SUPPORT FOR THOSE LEFT BEHIND

Joseph O. Prewitt Diaz[1]

We take great pride in sending or younger man and woman on combat missions to different parts of the world. We have welcomed back troops from Iraq and Afghanistan. The injured are handled differently, and the psychosocial support for the next of kin and extended family are not clearly articulated.  At times we have had to receive the remains of fallen heroes. On at least twenty occasions in the last three years, I have witnessed how the rites of mourning are at times not culturally, linguistically or psychosocially appropriate. There are at least three basic moments that support is needed: (1) the mechanics of handling the notification, (2) the funeral, and (3) the support received by the next of kin and extended family after the event.

The notification is frequently handled in two segments; first a warrior shows up to the home of record, gives the news of the loss and leaves. The second part is the arrival of a chaplain, and a liaison to assist the family in preparing the funeral services. In that very first private moment where “shock” sets in, the television cameras show up and begin a process of intrusive inquiry.  The respect paid to the grieving next of kin is a “camera on you face”. The format is that they show the next of kin crying, they show someone reading a recent email, and that ends the appreciation of a grateful nation for the sacrifice of one of its hero’s.

The funeral services come out of the “standard book” and culminate with a folded flag handed to the next of kin. That folded flag signifies the sacrifice of the fallen warrior, and the beginning of a new life of loneliness and despair for the next of kin and the extended family.

The support phase because of its length and complexity needs to be carefully planned. The official support system is located in a military installation, the Veterans Administration, and the Office of the member of Congress. The focus is on how the insurance monies are invested on behalf of the survivor. There are no visits to the home. Veterans Administration is located in the capitol city and there are limited outreach services. Local government doesn’t have the wherewithal for serving the survivors needs and rely on Veteran’s organizations for support. On all cases the focus is survival, the spiritual and psychosocial support needed available to the survivors is limited or non-existent. I was told by a government official recently “we are well prepared to handle the funeral, but can’t assist the survivors for an extended period of time that is the role of the family and the church”.

To continue to expand and fine-tune psychosocial support programs for the survivors of heroes I suggest that we study the words of a great Soldier and Statesman called Pericles. He teaches us in his Funeral Oration after the Peloponnesian War (Thucydides (c.460/455-c.399 BCE): Peloponnesian War, Book 2.34-46):

"Comfort, is what I have to offer to the parents of the dead who may be here. Numberless are the chances to which, as they know, the life of man is subject; but fortunate indeed are they who draw for their lot a death so glorious as that which has caused your mourning, and to whom life has been so exactly measured as to terminate in the happiness in which it has been passed. Turning to the sons or brothers of the dead, I see an arduous struggle before you. When a man is gone, all are wont to praise him, and should your merit be ever so transcendent, you will still find it difficult not merely to overtake, but even to approach their renown. If I must say anything on the subject of female excellence to those of you who will now be in widowhood, it will be all comprised in this brief exhortation. Great will be your glory in not falling short of your natural character; and greatest will be hers who is least talked of among the men, whether for good or for bad”.

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[1] Dr. Prewitt Diaz is a Visiting Professor in the School of Law of the University of Puerto Rico, and Director of the Disaster Law Center. He was awarded the 2008 APA International Humanitarian Award.  He is a trainer for disaster mental health professionals and chaplains in Puerto Rico. 

CRISIS COMMUNICATION, PSYCHOSOCIAL SUPPORT AND THE AMERICAN WAY

Crisis Communications is a required subject to achieve a “Certificate in Emergency/ Crisis  Management”. Most bureaucrats and politicians are trained in the subject. I became increasingly interested in the subject when the Director of FEMA had to resign in the high of the Katrina response. As I recall the TV clip, he was more interested in the color of shirt that he was going to wear for the interview, and spent precious hours with previous appointments that had nothing to do with the thousands of people displaced from New Orleans in the aftermath of Katrina.

The last week has been a time of crisis in the United States, and very little crisis communication has taken place between those that created the crisis that has sent millions of Americans on the road to despair. We began with the approval of laws regarding the external debt of the United States, continued with a down turn in the market, leading to a decrease S&P credit rating the rating of the United States to AA+.  The politicians decided that they needed a rest, and so Washington closed down for a five-week rest, where members of Congress went back to their District or on junkets so that they could conjure new ways to continue to take money out of the common man’s pocket. Thank you God!!! Between the rightist from the Tea Party, the Moderates from both parties and the populist from the left only God knows what now measures they would have concocted to “save the country” that would have resulted in greater calamity for the American people.

