August 28, 2003
The Emotional Toll of the Fires: More than Blood Pressure Affected
Many BC residents are currently experiencing great loss and stress associated with the raging fires that have burned in our forests, in some cases destroying residential areas as tragically demonstrated north of Kamloops and in Kelowna this past weekend. Many disaster relief workers, such as firefighters are bravely working around the clock to keep the fire from wreaking more havoc. Others are tirelessly organizing make-shift shelters and coordinating massive evacuation procedures. Losing a home, business or livestock; losing a forest ecosystem and the beauty and recreation opportunities offered by a provincial park and area trails; having nowhere to escape the smell and dense fog of smoke; being worried about friends and family, or fighting the flames to bring people hope — all of these realities are leaving people mentally and physically exhausted, scared and often hopeless.
It is important that people are directed to proper crisis services to deal with their trauma. Crisis lines, mental health centres, or counselling services and physicians’ offices may be experiencing increased flows of people in distress and in need of help for a long time after the flames have gone out.
Some useful tips on how to deal with a natural disaster and the life afterwards:
- shock, anxiety, panic and anger to some degrees are normal and they help people to respond in a timely way to a threat around them. It is important to re-establish an everyday routine such as: regular meals; brushing your teeth; washing yourself; spending time with family, friends and pets
- you can become sad and blue, losing your appetite, becoming hopeless, withdrawn, unable to sleep. Be with other people, talk about it and share news because you will find that others share your problems and sadness; you are not alone
- you can fear for your safety and future and feel regret about things you might have done, or possessions you should have taken with you. Many of these fears will gradually go away as you get established in the community again. Give yourself permission to grieve, and focus on the health and well-being of you and those you care about. Losing a house is devastating, but a home cannot burn: a home is not made of wood, but the people, activities and memories of family and daily life.
Human beings are remarkably resilient. That being said, traumatic events can trigger a range of mental disorders such as major depression or post-traumatic stress disorder. Those with pre-existing mental health problems as well as children are especially vulnerable to the present stress, trauma, and grief triggering further symptoms. Although it is still too early for post-traumatic stress disorder (PTSD) to emerge — an anxiety disorder that occurs when exposure to an unexpected and/or shattering event continues to have a serious negative effect on a person, long after any physical danger has passed — there are steps you can take to avoid it from manifesting itself, and to lower your distress levels. At the same time, it is important to remember that PTSD is very rare after a community trauma or disaster, and unlikely to develop in most people. While it is fairly common for some people to have an acute stress response, only a small proportion of people go on to develop PTSD. It is important to watch out for the following signs in the following weeks and months and contact a medical professional if they persist over the long term:
- having trouble with sleeping and eating
- having low energy, feeling depressed, crying often, feeling hopeless
- being anxious and fearful
- having recurring thoughts or nightmares about the event
- being unable to focus on daily activities
- avoiding activities or places out of fear of the traumatic situation returning
The Interior Health Authority’s Media Centre (www.interiorhealth.ca) has provided a useful list of crisis lines and mental health centres in the region with their contacts as well as information for youth, volunteers, seniors and other adults on how to deal with the present situation.
People can also turn to CMHA branches for help in finding resources and supports in their community. The CMHA BC Division website at www.cmha.bc.ca, the Anxiety Disorders Association of BC web site at www.anxietybc.com, and the CMHA-staffed Mental Health Information Line at 1-800-661-2121 provide detailed information about these and other mental health issues.
The Canadian Mental Health Association in BC is a charitable association which promotes the mental health of all British Columbians through community-based programs, education, and information and research services. We also encourage public involvement to strengthen mental health services, policy and legislation.
How Children and Adolescents React to Trauma/Disasters
Reactions to trauma or natural disasters may appear immediately after the event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary according to age:
For children 5 years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also notice children returning to behaviours exhibited at earlier ages (these are called regressive behaviours), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.
Children 6 to 11 years old may show extreme withdrawal, disruptive behaviour, and/or inability to pay attention. Regressive behaviours, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age. Also the child may complain of stomach aches or other bodily symptoms that have no medical basis. Schoolwork often suffers. Depression, anxiety, feelings of guilt and emotional numbing or "flatness" are often present as well.
Adolescents 12 to 17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, and anti-social behaviour. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion.
Some youngsters are more vulnerable to trauma than others, for reasons scientists don't fully understand. It has been shown that the impact of a traumatic event is likely to be greatest in the child or adolescent who previously has been the victim of child abuse or some other form of trauma, or who already had a mental health problem. And the youngster who lacks family support is more at risk for a poor recovery.
