This Web site is a component of the SAMHSA Health Information Network
|
This Web site is a component of the SAMHSA Health Information Network |
| | | | | | |  |
||||||||||
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
This Web site is a component of the SAMHSA Health Information Network. |
|
Mental Health Response to Mass Violence and TerrorismCHAPTER I: Background and OverviewOver the last decade, U. S. citizens increasingly have been the targets of mass violence and terrorism. The Los Angeles civil unrest following the Rodney King verdict in 1992, the World Trade Center terrorist bombing in New York City in 1993, the Oklahoma City terrorist bombing in 1995, the mass shootings at Thurston High School in Oregon in 1998 and at Columbine High School in Colorado in 1999, and the terrorist attacks of September 11, 2001, in New York, Virginia, and Pennsylvania, have resulted in thousands of fatalities and many more people whose lives have been changed forever. School violence continues to threaten the safety of children, teachers, and other school personnel. Terrorist acts against the United States also have been carried out overseas.the bombing of Pan Am Flight 103 in 1988, the bombing of military barracks at Khobar Towers in 1996, and the bombing of U.S. embassies in Kenya and Tanzania in 1998. Each tragic event affects the country as a whole, touches those residing in the affected communities, and alters the lives of those directly victimized. Growing evidence suggests that terrorism and mass violence places victims, bereaved family members, and emergency response personnel at risk for long-term physical, emotional, and psychological consequences (Office for Victims of Crime, 2000; Center for Mental Health Services, 2000b). Each criminal act of mass violence generates its own sequence of criminal justice activities.potentially including investigations, arrests, trials, sentencings, and appeals.each step bringing related challenges for families and victims. For more than 25 years, under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1974, the Federal Government has provided mental health assistance following presidentially declared disasters (P.L. 93-288 as amended). Most of these disasters have been nature-caused. The Federal Government has increasingly been called upon to assist communities responding to human-caused mass violence and terrorism. Because terrorist acts are Federal crimes, Federal criminal justice agencies have statutory responsibilities related to protecting victims' rights and providing support services, including responding to the psychological consequences. The U.S. Department of Justice's (DOJ) Office for Victims of Crime (OVC) has developed a working definition of "mass violence," which is "an intentional violent criminal act, for which a formal investigation has been opened by the Federal Bureau of Investigation (FBI) or other law enforcement agency, that results in physical, emotional, or psychological injury to a sufficiently large number of people as to significantly increase the burden of victim assistance for the responding jurisdiction" (p. 17580, U.S. Department of Justice, 2001). Terrorism has been defined in the U.S. Criminal Code as "an activity that (a) involves a violent act or an act dangerous to human life that is a violation of the criminal laws of the United States or of any State, or that would be a criminal violation if committed within the jurisdiction of the United States or of any State; and (b) appears to be intended to intimidate or coerce a civilian population, to influence the policy of a government by intimidation or coercion, or to affect the conduct of a government by assassination or kidnapping" [18 U.S.C. 3077]. To better serve victims of devastating attacks, an interagency agreement between the DOJ, OVC, and the U.S. Department of Health and Human Services (DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS) was signed in 1999 and concluded in 2001. This joint effort combined the substantial expertise, knowledge, and field experience of each agency. Since 1984, the DOJ's OVC has assisted crime victims through funding, direct support, and advocacy and compensation programs for crime-related expenses at the State and local levels. OVC has supported the development and provision of training on a range of crimerelated topics, resource materials, and demonstration projects.all aiming to help victims recover from the emotional and material effects of crime and to ensure their rights as they participate in the criminal justice system. OVC has undertaken pioneering work to better serve victims of rape, sexual and physical abuse, domestic violence, hate crimes, and homicide. OVC developed innovative programs and approaches to respond to the victims and their families of the bombing of Pan Am Flight 103, the Oklahoma City bombing, and the September 11, 2001, terrorist attacks. Since 1974, SAMHSA's CMHS has provided technical guidance and consultation to State mental health authorities to help them develop effective mental health recovery programs following presidentially-declared disasters. Operating through an interagency agreement with the Federal Emergency Management Agency (FEMA), CMHS has supported and overseen nearly 200 postdisaster mental health recovery programs. The majority of these programs, known as Crisis Counseling Programs (CCPs), have served communities following an array of natural disasters, including floods, tornadoes, hurricanes, earthquakes, and wildfires. In addition, CMHS has supported the development of numerous technical assistance publications. In collaboration with FEMA, CMHS has trained administrators, managers, and mental health providers from all 50 States and the District of Columbia to better prepare them should disaster strike in their communities. More recently, CMHS has supported CCPs designed to meet specialized needs following the Los Angeles civil unrest, the Oklahoma City bombing, and the September 11 terrorist attacks. The partnership between SAMHSA and DOJ brings together the breadth of skills, experience, and perspectives developed over years of assisting people affected by violent crime and natural disasters. The combined efforts aim to respond effectively to the mental health needs of individuals and communities affected by mass violence and terrorism and to protect the rights of victims and families. This manual provides orienting information and a training course designed to enable human service providers to:
Purpose of The ManualThis manual contains "the basics" of what mental health providers, crime victim assistance professionals, and faith-based counselors need to know to provide appropriate mental health support following incidents involving criminal mass victimization. The manual is primarily for mental health professionals, yet all service providers will find much of the material to be useful. Program planners, administrators, and clinical supervisors must acquaint themselves with the information in this manual to develop mental health response programs, respond to emerging issues and needs, and address clinical challenges. Psychological support and treatment, crime victims' services, and spiritual guidance and support are essential components of a crisis response. Mass acts of violence and terrorism commonly have widespread community impacts as well. Mental health intervention targets affected individuals and families as well as the larger community.
