Managed Health Network: Maintaining Resiliency Following Workplace Trauma (Part 1 of 2)

Uploaded by sacramentocoe on 14.01.2013


Okay, so, as explained, I'm a licensed psychologist.
I'm on contract with MHN, who many of you
have MHN as your EAP provider.
And when I use EAP, in this case, we're talking about Employee Assistance Program.
Notice it was the same for Emergency Action
So, I have a background in working with law enforcement and I do several things
for MHN. I do these trainings. I also am
one of the people that, if you use the Employee Assistance Program, you might be given my name
among others. And I also participate in their military family
life consultant program where we are flown all over the world to different
military bases to support our active duty members and their families.
So, they've sent me to Japan and England
and Germany and so forth.
So, I have a broad background in working with critical incidents. And if I can answer questions
afterward, we're a little bit pushed for time doing this, but...
I wanted to start today by -- I hope you don't mind -- I'm going to actually read to you for
about 3 minutes. Because, after this Sandy Hook incident,
I was very moved by this particular viewpoint that was in
the Bee and I don't know if all of you saw it. Sacramento is a long way
from Newtown, Connecticut. Even so, there may be
causes to the Sandy Hook Elementary tragedy that are nearby.
Closer than one might think. It's natural to go in search of causes
We want to know why and then to fix it.
We sleuth for causes. And, among our favorite villains, depending on our bias,
the NRA, perhaps the liberal judges, or
the movie violence. But the deeper cause
of causes is supremely local. It is the human heart.
Our nature. This is how the setting for Sandy Hook is,
in a way, shared by Sacramento or Wichita,
Miami, Spokane, or anywhere, actually.
As we rise to act on the horror 3,000 miles away,
we dare not avoid reflecting on the causes that reside in our very nature.
In a spot just a few inches behind
our eyes. I realize that by the common word heart,
I could also use the word soul. I refer to
something that at first seems too unspecific to fix. By this word,
I refer to our values, choices, relationships,
and practices. I refer to honesty,
compassion, and the balance between individuality and community.
And I do not mean to infer that some lack of heart
in Connecticut is to blame there. I am referring now only to the
wider culture and our responsibilities in it. The
social fabric is frayed. And each of us is
one thread in particular. And we have become --
I have become -- insulated and unconcerned for its integrity.
So I blame when I should look within.
And what do I find within?
If I'm honest, I see my comfortable and my accepted hatreds.
My limited affections. And my consumption of
entertainments that distract me from those who might try my patience
or exhaust my interest. Now take this
narcissism and multiply it over all of us. Over the millions of
us. In its full flower, we see a kind of moral
abdication. We have turned our cry for independence
into the demand to be left alone.
We then create huge bureaucracies that will care where I will not or can not.
And then some of us complain, rightly I think, that those bureaucracies
are too large and too costly.
If we saw this abdication, this vacuum, and understood its
negative power, we would repent. We would turn from our ways
and meet our neighbors. Learn the names of their kids. And watch for their
safety on the streets. We would bring meals when neighbors'
grandparents pass away. And ask to see pictures of their vacations.
Pray for their teenage daughter when they run away.
We would volunteer. We would repent of the most
insidious judgments where we have called others "wackos."
Or "flyover people." "Lefties," or "hicks."
We would stop all that and weave a new fabric.
History gives us a few examples of such spiritual
or cultural reformation, such as America's great awakenings, which contribute
to public sentiment about slavery.
Or, on a smaller scale, and more recently, we can point to a
grass roots effort like Mothers Against Drunk Driving.
The force of law comes to bear
on these examples, outlawing slavery and increasing punishments for drunken
driving. But the foundational assessment was, at first,
a matter of the public soul. And continues to be.
The tragedy was even more than an injury to us. It was an affront.
The killer shamed us. He shamed our
community and our humanity. One of our members
spited us. He snuck under our instruction
and avoided our scruples. He defied us.
Or, perhaps, ignored us. We move to bring justice for this affront,
yes. But what are we learning about ourselves?
We think, "How could this happen?" Like a fix-it person who's
certain the problem must be out there. Like a broken fuse in a circuit.
We fail to look inwardly. Most of the discussions
after Sandy Hook is about blame and not introspection.
Rather than "shame on us," the message
is "shame on the NRA." On the court
against prayer, on the Reagan-era disinvestment of community mental
health practice, or on video games, or movies.
But I think we -- and the way we live -- is more at the heart of the matter
than we want to admit. In the words of the late Pogo cartoonist
Walt Kelly, "We have met the enemy and he is us."
So, I wanted to start with that today
because I found it very thought provoking. It was in Viewpoint, Sacramento Bee,
on January 5. And I found it
very, very thought provoking in terms of looking at the whole
psychological aspect of this horrible tragedy that triggered your meeting
So, one of the things that we want to be prepared for is
the psychological aspect of a tragedy that could come your way.
