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Mental Health Matters Journal for Psychiatrists & GP's

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

suicide speaking book

What Rescue Workers Can Do

Written by NIMH

Police, Fire, and other First Responders

Violence or disasters can cause trauma in young people. Trauma results from hurt, harm or intense fear. It can be caused by harm to a person's body. It can be caused by fear in a person's mind. The National Institute of Mental Health (NIMH) works to help children who experience trauma. Other Federal agencies also provide help.

Rescue workers play important roles. They help children who experience violence or disaster. They help children cope with trauma. They help protect children from further trauma. They also help young people avoid or overcome emotional problems. These problems can result from trauma.

This fact sheet provides steps rescue workers can take. It gives information on:

· Coping with Trauma after violence and disasters

· What is Trauma?

· Helping Young Trauma Survivors

· How Rescue Workers Can Help

· Help for all people in the First Days and Weeks

· How Children React to Trauma

o Children under 5

o Children Age 6-11

o Adolescents Ages 12-17

· More about Trauma and Stress

· Additional Resources

Coping with Trauma After Violence and Disasters

Disasters cause major damage. Hurricanes Katrina and Rita were examples. They occurred in 2005. Many homes were destroyed. Whole communities were damaged. Many survivors were displaced. There were also many deaths.

Trauma is also caused by acts of violence. The September 11, 2001 terrorist attacks were examples. Another example was the 1999 shootings at Columbine High School in Colorado. The Oklahoma City bombing in 1995 was also an example. These acts claim lives. They also threaten our sense of security.

Beyond these events, children face many other traumas. Each year, young people are injured. They see others harmed by violence. They suffer sexual abuse. They lose loved ones. Or, they witness other tragic events.

Children are very sensitive. They struggle to make sense of trauma. They also respond differently to traumas. They often have emotional reactions. They may hurt deeply. They may find it hard to recover from frightening experiences. As a result they may need extra support. Rescue workers can provide this support. This may help children avoid or overcome long-term emotional problems.

What is Trauma?

There are two types of trauma — physical and mental. Physical trauma includes the body's response to serious injury and threat. Mental trauma includes frightening thoughts and painful feelings. They are the mind's response to serious injury. Mental trauma can produce strong feelings. It can also produce extreme behavior; such as intense fear or helplessness, withdrawal or detachment, lack of concentration, irritability, sleep disturbance, aggression, hyper vigilance (intensely watching for more distressing events), or flashbacks (sense that event is reoccurring).

A response could be fear. One could fear that a loved one will be hurt or killed. It is believed that more direct exposures to traumatic events cause greater harm. For instance, in a school shooting, an injured student will probably be more severely affected emotionally than a student who was in another part of the building. However, second-hand exposure to violence can also be traumatic. This includes witnessing violence such as seeing or hearing about death and destruction after a building is bombed or a plane crashes.

Helping Young Trauma Survivors

Helping children begins at the scene of the event. It may need to continue for weeks or months. Most children recover within a few weeks. Some need help longer. Grief (a deep emotional response to loss) may take months to resolve. It could be for a loved one or a teacher. It could be for a friend or pet. Grief may be re-experienced or worsened by news reports or the event's anniversary.

Some children may need help from a mental health professional. Some people may seek alternative kinds of help. They may turn to religious or community leaders.

Identify children who need the most support. Help them obtain it. Monitor their healing.

Identify Children Who:

· Refuse to go places that remind them of the event

· Seem numb emotionally

· Show little reaction to the event

· Behave dangerously

These children may need extra help.