While politicians covered or scratched each other’s back, the real Americans, the patriots were at work. Yesterday morning we woke up to the news that 30 Americans had lost their life in the battlefield. All the President could offer to those American families that have been sacrificing so much was an a acknowledgement that their dear ones had fallen in the battlefield. I wonder if, whether or when the Nation will honor those heroes with the same intensity as that wasted to make a political point in the Halls of Government the last few weeks. You see most of those men were “Navy Seals”, heroes only known to God!

Crisis communications suggest that in spite of great odds and difficulties the interlocutor has to provide accurate and timely information. It also recommends that for the well-being of all communication has to be such as to create an environment that fosters safety, connectedness, and has a calming effects on the individual and the community as a whole. It further suggests that a small group of people will be so affected that they may need to be referred for psycho-education and/or professional assistance.

Well the time has come to acknowledge that crisis communications have failed; there is a perception that government has failed its people (except the rich and power brokers). There is no longer a feeling of safety in our country. Those who can defend us are deployed half way around the world, and they too have been led down by the chain of command. There is no calmness, joblessness is on the rise, the economic measures suggested by the President have not worked, State governments are shutting down, elected politician are running away to other States so that they don’t have to make hard choices, the blame game is being played all over. How can we be calm? To boot, the programs that are being earmarked for cuts are the community mobilization, community clinics, and community mental health.  What are the elements of psychosocial support needed in such a sick environment?

Fortunately tomorrow is Monday, a new week begins with people in the corners of little towns and cities and freeway exits with cardboard sign saying “Handiman, busco trabajo!”.  Farmers will be cited for providing employment to children. And yet, another committee will be formed to offer solution to the psychosocial support needs of our population. 


All the while politicians and CNN, will continue, under the guise of transparency, to inflame the psyche of the common man/woman, probably increasing the symptoms of high blood pressure, heart conditions and strokes, while the politicians in Washington continue to fund raise for the next election and reduce the funds for physical and behavioral health programs, and many of our heroes die in the battle field to preserve freedom, safety and our rights of free speech. This is the American Way!!!

Psychosocial Support in the aftermath of the Oslo Bombings

Joseph O. Prewitt Diaz[1], PhD

I was astounded and saddened with the news of the bombing and shooting incident in a campground in Oslo yesterday. Our sincere and deepest condolences, to all the citizens of Norway.

Terrorism, whether from the right or the left, as a way to shake world order, seems to be on the increase.  The message to the world was “loud and clear” – terrorist will attack soft targets, to make themselves heard. The question for the world to ponder is what are the appropriate actions to reduce violence against the vulnerable civilian populace. Certainly peaceful actions will lead in-kind to peaceful results.

At prima-facia the bombing and shooting will certainly have an effect on the affected population, and on the Norwegian nation as a whole. The affected people are (1) the family and friends of those that lost their life or were injured, and (2) those that are watching the drama unfold on TV or through other media sources, without enough information wondering about their safety and well being.  

Three common reactions that will emerge are

•  Hatred, prejudices, animosity and distrust may increase due to person-blame behaviors.
• Some will unable to yet comprehend the tragedy that had struck them and will be numb and silent. Certain incidents might trigger off hidden fears and expressions of violent behavior.
• As the survivors return to their places many will feel psychological safety. A small group will feel uncertain and hopeless about their future. They will begin looking for a new place that they perceive as ‘safe".   

Psychosocial strategies:


As the first responders and mental health professionals approach the event-affected people. There are three needs that they may have. (1) Develop faith and trust. (2) An understanding that while most of the youth may recover, in the next few days, much stronger and more resilient. Others may not recover as quickly and will need grief counseling, and/or consultation with mental health professionals. (3) Potential short term response may include psycho-education, adequate and timely information, active participation in grieving rites, and an opportunity to share their feelings will lead to a feeling of comfort, well being, and an emerged hope for a safer future.

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[1] Dr. Prewitt Diaz is a humanitarian Psychologist who serves as a Visiting Professor and Director of the Disaster Law Center, School of Law, University of Puerto Rico. Her served with the American Red Cross as a Disaster Mental Health officer during the Oklahoma City Bombing and the 9/11 response in Somerset, PA.  He was the recipient of the APA International Humanitarian Award in 2008.

Top 10 Articles Published in Community Based Psychosocial Support since 2008

Prewitt Diaz JO: Integrating psychosocial programs in multi-sector responses to international disasters. Am Psychol; 2008 Nov;63(8):820-7.


North CS: A tale of two studies of two disasters: comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees. Rehabil Psychol; 2010 Aug;55(3):241-6. 


Henley R, Marshall R, Vetter S: Integrating mental health services into humanitarian relief responses to social emergencies, disasters, and conflicts: a case study. J Behav Health Serv Res; 2011 Jan;38(1):132-41.

Williams R, Alexander DA, Bolsover D, Bakke FK: Children, resilience and disasters: recent evidence that should influence a model of psychosocial care. Curr Opin Psychiatry; 2008 Jul;21(4):338-44.

