A Brief Look at Some Mental Health Issues When You're Helping Others

Planning on being in a disaster? Well, no, of course not. It's not the sort of thing you generally plan for (except for a few of us in places like the American Red Cross and the Marin County Health and Human Services folks). But still, in a matter of minutes, you might find yourself in a disaster area and, if you are among the uninjured, you might end up helping your friends and neighbors.

One thing you'll find whether you go to a disaster area on purpose to help out or just find yourself in a disaster area by an unhappy coincidence is that the care and sheltering aspect is huge. And, while not everyone is a trained medical professional treating broken bones and bruises, virtually everyone is by default a mental health worker.


For that reason, you'll need to know a few basics. Just having read a blog post sometime in which a few granules of information embedded in your brain can be enough, so let's give it a go!

The Marin County Health & Human Services Department recently hosted a training at its Canal Neighborhood San Rafael Campus. While it had a lot of useful information in it, I've also peppered in some information from the American Red Cross and from some personal experience.


If you find yourself working in a shelter, let's say a community center, a school gym or a church that's been turned into a shelter, everyone who walks in is a mental health patient to some extent. They are all suffering from stress to some degree and your job is to comfort them and to determine if they are in need of speaking to a mental health professional.

Image Credit: Affinity Rescue

Emergency room nurses and doctors speak of The Golden Hour. That's the very first hour from when a patient is in need of care, perhaps from an accident or a stroke. If they can make it to the hospital for treatment within that first hour, their odds of survival are much better statistically. For every additional minute after that first hour that they are not yet in a doctor's care, the odds of their survival become increasingly worse.


In the disaster mental health field, they talk about The Golden Month. People that are diagnosed and treated for mental health in the first 30 days after being affected by a disaster are less likely to have Post Traumatic Stress Disorder (PTSD) as a result of their experience. So, as someone helping people at the scene of a disaster or a location they've been evacuated to, you are the front line of mental health treatment. You are best positioned to quickly get a survivor the mental health assistance he or she might need.


At this stage, it's also useful to mention Retraumatization. That's something you want to try and minimize. Otherwise, it is a like a mental hammer to the head being applied over and over before someone who was at least okay is no longer doing fine and is at risk for PTSD.

So, what's Retraumatization?

An overwhelmed television media creates a PTSD nightmare
by reairing the same images of the towers over and over.

The best example that comes to mind (no pun intended) is the television media airing the collapsing of the Twin Towers over and over and over while people who were involved were still trying to mentally process what they had just been through. The more they watched, the more they felt the same sensation of the world collapsing around them over and over and over.


In a shelter setting, addressing retraumatization may be as simple as pulling a shade over a window that shows the fire ravaged landscape outside or putting a Disney movie on a television that was previously showing a building collapsing during the earthquake that just happened repeatedly. It's really common sense. Try and look at the environment you are in through the eyes of those affected by recent events and see if there's anything that makes them feel unsafe or vulnerable.

This actually is not Dr. Chip
Schreiber but Leiv Schreiber
is a damn good looking man
and this blog article seemed a
little on the dry side.

Dr. Chip Schreiber, who was quoted often in the Marin Health Services training, recommends disaster victims be addressed with "Listen, Protect and Connect." So, what does that mean in practice? Let's take a stab at that.

1. Listen: Resist that urge to complete a registration form or other related paperwork to rush to get to the next person. Ask about loved ones, neighbors (who may or may not be in the previous category), pets and their personal well being. Ask them what the experience was like. And, above all, listen to what they have to say and ask them to elaborate on points that seem to strike a nerve with them. If they are talking to you, that's a great sign. It means they are processing and sharing.
2. Protect: Tell them why they are safer now. Is the shelter out of a fire zone? Was a built to withstand a major earthquake like they one they just experienced? Is it above the flood level during a flash flood crisis? Are there trained doctors and nurses onsite to help just in case someone needs them? Is there ample food and water? Are there ways for loved ones to check online to find out they are safe and secure? Explain why they can now safer than they were an hour ago and that will give them permission to get out of survival mode and perhaps get a little rest.
3. Connect: Be real. No, really, be real. Don't tell them you "understand what they're going through" or that "other people have made it through worse." As a matter of fact, if their situation sucks because they've lost a home or can't find a pet or something like that, tell them that it sucks and that you are sorry they have to go through something like that. Let them know you are there for them. One Marin County worker in our class who was an admitted introvert, said one of the nicest things someone could do for her in a time of need was to sit there and ask nothing and say nothing for hours. Just be there. Don't try and solve anything. Don't try and say that when you were helping out in Whogivesablankistan that you saw much worse conditions. Just be real and be there and that's enough.

But, with all your good intentions, there are going to be people that you can't help on your own. Remember? Even Dr. Seuss told us:

Except when you don't.

Because, sometimes, you won't.

I'm sorry to say so

but, sadly, it's true

that Bang-ups

and Hang-ups

can happen to you.

In this case, that means you'll need to be ready to get a mental health professional involved. By "getting involved," I don't mean it's like ringing the bell at Trader Joe's when someone brings their own bags and yelling "I've got one that's three sockets short of a full set of wrenches here!" No, it's more like just making it part of the natural welcome to the shelter flow by matter of factly saying "There's one more person I'd like you to meet before we get you settled in." and introducing the person in need of some assistance to a mental health professional with a simple "Steve, this is Beth and she's going to finish up your registration." (No "Dr" please.) 


Naturally, you might be asking when you need to get a mental health professional involved. Here are a few things to look for:

• Disoriented: Do they seem like they aren't quite sure where they are or how they got there? Are they detached from reality?
• Depressed: Are they sleepy? Does it seem like they just don't care what happens going forward now that they've been through this disaster?
• Anxiety: Are they having trouble sitting still? Are simple decisions impossible to make? ("Would you like some water?" "I'm not sure.") Are they irritable?
• Mental Illness: If asked about their medication, do they include any prescriptions for anxiety or depression? Do they have difficulty remembering their name, the date, who's president?
• Addiction: Are they shaking, especially the hands? Are they scratching? Are their pupils remaining dilated? Slurred speech? How are they on Day 3, if they are still there? That's the day withdrawal from alcohol and many drugs becomes the most intense.
• Abuse: Do they seem inordinately afraid of other people? Are they concerned about whether a spouse can walk in and ask if they're at the shelter (Red Crossers know, they can't)? Do they flinch or startle easy when handed something, even a pen or a bottle of water?

Ty Webb, Philosopher to Teens of the 1980s

To wrap this up, I really want to reassure you as someone who is always trying to learn a little more, but never seems to know enough about any particular thing, it's okay you aren't an expert. If this blog article or a class you took with your employer or a relief organization like the Red Cross gave you just one tip, that's enough. Just trying to help people, however imperfectly we all do it, is enough. If your heart is in it and you sincerely care, those you are helping will see that and they'll immediately be on your team. In other words, to quote Ty Webb (Chevy Chase in Caddyshack): "Be the ball." And really, in this case, it's true. Be the ball and the rest will just figure itself out. 



And, if Ty Webb isn't your thing when it comes to your philosophy about helping those in a disaster, it turns out there are also a few quotes from Mother Teresa on the subject.

"We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop."