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Additional Resources for Mental Health and Substance Use
First Responder Peer Support Resources
Crisis Services for Public Safety Responders
Local Peer Support Resources for All Public Safety Responders
• Mark Holland – Mobile: 919-971-3064 http://guardianone.org/behavioral-health-service.html
• Emergency Chaplains - Ralph Thompson – Mobile: 919-280-8908 https://www.echap.org/contact
• North Carolina First Responder Peer Support Network 1-855-7NC-PEER (1-855-762-7337) http://www.ncffps.org/
Agency-Specific Resources
Durham County Emergency Services
• Durham County EMS Peer Support Coordinator: Helen Tripp – Mobile: 919-475-3991 (work) or
919-412-5083 (personal) Email: [email protected]
Durham County Fire Departments
• Contact your respective department clergy
• National Volunteer Fire Council (NVFC) – 1-888-731-FIRE (3473) https://www.nvfc.org/fireems-helpline/
• Provident First Responder Assistance Hotline - 855-207-1747 https://www.providentins.com/emergency-services/first-responder-assistance-program/;
Durham City Fire Department
• Department clergy: Shawn Field – Mobile: 919-475-6498, Marty Pearce – Mobile: 919-730-9408
Crisis Services for Public Safety Responders
Agency-Specific Resources
Durham City Police Department
• NCLEAP North Carolina Law Enforcement Assistance Program – 336-345-2089
https://greatnonprofits.org/org/north-carolina-law-enforcement-assistance-program-ncleap [email protected]
• SafeCall Now – 206-459-3020 https://www.safecallnow.org/
National Resources Available for All First Responders
• National Suicide Prevention Lifeline – 1-800-273-TALK (8255) Veterans Press 1 https://suicidepreventionlifeline.org/
• Code Green Campaign – EMS focused – 206-459-3020 http://codegreencampaign.org
• Firefighter Behavioral Health Alliance – Fire focused – 847-209-8208 http://www.ffbha.org
• SafeCall Now – All Responders – 206-459-3020 https://www.safecallnow.org/
COVID-19 Resources
• Optum 24-hour Emotional Support Help Line – 866-342-6892 For anyone experiencing anxiety or stress regarding COVID-19.
• The National Disaster Distress Helpline – 800-985-5990 Offers crisis counseling and emotional support 24 hours a day for anyone experiencing distress or other mental health concerns during the COVID-19 outbreak.
Additional Resources for Mental Health and Substance Use
Managed Care Organizations in NC
Alliance Health • 24-hour Crisis Line – 1-800-510-9132
• Other Phone: 919-651-8401
• 5200 Paramount Parkway Suite 200 Morrisville, NC 27560
• Counties Served – Cumberland, Durham, Johnston, Wake https://www.alliancehealthplan.org/venue/alliance-behavioral-healthcare-corporate-office/
Cardinal Innovations Healthcare • 24-hour Crisis Line – 1-800-939-5911
• Other Phone – 704-939-7700
• 550 S. Caldwell St. Suite 1500 Charlotte, NC 28202
• Counties Served – Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance, and Warren
https://www.cardinalinnovations.org/
Educational Resources
Mental Health First Aid http://mentalhealthfirstaid.org
• Contact Alliance Health for a class – Debra Duncan at [email protected]
Psychological First Aid https://learn.nctsn.org/enrol/index.php?id=38
During a Response: Understand and Identify Burnout and Secondary Traumatic Stress
Limit your time working alone by trying to work in teams. Responders experience stress during a crisis. When stress builds up it can cause:
• Burnout – feelings of extreme exhaustion and being overwhelmed.
• Secondary traumatic stress – stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic event.
Coping techniques like taking breaks, eating healthy foods, exercising, and using the buddy system can help prevent and reduce burnout and secondary traumatic stress. Recognize the signs of both of these conditions in yourself and other responders to be sure those who need a break or need help can address these needs.
Signs of Burnout:
o Sadness, depression, or apathy
o Easily frustrated o Blaming of others,
irritability o Lacking feelings,
indifferent o Isolation or
disconnection from others
o Poor self-care (hygiene)
o Tired, exhausted or overwhelmed
Feeling like:
• A failure
• Nothing you can do will help
• You are not doing your job well
• You need alcohol/other drugs to cope
Signs of Secondary Traumatic Stress
• Excessively worry or fear about something bad happening
• Easily startled, or “on guard” all of the time • Physical signs of stress (e.g. racing heart) • Nightmares or recurrent thoughts about the
traumatic situation • The feeling that others’ trauma is yours
Responder Self-Care Techniques
• Limit working hours to no longer than 12-hour shifts.
• Work in teams and limit amount of time working alone.
