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MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM: A FIELD GUIDE

CHAPTER V: Populations with Special Needs

• Age Groups
• Table 1: Reactions to Trauma
• Highly Impacted Survivors and Families
• Cultural, Ethnic, and Racial Groups
• People with Serious and Persistent Mental Illness
• Human Service, Criminal Justice, and Emergency Response Workers

Terrorism and mass violence inevitably touch all who are in their zone of impact. This zone may include people of different ages and economic means; people of various cultural, racial, and ethnic backgrounds; people with different sexual orientations and family configurations; people who speak foreign languages; people from many occupational groups; and people who have roles in emergency response and recovery efforts.

The basic human need for survival, safety, protection, connection with loved ones, and accurate information are shared, while additional needs may be more specific to a particular group. Workers are most effective when they are informed about, respectful of, and responsive to the various groups in the affected community. Special consideration should be given to the following groups as well as others with special needs:

• Age groups (e.g., children, teenagers, older adults);
• Highly impacted survivors and families;
• Cultural, ethnic, and racial groups;
• People with serious and persistent mental illness;
• Human service, criminal justice, and emergency response workers.

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Age Groups

Each age group is vulnerable in unique ways to the stress of trauma, victimization, and sudden bereavement. Some of the reactions listed in Table 1 may be immediate, while others may appear months later. Table 1 describes possible behavioral, physical, and emotional reactions of different age groups and options for helpful intervention.

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Highly Impacted Survivors and Families

Research has shown that those who directly experience violent victimization and mass traumatization, witness the serious injury and physical mutilation of others, or suffer the murder of a loved one have a likelihood of intense and prolonged emotional, behavioral, and physical reactions. They are likely to suffer high levels of distress during the immediate response phase and may have periods of difficulty for years to come. Critical events that occur throughout the criminal justice process, such as trials, sentencing hearings, and appeals, are especially significant to this group and are often linked to restimulation of psychological wounds.

Workers support these survivors and family members by providing respectful and practical assistance, making needed information reliably available, and supporting the multiple pathways for coming to terms with overwhelming trauma and loss. Religious and cultural traditions; spiritual practices; community, family, and personal rituals; and symbolic gestures can soothe survivors' anguish and assist them with finding meaning and the courage to continue living. At different points during the process of coming to terms with loss and trauma, activities and interventions such as counseling, support groups, medication, spiritual guidance, social activism, helping others, artistic expression, and symbolic healing rituals may be helpful.

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Cultural, Ethnic, and Racial Groups

Workers must respond sensitively and specifically to the various cultural groups affected by mass violence. The death of a loved one, community trauma, and mass victimization are interwoven with cultural overlays. Rituals surrounding death, the appropriate handling of physical remains, funerals, burials, memorials, and belief in an afterlife are all deeply embedded in culture and religion. The serious injury of a family member brings families from different cultures into contact with Western medicine and the healthcare delivery system. The situation may be even more challenging when English is not the family's primary language.

Cultural and ethnic groups with histories of violent oppression, terrorism, or war in their countries of origin may interpret community violence in the United States through their experiences of prior traumatization. Those who have suffered from political oppression and abuses of military power may find the prominent visibility of uniformed personnel highly distressing or even traumatizing. Some survivor groups may live in a context of poverty, discrimination, or marginalization and face high rates of violent crime in their neighborhoods, potentially making them more vulnerable to disaster impact.

Workers convey cultural sensitivity when they provide informational briefings, notifications, and applications for services and benefits in primary spoken languages. Workers must learn about each affected group's cultural norms, practices, and traditions; views regarding mental health, trauma, and grieving; and the group's local history and community politics. Establishing working relationships with trusted organizations, service providers, and community leaders often facilitates increased acceptance.

Workers communicate cultural sensitivity when they:

• Use culturally accepted courteous behavior (e.g., greetings, physical space, know who is considered "family");
• Describe their role in culturally relevant terms;
• Take time to establish rapport;
• Provide information and services in appropriate languages;
• Ask about cultural practices when they are unsure;
• Value diversity and respect differences;
• Develop and adapt approaches and services to fit special group needs.

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People with Serious and Persistent Mental Illness

Many survivors with mental illness function fairly well following a community disaster, especially if essential services and support networks have not been interrupted. Most have the same capacity as the general population to "rise to the occasion" and perform heroically during the immediate response period. However, those who are directly involved and traumatized by the event may need additional mental health support services, medications, or hospitalization to regain stability. For survivors previously diagnosed with posttraumatic stress disorder (PTSD), emergency response stimuli (e.g., sirens, helicopters, mass casualties) may trigger an exacerbation due to associations with prior traumatic events.

The range of support services designed for the general population is equally beneficial for survivors and family members with mental illness. As with all special population groups, workers need to be aware of how people with mental illness perceive disaster assistance and services, and build bridges that facilitate access.

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Human Service, Criminal Justice, and Emergency Response Workers

Workers in all aspects of emergency response and disaster relief experience considerable demands to meet the needs of survivors, families, and the community. Depending on their role, workers may be exposed to human suffering, fatalities, people with serious physical injuries, family demands and anguish, community anger, and other difficulties. They may experience physical stress symptoms or show signs of stress overload. Indicators include irritability, over-involvement with and inability to leave the operation, difficulty focusing, being unproductive, feeling depressed, or feeling emotionally overwhelmed. Workers may intervene by suggesting or using the strategies described in the next section.

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