As we consider the potential psychosocial consequences of pandemic influenza the scenarios can quickly overwhelm. The published plans from WHO, Federal and state officials break down the tasks nicely but the plans are estranged from the range of human behavior. We are not even sure if the plans have goals that are supported by the community. For example is the goal to save my life, the greatest number of lives, to save society or to save a society of souls.
A book on problem solving (?Turing) suggests looking at how other people solve similar problems.
Here I suggest that smallpox and SARS are similar problems. The Univ Pittsburgh Center for Biosecurity has an online scenario for a developing smallpox pandemic called "Atlantic Storm"
http://www.upmc-biosecurity.org/ I highly recommend a review of that slide show and if we can dig it out to look at the Dark Winter exercise from 2001.
In Aug 2002 I participated in a 5 day multidjurisdictional exercise on smallpox called "Pale Horse." I presented on the MH aspects in March 2003 to Disaster Psychiatry Outreach. We saw many of the issues acted out during the 2003 SARS outbreak but we also saw many very successful and clever adaptations to the outbreak.
The key issues are risk communication and demand management. There is plenty of room for important positive contributions from nonofficial forums.
In the light of the published smallpox scenarios and actual experience with SARS, we can consider what we actually need to do as members of a community to support the social infrastructure.
For example, when the headlines read that WHO has announced the world is entering a phase of pandemic influenza, do we believe that citizens will look at the published plans and then try to go buy 4 weeks of supplies? What will happen at the stores? How will people react? How do we diffuse the pressure and still meet the peoples needs? How do we get people to show up for work inside closed institutions like nursing homes, prisons or forensic mental health facilities? Is it important?
How do we advise others on how to balance personal needs for perceived safety versus the need for society to continue? What is the point of personal survival if society is catastrophically changed? Can a sufficient number of people develop a social contract with each other dedicated to the survival of society? Would such a strategy increase the survival probability for more people?
Everyone has the opportunity to help build resiliency. Those of us who are concerned can reach out to each other and define an environment that will help direct policy decisions. Dr. Stephen Southwick of Yale University has described a 12 Step program for building resiliency. These steps are not a direct path to recovery but serve as tools for the journey.
1.Support spirituality of the population
a. connect with churches
b. provide training for church volunteers on disasters and mental health
c. promote the participation of churches in coordinated community response.
d. build strength in diversity
2.Support peer communication for social support
a. provide access to phones
b. provide access to internet
c. support dedicated local talk radio and cable access TV
3.Support constructive actions for the impacted persons by establishing natural mentors and role models
a. a buddy system of volunteers with evacuees can be helpful to get through the multiple ?little? hassles that wear people down.
b. the buddy can help persist with calling numbers that are busy or voice message only or refer to multitude of other numbers
c. the buddy can help problem solve the ?assistance burden,? where the person receiving assistance must jump through hoops that do not provide the needed services
4.Support regular exercise, physical training and recreational activities
5.Support disaster recovery training for volunteers,
a. channel the altruism of the population towards planned constructive action.
6.Enlist the children in activities,
a. the children could organize color coded handouts that are distributed for information
b. the children?s world view can help the adults with perspective
c. the children help promote a sense of the future and recovery
7.Enlist all impacted persons in the problem solving to develop an active coping skills
8.Keep a goal in the grieving process towards acceptance
a. The shock of multiple losses is accompanied by a natural grieving process.
b. Many including the decision makers will need support towards accepting the magnitude of changes that are in store.
9.Assist the process of stress inoculation
a. No matter how competent and caring the support communities, there are going to continue to be hassles and obstacles along the way to recovery
b. Build on the survival so far to instill confidence in the ability to continue to meet the challenges with assistance
10.Leadership, operational personnel and all those affected will need assistance to develop cognitive flexibility.
11.Permit humor
a. Humor can be one of the most developed coping strategies
b. Distinguish between bitter cynicism and sweet irony
12.Instill optimism ? things were bad, they are tough now, but by our actions they will get better
We can promote these skills now and apply them now to pandemic preparations.
cr
A book on problem solving (?Turing) suggests looking at how other people solve similar problems.
Here I suggest that smallpox and SARS are similar problems. The Univ Pittsburgh Center for Biosecurity has an online scenario for a developing smallpox pandemic called "Atlantic Storm"
http://www.upmc-biosecurity.org/ I highly recommend a review of that slide show and if we can dig it out to look at the Dark Winter exercise from 2001.
In Aug 2002 I participated in a 5 day multidjurisdictional exercise on smallpox called "Pale Horse." I presented on the MH aspects in March 2003 to Disaster Psychiatry Outreach. We saw many of the issues acted out during the 2003 SARS outbreak but we also saw many very successful and clever adaptations to the outbreak.
The key issues are risk communication and demand management. There is plenty of room for important positive contributions from nonofficial forums.
In the light of the published smallpox scenarios and actual experience with SARS, we can consider what we actually need to do as members of a community to support the social infrastructure.
For example, when the headlines read that WHO has announced the world is entering a phase of pandemic influenza, do we believe that citizens will look at the published plans and then try to go buy 4 weeks of supplies? What will happen at the stores? How will people react? How do we diffuse the pressure and still meet the peoples needs? How do we get people to show up for work inside closed institutions like nursing homes, prisons or forensic mental health facilities? Is it important?
How do we advise others on how to balance personal needs for perceived safety versus the need for society to continue? What is the point of personal survival if society is catastrophically changed? Can a sufficient number of people develop a social contract with each other dedicated to the survival of society? Would such a strategy increase the survival probability for more people?
Everyone has the opportunity to help build resiliency. Those of us who are concerned can reach out to each other and define an environment that will help direct policy decisions. Dr. Stephen Southwick of Yale University has described a 12 Step program for building resiliency. These steps are not a direct path to recovery but serve as tools for the journey.
1.Support spirituality of the population
a. connect with churches
b. provide training for church volunteers on disasters and mental health
c. promote the participation of churches in coordinated community response.
d. build strength in diversity
2.Support peer communication for social support
a. provide access to phones
b. provide access to internet
c. support dedicated local talk radio and cable access TV
3.Support constructive actions for the impacted persons by establishing natural mentors and role models
a. a buddy system of volunteers with evacuees can be helpful to get through the multiple ?little? hassles that wear people down.
b. the buddy can help persist with calling numbers that are busy or voice message only or refer to multitude of other numbers
c. the buddy can help problem solve the ?assistance burden,? where the person receiving assistance must jump through hoops that do not provide the needed services
4.Support regular exercise, physical training and recreational activities
5.Support disaster recovery training for volunteers,
a. channel the altruism of the population towards planned constructive action.
6.Enlist the children in activities,
a. the children could organize color coded handouts that are distributed for information
b. the children?s world view can help the adults with perspective
c. the children help promote a sense of the future and recovery
7.Enlist all impacted persons in the problem solving to develop an active coping skills
8.Keep a goal in the grieving process towards acceptance
a. The shock of multiple losses is accompanied by a natural grieving process.
b. Many including the decision makers will need support towards accepting the magnitude of changes that are in store.
9.Assist the process of stress inoculation
a. No matter how competent and caring the support communities, there are going to continue to be hassles and obstacles along the way to recovery
b. Build on the survival so far to instill confidence in the ability to continue to meet the challenges with assistance
10.Leadership, operational personnel and all those affected will need assistance to develop cognitive flexibility.
11.Permit humor
a. Humor can be one of the most developed coping strategies
b. Distinguish between bitter cynicism and sweet irony
12.Instill optimism ? things were bad, they are tough now, but by our actions they will get better
We can promote these skills now and apply them now to pandemic preparations.
cr
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