We’ve just gone through what may well become a typical summer of extreme weather events. Floods, fires, cyclones, thousands of displaced people, hundreds of emergency services personnel working around the clock to restore safety and calm, and others setting up the systems for the months and years of recovery ahead. Whilst we can predict that disasters will happen, and often even when, the impacts on individuals are always unexpected, and immediately and dramatically render everything else about life atypical.
This year, with floods in Queensland and NSW, fires in NSW, Victoria and Tasmania, and cyclones in WA and Queensland, numerous APS Branches and their local psychologists were dealing with the impacts of extreme weather disasters on their communities. Some members were simultaneously disaster-affected people as well as health professionals meeting the needs of a distressed community. Like the residents of a disaster-affected community, health professionals in the area are quite often in high arousal as well. They are likely to be surrounded by highly stressed people and may well have been personally affected by the events. They might have vulnerable clients who are personally affected. On top of this, they are likely to be looked to as people who ought to know what to do and how to cope. They might be expected, or expect themselves, to play an important role in caring for a distressed population. At the very least, they would be considered a source of helpful information about where to get help.
Under these circumstances, it is tempting to think that psychologists have a professional responsibility and a special role to assist in the immediate aftermath of a disaster; that our particular skill-set means that we should be able to help amidst widespread distress. Navigating these expectations is a challenge for APS Branches and their local members in affected communities. This article has been prepared to provide guidance to members and local Branches who find themselves in these circumstances and to present how some APS Branches have responded to their local communities following recent natural disasters.
Keeping adrenalin in check
When a disaster occurs, people go into high arousal – a state of high adrenalin. Dr Rob Gordon MAPS, member of the APS Disaster Reference Group and renowned disaster expert, explains that this arousal will last for as long as three main ingredients are present – novelty, uncertainty and conflict. Such a state has many advantages for fleeing or fighting a threat: speed and endurance, decisiveness, concrete problem solving, narrowed focus, egocentric thinking, loss of self-awareness, black-and-white judgments. But being in high arousal makes reflective thinking, complex decision making and emotional processing of experiences very difficult.
Professor Richard Bryant FAPS, another expert member of the APS Disaster Reference Group, reminds us often that a disaster zone is not a clinic. After the Port Arthur massacre, and 9/11, when scores of psychologists turned up offering to help, the message started to sink in that the unsolicited presence of mental health professionals offering counselling in a disaster zone is rarely welcome. Indeed, it can even interrupt the normal pathways of recovery which depend on people drawing on their personal resources and social support networks to cope. So if not individual psychological care, what is needed, and what can APS Branches do best when their community is burnt out or waist deep in muddied water?
Providing Psychological First Aid
A useful starting place is to revisit the principles of Psychological First Aid (PFA), widely recognised as the first approach in promoting recovery (for more details, see www.psychology.org.au/APS/media/pdfs/Legacy/Red-Cross-Psychological-First-Aid-Book.pdf). The steps of PFA are to promote calm, safety, connections, efficacy, hope, and help. These steps signpost the most useful support Branches can provide for their members and their community following a disaster. It’s important to note that in the early stages, much of the help that psychologists provide can be given as citizens, not as health professionals, using the PFA commonsense principles of support to promote normal recovery. Psychologists’ therapeutic work is usually more valuable much later in the recovery process, even months or years down the track.
Promote calm
Reducing one’s own arousal is pivotal. It is difficult to reflect, make complex decisions and set up useful long-term systems when adrenalin is high and people are in emergency mode. Consulting with experts outside the disaster zone and not caught up in the unfolding drama can be helpful. The Disaster team at the APS is a useful resource APS Branches can use to help think through their own ideas for how to best respond to the needs of their members and community. At a Branch meeting shortly after a recent flood disaster in Queensland, the local Branch agreed on a strategy of ‘not rushing in’, ‘going slow’, and being part of coordinated recovery, an approach which fits perfectly with best practice for psychological support following a disaster.
Helping to calm others is also a key part of PFA. Along with acknowledging and validating people’s thoughts and feelings, providing information is a key strategy for calming people. APS Branches are often quick to share information with members and with the public about recovery, self-care, stress and coping to both calm, inform and resource community members.
