Principles and Strategies
of Crisis Intervention
Prof. Kieran Graham Mundy Ph.D.
Principles & Strategies of Crisis
Intervention
BACKGROUND
Reduce the Impact of Vf by raising the coping level threshold of the victim in the victimizing habitus
General Principles of Crisis Intervention
Universal ConceptsTopic 1
Topic 2
Topic 3
INTERVENTION
STRATEGIES
Background
To reduce the Impact of VfIn resource-poor countries far more people die as a result of natural disasters than in
resource-rich countries – the ratio is 9:1.
Social intervention primarily aims to have social effects– but it also has secondary psychological effects.
Psychological intervention primarily aims to have
psychological effects –but it also has secondary social effects.
Background
General Principles
Develop a
coordinated &
effective system of help.
Identify (and name) people responsible for specific tasks.
Make plans to meet social and mental health needs.
Train people for social and psychological
crisis intervention.
Prepare before the Crisis
• Setting (the affected
area)
• Culture (the Tohoku
region)
• History and nature of
problems
• Local perceptions of
stress & illness
• Local ways of coping • Community resources
Assessment
Make a general assessment of the victimizing
Ongoing involvement is basic to ensure
sustainability.
If many agencies work independently without co-ordination there is wastage of valuable resources.
If possible, staff,
including management staff, should be hired from the local
community.
Working Together
Maximize care by
families and loved
ones.
Make active use of
resources in the
community.
Use mental health
specialists to do
on-the-job
training,
supervision, and
support for people
wanting to
work/working with
disaster survivors
and victims.
Access to services should be for the whole community.
Access should not be restricted to
subpopulations
identified on the basis of exposure to certain stressors.
Outreach awareness programs to ensure the treatment of
vulnerable or minority groups within PHC
should be established. You can get help here!
Training and
supervision for aid
workers should be
done by mental
health specialists -
or under their
guidance - for a
substantial amount
of time to ensure
lasting effects of
training and
responsible care.
Short one-week or
two-week skills
training without
thorough follow-up
supervision are not
the best way to go.
Focus should be on long-term development of community-based mental health care services and social interventions rather
than short-term relief of psychological stress during the acute phase of the crisis.
Impetus and funding for mental health programs is highest during or
immediately after the crisis – people forget!
Mental health programs should be designed to give help for many
years(e.g. HIBAKUSHA – Atomic Bomb Survivors).
Intervention Strategies
for Populations Exposed
to SEAs
Social Intervention in AE phase
(1) Give ongoing trustworthy information about:
• the emergency (e.g., Fukushima Daiichi Nuclear incident)
• What “the authorities” are doing to make people safe
• Relief - what each aid organization is doing and where it is
located
• Where absent relatives are and how to communicate with
them
Information should be given according to principles of risk
(2) Trace family members (in particular) for:
•
Unaccompanied minors
•Elders
•
Other vulnerable groups
(3) Make volunteers aware of:
•
The nature of normal grief
•
That many people will be disorientated
•
The need for active participation by all able-bodied
After the Higashi Nihon Daishinsai, in Iwate Prefecture the local government adopted a policy of equality ignoring village social structures (IDPs were allocated temporary housing by lottery).
IDPs were also secondarily victimized in the aftermath of the Great Hanshin-Awaji
Earthquake when ~5000 people in Kobe were relocated to temporary housing in a different part of the Kansai Region; many committed suicide due to loneliness or died of illness resulting from alcoholic abuse.
In contrast, Miyagi Prefecture applied a policy to maintain vertical communities as much as possible in evacuation centers and temporary housing (IDPs live basically with same families of their original villages/communities).
Aim to keep
family members
and local
communities
together as
much as possible
(5) Arrange meetings
to brainstorm
all
community decisions:
• About where to locate religious places, schools, and water
supply in emergency housing arrangements
• About how to provide religious, recreational and cultural
space in the design of emergency housing.
