Disaster

Mental Health
Identifying and Accommodating High-Risk,
High-Vulnerability Population in Disasters

NR-42
Group 1
DEFINING AND
UNDERSTANDING
VULNERABILITY
Vulnerability comes from the Latin word
for "wound," vulnus. Vulnerability is the
state of being open to injury, or
appearing as if you are.
The characteristics determined by
physical, social, economic and
environmental factors or processes
which increase the susceptibility of an
individual, a community, assets or
systems to the impacts of hazards
according to UNDRR Terminology, 2017
Vulnerability relates to a
number of factors, including:
Physical factors

Social factors

Economic factors

Environmental factors
 What makes
people vulnerable?
Vulnerability is the human
dimension of disasters and is
the result of the range of
economic, social, cultural,
institutional, political and
psychological factors that
shape people’s lives and the
environment that they live in.
In relation to hazards and
disasters, vulnerability is a
concept that links the
relationship that people have
with their environment to social
forces and institutions and the
cultural values that sustain and
contest them.
 Models for Understanding
Vulnerability

Medical Model Functional Model

This model is derived from The functional model, also called the
“social model,” moves the focus from
disease, trauma, or health
categorizing deficits at an individual
conditions that disrupt what
level, such as found in the medical
is considered to be “normal” model, to understanding the
functionality—physically, vulnerability in the context of the
mentally, or socially. built, social, and political
environment.
USING AN EQUITY
AND
EMPOWERMENT
LENS
Using an Equity and
Empowerment Lens can
assist in understanding
how decisions, policies,
procedures, and
strategies can impact
high-risk, high-
vulnerability
populations and
individuals.
 4 domains of
Equity and
Empowerment
Lens
People Domain Place Domain
Refers to the physical space
Refers to and also the social
individuals, groups, relationships and meaning
communities, or attached to a physical
location that give it context
populations. and value.

Process Domain Power Domain

Encompasses the Addresses who is
policies, plans, and making decisions and
decision-making who is impacted by
structures. those decisions.
 The Life
Cycle

of
Disaster
Preparedness
Preparedness involves planning and
getting ready for disasters by individuals,
families, organizations, businesses, and
com�munities. The state of preparedne

Planning, personal preparedness, training,

and exercises are vital to all strategies
and actions involved
 Organizational Planning and
Preparedness
Individual governmental agencies, not-
for-profit organizations, faith-based
organizations, schools, and businesses
that work directly with high-risk, high-
vulnerability populations need business
continuity plans as well.
 Emergency Continuity of
Plans Operations
The emergency plans of an
Plans (COOPs)
agency explain the role
A COOP works in
and actions of the
tandem with emergency
organization in responding
plans and specifically
to the specific needs of
addresses how the entity
that agency in a disaster,
will continue to carry out
as well as the role that the
critical functions during
agency will play in a
an emergency or other
community-wide response
disruption
to a disaster
 Training and Exercises
Training and exercises are part of every
emergency management planning
process in that they prepare
professionals and the public to test plans
and to identify gaps, alternate
strategies, and need for improvement.
 Training Exercise

Include awareness Involve staff from

curricula in training for varying levels of
staff to deepen practice, settings, and
understanding of working expertise within the
with diverse and at-risk agency to participate in
populations. Include planning exercises as
specific information about they bring valuable
emergency-related issues perspectives to the
process
Response
The response phase of the disaster life cycle
encompasses the period during and
immediately after a disaster occurs.

FEMA defines response as the immediate actions to

save lives, protect property and the environment, and
meet basic human needs. Response also includes the
execution of emergency plans and actions to support
short-term recovery (FEMA, 2008).
Recovery
Recovery in the disaster cycle is characterized
by actions that help to restore functioning at
predisaster levels, often described as a return
to a sense of “normalcy.”
 Short term Long term
Recovery Recovery
Involve restoring involve repairing and
rebuilding damaged
utilities,
infrastructure, restoring
removing debris, routines and mental
and providing health functioning, and
redeveloping
temporary housing
communities.
Recovery Needs are Basic Needs
referred to Maslow’s Hierarchy of
Needs and Nightingale’s
Environmental Theory of Nursing
Assistive Technology
Assistive technology is an umbrella term covering the systems and
services related to the delivery of assistive products and services.

Assistive products maintain or improve an individual’s functioning

and independence, thereby promoting their well-being.

Hearing aids, wheelchairs, communication aids, spectacles,

prostheses, pill organizers and memory aids are all examples of
assistive products
 The mental health of the

population must also be Mental Health

considered and monitored
during recovery from any Recovery from
disastrous event. For
example, some people may
a Disaster
relive previous traumatic

experiences or revert to
using substances to cope.
Behavioral health responses such as
post-traumatic stress disorder (PTSD),
substance use disorder, and increased
risk for suicide should always be
considered when assessing individuals’
responses to a disaster.