• Write in a journal. • Talk to family, friends, supervisors, and
teammates about your feelings and experiences. • Practice breathing and relaxation techniques. • Maintain a healthy diet and get adequate sleep
and exercise. • Know that it is okay to draw boundaries and say
“no.” • Avoid or limit caffeine and use of alcohol.
It is important to remind yourself:
• It is not selfish to take breaks. • The needs of survivors are not more important
than your own needs and well-being. • Working all of the time does not mean you will
make your best contribution. • There are other people who can help in the
response.
Responding to disasters can be both rewarding and stressful. Knowing that you have stress and coping with it as you respond will help you stay well, and this will allow you to keep helping those who are affected.
If you would like to confidentially talk/text to your behavioral health officer, please call Mark Holland, PhD, LCMHCS, at 919.971.3064 or email at [email protected]
Source:
https://emergency.cdc.gov/coping/responders.asp
·U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administrationwww.samhsa.gov
Managing Stress During A Crisis
NMH06-0235
Getting HelpIf you feel you need additional information, you may fi nd this list of resources to be helpful.
SAMHSA ResourcesInformation Clearinghouses
Disaster Technical Assistance Center (DTAC) (800) 308-3515 www.mentalhealth.samhsa.gov/dtac
National Mental Health Information Center (NMHIC)P.O. Box 42557, Washington, DC 20015(800) 789-2647 (English and Español) (866) 889-2647 (TDD)www.mentalhealth.samhsa.gov
National Clearinghouse for Alcohol and Drug Information (NCADI)P.O. Box 2345, Rockville, MD 20847-2345(800) 729-6686 (English and Español)(800) 487-4889 (TDD)www.ncadi.samhsa.gov
Treatment Locators
Mental Health Services Locator(800) 789-2647 (English and Español)(866) 889-2647 (TDD)www.mentalhealth.samhsa.gov/databases
Substance Abuse Treatment Facility Locator(800) 662-HELP (4357) (Toll-Free, 24-Hour English and Español Treatment Referral Service)(800) 487-4889 (TDD)www.fi ndtreatment.samhsa.gov
Hotlines
National Suicide Prevention Lifeline(800) 273-TALK (8255)(800) 799-4889 (TDD)
A Guide for Supervisors
Other Federal Resources
Centers for Disease Control and Prevention—Mental Healthhttp://www.bt.cdc.gov/mentalhealth/
Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Scienceshttp://www.usuhs.mil/psy/factsheets.html
Federal Occupational Health Employee Assistance Program for Federal and Federalized Employeeshttp://www.foh4you.com or (800) 222-0364(888) 262-7848 (TTY)
National Center for Post-Traumatic Stress Disorder (PTSD) http://www.ncptsd.va.gov/topics/katrina.html
U.S. Department of Health and Human Services—Employee Assistance Program(202) 690-8229 [email protected]
Promoting a Positive Workplace EnvironmentA proactive stress management plan focuses both on the environment and the individual. A clear organizational structure with defi ned roles and responsibilities for linestaff responders, leads, supervisors, and managers reduces the potential for staff stress. An effective manager is familiar with the many facets of worker stress and takes a wide range of steps to integrate stress management strategies in the workplace.
As a supervisor or manager you must assume shared responsibility for promoting a positive and healthy work environment, and not rely exclusively on workers initiating their own self-care practices. You should address the following dimensions when designing a stress management plan that prioritizes environmental and organizational health:
Effective management structure and leadership
Clear purpose, goals, and training
Functionally defi ned roles
Administrative controls
Team support
Plan for stress management.
Managers today face the challenges of supplying energy and passion, promoting a positive attitude, and creating an environment in which people feel connected to their work and their colleagues. Managers can boost employees’ perception of strong management support through feedback, open communication, and high visibility—that is, through a dynamic and supportive leadership style, one that engages others so as to raise each other to high levels of motivation.
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The following are principles of leadership that you can apply in the ordinary course of your daily life: meet challenges head on; be curious and daring; create a culture where failure and error are looked upon as steps toward success; and demonstrate personal courage to galvanize a team or organization that lacks resolve. The most inspiring opportunities for courage come when you face the longest odds.
Minimizing Stress in the Workplace
Set the tone by treating coworkers with respect and valuing their contributions.
Hold regular staff meetings to plan, problem solve, recognize accomplishments, and promote staff cohesiveness.
Clearly communicate the rationale behind procedural or supervisory changes and performance expectations.
Create a formal employee suggestion system and encourage staff to contribute.
Resolve confl icts early and quickly.
Prepare workers for concrete tasks that they may perform through technical training.
Acknowledge that work is often stressful and connect staff to professional help if necessary.
Promote an atmosphere where attention to one’s emotional state is acceptable and encouraged rather than stigmatized or disregarded.