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Bundaberg, Qld
The APS Bundaberg Branch began their response to the January 2013 floods with emails to members directing them to resources about evidence-based disaster response and recovery strategies from the APS website. They also utilised APS endorsed publicity providing articles to local media on what to do in a disaster, including how and when to get help. A meeting was held at the end of the first week to offer support to local psychologists personally affected and discuss ways the Branch or individuals could respond. The APS banner was set up with resources at the main evacuation centre alongside Lifeline and St John’s ambulance, manned by local psychologists who were not personally affected.
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Promote connections
Another core component of PFA is to connect people with support networks. Branches promote connections amongst members in a variety of ways: through email contact following an event; by meeting up early after a disaster to discuss how to support each other; by serving as a contact point, resource and support for members both professionally and personally; and by holding briefings, peer consultation opportunities and other meeting opportunities.
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Toowoomba QLD
The University of Southern Queensland Psychology Department in association with the APS Toowoomba Branch created a program called Water-Wings following the 2011 floods. This resource provided a meeting point for psychologists to share support and professional consultation around the challenges of disaster assistance. They held weekly informal drop-in meetings, telephone access for those who couldn’t meet in person, and a secure electronic discussion list for ongoing peer support.
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Promote safety
Promoting safety is a key focus of emergency services in a disaster zone. The Red Cross works in this space with their psychosocial recovery program, using personal support to calm and stabilise people who are distressed, and providing referrals for people who clearly need more support.
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Bundaberg QLD
The APS Bundaberg Branch, along with members of the APS Disaster Response Network, helped the Red Cross with their early response work after the floods. Psychologists assisted Red Cross staff in dealing with distressed and/or extremely agitated displaced individuals at the evacuation centres, accompanied staff on outreach visits and participated in debriefing sessions. They also offered strategies for dealing with more difficult situations to the disaster management groups. Local psychologists also linked in with other APS psychologists who travelled to the region through Red Cross deployment, creating a small but supportive network of colleagues enabling the sharing of information and opportunity for debriefing.
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Promote self-efficacy and hope
Self-efficacy, the belief in one's capability to exercise some measure of control over traumatic adversity, has both enabling and protective functions following disasters. Engaging people in meeting their own needs, reassuring them that feelings are normal, and helping them to prioritise and solve problems, are key ways of promoting self-efficacy following disasters. An important task is to convey the expectation that people will recover – in other words, to promote hope.
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Illawarra NSW
Chair of the APS Illawarra Branch and experienced disaster psychologist, Lyn Page MAPS, was quick off the mark to prepare resources for Branch members when bushfires threatened her area. Lyn was invited to talk with a local Landcare group in a bushfire-affected area about coping with disasters. The group talked about being good listeners for people who are distressed or angry, caring for oneself by setting personal boundaries, and importantly, how the group could function as a resource and support for members to facilitate their community as well as their own recovery. Mentoring local groups, or leaders, is a way psychologists can promote self-efficacy amongst people in an affected area.
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Promote help
Rob Gordon talks often about the challenge of enrolling disaster survivors into their unaccustomed role as help-seekers, when, pre-disaster, the majority will have always managed their own lives without external assistance. An early task, therefore, is to orient people to the sort of help that is available. This includes finding out the types and locations of government and non-government services, providing information and directing people to available services. Branches can facilitate this process by gathering information about who’s who in the local area and directing people to existing services, rather than setting up a new counselling service or helpline.
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Tasmania
APS Student Subscriber and doctoral psychology student, Mel Irons, created a Facebook page called ‘Tassie Fires We Can Help’ on day two of the devastating east coast bushfires. The aim was to provide a place for people to seek assistance, connect people in the bushfire-affected community with those offering help, and share accurate information. Mel created this page as a citizen, not as a health professional, but used her psychological skills, knowledge and access to APS resources to build a resource that was appropriate and helpful – and ticked almost all the PFA boxes.
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Looking ahead – upskilling to provide longer-term care for the community
After the initial period of chaos and distress, once people’s basic needs for food and shelter are met, psychologists are more likely to be called upon to meet ongoing needs for psychosocial support and mental health care in a disaster-affected community. In addition to government-funded rollouts of psychological intervention training, as happened after the 2009 Black Saturday bushfires and 2011Queensland Cyclone/Floods, APS Branches have identified their own member training needs, and the APS has supported them with public briefings and subsidised disaster workshops and webinar series.
A large range of disaster resources has been developed by the APS and can be accessed from www.psychology.org.au/topics/disasters/