Some of these might include
sudden death, which can be an unexpected death or a death that
occurs within hours of the onset of symptoms.
It could be a traumatic death, which is sudden and
unanticipated. Traumatic death is usually violent, mutilating, or
destructive. And it can also be random
and/or preventable.
The sudden death shatters the world that we live in.
What we've come to know as things that we can expect day-to-day, hour-to-hour
is shattered completely. And the aftermath can be very traumatic
for people. Sudden loss is the loss
that occurs without any forewarning. In an instant, life is
forever changed. Accidental loss, often a body
injury caused by an accident, and that might have a different impact.
If you think about these different kinds of loss and how you would react to them,
a traumatic event is an event or series of
events that causes severe stress reactions.
So, sudden accidental or traumatic death might be
heart attack, stroke, ruptured aneurism, accident, suicide,
homicide, sudden infant death, natural disaster
such as Katrina or the tsunami, or human
caused disasters such as September 11, Oklahoma City, or
Sandy Hook. Each of these leaves
survivors bereaved, stunned, unable to function
at times. As the officer was saying,
some people he thought would be able to step up and help out in a crisis
were hiding under the desk and people he least expected were able to step forward.
And that's not surprising, because we react
to this shock in very different ways.
And some people develop full post traumatic stress disorder. One of the things that
we've learned from research is that it's often a very good idea to have a
critical incident stress debriefing within 72 hours
of these traumatic incidents. If you have
MHN as your provider, they provide this.
And Renee Holly is here today. If you need to know more about that service,
provided through MHN, you can contact her afterwards.
During -- so,
some of the normal reactions that people have during a trauma
are behavioral, cognitive, emotional,
and physical. And so you won't be surprised by any of these,
I'm sure, the behavioral ones include withdrawal and isolation,
decreased motivation,
and decreased communication.
Emotional: fear, anxiety, anger, depression, sadness.
And reduced concentration, reduced decision making
and increased psychosomatic complaints. If any of you have been around a person
that's starting to develop these normal reactions,
and you may have wondered, "At what point does it become a good idea to refer
this person to a professional?" Any ideas of when that might be?
When would you look at these kinds of symptoms
as normal and then start to say to yourself,
"This person is troubled a little bit beyond that."

Because some of these kinds
of normal reactions can, in fact, be the
background of some of the active shooters. Has that dawned on
anyone? The withdrawal, the isolation.
So, sometimes we find these kinds of folks have been
traumatized earlier in their lives. And they've been hiding away
-- this fellow in Connecticut had been very withdrawn from people.
So, at what point
in your role as educators
would you say that you need to begin to think about getting somebody professionally
evaluated? When does being slightly withdrawn become
morbidly withdrawn? When does slightly depressed
or a little out of sync become, "This person is morbidly depressed.
This person has suicidal ideas."
Any ideas? [When they start to communicate those?]
[Maybe through writing or if there's
an assignment, something that's actually written down or communicated somehow?]
Absolutely. And I don't know how it struck
you when he said most of these active shooters are between
13 and 20. Did I catch those numbers right? Between 13 and 20.
These are adolescents. These are very, very young people.
And those of you that are in education well know that at that
age is when people experience -- what?
Angst. Angst!
Identity crisis. Sexual orientation
crisis. You know. Are they cool, are they
hip? Do they fit in? Okay? And so, you might think, "Oh my goodness.
All the kids in my high school are potential shooters."
And, in fact, we have had a history in mental health
where people in their teens are diagnosed schitzophrenic
or something. They're not schizophrenic at all! They're teenagers.
They look so similar -- at times.
So, again, what I want you to leave here with, though, is how do you
begin to sense that it's a little bit more extreme?
And the gentleman is absolutely correct. One way you would know is that they become
sort of preoccupied with it. They're writing about it. They're
drawing gory pictures. They're telling their friends.
They're reporting to somebody that they're very lonely.
They're isolated. They take up morbid interests.
They thoroughly enjoy lots and lots of violent games
and videos and movies. Okay? Now, my
question: is there anybody left in law enforcement in here?
Okay. Because my question is this: let's say one of these very sensitive
teachers or principals notices this, they're concerned, and they
call law enforcement. What's going to happen next?
[As far as a school situation?]
[He's probably going out to talk with the kids.
And going -- everything from the parents to the teachers to
student and the student's friends.] So it would be responded to. Because I've had
people tell me, "Oh, well, we were told that if he hadn't done anything yet, there was nothing we could do."
He hadn't acted on it. But you're saying it would be. [Every situation
is different, but, on a situation where I've been
involved, that's what you would do. That's the proper course of action.] Okay. Good.