Te Brake H, Dückers M, De Vries M, Van Duin D, Rooze M, Spreeuwenberg C: Early psychosocial interventions after disasters, terrorism, and other shocking events: guideline development. Nurs Health Sci; 2009 Dec;11(4):336-43. 


Udomratn P: Mental health and the psychosocial consequences of natural disasters in Asia. Int Rev Psychiatry; 2008 Oct;20(5):441-4.

Smith E, Wasiak J, Sen A, Archer F, Burkle FM Jr: Three decades of disasters: a review of disaster-specific literature from 1977-2009. Prehosp Disaster Med; 2009 Jul-Aug;24(4):306-11.

Walsh DS: Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: an integrative review. Int J Nurs Pract; 2009 Aug;15(4):231-40.


Ray-Bennett NS: The role of microcredit in reducing women's vulnerabilities to multiple disasters. Disasters; 2010 Jan;34(1):240-60.

Findley SE, Sanchez M, Mejia M, Ferreira R, Pena O, Matos S, Stockwell MS, Irigoyen M: Effective strategies for integrating immunization promotion into community programs. Health Promot Pract; 2009 Apr;10(2 Suppl):128S-137S. 

Psychosocial support is a simple tool for protection and community development

Joseph O. Prewitt Diaz[1] PhD

An increase in natural disasters and conflicts, an awareness of disaster-affected peoples needs, and a group of people that assured that the human rights of disaster affected people are protected has created the synergy for psychosocial support to be acknowledged and placed at the forefront of disaster response.

This synergy has created guidelines and standards that are to be upheld in responding to a disaster. But, what is community based psychosocial social support? Form my optic it is a set of activities that involves psychosocial actions, planning and establishing of  “place”.

Psychosocial actions are the result of community members joining together to identify those activities that impact the quality of life. After a disaster, community mapping, and gathering of data through inclusive community meetings leads to identifying projects that will increase voluntarism, contribute to change, and fosters social planning.

Psychosocial planning consist of three phases: In the first place establish dialogue between all segments of the community, decide the risks and resilience factors, and describe strategies to influence leadership and external stakeholders to develop policies that will impact eh affected-community. Secondly, move from developing policies to implementing policies by identifying programs that are needed to address risks factors and the mechanics of developing the program, Thirdly, engage the community members in activities that will address the needs of all segments of the community. These activities lead people by defining their “place” by focusing on feelings, motives and purposes of the affected-people.

Community based psychosocial support is a developmental cycle by transforming victims into practitioners, and new arrivals into volunteers. There changing knowledge, skills and communication within and without are part of a developing identity--- a re-established place.

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[1] Dr. Prewitt Diaz is a Visiting Professor and Director of the Disaster Law and Policy Center, School of Law, University of Puerto Rico. He was awarded the Distinguished Service Award from the Indian Red Cross Society for the development of psychosocial support programs in several Indian States. 

Learnings from Psychosocial Supports projects managed by external “Experts” after disasters

Joseph O. Prewitt Diaz,[1] PhD

I just completed over fifty after action reports of psychosocial support programs during the 2004 South Asia Tsunami and the January 2010 Haiti Earthquake. We were trying to understand the impact of external psychosocial experts in diverse groups ranging from community organizations (local NGO’s and GO) to work organizations (INGO’s representing the UN family the Red Cross family and the Faith based family).

Findings:

1.     Many projects were conducted to achieve justice (defined as equal opportunity or equity within a given context). Societal equity in several cases was defined based on the world-view of the external experts rather than consulting the disaster-affected people. Shared resources and mutual concerns for each other were not considered in the development of the projects.  This resulted in a lack of knowledge about shared but unspoken values, norms and cultural practices. The projects lasted as long as the ex-patriate expert remained in-situ and disappeared or was reformulated as soon as the expatriate left the area.

2.     Extensive and excessive use of participation in coordinating groups created a “we-they” relationship with the disaster-affected groups. This let to strong monolithic team culture that focused on the groups “own” job and a self-protective stance (ie. PSP group, WASH watsan groups or the protection cluster).

Lessons learned

1.     Reach out and develop connections within the context of the affected-people. This will foster mutual respect, and a desire to work together, volunteer, identify and use own social capital, and rely on community leadership and skills to improve the well-being in their communities.

2.     Neutralize the “we-they”. Some of the most mentioned suggestions were: (a) community meetings and “melas” (focused meetings), (b) assure representation of all segments of the community (women, children, elderly and differently abled among the most important), and (c) through needs assessment and community mapping activities identify and prioritize particular problems or concerns, and identify the methods on how to tackle the challenge.

3.     Spend significant time building trust and showing respect for the disaster-affected people.

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