(6) Discourage unceremonious disposal of
corpses to control communicable diseases
:
• Dead bodies carry no or extremely limited risk for
communicable diseases disorientation
(7) Encourage normal cultural and religious
events
:
•
including grieving rituals in collaboration with
(8) Encourage activities that facilitate the inclusion
of:
• orphans, widows, widowers, or those without their families into
social networks.
(9) Encourage normal recreational activities for
children:
• Do not give out items like football jerseys, modern toys. These
may have been considered luxury items in the local context before the crisis.
(10) Encourage children to go back to school:
• Even if this Is only a symbolic gathering at first
(11) Involve adults in purposeful activities:
• constructing/organizing accommodation, organizing family
Provide
non-sensationalistic press releases, radio programs, posters and leaflets to reassure people.
Focus of public education about normal stress
reactions widespread. Focus on
psychopathology during AE phase may potentially lead to unintentional
harm.
Expect natural recovery.
Psychological Intervention in AE
phase
(1) Establish contact with local PHC/emergency
care:
• Manage urgent problems (e.g., danger to self or others,
psychoses, severe depression, mania, epilepsy) within PHC system run by local government or NGOs
• Meet the needs of survivors who use psychotropic
medication. Sudden discontinuation of (any) medication could be fatal.
• Most survivors (about 80%) will not ask for counseling even
(2) What you can do:
• Most acute mental health problems during the AE phase
are best managed without medication following the principles of PSYCHOLOGICAL FIRST AID.
1.
Listen
2.
Convey Compassion
3.
Assess Needs
4.
Ensure Basic Physical Needs Are Met,
5.
Do Not Force Talking
6.
Provide Or Mobilize Company From Preferably
Family Or Significant Others
7.
Encourage But Do Not Force Social Support
Social Intervention in
Reconsolidation Phase
(2)
Organize outreach and psycho-education:
• Educate survivors on availability or choices of mental health
care.
• Commencing no earlier than four weeks after the AE phase,
carefully educate survivors on the difference between psychopathology and normal psychological distress.
• Avoid suggestions of wide-scale presence of psychopathology.
• Avoid jargon and idioms that carry stigma (e.g. victims of 3/11
Ψ Intervention in Reconsolidation
Phase
(1 & 2) Educate other humanitarian aid workers and
community leaders (how to identify?) in core
psychological care skills to raise awareness and
encourage community support:
•
Core psychological care skills
•
“PSYCHOLOGICAL FIRST AID”
•
EMOTIONAL SUPPORT
•
PROVIDING INFORMATION
•
SYMPATHETIC REASSURANCE
•
RECOGNITION OF CORE MENTAL HEALTH
(3) Train and supervise PHC workers in basic mental
health knowledge and skills
(based on the curriculum in WHO/UNHCR’s (1996) Mental Health of Refugees):•
Provision of appropriate psychotropic
medication
•
“Psychological first aid”
•
Supportive counseling
•
Working with families
•
Suicide prevention
•
Management of psychosomatic complaints
(4) Collaborate with traditional healers if
feasible:
•
Try to establish a working alliance between
traditional and allopathic practitioners – it may be
possible in certain contexts
(5) Ensure continuation of medication for
psychiatric patients:
•
Some survivors may not have had access to
(7) Train and supervise volunteer,
paraprofessional /professional community
workers (i.e., support workers, counselors) to
assist PHC workers with heavy case loads:
•
Provide training in core skills
•
Assessment of individual needs
•
Families’ and groups’ perceptions of problems
•
‘Psychological first aid
•
Providing emotional support
•
Grief counseling
•
Stress management
•
‘Problem-solving counseling’
•
Mobilizing family and community resources
(8) Facilitate creation of community-based
self-help support groups:
•
Focus of self-help groups is typically:
•
problem sharing
•
brainstorming for solutions or more effective ways
of coping (including traditional ways)
•
generation of mutual emotional support
Kieran G. Mundy