That's good to know. And especially nowadays, I guess.
[We take every threat, no matter how minimal it is, very seriously. And we have
a threat assessment officer who's a sergeant with the Sheriff's Department who actually does a threat
assessment to determine whether or not there's a potential for credibility there.
So we look at the -- no matter how small it is, we pay very serious attention to it.
And try to protect whoever the person is that
may be a threat. As well as the students and the staff and the parents.] Right.
Okay. Excellent. So that's good to know. Because if we sit here and say to you,
"Come on, let's sharpen our tools. Let's sew our fabric back together.
Let's be a little bit more in tune with what's going on around us and how
our children are being raised." We want to know that if we do make that phone call,
that somebody's going to respond and go out and do something about it.
But it's not like some times in the past where that wouldn't have happened.
[Is there
not an intermediary action before
-- would there be something within the school? Do you
notice drawing on the papers or standing on the hallway
-- that was kicked in?] Yes, I think the gentleman earlier talked
about kind of escalating within the system before involving...
[or parents or counselors are still there?
Kind of situations if
that they're talking to teachers that have their same students
to see what the behavior is there so
if there is a step process would you go
...] I think the recommendation that was made earlier
was to exhaust the internal chain of command, if you will.
And then bring in external. I don't know if anyone disagrees with that.
My fear when I look at situations like this
is that so many of us take that attitude
of "somebody else will get involved."
You know, "Somebody else will do it." Or, "I don't want to overreact. Gee.
Now we've had Sandy Hook, and so every kid that's drawing
a hang man is going to get summoned before the police."
It's very -- it's a
very tight rope to walk, isn't it? Between overreacting and
underreacting. Personally, I'd rather that we
overreact for a while. You know? What's the worst
that can happen? The police go and question the child
and the family and maybe he gets counseling. Good.
One thing that I've noticed about all of these tragic situations is that somebody
knew in advance that these people were planning their
What a shame that it couldn't have been prevented.
And some of them will not be prevented. But if we can even prevent a few
with this increased knowledge and sensitivity.
So, teenagers are especially filled with angst.
They are difficult to assess
in terms of their mental health issues, but
those of you who have been around this age group kind of have a
second feel, if you will, for what's normal and what's
becoming pathological. And usually, your greatest
indicator is preoccupation. They're becoming preoccupied with
something. To the exclusion of social connectedness.
So, what happens during the grief and loss process?
You may recognize this as being Elizabeth
K├╝bler-Ross' stages of death and dying. And it's very similar.
We go through shock and denial. If you think about your personal
reactions when you heard about Sandy Hook. Some of us were
in shock and denial. Then we
go into, usually, and anger. A guilt.
Or bargaining. We're looking to blame somebody.
We're looking to find out why they did this. Where was the weak link?
Who's to blame? What kind of a mother was this, having guns in her house, etc.?
And then there's a depression and an acceptance.
And then we start scrambling to try to prevent it from happening again.
And I think that the prevention is part of the social
fabric, as well.
As I was planning to do this presentation today, I thought, "You know, the people
I'm going to be addressing are probably the most
sensitive, sewn together people
that least need to be reminded of this." Because I know
that people in education are often most aware
of what's going on, on a day-to-day basis in families' lives.
But, it's a good reminder to all of us.
So, what are some of the specific
challenges that are faced by the loss? And the
grieving process -- what does it trigger?
And you're going to see that shattering of the world as
you assume it to be is a number one. If you are dealing with
children or adults who have had a profound loss,
they start to doubt their perception of reality.
How could they have missed this? What could they have done differently?
Did they follow the recommendations that were given to them
at that workshop on Tuesday in January?
Could they have done something different?
The whole world as you assume it to be is questioned. The intensified
grief response that follows is often
the failure of an ability to say goodbye. To reach closure
with somebody that you cared about. People are forced
to face the loss of a loved one when they were making
Christmas preparations, for example.
There can be multiple losses. Losses of an
individual person, that person's friends, all of these
things are worsened by the public
coming in. The officer mentioned how the media arrived so quickly.
And invades the privacy of many of these families.
And one of the things that you'll notice after
tragedies like this is that many people start to doubt their religious beliefs.
And their personal priorities come into question. People will change
their careers. Change where they live.
They suddenly realize how finite life can be.
And they start to make big changes. And then, of course, there can be
tremendous legal and financial issues that come from it, as well. Any of these
crises. So, what can
you do in your role? Well, you can
ensure safety to as great a degree as you can by being prepared.
That's why you're here today. You can offer critical
incident stress debriefings if you have access to people that can do that for you.
And there are many people trained nowadays to provide that.
