Recommendations for mental health intervention based on CDC guidance CDC 2007

1. Potential risk groups that are regarded as particularly vulnerable include:

• selected age groups (infants, children and the elderly)

• cultural and ethnic groups (immigrants, those who do not speak English, undocumented aliens)

• "low visibility groups" (homeless, mobility-impaired, mentally challenged, mentally ill)

• persons in group facilities (hospitals, chronic care facilities, prisons)

• those who provide human services, including health-care and disaster relief work.

2. The needs of survivors and anticipated reactions include the following:

• concern for survival

• grief for personal losses, including loved ones and possessions

• fear and anxiety about personal safety and safety of loved ones

• sleep disturbances

• concerns about relocation and crowding

• the need to ventilate about events related to the disaster

• the need to be part of the recovery efforts.

3. Reactions that indicate the need for mental health referral include:

• disorientation (memory loss, disorientation in time or place, or inability to recall recent events)

• depression (including withdrawal, feeling of despair that is disproportionate to the event)

• anxiety (including obsessive fear of another disaster)

• mental illness (hallucinations, delusional thinking, etc.)

• inability to provide self-care (absence of eating, etc.)

• suicidal or homicidal thoughts

• abuse of alcohol or drugs

• domestic violence or child abuse.

4. Organizational approaches to reduce stress include the following:

• there must be effective management structure and leadership that provides a clear chain of command, and disaster orientation for all workers - shifts that are no longer than 12 hours per day, daily briefings with credibility, appropriate supplies, and communication tools such as cell phones, radios, etc.

• there must be a clearly defined goal and purpose

• roles must be defined

• there must be positive reinforcement with consideration for a buddy system for monitoring stress reactions

• stress management is necessary and should include assessment, rotation between low- and high-stress tasks, time breaks, education about signs and symptoms of stress, individual and clearly defined tours of duty.

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