A disaster recovery (DR) plan is a formal

document created by an organization
that contains detailed instructions on
how to respond to unplanned incidents
such as natural disasters, power outages,
cyber attacks and any other disruptive
events.
 Mitigation

FEMA (2008) defines mitigation as:

Activities providing a critical foundation in the effort
to reduce the loss of life and property from natural
and/or manmade disasters by avoiding or lessening
the impact of a disaster and providing value to the
public by creating safer communities. Mitigation
seeks to fix the cycle of disaster damage,
reconstruction, and repeated damage. These
activities or actions, in most cases, will have a long-
term sustained effect.
 Structural
mitigation
Harden existing facilities and
build new structures, hospitals,
clinics, residential care
facilities to withstand likely
hazards such as tornadoes,
hurricanes, or flooding.
This may prevent damage
resulting in injury/death and/
or the need for evacuation
Nonstructural
mitigation
Protect critical supplies
and keep them in safe
areas. For
example, in areas likely
to experience
earthquakes, tie and
secure cabinets,
containers, and shelves.
 Factors Affecting
Mitigation Procedures

Lack of time, education, or understanding to implement

measures.

Lack of funds to act on mitigation measures such as

purchasing insurance, shuttering windows, making
structural changes to homes, building a safe room, and
buying and stockpiling extra supplies of food,
medications, and other goods.
 Factors Affecting
Mitigation Procedures

Having limited or no physical capacity to carry out the

measures without assistance

Living in substandard rental housing that is in a constant

state of disrepair, but the owner refuses to act on behalf
of the tenant
The following principles are
meant to guide nurses when
working toward a more inclusive
approach to emergency programs
in all phases of disaster.
 Professional
Continuing Education
Continually learn about ways to
improve the integration of
high-risk, high-vulnerability
populations in emergency
management programs during
all phases of disaster.
Involvement
Build sustainable relationships
with individuals and
organizations that represent
high-risk, high-vulnerability
populations
Assessment
Establish informal and
formal assessments to
measure the integration of
high-risk, high-vulnerability
populations in emergency
programs.
Flexibility
Programs and plans must be
flexible to allow for improvement
and change toward a greater
outcome in serving high-risk, high-
vulnerability populations in all
phases of disaster
 Building Capacity
Create plans, build resources, train staff and
clients, and exercise plans to build capacity of
individ- uals, families, and communities. For those
visiting nurses or others providing in-home service
delivery, this can be an extremely beneficial way
to ensure directed awareness and planning takes
place to mitigate further risks for certain persons.

 Disaster Mental
Health and High-
Vulnerability
Populations
 Coordination
Coordinate resources, information, and
plans across organizations, governmental
agencies, and health systems to maximize
resources and more effectively meet the
needs of individuals, staff, organizations,
and communities in all phases of disasters.
 Collaboration
Floods and flashfloods are
common products of
torrential rains especially if
it occurs after a long
period of dry conditions.
 Anticipation

When functioning on scene during a

disaster, articulate anticipated near future
impacts for your charge even if not part of
the immediate medical response
 Agents of Change
Nurses know their community. They cross over
many specialty skills areas to touch people
directly. Nurses are in a position to be
advocates on scene and during recovery for
the holistic approach to those impacted by
disaster because they are trusted agents to the
individual as well as part of the care services
team
 EXAMPLES
ORGANIZED
AROUND THE
ECOSYSTEM
MODEL
The ultimate goal of an ecosystemic framework is to
inculcate change at various systemic levels and across
various time points in the disaster life cycle
Post-Disaster
Personal
Assessment
Tool
The following tool can be used by a nurse,
caseworker, and others who are assisting
survivors with recovery. Staff would go through
the form together. This tool takes into account
important health, social, educational, and
other critical areas for a person who is in the
recovery process, and helps to prioritize
areas that need to be addressed to begin
recovery
 After ranking the importance of the items just
listed, circle the items that you know are in your
community. Then consider:

How many “very important” items are circled?

Will they be available in your neighborhood
soon?

Do you have enough support and are you

safe if you do not have some of the “very
important” items that you need in your
neighborhood?
Do you need more information about your
neighborhood before you can make a
decision?