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During the Crisis—At the SceneAt the disaster scene, you, as a manager, can provide certain supports for workers to mitigate stress and help them effectively perform the tasks at hand.
Minimizing Stress During the Crisis—At the Scene
Clearly defi ne individual roles and reevaluate them if the situation changes.
Institute briefi ngs at each shift change that cover the current status of the work environment, safety procedures, and required safety equipment.
Partner inexperienced workers with experienced veterans. The buddy system is an effective method to provide support, monitor stress, and reinforce safety procedures. Require outreach personnel to enter the community in pairs.
Rotate workers from high-stress to lower-stress functions .
Initiate, encourage, and monitor work breaks, especially when casualties are involved. During lengthy events, implement longer breaks and days off, and curtail weekend work whenever possible.
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Establish respite areas that visually separate workers from the scene and the public. At longer operations, establish an area where responders can shower, eat, change clothes, and sleep.
Implement fl exible schedules for workers who are directly affected by an event. This can help workers balance home and job responsibilities.
Reduce noise as much as possible by providing earplugs, noise muffl ers, or telephone headsets.
Mitigate the effects of extreme temperatures through the use of protective clothing, proper hydration, and frequent breaks.
Ensure that lighting is suffi cient, adjustable, and in good working order.
Lessen the effect of odors and tastes, and protect workers’ breathing by supplying facemasks and respirators.
Provide security for staff at facilities or sites in dangerous areas, including escorts for workers going to and from their vehicles.
Provide mobile phones for workers in dangerous environments. Ensure that staff know who to call when problems arise.
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After the CrisisThe ending of the disaster assignment, whether it involved immediate response or long-term recovery work, can be a period of mixed emotions for workers. Though there may be some relief that the disaster operation is ending, there is often a sense of loss and “letdown,” with some diffi culty making the transition back into family life and the regular job. The following are action steps that can help ease the disengagement and transition process for workers.
Minimizing Stress for Workers—After the Crisis
Allow time off for workers who have experienced personal trauma or loss. Transition these individuals back into the organization by initially assigning them to less-demanding jobs.
Develop protocols to provide workers with stigma-free counseling so that workers can address the emotional aspects of their experience.
Institute exit interviews and/or seminars to help workers put their experiences in perspective and to validate what they have seen, done, thought, and felt.
Provide educational inservices or workshops around stress management and self-care.
Offer group self-care activities and acknowledgments.
This information has been excerpted from SAMHSA’s “A Guide to Managing Stress in Crisis Response Professions.” DHHS Publication No. SMA 4113 Printed 2005
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Use the experience to change your life in positive ways—Few of us get the opportunity and privilege of serving and being with individuals and communities in the hours of their greatest need. It is indeed a privilege. With that privilege comes responsibilities. One is the responsibility to be as well prepared as possible to be optimally helpful. If there is the potential for being deployed again, take all opportunities available to become as prepared as possible.
There is also a responsibility to use this unique experience as a way of honoring and bearing witness to the loss and suffering of others, to use the experience to positively infl uence our lives. Are our priorities and values what they should be? Are we as prepared for adversity as we should be? Do we value our family, friends, and colleagues as we should? When we see others whose lives have been turned upside down, lives prematurely ended, and lives forever changed through loss, we are well served by reassessing our own values and priorities.
SAMHSA Resources
Information Clearinghouses
Disaster Technical Assistance Center (DTAC) (800) 308-3515 www.mentalhealth.samhsa.gov/dtac
National Mental Health Information Center (NMHIC)P.O. Box 42557, Washington, DC 20015(800) 789-2647 (English and Español) (866) 889-2647 (TDD)www.mentalhealth.samhsa.gov
National Clearinghouse for Alcohol and Drug Information (NCADI)P.O. Box 2345, Rockville, MD 20847-2345(800) 729-6686 (English and Español)(800) 487-4889 (TDD)www.ncadi.samhsa.gov
Treatment Locators
Mental Health Services Locator(800) 789-2647 (English and Español)(866) 889-2647 (TDD)www.mentalhealth.samhsa.gov/databases
Substance Abuse Treatment Facility Locator(800) 662-HELP (4357) (Toll-Free, 24-Hour English and Español Treatment Referral Service)(800) 487-4889 (TDD)www.fi ndtreatment.samhsa.gov
Hotlines
National Suicide Prevention Lifeline(800) 273-TALK (8255)(800) 799-4889 (TDD)
·U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administrationwww.samhsa.gov
A Post-Deployment Guide for Emergency and Disaster Response Workers
NMH05-0219
Returning Home After Disaster Relief WorkGetting HelpIf you feel you need additional information, you may find this list of resources to be helpful.
