Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 10 Psychosocial and Pharmacological Interventions 183
“Mental Health and Mass Violence Review” offered by a panel of leading
researchers and practitioners in the 2007 publication titled Evidence-Based
Early Psychological Intervention for Victims/Survivors of Mass Violence:
A Workshop to Reach Consensus on Best Practices (National Institute of
Mental Health [NIMH], 2002). The reader should note this document not
only as a clinical resource but also as a remarkable attempt to integrate a
very wide, diverse, and heterogeneous body of literature. Specifically, the
authors recommend the following equivalent of a disaster hierarchy of
needs, which should guide clinical assessment and intervention relevant to
an individual’s current most pressing issues:
1. Foster sense of safety: Promoting an actual and nurturing a perceived
sense of safety is the fi rst line of intervention for the disaster
mental health clinician. This involves mitigating ongoing
actual threats of a disaster and reducing harm due to indirect affects
of disaster. An example of the latter would be not having
access to necessary medical care. Obviously, until personal safety
and a sense of security are established, all other intervention efforts
would not only be misguided but also ineffectual. The provision
of safety, or at the minimum fostering a sense of it, may be
complicated by clinical issues presented by older persons.
2. Facilitate personal calming: Even after a threat has been reduced
to a manageable level, individuals often have great diffi culty reducing
their heightened physiological response to a disaster. This
inability to calm oneself may elicit internal cues that bodily indicate
it is not safe yet, thus perpetuating a cycle of hyper-vigilance
and further duress. This early maladaptive response is not only
extremely uncomfortable, but its endurance may predict poor
psychiatric prognosis. Very basic helping techniques like deep
breathing and distraction-based efforts may help calm individuals
who are at risk from having more permanent disaster-related
symptoms develop. Basic group activities that encourage light
recreational or productively helpful activity may quell an overstimulated
nervous system.
3. Develop sense of personal/self and community effi cacy to cope
or overcome: While basic coping skills may be taught at this early
stage to help manage acute symptoms of distress, a person, and
more collectively a community of people, must believe in their
capacity to get through their experiences and feel better as a result
of their efforts. If coping strategies are viewed as useless or