From Crisis to Recovery: Resilience, Response and Planning

by George W. Doherty

President, Rocky Mountain Region Disaster Mental Health Institute

Abstract

     Natural and man-made disasters present challenges for first responders and behavioral health professionals. Crises can affect people on many different levels, including psychological well-being. Planning and coordination are important components of the response to crises, disasters, and critical incidents. Strategic planning is an effective method of identifying needs, resources and developing a plan of action. It is crucial that response, resilience, recovery and follow-up be included in our planning. A strategic plan includes a number of tactical interventions.

     Some additional variables important in responding include cultural knowledge and sensitivity. We need to prepare to respond appropriately within a culture not our own, whether locally, nationally, or internationally. The purpose of a behavioral health plan is to ensure an efficient, coordinated and effective response to the behavioral health needs of the affected population during times of disasters. Knowing which tactical intervention to best use with which individuals or groups and at what times and under what circumstances is at the heart of planning for all effective early intervention programs. A behavioral health disaster plan is essential for coordination of behavioral health emergency response efforts with other emergency response organizations during and following disasters.

What Is Crisis Intervention?

Everly& Mitchell (1999) define crisis intervention as “the provision of emergency psychological care to victims to assist those victims in returning to an adaptive level of functioning and to prevent or mitigate the potential negative impact of psychological trauma.” Procedures for crisis intervention have evolved from the work of people such as Erich Lindemann (1944), who conducted studies on grieving in the aftermath of a major conflagration at a nightclub. Kardiner and Spiegel (1947) devised three basic principles in crisis work:

  1.  immediacy of interventions;

  2.  proximity to the occurrence of the event; and

  3.  the expectancy that the victim will return to adequate functioning.

Gerald Caplan (1964) concentrated on community mental health programs that emphasized both primary and secondary prevention. While there are many models of crisis intervention, there is general agreement about the goals of crisis intervention that are employed by emergency mental health professionals. These goals are1:

  1.  to alleviate the acute distress of victims;

  2.  to restore independent functioning; and

  3.  to prevent or mitigate the aftermath of psychological trauma and post-traumatic stress disorder (PTSD)

Factors identified by those who have studied crisis intervention as important agents of change in crisis procedures include: ventilation and abreaction, social support and adaptive coping (Flannery, 1998; Raphael, 1986; Tehrani& Westlake, 1994; Wollmann, 1993).

Crises and Crisis Intervention

Crises can affect people on many different levels, including psychological well-being. In order for an event to qualify as a “crisis,” there must be some sense of disruption to one's sense of balance in life; a failure of one's usual coping mechanisms to re-establish equilibrium; and some evidence of functional impairment, such as an inability to concentrate; memory difficulties; sleep disturbances, etc. In a crisis, coping skills fail to re-establish a sense of balance and control in life. People can be at a loss as to where to turn for help.

Although the terms “crisis” and “emergency” may be used interchangeably in the context of counseling, it is useful to distinguish between the two (Chrzanowski, 1977). In psychodynamic theory, “crisi