Other Federal Resources
Centers for Disease Control and Prevention—Mental Healthhttp://www.bt.cdc.gov/mentalhealth/
Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Scienceshttp://www.usuhs.mil/psy/factsheets.html
Federal Occupational Health Employee Assistance Program for Federal and Federalized Employeeshttp://www.foh4you.com or (800) 222-0364(888) 262-7848 (TTY)
National Center for Post-Traumatic Stress Disorder (PTSD) http://www.ncptsd.va.gov/topics/katrina.html
Before Returning to WorkDuring your disaster response and recovery efforts, you most likely worked under less than desirable conditions while taking care of others. Before you return to your normal duties, you will want to take care of yourself by making sure that all your basic needs are met. These include the following:
Maintaining a healthy diet, routine exercise, adequate rest/sleep
Spending time with family and friends
Paying attention to health concerns
Meeting neglected daily personal tasks (e.g., pay bills, mow lawn, shop for groceries)
Refl ecting upon what the experience has meant personally and professionally
Getting involved in personal and family preparedness.
Signs of StressThe following is a list that you may fi nd helpful in identifying signs of stress in yourself or others who have had experiences similar to yours:
Anxiety, fear
Grief, guilt, self-doubt, sadness
Irritability, anger, resentment, increased confl icts with friends/family
Increased use of alcohol or other drugs
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Feeling overwhelmed, hopeless, despair, depressed
Anticipation of harm to self or others; isolation or social withdrawal
Insomnia
Gait change
Hyper-vigilance; startle reactions
Crying easily
Gallows/morbid humor
Ritualistic behavior
Memory loss, anomia (i.e., diffi culty naming objects or people)
Calculation diffi culties; decisionmaking diffi culties
Confusion in general and/or confusing trivial with major issues
Concentration problems/distractibility
Reduced attention span and/or preoccupation with disaster
Recurring dreams or nightmares
Fatigue
Nausea
Fine motor tremors
Tics or muscle twitches
Paresthesia (e.g., numbness and tingling in extremities)
Profuse sweating
Dizziness
Stomach or gastrointestinal upset
Heart Palpitations/fl uttering
Choking or smothering sensation
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Intrusive thoughts
Relationship problems
Job/school-related problems
Decreased libido/sexual interest
Appetite change
Overly critical, blaming
Decreased immune response.
Expecting the UnexpectedUpon returning to your routine duties, you may notice changes in yourself, your coworkers, or your work environment. The following are a few examples of potential diffi culties you may face and some tips on how to overcome them.
Pace change—The disaster environment often moves at a pace that is much faster than the normal workplace. After working in a disaster response environment, this begins to feel normal. When returning to normal work, it may appear that people are moving at a much slower pace than you remember. It is easy to misinterpret this as laziness or lack of caring or motivation. Remember that it is probably you who has changed, not them. Be slow to judge, criticize, or make assumptions.
Unrelenting fatigue—Even with what seems like suffi cient sleep, you may experience chronic fatigue. This may be a result of several factors. You may need more rest than you realize.
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Sometimes chronic stress results in never feeling rested. Chronic fatigue may also be a result of a medical condition. See a doctor if chronic fatigue persists.
Cynicism—Typically, during disaster work you see the best and the worst in individuals and systems and it is easy to become cynical. This is expected. These feelings often diminish over time once you are able to focus on the positive results of your work.
Dissatisfaction with routine work—It is very rewarding to be involved, directly or indirectly, in saving lives and protecting our fellow citizen’s health and safety. Most work does not provide such dramatic and immediate reinforcement. You might start seeing your daily work routine as lacking meaning and satisfaction. These feelings are normal. To counter these feelings, incorporate the positive things you have learned during disaster response into your personal and professional life.
Easily evoked emotions—Sometimes the combination of intense experiences, fatigue, and/or stress leaves you especially vulnerable to unexpected emotions. For example, you may cry easily, be quick to anger, or experience dramatic mood swings. These are normal reactions that typically subside over time. In the meantime, be aware of your reactions, discuss your experiences, and be sensitive of comments that might be hurtful or upsetting to others.
Relating your experiences—While you may want to share your experiences with others, you may be unsure if it is appropriate. This is normal. Exercise care when discussing your disaster relief experiences, especially graphic and disturbing topics while in the presence of children or others who are emotionally vulnerable.
Diffi culties with colleagues and supervisors—You may not experience a welcome back from your colleagues and supervisors that meets your expectations. Coworkers may resent having to assume additional workloads, may not understand the diffi culty of the work you did, or may resent the recognition that you are receiving as a responder. In response to any negative feelings, express appreciation for their support during your deployment and take care in relating your experiences.
