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MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM: A FIELD GUIDE
CHAPTER VI: Stress Prevention, Management, and Intervention
Workers must cope with a range of challenging stressors. The devastating
losses, casualties, destruction of property, and emotional pain of survivors
and bereaved loved ones touch providers in powerful and personal ways. The
emergency response working environment often involves physical hardship, unclear
roles and responsibilities, limited resources, rapidly changing priorities,
intrusive media attention, and long work hours.
Despite the inevitable stress associated with community crisis response,
workers experience personal gratification using their skills to assist fellow
humans in need. Active engagement in the disaster response can be an antidote
to feelings of vulnerability, powerlessness, and outrage commonly experienced
by the community.
A proactive stress management plan focuses on two critical contexts: the
organizational and the individual. Adopting a preventive approach allows managers
and workers to anticipate stressors and manage potential crises rather than
simply reacting to them after they occur.
When stress prevention and management strategies are built into operations
and the organizational culture, providers feel valued and supported as they
engage in this emotionally demanding work. Suggestions for organizational
stress prevention, management, and intervention are presented in Table 2,
and suggestions for individual stress prevention, management, and intervention
are presented in Table 3.
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TABLE 2: Organizational Approaches for Stress Prevention, Management, and Intervention
Dimension |
Intervention |
| Effective Management Structure
and Leadership |
- Clear chain of command and reporting relationships
- Available and accessible leads and clinical supervisors
- Use of managers experienced in emergency response and community trauma
|
| Clear Purpose, Goals, and Training
|
- Clearly defined intervention goals and strategies appropriate to different
assignment settings (e.g., crisis intervention, community memorial)
- Training and orientation for all workers
|
| Functionally Defined Roles |
- Staff who are oriented and trained according to written role descriptions
for each assignment setting
- When setting is under jurisdiction of another agency (e.g., Mayor's Office,
Medical Examiner's Office, American Red Cross), staff are informed of mental
health provider's role, contact people, and mutual expectations
|
| Administrative Controls |
- Shifts no longer than 12 hours with 12 hours off
- Rotation between high, mid, and low-stress tasks
- Breaks and time away from the assignment
- Necessary supplies (e.g., paper, forms, pens, educational materials)
- Communication tools (e.g., mobile phones, radios)
- Delegating "regular" workload so workers do not attempt disaster response
and usual job
|
| Team Support |
- Buddy system for support and monitoring stress reactions
- Positive atmosphere of support, mutual respect, and tolerance
- Clinical support, consultation, and supervision processes built on trust,
safety and respect
|
| Plan for Stress Management |
- Attention to workers' functioning and stress management
- "Floating through" work areas to observe signs of stress
- Education about signs and symptoms of worker stress and coping strategies
- Intervention plan incorporating elements from Table 3
- Exit plan for workers leaving the operation
|
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TABLE 3: Individual Approaches for Stress Prevention, Management, and Intervention
Dimension |
Intervention |
| Management of Workload |
- Setting task priority levels with realistic work plans
- Recognizing that "not having enough to do" or "waiting" is an expected
part of disaster mental health response
|
| Balanced Lifestyle |
- Eating nutritious food and staying hydrated, avoiding excessive caffeine,
alcohol, and tobacco
- Getting adequate sleep and rest, especially on longer assignments
- Getting physical exercise when possible
- Maintaining contact and connection with primary social supports
|
| Stress Reduction Strategies |
- Reducing physical tension by using familiar personal strategies (e.g.,
taking deep breaths, gentle stretching, meditation, washing face and hands,
progressive relaxation)
- Pacing self between low and high-stress activities
- Using time off to "decompress" and "recharge batteries" (e.g., getting
a good meal, watching TV, exercising, reading a novel, listening to music,
taking a bath, talking to family)
- Talking about emotions and reactions with coworkers during appropriate
times
|
| Self-Awareness |
- Recognizing and heeding early warning signs for stress reactions
- Accepting that one may not be able to self-assess problematic stress reactions
- Recognizing that over-identification with or feeling overwhelmed by victims'
and families' grief and trauma may signal a need for support and consultation
- Understanding the differences between professional helping relationships
and friendships to help maintain appropriate roles and boundaries
- Examining personal prejudices and cultural stereotypes
- Recognizing when one's own experience with trauma or one's personal history
interfere with effectiveness
- Being aware of personal vulnerabilities and emotional reactions and the
importance of team and supervisor support
|
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