Transcript of Get Ready Report Podcast, episode 29

Mental health and emergencies

This is the American Public Health Association’s Get Ready Report, coming to you from Washington, D.C., This episode, entitled “Mental Health and Emergencies,” interviews Dr. Robert Motta, director of the Child and Family Trauma Institute at the Saltzman Community Services Center at Hofstra University. He is interviewed by Get Ready Team member Nathan Bhatti.

Can you describe your role as the Director of the Child and Family Trauma Institute at Hofstra University?
Well first of all, I’ve been doing research in trauma and post traumatic stress disorder, for, I’m going to say, 25 years, something in that neighborhood — after a while you lose count. But in any event, what we have tried to do is take these research findings and use them for the good of the community. So we started a Child and Family Trauma Clinic at Hofstra, and the type of people we see are just a general range of people who have experienced various traumas, and that can be anything from war trauma, house fire, rape, hurricanes, anything, but the latest have been mostly the Hurricane Sandy Victims. My role specifically is basically training and supervision so that the people who come to the clinic are screened by me but are seen by our doctoral students in sessions, and I supervise every session that the students see the victims. So my role is to really guide the students and supervise them, in terms of treatments of trauma, it’s just something that I have a lot of experience with. But, in addition, these students are also trained by me in classes, in terms of what is trauma, how is it dealt with, etc. they are pretty confident and comfortable.

In addition to the physical damages caused by natural disasters and health emergencies, what impact can these events have on mental and emotional health?
They can have very dramatic effects on emotional and mental health. Let me put it this way, that all of us have certain assumptions about life, so such things as you work hard and you get ahead, good is preferable to evil, honesty is preferable to dishonesty, that sort of thing. We have these guidance principles and when there is a natural disaster, it’s almost, as if, we begin to question our basic views and assumptions about the world, so that we have an increased sense of self-doubt, we have an increased sense of vulnerability, and I would say an increased pessimism about how the world works and what can happen to a person.

Generally, there’s a significant increase in vulnerability, so when people are traumatized by natural disasters, for example, a certain percentage of them will develop long-standing trauma reactions referred to as post-traumatic stress disorders and these long standing trauma reactions are often characterized by anxiety, depression, suspiciousness, self-doubt and a pessimistic view of the world. But what defines it as post traumatic stress disorder is that it lasts a long time, and sometimes these reactions can last a lifetime. I had one gentleman, who was a survivor of World War II, in his late 80s, and he still has PTSD. He wakes up in the middle of the night, he has panic attacks. I would say that the emotional consequences are much more common than the physical consequences.

As you know, Get Ready seeks to prepare Americans for emergencies before (they) happen, how can families, especially ones with children, prepare for mental health trauma that can occur, especially when disaster strikes as you mentioned?
I think that one of the ways that families can prepare is…the obvious, letting children know that things happen, sitting with them and watching television and explaining to them that these things happen but they’re not the end of the world and we can handle it. So I would say that step 1 is to give the child a sense that yes, bad things happen but mom and dad are able to manage and everything will work out, so you give them a sense of hopefulness.

Let me say, a very important thing that families need to really grasp, that I would say most often do not grasp, that could be very helpful for children is the following: A: Children are very often more influenced by the reactions of the parents than they are by the actual event. So that, for example, in Hurricane Sandy, some children like water and they like mud and they like playing in the dirt that’s not really the issue; what really disturbs the children is not the water in the bedroom, what disturbs the children is the perception that their parents are distressed and maybe not able to cope with it. So, seeing their parents crying, seeing their parents overwhelmed and not being able to cope with it really affects the children more than the actual event.

B: What parents can do is be knowledgeable about this, so they can monitor their reactions and to a certain control during these sorts of events, to give them the sense that mom and dad can handle this, so reassuring the child. So I would say that parents really need to prepare themselves by recognizing that their reactions are going to affect the children more than the event itself. I think that this is a really important piece of the equation.

I remember a case, just to summarize it, is that a boat sank and the family was surrounded by sharks; the family survived and the little girl, who was about three years of age in the water with the sharks, and when she was asked if she was scared, she said no. And when they asked, well why were you not scared, she said “well, Daddy said, just punch the sharks in the nose.” So, this girl really didn’t have a sense that yes, we can be eaten alive and or killed, she just saw that they were surrounded by these big fish and just punch them in the nose and they will go away. So the point I’m trying to make is that children often don’t perceive the actual event with their reaction but are reacting to the parents’ reactions to these events.

