First responders are there to save people in physical danger, but no disaster response is complete without psychological first aid too.

Between Hurricane Maria, Hurricane Harvey, and the shooting in Las Vegas, the Red Cross’s disaster mental health team has had a busy few months (or as it's officially called, they’ve been in an ~active operational state~). Here are some things you might not know.

Special thanks to the experts who provided intel and anecdotes for this post: clinical psychologist and disaster mental health volunteer Daniel Mosley, EdD; clinical psychologist and disaster mental health volunteer Susan Silk, PhD; and Valerie Cole, PhD, manager of the Red Cross's Disaster Health Services and Disaster Mental Health.

Photo by Chuck Haupt for the American Red Cross

We're deployed pretty much as soon as it's safe to do so. We'd never be sent in harm’s way — for example, before a hurricane is over — but sometimes, we have to be ready to roll out with 24-48 hour’s notice.

But we don't have to pay anything like flights, food, or shelter. From the moment we leave our homes to the moment we get back, we're taken care of — though sometimes that means staying in a volunteer shelter area, depending on the circumstances and how devastated an area might be.

Big disasters require a larger volunteer response — and indeed, are more attractive to potential volunteers sometimes — but year around, we can be found responding to small disasters, too.

We come from different backgrounds — we can be social workers, psychologists, counselors, therapists, psychiatrists, psychiatric nurses, etc. That said, we're not there to form lasting relationships. Sometimes we only talk to someone for five or ten minutes, so we do what is known as psychological first aid, which involves responding to immediate emotional distress and mitigating possible long term consequences.

Photo by Chuck Haupt for the American Red Cross

We try to help people remember what it was they did last time they had a major problem or major challenge, and how they can apply that to what they're facing now. We try to make sure they’re connected with support systems, like their families and their friends. We help them problem solve. We help remind them that they have the tools they need and that they can get through this.

Some people have more extreme reactions than they expect to — they can become hyper-vigilant or easily startled, they might have difficulty with concentration or memory, and they might have trouble sleeping or feel irritable.

We can share with people that these are very normal reactions to the situation, and that there’s every reason to believe that they won't feel like that forever. In fact, most people will go back to their normal level of functioning in four to six weeks.

This is why what we do is technically known as enhanced psychological first aid. Anyone can be trained in psychological first aid, but our professional expertise helps us recognize when someone is having a reaction that requires more help and intervention.

Sometimes, after someone goes through a major disaster, the most helpful thing we can do for them is create a safe space where they can tell their story, where they don't feel like we're distracted or rushed, and where they can just talk about what happened to them, the life they had before this, and their concerns about the future.

Photo by Chuck Haupt for the American Red Cross

We might end up somewhere unexpected too, like a small town on the outskirts of an affected area, where only a handful of people are in need of help. It all depends on the operation, and sometimes, we don't know what we'll be doing until we get there.

There's no room to get bent out of shape when plans change, when we have to work with new people with potentially conflicting personalities, or when we don't have a chance to see the impact of our work. We just have to go where we're needed for the short period of time we have, and trust that we made a difference.

Some people find out that disaster counseling is definitely not for them — sometimes it's more draining and intense than they were expecting, or they dislike how they can't see the impact of their work the way they can with long-term therapy relationships.

This work is hard — the hours are long, we're often in less-than-ideal conditions, and it can be emotionally taxing. Sometimes, responders need to be able to take a walk with a disaster mental health person and be reassured that they're valuable, that they're doing a good job, and get some stress management strategies.

Also, it's our responsibility to be an advocate for mental health across the operation. We make sure people are getting their days off, that working conditions are the way they’re supposed to be, etc., because if we don’t take care of our workers, they can’t take care of the community.

Those are understandably very emotionally intense experiences and rarely do they get any easier.

Photo by Daniel Cima for The American Red Cross

Yes, disasters are traumatic and difficult, but only 10-15% of people who experience a disaster are at risk for having more long-term PTSD-like symptoms.

This can mean working with schools and community centers to teach local leaders how to support people in the coming weeks and on anniversaries, or creating other long-term plans. Once the community is able to take on the responsibilities of taking of their own people, that’s when we turn it over to them and move out.

This is especially helpful in situations like the hurricane in Puerto Rico, where local volunteers helped translate due to a shortage in Spanish-speaking Red Cross volunteers.

We don't always get to see how we've made a difference because of the short timeframe we're there for, and it can be emotionally exhausting and difficult work. But at the same time, we get to witness the resilience of people and their altruism, helpfulness, hope, and kindness as they pull through as a community, and that makes it incredibly rewarding.

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