How to help
Early intervention to help children and adolescents who have suffered trauma from violence or a disaster is critical. Parents, teachers and mental health professionals can do a great deal to help these youngsters recover. Help should begin at the scene of the traumatic event and includes the following:
- Find ways to protect children from further harm and from further exposure to traumatic stimuli. If possible, create a safe haven for them. Protect children from onlookers and the media covering the story.
- When possible, direct children who are able to walk away from the site of destruction and away from continuing danger. Kind but firm direction is needed.
- Identify children in acute distress and stay with them until initial stabilization occurs. Acute distress includes panic (marked by trembling, agitation, rambling speech, becoming mute, or erratic behaviour) and intense grief (signs include loud crying, rage, or immobility).
- Use a supportive and compassionate verbal or non-verbal exchange (such as a hug, if appropriate) with the child to help him or her feel safe. However brief or temporary the exchange, such reassurances are important to children.
After a disaster occurs, the family is the first-line resource for helping. Among the things that parents and other caring adults can do are:
- Explain the natural disaster as well as you are able.
- Encourage the children to express their feelings and listen without passing judgment. Help younger children learn to use words that express their feelings. However, do not force discussion of the traumatic event.
- Let children and adolescents know that it is normal to feel upset after something bad happens.
- Allow time for the youngsters to experience and talk about their feelings. At home, however, a gradual return to routine can be reassuring to the child.
- If your children are fearful, reassure them that you love them and will take care of them. Stay together as a family as much as possible.
- If behaviour at bedtime is a problem, give the child extra time and reassurance. Let him or her sleep with a light on or in your room for a limited time if necessary.
- Reassure children and adolescents that the traumatic event was not their fault.
- Do not criticize regressive behaviour or shame the child with words like "babyish."
- Allow children to cry or be sad. Don't expect them to be brave or tough.
- Encourage children and teens to feel in control. Let them make some decisions about meals, what to wear, etc.
- Take care of yourself so you can take care of the children.
When disaster affects a whole school or community, teachers and school administrators can play a major role in the healing process. Some of the things educators can do are:
- If possible, give yourself a bit of time to come to terms with the event before you attempt to reassure the children. Sometimes in a natural disaster there will be several days before schools reopen and teachers can take the time to prepare themselves emotionally.
- Don't try to rush back to ordinary school routines too soon. Give the children or adolescents time to talk over the traumatic event and express their feelings about it.
- Respect the preferences of children who do not want to participate in class discussions about the traumatic event. Do not force discussion or repeatedly bring up the catastrophic event; doing so may re-traumatize children.
- Hold in-school sessions with entire classes, with smaller groups of students, or with individual students. These sessions can be very useful in letting students know that their fears and concerns are normal reactions. Many communities have counselling teams that will go into schools to hold such sessions after a disaster. Involve mental health professionals in these activities if possible.
- Offer art and play therapy for young children in school.
- Be sensitive to cultural differences among the children. In some cultures, for example, it is not acceptable to express negative emotions. Also, the child who is reluctant to make eye contact with a teacher may not be depressed, but may simply be exhibiting behaviour appropriate to his or her culture.
- Encourage children to develop coping and problem-solving skills and age-appropriate methods for managing anxiety.
- Hold meetings for parents to discuss the traumatic event, their children's response to it, and how they and you can help. Involve mental health professionals in these meetings if possible.
Most children and adolescents, if given support such as that described above, will recover almost completely from the fear and anxiety caused by a traumatic experience within a few weeks. However, some children and adolescents will need more help perhaps over a longer period of time in order to heal. Grief over the loss of a home may take months to resolve, and may be reawakened by reminders such as media reports or visiting the site of a burned home. It’s important to identify the youngsters who are in need of more intensive support and therapy because of profound grief or some other extreme emotion. Children and adolescents who may require the help of a mental health professional include those who show avoidance behaviour, such as resisting or refusing to go places that remind them of the place where the traumatic event occurred, and emotional numbing, a diminished emotional response or lack of feeling toward the event. Youngsters who have more common reactions including re-experiencing the trauma, or reliving it in the form of nightmares and disturbing recollections during the day, and hyperarousal, including sleep disturbances and a tendency to be easily startled, may respond well to supportive reassurance from parents and teachers.
(from National Institute of Mental Health)
Teri Johnson
CMHA Kootenays
426-5222
Jennifer Marte
CMHA Kelowna
861-3644
Murphy Kennedy
CMHA Kamloops
374-0440
Sandy Rysen
CMHA Vernon/Salmon Arm
542-3114
Provincial media contacts:
Sarah Hamid-Balma
Public Education and Communications Coordinator
CMHA BC Division
604-688-3234 or 1-800-555-8222
Dr. Sarah Newth
Anxiety Disorders Association of BC
604-822-7921