Cultural issues—Culture affects how an individual reacts to trauma. For example, showing emotion, discussing problems with others, or touching is acceptable with some groups and not with others. On the basis of this understanding, it is important to appreciate and respect these differences.
When to Seek HelpRemember, stress is a normal reaction to abnormal situations like disasters. If you experience the following signs of persistent or severe stress, seek help from a licensed mental health professional.
Disorientation (e.g., dazed, memory loss, unable to give date/time or recall recent events)
Depression (e.g., pervasive feeling of hopelessness and despair, withdrawal from others)
Anxiety (e.g., constantly on edge, restless, obsessive fear of another disaster)
Acute psychiatric symptoms (e.g., hearing voices, seeing visions, delusional thinking)
Inability to care for self (e.g., not eating, bathing, changing clothing, or handling daily life)
Suicidal or homicidal thoughts or plans
Problematic use of alcohol or drugs
Domestic violence, child abuse, or elder abuse
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Sometimes it may be diffi cult to determine if what you are experiencing is a result of a physical illness or stress (or both). In some disaster situations, workers may have been exposed to infectious disease and/or environmental exposure that may result in signs and symptoms similar to stress. When in doubt, get an evaluation from a health care professional.
Coping SuggestionsFind ways to use your disaster experience to better understand yourself—You have had an experience/opportunity that not many people have had. During that experience you undoubtedly learned things about yourself. What stresses you most? What were you able to handle in ways that surprised yourself? What unrecognized skills/talents did you discover? What did you learn about how you function in extreme environments? Use the experience to better understand yourself.
Find ways to use disaster experience to enhance your job function—Your normal job role probably does not involve disaster response. What skills/knowledge did you bring from your normal role that was helpful? What skills/knowledge/perspective did you gain from the disaster deployment that can enhance your normal job function? Did your experience point you in directions in which you would like to move professionally or make you cognizant of assignments you would like to seek or avoid?
Whether your disaster relief assignment took you to the front lines or behind the scenes, you have made an enormous contribution to our fellow Americans. You have faced diffi cult challenges to help people in a time of extraordinary need. You have experienced rare and rewarding opportunities that have proven to be uniquely stressful. The effects of that stress can cause diffi culties as you reenter the workplace. This brochure contains useful information to ease your transition and enhance your return to your usual work routine.
Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) | [email protected] https://store.samhsa.gov|
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Tips for Families of Returning Disaster Responders: ADJUSTING TO LIFE AT HOME
It is a process of reconnection for you and all those connected to your loved one.
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IntroductionIncreasing attention is being paid to thechallenges that emergency and disasterresponders face as they perform their workand then return to their loved ones and normalroutine. As the family member of a responseworker, you have faced your own challenges inkeeping your household functioning while yourloved one was away. This tip sheet containsuseful information to help you reunite with a lovedone who has returned home after an assignment.
Returning HomeReunions following disaster assignments awayfrom home are usually eagerly anticipated byall. While they can sometimes be harder than weexpect, they can be effectively managed. Whenwelcoming a loved one who is returning fromdisaster response work, keep the following in mind:
� Homecoming is more than an event; it is a process of reconnection for you and all those connected to your loved one.
� Even though coming home represents a returnto safety, security, and “normality” for yourloved one, the routines and pace at home aremarkedly different than life in a disaster zone.
� In your loved one’s absence, you and other household members have likely
assumed many roles and functions that may now need to change. Be patient during this period and recognize that many routines may not return—at least immediately—to what they were like previously.
� It may be helpful to take time to reconnect with your returning loved one before inviting your larger social circle to visit. Take the time you need first.
Before your loved one returns to work and traditional duties, you can help remind him or her to address some basic needs that are often neglected during disaster response work. You can help your returning loved ones in the following ways:
n Encourage them to get adequate rest.n Remind them to maintain a healthy diet and exercise
routine, even if it’s just walking.n Suggest they spend relaxation time with family
and friends.n Remind them of the importance of staying healthy and
seeking medical care as needed.n Help them catch up on neglected daily personal
tasks (e.g., paying bills, mowing the lawn, shopping for groceries).
n Ask them to reflect upon what the experience meant personally and professionally.
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Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) TIPS FOR FAMILIES OF RETURNING DISASTER RESPONDERS:ADJUSTING TO LIFE AT HOME
[email protected] https://store.samhsa.gov
Adjusting to Life at HomeSome other things to keep in mind while adjusting to the return of a loved one includethe following:
� Celebrating a homecoming is important and should reflect your own style, preferences, and traditions.
� Asking your returning loved one to refrain from discussing graphic, gruesome, and highly distressing details will help to avoid upsetting or traumatizing others. This is especially important when discussing the experience with, or in the presence of, children. Consider sharing the more positive aspects of your experience.
