Trauma - Managing Mental Health Reactions to Major Disasters and Traumas

Information for Commanders

Traumatic events, sometimes referred to as critical incidents, tend to be sudden and unexpected. Such events may include natural disasters (e.g. Tsunami, earthquakes and floods), combat and other military operations, vehicle accidents, or physical assault. While many of the people involved in these events may escape physical injury, there is often a serious emotional toll. It is common for people who have experienced, witnessed or responded to traumatic situations to have very strong emotional reactions. Understanding normal responses to these abnormal events can aid you in effectively managing exposed personnel.

What happens to people after a disaster or other traumatic event?

Each person reacts differently to these types of events. Some may appear to be largely unaffected while others may experience significant and strong emotional reactions. Importantly, while many people may have strong reactions in the early stages, most go on to recover well over time with the use of their natural coping strategies and social supports.

There are a range of emotional reactions that are commonly experienced in the early stages after exposure to a trauma.

• One type of reaction is shock. Shock is a sudden and intense disturbance of one’s emotional state that leaves the individual feeling stunned or dazed. People in shock often have trouble taking in information and responding to the environment. Shock or denial (which involves difficulty acknowledging that something very stressful has happened or not completely understanding the intensity of the event), may have a short term protective role of shielding the individual from the emotional intensity of the event.

Personnel at the scene of a disaster may find that they act on "autopilot". When there is an important job to do, personnel focus on the skills they have learnt in training. This is an important part of completing the job one is trained to do and carrying out one’s tasks effectively. It is also important to be aware that in such circumstances the individual may experience a delayed emotional reaction after the immediate crisis has passed and tasks completed.

• Feelings may become intense or unpredictable. Personnel may become irritable, and they may experience mood swings. They might appear anxious or nervous, or even become depressed.

• Thoughts and behaviour patterns may be affected. For example, personnel may experience repeated vivid memories of the event ("flashbacks") which may, in turn, cause physical reactions such as rapid heart beat or sweating. They may find it difficult to concentrate or make decisions, and they may become more easily confused. Sleep and eating patterns can also be disrupted. Personnel may also begin to avoid certain activities or reminders of the event.

• Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, can lead to feelings of depression, anxiety, or guilt. Other reminders such as dealing with people involved in the incident or returning to a similar environment may also trigger upsetting memories. These "triggers" may be accompanied by fears that the stressful event will be repeated.

• Interpersonal relationships often become strained. Personnel may experience greater conflict in the workplace or with family members, or they may become withdrawn and isolated.

• Physical symptoms may accompany the extreme stress. For example, headaches, nausea and chest pain may result and may require medical attention. Preexisting medical conditions may worsen.

How do personnel respond differently over time?

A number of different factors affect each individual’s recovery, including:

• The extent of the trauma. Highly threatening and long lasting events, or those involving loss of life and substantial property loss, often take longer to resolve.

• The person's general ability to sustain stress and cope with emotional challenges. People who have coped well with other difficult and stressful circumstances usually find it easier to cope with trauma.

• Other stressful events preceding the traumatic experience. The more stress the individual is living with prior to the traumatic event (e.g. Personal or health problems, work stress), the more difficult he/she is likely to find it to cope with the trauma.

What can I do to assist my personnel?

• Acknowledge the contribution that personnel may have made during and subsequent to the event.

• Create an expectation that after a short time the unit will return to normal and of normal recovery by the personnel themselves.

• Promote a genuine environment of concern and support. Encourage junior and senior commanders alike to display an awareness of the common effects of trauma, and ensure that personnel are aware of support services available to them.

• Monitor the progress of personnel and provide basic, on-the-spot assistance to those in need. For example, you may wish to reduce unit workload or attempt to accommodate any family requirements that personnel may have.

• Be flexible in the allocation and scheduling of work (if possible).

• Allow personnel who have been through a traumatic incident to work together for a while in order to support one another (if possible).

• Encourage participation in psychological screening and specialist counselling.

• Encourage personnel to discuss their feeling. Often personnel are worried about traumatising others if the talk about the event. However, they can talk about their feelings without talking about potentially distressing details.

• Model desirable behaviours (i.e. utilise psycho-educational briefs and psychological screening services, employ tolerance and concern).

When should I seek professional help for my personnel?

In Australia - In accordance with ADF policy, regional Critical Incident Mental Health Support (CMS) coordinators should be informed of any significant critical incident in order to advise command on coordination of an appropriate response. All regions of Australia should have local call out procedures or the coordinator can be contacted through the local Mental Health Team (details of all teams can be found at http://www.defence.gov.au/health/). The aim of any CMS response is to assess the level of psychological impact, reduce the severity of trauma symptoms and help restore personnel to their previous levels of functioning as quickly as possible.

On Overseas Deployment – Due to the type of work conducted by Defence and the likelihood of exposure to potentially traumatic events, the ADF has a comprehensive system of mental health support to operations. This includes predeployment briefings, deployable psych support teams, Return to Australia Briefings and Post Operational Psychological Screening. However, commanders can also request the deployment of an operational CMS team if they feel a particular event on a deployment warrants specialist attention.

Typically, trauma symptoms such as those described above recede reasonably quickly following the event (i.e. Days or weeks). However, in some personnel serious problems continue to interfere with daily living for longer periods. Common examples include continuing to experience overwhelming anxiety or sadness, which in turn may impact upon job performance and interpersonal relationships.

If it is suspected that any personnel are suffering from prolonged reactions they should be given the opportunity to consult with an appropriately trained and experienced mental health professional. Mental health providers and professionals work with individuals affected by trauma to help them find constructive ways of dealing with the emotional impact.

23 September, 2008