Human service workers, including disaster relief volunteers, faith-based volunteers, senior center personnel, cultural group social service providers, public assistance workers, and day care center staff, have contact with survivors, their families, and bereaved loved ones. Many who are experiencing post-event physical and psychological symptoms seek initial treatment and assistance from their health care providers. Each of these service provider groups may benefit from the material in this manual and the related training in order to better understand and more effectively serve survivors and families of victims. Mental health professionals, crime victim assistance providers, and faith-based counselors responding to mass acts of violence and terrorism must be prepared and mobilize rapidly. Priorities and areas of emphasis for each group may conflict, overlap, or leave gaps in service. Preplanning and post-event coordination are essential to minimize heat-ofthe- moment misunderstandings and turf battles. The training course outlined in Chapter VII provides an opportunity for these disciplines to share their experience and knowledge, receive a common foundation of information, and collaborate in order to best respond to community needs. Overview of The ManualThis manual includes background information for mental health responders, guidance for setting up the training course, training course design, and recommendations for in-service training addressing long-term recovery issues. The training course and materials may be adapted for preparedness training before a crisis has occurred, for immediate mental health response training shortly after an incident, or as part of staff training for a long-term mental health recovery program. A brief description of each chapter follows. Chapter II: Human Responses to Mass Violence and Terrorism The impact of mass criminal victimization is widespread and to varying degrees affects victims, responders, and the community-at-large. This chapter describes characteristics of disaster events that are likely to result in serious and long-lasting psychological effects. It compares the dimensions of human-caused and natural disasters. Survivor risk factors that can contribute to severe, persistent reactions are discussed, as are characteristics related to resilience. This chapter presents the physical, behavioral, emotional, and cognitive reactions to trauma, victimization, and sudden bereavement experienced by adults, adolescents, and children. Considerations for responding to cultural, racial, and ethnic groups also are discussed. Chapter III: Mental Health Intervention Since tragic events change not only individual lives, but also the sense of safety within the entire community, this chapter describes individual and community-based mental health interventions. A discussion of key concepts for mental health support and intervention may assist all service providers in dealing with victims, survivors, and family members. Cultural sensitivity and competence is essential for mental health responders. This chapter describes a range of immediate and long-term mental health interventions appropriate for adults, children, and adolescents. A table with common reactions to trauma and practical suggestions for intervention is provided at the end of the chapter. The organizational structure for emergency response to mass casualty criminal incidents is complex. Emergency medical services, law enforcement, search and rescue, the medical examiner's office, emergency management, the criminal justice system, and government authorities have key roles and responsibilities throughout the immediate response. Jurisdictions may move from the local to State to Federal levels and span various agencies. The mental health response supports the primary emergency response agencies in authority. This chapter provides an overview of the incident command system and the roles, jurisdictions, and responsibilities of these key organizations, and emphasizes the importance of coordination among all responder groups. Chapter V: Stress Prevention, Management, And Intervention While helping survivors and their loved ones following tragic events is often meaningful and rewarding, it can also be psychologically demanding. This chapter describes sources of mental health responder stress, including environmental and individual factors. It presents a range of approaches for stress prevention, management, and intervention. Mental health providers engaged in crisis response over an extended period are at risk for compassion fatigue and secondary traumatization. The chapter emphasizes critical components of a comprehensive, multifaceted program for staff stress prevention and intervention. Chapter VI: Setting Up Training Training may be provided as part of preparedness activities to orient mental health providers joining the immediate response and as part of more formal mental health program implementation. Training should be adapted to the unique characteristics of the incident, local issues, and community needs, and to the service provider groups attending the training. Effective trainers are excellent facilitators of adult learning and have relevant knowledge and experience in at least several of the following areas: community crisis response, disaster mental health, trauma, bereavement, crime victimization, crime victim advocacy, and stress management. Specialists in topics such as children and trauma, cultural competence, or the criminal justice process, and representatives from key agencies or programs may present portions of the comprehensive training. Chapter VII: Comprehensive Training Course Outline The training course outline includes nine modules with objectives, materials, procedures, and duration described for each one. Each module integrates brief lectures with overheads, group discussions with questions, videotapes, and group learning exercises. The training design may expand or contract depending on local needs. The outline is not intended to be a detailed prescriptive curriculum, instead it highlights necessary topics and provides methodological suggestions for addressing them. Trainers may incorporate and adapt the materials as needed. Chapter VIII: Additional Training Needs and Options Each disaster, community, and mental health intervention program will generate additional training needs beyond the course outlined in Chapter VII. In-service training for mental health providers may address phase-related issues such as acknowledgment of the 1-year anniversary or emerging mental health needs such as brief counseling for traumatic bereavement and posttraumatic stress disorder(PTSD). Training may be provided for paraprofessional counselors working under the auspices of the intervention program or for human services workers employed by other agencies. Overview of ResourcesRecommended readings and references throughout this manual provide more information on research, field experience, and sound clinical suggestions. References cited throughout the manual, as well as additional resources, are included at the end of the manual. Recommended videotapes for use in the comprehensive training are listed at the end of Chapter VII. A list of useful Internet sites is provided at the end of the References section.
|
|
|
| Home | Contact Us | About Us | Awards | Accessibility | Privacy and Disclaimer Statement | Site Map |