� Talking about disaster experiences is a personal and delicate subject for both you and your loved one. Many people prefer to limit sharing such experiences with only a coworker or close friend. Often the need or desire to talk about the disaster experience will vary over time. Let your returning loved one take the lead. Listening rather than asking questions is the guiding rule. You might feel abandonment or anger about your loved one having been away, which might make it hard for you to listen actively and with empathy. These feelings are natural and will likely go away over time.
� Keeping your social calendar fairly free and flexible for the first few weeks after the homecoming is important. Respectthe need for time alone and time with significant others, especially children.
Explain to those who may feel slighted that this is a strong recommendation for returning disaster responders.
� Allowing your loved one an adjustment period will help him or her to adapt physically to the local time zone as well as to environmental changes, such as temperature, continuous noise, or interruptions.
SIGNS OF STRESSBelow is a list of some of the common signs of stressto look for in your returning loved one. These arenormal reactions to working in stressful situations,but if they persist for more than two weeks or worsen,professional help may be needed. Contact yourprimary care physician or seek assistance from atrusted mental health professional. Please also referto the next section of this tip sheet, titled When ToSeek Help.
� Anxiety, restlessness, fear� Insomnia or other sleep problems� Fatigue� Recurring dreams or nightmares or intrusive thoughts� Stomach or gastrointestinal upset/appetite change� Heart palpitations/fluttering� Preoccupation with the disaster events or people
they helped� Sadness and crying easily, hopelessness, or despair� Hyper-vigilance; easily startled� Irritability, anger, resentment, increased conflicts
with friends/family� Overly critical and blaming others or self� Grief, guilt, self-doubt� Increased use of alcohol or other drugs, misuse of
prescription medication� Isolation or social withdrawal� Morbid humor� Decision-making difficulties� Confusion between trivial and major issues� Concentration problems/distractibility� Job- or school-related problems� Decreased libido/sexual interest� Decreased immune response (e.g., frequent colds,
coughs, other illnesses)
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Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) | [email protected] | https://store.samhsa.govTIPS FOR FAMILIES OF RETURNING DISASTER RESPONDERS:
ADJUSTING TO LIFE AT HOME
� Engaging in activities you enjoyed doing together, such as playing games, shopping for food, sharing favorite meals, and other activities can help you reconnect.
� Knowing that your children’s reactions may not be what you or your returning loved one may have expected or desired is important. Very often children will act shy at first. They may withdraw or act angry as a response to their parent’s absence. Be patient and understanding concerning these reactions and give children time to get reacquainted.
� Being flexible with your homecoming expectations will allow you to share time without placing too much pressure on anyone. It is normal to experience some disappointment or letdown when the homecoming is not what you had hoped. The reality of homecomings and reunions seldom matches one’s ideas or desires.
Each day may be different and bring with it new or recurring challenges. With time, patience, and the use of available resources, a positive outcome can be achieved.
When To Seek HelpRemember, post-assignment stress responses like those listed in this tip sheet are generally common reactions to traumatic situations like disasters. However, the following symptoms are signs of severe stress, or could indicate a medical emergency. If your loved one experiences these symptoms, seek the help of a primary care physician or mental health professional. You can also download the SAMHSA Behavioral Health Disaster Response Mobile App and access resources specific to all deployment phases, including tips for re-entry (for responders, supervisors, and family members). The Helpful Resources section at the end of this tip sheet contains links to help you find a licensed mental health or substance abuse clinician.
Signs of when to seek help are as follows:
� Disorientation (e.g., having a “dazed” feeling, experiencing memory loss, not being able to give date/time or recall recent events)
� Significant depression (e.g., pervasive feeling of sadness, feeling alone and without the ability to experience any joy in living)
� Suicidal (e.g., pervasive feelings of hopelessness and despair) or homicidal thoughts or plans
� Anxiety (e.g., constantly on edge, restless, obsessive fear of another disaster)
� Acute psychiatric symptoms (e.g., hearing voices, seeing visions, having delusional thinking)
� Inability to care for self (e.g., not eating, bathing, changing clothing)
� Problematic use of alcohol or drugs, misuse of prescription medication
� Domestic violence, child abuse, or elder abuse
Signs of Positive Change Even though they may be experiencing some signs of stress, many returning disaster responders may also exhibit positive changes from the experience, such as the following:
� Not taking life for granted—living life tothe fullest.
� Becoming more understanding and tolerant.
� Having increased appreciation for relationships and loved ones.
� Being grateful for what they have.
� Having an improved “perspective.”
� Experiencing enhanced spiritual connection.