How would you suggest that community systems, like workplaces or other areas of our community, how can they get prepared?
That’s a good question. I think that schools and other organizations in the community really need to form networks ahead of time, they really need to form some kind of organization maybe even a call list, where people know that they can help each other, in other words, that there can be groups that are formed that are available to people who are very distressed. Also, schools and communities can do their homework in terms of what are the available services that can be brought up in a given situation. In other words, what emergency services exist — financially and health wise — so that when the emergency does occur, they are prepared. I did definitely get a sense that during our recent experience with the hurricane that people were mostly unprepared. They were trying to problem solve within the midst of a crisis which is really not the way to go. There really ought to be an organizational structure that people can rely on; where they can contact the school and find word about where to find emergency shelter, where to find food — that’s the way to go.

What do you tell your students when you speak about mental health preparedness?
Sure, okay. I would say that one of the critical issues that — this is a difficult issue — that I talk to students about that is very important in term of dealing with mental health issues is the following: One of the things that we know from incredible a considerable amount of research is that people get better when they are able to verbalize, to get off their chests, their concern about, let’s say, a natural disaster or any kind of traumatic event. So when people are able to talk about a traumatic event within the safety and security of, let’s say a therapist or another mental health’s workers office, and that’s how they are going to get better. Dealing with the problem in a non-fearful non-anxious manner is very helpful; okay, so that we know.

But here is the problem, and this is something I talk a lot about with students: The problem is that if you look at the diagnosis of post traumatic stress disorder, one of the defining criteria for diagnosing this disorder is avoidance, so that people who are traumatized, their normal mode of coping, which is not effective at all in the long run, it is to avoid the problem. To avoid thinking about it, to avoid dealing with it, to push it out of their minds, to pretend it didn’t happen, that sort of thing. But, unfortunately that prolongs the emotional distresses that a person experiences that can make the distress go on for many years.

The difficulty that therapists and students face is that they have to get the person to talk about and deal with their trauma, but in doing so, this may cause the patient to leave, to flee, because it creates so much anxiety to discuss these things. The therapist, in this case a student therapist, has to walk a very fine line between encouraging the client to talk about their problems but not pushing too hard that the patient becomes overwhelmed and leaves; in other words you have failed because you provided no treatment whatsoever. So that particular issue of dealing with the problem, but doing it in a gentle way that takes into account the resources and capabilities of the patient is the real tricky part of treating trauma and that’s what we talk about a lot because that is something that even seasoned people like me have lost patients because we push too hard or push too early. You really have to have a feel for them.

A lot of our supervision centers around this issue, about how much can we move forward, how much do we need to delay or soften what we are talking about, maybe we need to talk about other issues, rather than the fact that they lost their homes or someone is injured within their family; balance or timing in therapy is very important.

As someone who is a lay-person and not a clinician, I think it is really important that we understand that these traumatizing events can have really harsh impacts on these individuals, and often we can’t determine how best to help them, so resources and plans should be available in terms of prevention and how to help people and point them in the right direction.
Exactly. Honestly, I must tell you that dealing with trauma and trauma issues is one of the most difficult things because you want to help the person but sometimes — I’m sure you’ve heard the expression, “the road to hell is paved with good intentions” — your best intentions are going to fail because you are too eager to help them and you really have to have a certain pace to get things accomplished. That requires being very sensitive to the patient and how much they can handle and that sort of thing. People vary tremendously in terms of what their capabilities are in dealing with stress.

You mentioned that you and your students were involved in both the relief efforts of, still dealing with, the effects from Hurricane Sandy. Could you briefly describe the work that you and your students were involved in?
Sure. Well, one of them is informational, where we go to libraries and meet with people from the community and primarily talk about what kinds of reactions happen when people are traumatized and the importance of working together and the importance of social support, the real importance of people helping people. That is a very critical piece because in a trauma situation, everybody feels isolated, they feel like “Oh my God, this is happening to me, I’m alone in the world ” So social support is really an important thing. What we noticed is that when we would go into the library, for example, our informational sessions would turn a group therapy session.

The second part of what we do besides from the informational piece is that we are running these therapy groups to have people gather around to talk about their problems and normalize what there are going through and create strategies for social support, etc. We at Hofstra, are having an event, mainly informational, for community mental health workers on Friday, May 17, in which a number of community organizations are going to be coming to learn more about trauma, what’s normal, what’s not normal, what you can do and that sort of thing.

So, I would say that the short answer is two things: One is that we provide information and the other is that we actually run groups for people who are having problems. Usually, the community gets that information through various libraries. We have been going to the Seaford library, and I believe we will be going to another library soon — so those are the two things we do. We have our clinic too where we see people, and for the victims of Hurricane Sandy we are actually providing a free service because the students and I are not getting paid. To me it’s about helping the community and teaching the students that matters. All these Hurricane Sandy people that we are seeing, we’re seeing for free…I think that other universities can do this, I think that other mental health institutions can do this by simply providing a free service because I don’t think that natural disasters have to be profiting — you really ought to help people.

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