When it comes to disasters and mass casualty events, “it’s never a question of ‘if’; it’s only a question of where, when and what type,” Wayne Dailey, PhD, Assistant Clinical Professor, told attendees at the Feb. 21 meeting of the Yale Division of Public Psychiatry.
The Division of Public Psychiatry is an academic division spanning across the institutions within the Department of Psychiatry. It is organized to support scholarship, educational activities, and policy development associated with the field of public psychiatry.
The meeting, held at the Connecticut Mental Health Center (CMHC), focused specifically on disaster mental health response when preparing for disasters and mass casualty events.
“When a big disaster hits, it throws people back on their heels,” Dailey said. “People who have competent lives, for the most part, are all of a sudden bewildered, overcome, feel hopeless and helpless, and so what you want to do is try to reconnect them with their strengths and with other assets that can assist them in their recovery and plan for their recovery.”
Dailey is a licensed clinical psychologist who served for four years as Deputy Commissioner of the Connecticut Department of Mental Health. He helped organize and lead the Connecticut Disaster Behavioral Health Response Network (DBHRN), which served as a model for many other states.
Dailey served on over 30 disaster and mass casualty deployments, including the Sept. 11 terrorist attacks, the Boston Marathon bombing, the Sandy Hook Elementary School shooting and the fatal World War II-era B-17 bomber crash at Bradley International Airport.
Dailey described the differences between treating patients in a disaster situation, versus in a clinical setting.
“The initial focus in a disaster relief operation is on the immediate needs of people that are directly affected in the communities that are directly affected,” he said.
One of the primary differences, he said, is that disaster mental health operations are typically not office based.
“The initial response is face-to-face, it’s in the field,” he said. “You go to where the client is, not ask them to go to you.”
Most interventions use psychological first aid and are very brief, he said. A responder may only work with someone for as little as 15 minutes.
Many individuals with an urgent need for mental health supports following a natural disaster can be expected to include many people with no significant pre-disaster mental health needs, Dailey said.
Dailey said the first priority in mental health disaster response is making people feel safe where they are and address any immediate needs for food, water or shelter.
“And then spend time with them noodling out, how have they dealt with big problems in the past? Who are their resource people?” he explained. “You can’t go back to change the past. … But we try to get people focused on the here and now. You can’t fix [what happened], but what can you do right now to take a small step, within the next two or three hours … to make things a little bit better rather than a little bit worse.”
Dailey’s presentation was a precursor to preliminary discussions surrounding willingness to form a disaster response team at CMHC. The team would be trained and prepared for deployment to assist in disaster situations locally, and potentially elsewhere.
Dailey explained typical challenges disaster mental health response teams face, including a significant pressure to act quickly and respond, regardless of whether a provider is at or over capacity, or whether they are assured that additional resources will be provided. Additionally, disaster planning requires developing a continuity of operations and contingency plan to support existing staff and clients.
But ultimately, participating in mental health disaster response is a rewarding experience, Dailey said.
“Assisting people in crisis situations can be a great learning experience and a means to achieve personal and professional satisfaction that can go beyond typical day-to-day work. It’s a wonderful humbling experience, as well.”