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Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) | [email protected] | https://store.samhsa.gov
Multiple Disaster Response AssignmentsResponders may be called to another disaster assignment after only a short time home. This can be challenging and stressful for everybody. It is natural to feel sad, even to cry. You have reconnected once again and begun to establish routines. Try to understand if your loved one distances him- or herself physically or emotionally in preparation for leaving.
At the time of departure, it is important that you let your loved one know how proud you are of his or her sacrifice and commitment. Expressing pride while saying goodbye is positive and can help strengthen everyone.
If you or someone you know is struggling after a disaster, you are not alone.
WEB: https://www.samhsa.gov/find-help/disaster-distress-helpline
Call 1-800-985-5990 or text “TalkWithUs” to 66746 to get help and support 24/7.
Helpful Resources Substance Abuse and Mental Health Services Administration (SAMHSA)5600 Fishers LaneRockville, MD 20857 Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) Email: [email protected] SAMHSA Store: https://store.samhsa.gov
Substance Abuse and Mental Health Services AdministrationDisaster Technical Assistance Center (SAMHSA DTAC)Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) Website: https://www.samhsa.gov/dtac
SAMHSA Behavioral Health Disaster Response Mobile App Website: https://store.samhsa.gov/product/PEP13-DKAPP-1
Administration for Children and Families* Website: https://www.acf.hhs.gov/
Department of Veterans Affairs*National Center for Posttraumatic Stress Disorder (PTSD)PTSD Information Voicemail: 1-802-296-6300 Website: https://www.ptsd.va.gov
Treatment LocatorsMental Health and Substance Abuse Treatment Facility Locator Toll-Free: 1-800-662-HELP (1-800-662-4357)(24/7 English and español); TTY: 1-800-487-4889 Website: https://findtreatment.samhsa.gov
MentalHealth.govWebsite: https://www.mentalhealth.govMentalHealth.gov provides U.S. government information and resources on mental health .
HotlineNational Suicide Prevention LifelineToll-Free: 1-800-273-TALK (1-800-273-8255) TTY: 1-800-799-4TTY (1-800-799-4889)Website: https://www.samhsa.govThis resource can be found by accessing the Suicide Prevention Lifeline box once on the SAMHSA website.
*Note: Inclusion of a resource in this fact sheet does not imply endorsement by the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.
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HHS Publication No. SMA-14-4872(Revised 2014; previously NMH05-0220)
·U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESSubstance Abuse and Mental Health Services Administrationwww.samhsa.gov
A Post-Deployment Guide for Families of Emergency and Disaster Response Workers
SAMHSA Resources
Information Clearinghouses
Disaster Technical Assistance Center (DTAC) (800) 308-3515 www.mentalhealth.samhsa.gov/dtac
National Mental Health Information Center (NMHIC)P.O. Box 42557, Washington, DC 20015(800) 789-2647 (English and Español)(866) 889-2647 (TDD)www.mentalhealth.samhsa.gov
National Clearinghouse for Alcohol and Drug Information (NCADI)P.O. Box 2345, Rockville, MD 20847-2345(800) 729-6686 (English and Español)(800) 487-4889 (TDD)www.ncadi.samhsa.gov
Treatment Locators
Mental Health Services Locator(800) 789-2647 (English and Español)(866) 889-2647 (TDD)www.mentalhealth.samhsa.gov/databases
Substance Abuse Treatment Facility Locator(800) 662-HELP (4357) (Toll-Free, 24-Hour English and Español Treatment Referral Service)(800) 487-4889 (TDD)www.fi ndtreatment.samhsa.gov
Hotlines
National Suicide Prevention Lifeline(800) 273-TALK (8255)(800) 799-4889 (TDD)
Other Federal Resources
Centers for Disease Control and Prevention—Mental Healthhttp://www.bt.cdc.gov/mentalhealth/
Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Scienceshttp://www.usuhs.mil/psy/factsheets.html
NMH05-0220
Returning Home After Disaster Relief Work
Getting HelpIf you feel you need additional information, you may find this list of resources to be helpful.
Returning HomeReunions following deployment are usually eagerly anticipated by all. However, they are sometimes more complicated than we may think. When welcoming a loved one who is returning from disaster relief work, keep the following in mind:
Homecoming is more than an event; it is a process of reconnection for your family and loved one.
Though coming home represents a return to safety, security, and return to “normal,” the routines at home are markedly different than life in a disaster zone.
In your loved one’s absence, you and your family members have assumed many roles and functions that may have to now be renegotiated. Be patient during this period and recognize that many things do not return, at least immediately, to what they previously were like.
Go slowly. Your returning loved one, you, and your family need time—time together if possible—before exposure to the demands of the larger community, friends, extended family, and coworkers.
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Adjusting to Life at HomeIn the disaster environment, it is common to talk about things that may be upsetting to people not directly involved (e.g., dead bodies, graphic images). Extreme care should be taken by returning family members (monitored by loved ones) to ensure that relating experiences does not unnecessarily upset or traumatize others. This is especially important in discussing the experience with, or in the presence of, children.
Celebrating a homecoming is important and should refl ect your own family’s style, preferences, and traditions.
Talking about disaster experiences is a personal and delicate subject. Many people prefer to share such experiences with a coworker or friend. Some may want to talk at length about their experience. Sometimes the need/desire to talk about experiences will vacillate a great deal. Let your returning loved one take the lead. Listening rather than asking questions is the guiding rule.
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Keeping your social calendar fairly free and fl exible for the fi rst weeks after the homecoming is wise. Respect the need for time alone and time with especially important people such as spouses. Explain to those who may feel slighted that this is a normal requirement of returning personnel.
Your loved one may need time to adjust to the local time zone, as well as environmental changes such as continuous noise or interruption.
Your children’s reactions may not be what you or the returning loved one may have expected or desired. Very often children will act shy at fi rst. Older children may feel and act angry because of their parent’s absence. Be patient and understanding concerning reactions and give them time to get reacquainted.
Be fl exible with reasonable expectations. It is normal to experience some disappointment or let down when homecomings are not what you had hoped. The reality of homecoming and reunion seldom match one’s fantasies and preconceived scenarios.
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First Things First...Before most recovery workers are ready to return to normal work and family duties, it is important to meet some basic needs that are often neglected during disaster deployment. These include the following:
Maintaining a healthy diet, routine exercise, and adequate rest/sleep
Spending time with family and friends
Paying attention to health concerns
Meeting neglected daily personal tasks (e.g., pay bills, mow lawn, shop for groceries)
Refl ecting upon what the experience has meant personally and professionally
Getting involved in personal and family preparedness.
Signs of StressFollowing is a list that you may fi nd helpful in identifying signs of stress in your family or returning loved one, including:
Anxiety, fear
Grief, guilt, self-doubt, sadness
Irritability, anger, resentment, increased confl icts with friends/family
Increased use of alcohol or other drugs
Feeling overwhelmed, hopeless, despair, depressed
Anticipation of harm to self or others; isolation or social withdrawal
Insomnia
Gait change
Hyper-vigilance; startle reactions
Crying easily
Gallows/morbid humor
Ritualistic behavior
Memory loss, anomia (i.e., diffi culty naming objects or people)
Calculation diffi culties; decisionmaking diffi culties
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Confusion in general and/or confusing trivial with major issues
Concentration problems/distractibility
Reduced attention span and/or preoccupation with disaster
Recurring dreams or nightmares
Fatigue
Nausea
Fine motor tremors
Tics or muscle twitches
Paresthesia (e.g., numbness and tingling in extremities)
Profuse sweating
Dizziness
Stomach or gastrointestinal upset
Heart Palpitations/fl uttering
Choking or smothering sensation
Intrusive thoughts
Relationship problems
Job/school-related problems
Decreased libido/sexual interest
Appetite change
Overly critical, blaming
Decreased immune response.
Possible RedeploymentLeaving home once again and returning to the site of a disaster or other location is stressful for everybody. It is a sad time, and it is natural to feel sad, even to cry. You have drawn close once again and begun to establish routines. Your loved one may psychologically and/or emotionally distance himself/herself in preparation for leaving. Try to understand if this happens.
At the time of departure, it is important that you let your loved one know how proud you are of their sacrifi ce, and their commitment to their job and country. Expressing pride while saying goodbye is positive, and will strengthen you, your children and other family members, and the departing family member.
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When to Seek HelpRemember, pre- or post-deployment stress is a normal reaction to abnormal situations like disasters. If you or a deployed family member experiences the following signs of persistent or severe stress, seek help from a licensed mental health professional.
Disorientation (e.g., dazed, memory loss, unable to give date/time or recall recent events)
Depression (e.g., pervasive feeling of hopelessness and despair, withdrawal from others)
Anxiety (e.g., constantly on edge, restless, obsessive fear of another disaster)
Acute psychiatric symptoms (e.g., hearing voices, seeing visions, delusional thinking)
Inability to care for self (e.g., not eating, bathing, changing clothing, or handling daily life)
Suicidal or homicidal thoughts or plans
Problematic use of alcohol or drugs
Domestic violence, child abuse, or elder abuse
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Increasing attention is being paid to the challenges that recovery workers face as they
perform their work and then return to their families and pre-deployment duties. As a
family member of an emergency or disaster response worker, you have faced your own
challenges in keeping your family functioning while a loved one is away. This brochure
contains useful information to help you reunite with a deployed family member.
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