Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 4 Coordinating Services 77
vide general advice and direction. This is likely due to the understanding
that in a large-scale emergency response, much of the recovery will rely
on the self-sufficiency of individuals. It is incumbent on each individual
and family to be proactive in the planning stage (Scherr, 1996; Torgusen &
Kosberg, 2006). Specific recommendations for assisting older persons who
are not living in the immediate vicinity of family have been prepared by
the AARP (2006) .
It is this level of familial, proactive planning that best individualizes
preparedness. While more global, community-based responses with organized
structure are essential, a family and/or individual can inform a more
personally nuanced plan of action in event of a disaster. It is this relational
context that often provides the impetus for individuals to engage and
cooperate with a disaster mental health response protocol. At the core of
effective and organized service delivery is personalized coordination that
incorporates an individual’s mental health and his or her ability to trust
and follow the guidance of disaster responders.
SERVICE COORDINATION, MENTAL HEALTH,
AND THERAPEUTIC RAPPORT
Prior mental health history is another significant risk factor that must be
addressed by the disaster mental health service provider. A significant
predisaster mental health history may not only be a poor prognostic indicator
relative to a person’s clinical response to disaster, but it may also
interact with conditions and circumstances that may impede effective
planning. For example, a SWiFT 1–assessed individual with a prior trauma
history and a diagnosis of paranoid schizophrenia would present a very
unique challenge to a relocation demand induced by an event. The latter
would likely require a very nuanced intervention. Historically depressed
individuals whose symptoms are exacerbated by disaster may be resistant
to engage in anything that promotes recovery or even safety due to maladaptive
thoughts that nothing will help . Underscoring each of these examples
is a basic premise that standard recovery efforts may need to be
individualized for the mental health population. In addition, developing
a trusting rapport with a recovery worker also can be a significant facilitative
factor in improving the chances the recovery services offered are received
and utilized by this population.
Even without prior history or diagnosis, many psychological variables
play an influential role in whether or not a system’s response to a person’s