Do you need to talk to a case

manager about this before you make
a decision?
Human Services in Disasters
and Public Health
Emergencies: Social
Disruption, Individual
Empowerment, and
Community Resilience
 HUMAN SERVICES
“UNDER CLEAR SKIES”
“Human services” have been broadly defined
as approaching the objective of meeting
human needs through an interdisciplinary
knowledge base, focusing on prevention as
well as remediation of problems, and
maintaining a commitment to improving the
overall quality of life of service populations.
 Examples of means
tested human services:
1
Temporary Assistance for Needy
Families (TANF)
2
Supplemental Nutrition Assistance
Program (SNAP, better known as
Food Stamps)
3
Women, Infants, Children
(WIC)
4
Low Income Home Energy Assistance
Program (LIHEAP)

5 Medicaid
 Examples of non-
means-tested services:
1. Child care systems

2. Child welfare systems

3. Aging services

4. Domestic violence
prevention and service
programs
 Human Security
Human security is defined as Human insecurity
safety from chronic threats, can result from
such as discrimination, human actions,
unemployment, or
natural events, or an
environmental degradation,
interaction of human
and protection from sudden
crises, including economic decisions and
collapse, environmental natural processes
disasters, acts of violence, (United Nations,
or epidemics. 2003).
What is Social Well-being?
-Ability of the people to be free from want of basic needs
and to coexist peacefully in communities with
opportunities for advancement

“disasters create the possibility of changed individuals in

changed families within a changed community”
according to Hill and Hansen (2019)
4 Stages of Crisis
 1st stage - Warning
defined as the signs
of approaching
danger
3rd stage - Reorganization
occurs at some point
during or after impact. In
this stage, individuals this stage that communities
aspire to work out solutions
and to escape the crisis.
2nd stage - Anxiety
time when your
anxiety heightens
4th stage - Change
occurs when the main
threat has passed. It is at
are able to focus on
rebuilding
 Well-being comprises two
general approaches: Hedonic
and Eudemonic

-The hedonic approach -The eudemonic approach

focuses on happiness, and focuses on meaning and
it defines well-being in self-realization, and it
relationship to attaining defines well-being as the
pleasure and avoiding degree to which a person is
pain. fully functioning.
 Empowerment
Empowerment is a concept central
to the domain of human services,
particularly human services in
disasters.
In the case of disaster human services,
the empowerment takes place at the

-micro-level (individual/family) and the

-mezzo-level (community).
Norris and Stevens (2007) found that
community resilience emerges from four
primary sets of adaptive capacities.
These capacities are economic
development, information and
communication, social capital, and
community competence.
The Federal Emergency Management
Agency (FEMA) mission is “to support our
citizens and first responders to ensure
that as a nation we work together to
build, sustain, and improve our capability
to prepare for, protect against, respond
to, recover from, and mitigate all
hazards.”
The focus on empowerment
within FEMA lies in two of their
largest programs:
Individual Assistance and
Public Assistance

These programs provide funding to individuals,

communities, and states to recover from the
impacts of disasters
Volunteer organizations, such as the Red
Cross, provide assistance to families
focused on meeting basic human needs and
social needs. Volunteer organizations and
federal, state, and local governmental
social service agencies provide a variety of
resources to the population impacted by
disasters.
 Human Services in Disaster
Response and Recovery

Human services play a critical role in disaster

response and recovery. Two distinct processes define
the ways that natural, technological, or intentional
disasters transform the landscape of human service
needs in impacted populations
First, because disasters can disrupt the infrastructure
by which communities meet community members’
human needs, those disruptions in systems upon
which individuals depend can put human service
systems’ clients at significant risk until the human
service infrastructure can be reconstituted.

Second, disaster impacts create new human

service needs that did not exist before the
disaster event
Three key drivers of new disaster-
caused human service needs are
the:

Extent and duration of evacuations

and mass movements,
Critical and social infrastructure
damage
Work/wage disruptions
Within Maslow’s hierarchy, it is possible to recognize
specific disaster human service systems operating to
address needs and promote empowerment at every level
of the hierarchic pyramid
 THEORY
SUPPORTING
THE ROLE OF
NURSES IN
HUMAN SERVICE
TRADITIONALLY, THE FOCUS OF NURSING HAS
BEEN ON THE PERSON OR POPULATION RATHER
THAN DISEASE.

NIGTHINGALE STATED, “ALL THE RESULTS OF

GOOD NURSING MAY BE SPOILED OR UTTERLY
NEGATIVE BY ON DEFECT, PETTY
MANAGEMENT, OR IN OTHER WORDS, BY NOT
KNOWING HOW TO MANAGE THAT WHAT YOU
DO WHEN YOU ARE THERE, SHALL BE DONE
WHEN YOU ARE NOT THERE”
THIS STATEMENT IS CONSISTENT WITH THE
FOCUS OF EMPOWERMENT IN COMMUNITY
DEVELOPMENT.
NURSING HAS A ROLE IN SOCIAL
WELL-BEING AND EMPOWERMENT
NURSES HAVE A ROLE IN HUMAN SERVICES
IN DISASTERS
THEORY: NURSING MODEL OF TRANSITION
BY SCHUMACHER & MELEIS, 1194.