Recognize the different reactions. If you
have staff members that are starting
to drift apart from the group after an incident
or some that are becoming kind of bossy,
different character reactions.
Sometimes people get specific symptoms. I worked with a soldier
once who was just back from Iraq and Afghanistan. And the poor kid
had chronic hiccups.
Just hiccuping away. And he'd been to all the medical folks
and nobody could figure out why he was hiccuping away.
And I said to him, "Well, let's talk about your time over there a little bit.
Let's start with the -- you get up in the morning. You shave.
Then what happens?" "Oh, well, you know...
We're fine, he said to me. We all came back fine. There were no injuries in my group."
I said, "Good, but just keep telling me about that day."
"Oh, so then you're in the middle of shaving and one of these
little missiles comes over." Phew...
Oh, gosh. That would make me
jolt. So, we began to go through the day. And, of course, this kid
without realizing it, had been exposed to things that were outside the range
of normal human experience. He was tough. He was a soldier.
He was told that everything was fine. We all came back intact.
That's great. Except he was scared to death. He was 19 years old.
And absolutely scared to death.
So, guess what happened to his hiccups by him associating that he was terrified
with these hiccups?
They went away. One session.
Oh, he was
embarrassing after that. He'd come over and hug me and kiss me in public. It was awful.

You want to adjust workplace expectations if there's a tragedy
in your world so that a person can get back to work
at the rate that they can get back to work.
And encourage your employees to seek professional help (EAP again).
This one meaning Employee Assistance Program. It's funny that they have this
same acronym, isn't it? Emergency Action,
Employee Assistance. Okay. Allow time
to feel and understand the loss. Help people to find
appropriate support.
And maintain physical well being.
Maintain realistic expectations. There's research on how
to respond to critical incidents nowadays.
In earlier times, they thought it was best that people talk about the incident in detail.
And go into the bloody, gory details. We're now not so sure that that's the
best way to approach it. So, if you have an incident and you want help,
make sure that the people are properly trained in critical incident
stress debriefing. Just because someone's a therapist or psychologist
does not mean that they are current on all of that. So, you want
to make sure.
So, part
of what you can do -- part of what anyone can do, you don't need to be a
psychologist to do this -- is listen and provide emotional support.
You listen to what was traumatic for that particular
You listen to their version of the events that took place.
And you provide not only emotional support, but
physical support in the here and now. If you ever have an incident,
and let's say the call is made: it's all clear.
You can come out of lock down. You're going to want to make
sure that people have something to sit on.
That they have water to drink.
That there's physical and emotional support available.
Those kinds of immediate here and now
interventions have been associated with healthier
recovery from trauma. Just
very, very basic. Can I make a phone call for you?
Is there anyone that you would like notified?
And these kinds of things help people with their recovery.
Providing reassurance. Being patient.
Oh, that one's a tough one. I can't tell you how
often I hear in my office people saying, "Well, nobody wants to hear
about it anymore."
Maybe nobody wants to hear about it anymore because it scares them. Right?
And so, if somebody ever says that to you,
"Nobody wants to hear about it anymore," you might want to encourage them to
seek professional help. Because that professional person is going
to hear about it. They're getting paid to do so.
But that is something that people run into that's very real.
And encourage open discussion
about the event.
To the degree that they want to do it. I am not for dragging details out of people
that don't want to go into their gory details.
Okay. So, what is resilience? Resilience
means that we have coped well with
change. We have
adapted ourselves.
We have sustained our health and energy when under pressure.
And these are just kind of some practical things like continuing an exercise
plan. Continuing to be careful with your sleep patterns. What you're
eating. That you're a person that can bounce back
from setbacks. You can overcome adversity.
And change to a new way of thinking. Now,
the thing is, that all sounds great, but if somebody tells you
your little 6-year-old has been murdered by a madman, these things
are going to become very, very difficult to do. You're not going to be able to sleep.
You're not going to be able to eat appropriately. And you're not going to be able to function.
And so, those around you are going to want to help
with very particular things. Maybe they're going to want to offer child care for your other kids
while you're in this state of stun. Or they may want to
bring over meals. Or they may want to drive you
to the therapist's office that you need to see. Or the doctor's office for sleep
medication or what have you. So, a lot of what people need in that period where they're
not feeling so resilient is very, very practical help.
We're back to that fabric of society
where people look out for each other, right? In very practical ways.

So, one of the things that we know is that suicide
is -- 1.3% of all deaths
are from suicide. Wait, that's not where I want to be.

One suicide occurs every 17 minutes in this country. That's kind of
amazing. And it's usually
the most vulnerable. A young person, aged
15-24 dies by suicide every 2 hours.
And the most vulnerable is older men over the age of 80.
Isn't that something?
That's the most vulnerable age group for that.