Geriatric Mental Health Disaster and Emergency Preparedness

322 Geriatric Mental Health Disaster and Emergency Preparedness
As part of their therapy regime at Brooklyn VA Medical Center, clinicians
have taken advantage of disaster drill days that often are staged at
the medical center without prior notice. The purpose of the drill is to simulate
what would happen if a disaster occurred during normal hours of operation
when the facility is at maximum activity. A disaster drill involves
an announcement over the public address system—“Disaster in effect”—
followed by an alarm. Prior to the drill, every service personnel and most
noncommissioned staff are assigned specific task assignments to be activated
in a disaster situation. This interruption of the normal flow provides
an opportunity to revisit the protocol that went into effect after September
11 and to explore the veterans’ response to a biochemical or nuclear attack.
These drills are often anxiety provoking for the veterans until they are
notified that it is a drill. Yet the drills have helped heighten their awareness
of the implications of being away from home in the event of a disaster.
These drill days have provided another benefit—they have identified
the most optimal means for the facility to meet the needs of the veterans.
The disruptions have been recast into a therapeutic forum for discussion
in which the veterans have been better able to identify (1) what they would
need to do and have in a disaster and (2) what the facility would need to
do and have on hand to assist this population in the event of a disaster. As
a result of these ad hoc sessions, the following therapeutic interventions
have been added: (1) periodic and deliberate psychoeducation in disaster
preparedness; (2) discussions about disaster plans that involve the family;
(3) group therapeutic activities such as trips to restaurants, the theater,
or other activities that include spouses; and (4) facilitating veterans’
voluntary initiatives such as fund-raising and direct assistance to soldiers
returning from Iraq or Afghanistan.
Traditionally, the inclusion of discussion regarding political and social
issues in individual or group therapy has been discouraged. This is grounded
in the belief that to focus on these more global issues in a process group enables
the veterans to avoid identifying and working through their own personal
feelings (i.e., helplessness, abandonment, and betrayal) and thereby
misses the opportunity to use therapy for insight into how their beliefs and
behaviors contribute to maintaining their symptoms. However, the events
of September 11, 2001, precipitated an awakening within many combat
veterans and a movement toward confronting their past in an unprecedented
way. Many veterans at the Brooklyn VA Medical Center have begun
to challenge long-held, irrational core beliefs about their behavior in
war in a more realistic way. As a result, some have come to recognize a previously
held irrational belief (i.e., I am evil) as connected to a behavior that