CONCEPT OF
TRANSITION:

A PASSAGE OR MOVEMENT
FROM ONE STATE OR
CONDITION TO ANOTHER.
THREE TYPES OF
TRANSITIONS

DEVELOPMENTAL
SITUATIONAL
HEALTH-ILLNESS.
 SITUATIONAL TRANSITION
    ----------------------------------- THREAT OF TSUNAMI
CHANGING VS
ENVIRONMENT CONDITIONS THAT HOUSE ATTACHMENT
AFFECT THE LIVES OF CLIENTS

DEVELOPMENTAL TRANSITION A FAMILY OF FIVE EXPERIENCED

   ------------------------------------- SUPER
INCLUDES TYPHOON BOTH PARENTS DIED;
BIRTH, ADOLESCENCE, MENOPAUSE, ELDEST WILL TAKE OVER THE
AGING, DEATH, ROLE CHANGES FAMILY.

HEALTH & ILLNESS TRANSITION RIDER NEEDS TO AMPUTATE

-------------------------------------------- HIS LEGS DUE TO VEHICULAR
RECOVERY PROCESS, HOSPITAL DISCHARGE, ACCIDENT CAUSE BY MASSIVE
DIAGNOSIS OF CHRONIC ILLNESS.
EARTHQUAKE
THE MODEL OF TRANSITION SUGGESTS THAT
NURSES SHOULD VIEW THE PATTERN OF
RESPONSES AND IDENTIFY THE VULNERABILITIES
AND CRITICAL NEEDS DURING TRANSITION.
PATTERN OF RESPONSES – INDICATOR OF
HEALTHY TRANSITION
PROCESS INDICATORS – MOVE CLIENTS IN THE
DIRECTION OF HEALTHY OR TOWARD
VULNERABILITY AND RISK ALLOW EARLY
ASSESSMENT AND INTERVENTION BY NURSES TO
FACILITATE HEALTHY OUTCOMES.
OUTCOME INDICATORS – TO CHECK IF A
TRANSITION IS HEALTHY OR NOT; MASTERY OF
SKILL OR IDENTITY REFORMULATION
VULNERABILITY CRITICAL NEEDS

REPATTERNING/

DEATH/MORTALITY
RECONSTRUCTING

DEPRESSION THERAPEUTIC
PTSD COMMUNICATION

DEPRESSION PROVISION
PTSD THERAPEUTIC
PWD COMMUNICATION
4 USING THE CONCEPT OF
TRANSITION, NURSING
INTERVENTION ARE AIMED AT
5 SUPPORTING INDIVIDUALS TO
CREATE CONDITIONS CONDUCIVE
TO HEALTHFUL OUTCOMES
(SCHUMACHER&MELEIS,1994)
EVIDENCED-BASED PRACTICE IN THE
FIELD OF DISASTER MENTAL HEALTH
SUPPORTS THIS MODEL THAT ADDRESSING
THE CONCRETE HUMAN SERVICES NEEDS
OF DISASTER SURVIVORS IS A CRITICAL
PRIMARY INTERVENTION TO REDUCE THE
PREVALENCE OF LONG-TERM
PSYCHOLOGICAL ILLNESS OR INJURY IN
IMPACTED POPULATION. 1
 "THE AIM WILL BE TO
PROVIDE HUMAN SERVICES
FOR PROBLEMS THAT ARE
ACCOMPANIED BY
EMOTIONAL STRAIN"
 THERE SHOULD BE ECONOMIC
RECOVERY AND PSYCHOLOGICAL
RECOVERY FOR INDIVIDUAL
FAMILIES AND COMMUNITIES.
THE ROLE OF NURSES IN
HUMAN SERVICES
The role of nursing in human services
during disasters is to understand that
individuals impacted by disasters will
experience some level of psycho-social
disruption, to screen for human service
issues, and to provide appropriate
referral.
Screening Assessment
 Three Elements of Role of
Nursing in Human services
during disaster
Understanding the Screening for human
potential human service needs as the referral to the
service issues for individuals transition appropriate
people within the between pre- and organization
disaster impact area postdisaster realities
 CASE
MANAGEMENT IN
DISASTERS
The case management model is a useful model
within disaster management to meet the human
service needs of individuals and families.

The case management model is in reality not one

but an array of models that use an interdisciplinary
approach and can be defined as a collaborative
process to assess, plan, implement, coordinate,
monitor, and evaluate options and services to meet
health needs.
Thank
you!