision of appropriate psychotropic
medication
•
“Psychological first aid”
•
Supportive counseling
•
Working with families
•
Suicide prevention
•
Management of psychosomatic complaints
•
Substance use issues
(4) Collaborate with traditional healers if
feasible:
•
Try to establish a working alliance between
traditional and allopathic practitioners – it may be
possible in certain contexts
(5) Ensure continuation of medication for
psychiatric patients:
•
Some survivors may not have had access to
medication during the acute phase of the crisis.
(7) Train and supervise volunteer,
paraprofessional /professional community
workers (i.e., support workers, counselors) to
assist PHC workers with heavy case loads:
•
•
•
•
•
•
•
•
•
•
Provide training in core skills
Assessment of individual needs
Families’ and groups’ perceptions of problems
‘Psychological first aid
Providing emotional support
Grief counseling
Stress management
‘Problem-solving counseling’
Mobilizing family and community resources
Referral
(8) Facilitate creation of community-based
self-help support groups:
•
Focus of self-help groups is typically:
•
problem sharing
•
brainstorming for solutions or more effective ways
of coping (including traditional ways)
•
generation of mutual emotional support
•
generation of community- level initiatives
Tokiwa
University,
Mito,
Japan
Kieran G. Mundy