In general adult helpers should:

· Attend to children

o Listen to them

o Accept/do not argue about their feelings

o Help them cope with the reality of their experiences

· Reduce effects of other sources of stress including:

o Frequent moving or changes in place of residence

o Long periods of time away from family and friends

o Pressures at school

o Transportation problems

o Fighting within the family

o Being hungry

· Monitor healing

o It takes time

o Do not ignore severe reactions

o Attend to sudden changes in behaviors, speech, language use, or in emotional/feeling states

· Remind children that adults

o Love them

o Support them

o Will be with them when possible

How Rescue Workers Can Help:

After violence or disaster rescue workers should:

· Protect children:

o From further harm

o From traumatic sights and sounds

o From onlookers and media

· Be kind, but firm in directing children:

o Away from the event site

o Away from injured survivors

· Keep children together with family and friends

· Identify children in acute distress

o Stay with them until they are calm

o They may tremble

o They may ramble

o They may become mute

o They may exhibit erratic behavior

§ Loud crying

§ Rage

§ They may sit completely still or frozen

· Be tolerant of difficult behavior

· Be tolerant of strong emotions

· Supportive acts help children feel safe:

o A quick hug

o A reassuring word

Help for all people in the First Days and Weeks

Key steps can help adults cope. Adults can then provide better care for children. Create safe conditions. Be calm. Be hopeful. Be friendly. Connect to others.

Be sensitive to difficult people. Encourage respect for adult decision-making.

In general help people:

· Get food

· Get a safe place to live

· Get help from a doctor or nurse if hurt

· Contact loved ones or friends

· Keep children with parents or relatives

· Understand what happened

· Understand what is being done

· Know where to get help

· Meet their own needs

Avoid certain things:

· Don't force people to tell their stories

· Don't probe for personal details

· Do not Say:

o "Everything will be OK."

o "At least you survived."

o What you think people should feel

o How people should have acted

o People suffered for personal behaviors or beliefs

o Negative things about available help

· Don't make promises that you can't keep

o (Ex: "You will go home soon.")

How Children React to Trauma

Children's reactions to trauma can be immediate. Reactions may also appear much later. Reactions differ in severity. They also cover a range of behaviors. People from different cultures may have their own ways of reacting. Other reactions vary according to age.

One common response is loss of trust. Another is fear of the event reoccurring. Some children are more vulnerable to traumas. Children with mental health problems may be more affected. Children with experience of other traumas may be more affected.

Children Age 5 and Under

Children under five can react in a number of ways:

· Facial expressions of fear

· Clinging to parent or caregiver

· Crying or screaming

· Whimpering or trembling

· Moving aimlessly

· Becoming immobile

· Returning to behaviors common to being younger

o Thumb sucking

o Bedwetting

o Being afraid of the dark

Young children's reactions are strongly influenced by parent reactions to the event

Children Age 6 to 11

Children in this range may:

· Isolate themselves

· Become quiet around friends, family, and teachers

· Have nightmares or other sleep problems

· Become irritable or disruptive

· Have outbursts of anger

· Start fights

· Be unable to concentrate

· Refuse to go to school

· Complain of physical problems

· Develop unfounded fears

· Become depressed

· Become filled with guilt

· Feel numb emotionally

· Do poorly with school and homework

Adolescents Age 12 to 17

Children in this range have various reactions:

· Flashbacks to the event (flashbacks are the mind reliving the event)

· Avoiding reminders of the event

· Drug, alcohol, tobacco use and abuse

· Antisocial behavior i.e. disruptive, disrespectful, or destructive behavior

· Physical complaints

· Nightmares or other sleep problems

· Isolation or confusion

· Depression

· Suicidal thoughts

Adolescents may feel guilty. They may feel guilt for not preventing injury or deaths. They also may have thoughts of revenge.

More About Trauma and Stress

Some children will have prolonged problems after a traumatic event. These may include grief, depression, anxiety and post-traumatic stress disorder (PTSD). Children may show a range of symptoms:

· Re-experiencing the event

o Through play

o Through trauma-specific nightmares/dreams

o In flashbacks and unwanted memories

o By distress over events that remind them of the trauma

· Avoidance of reminders of the event

· Lack of responsiveness

· Lack of interest in things that used to interest them

· A sense of having "no future"

· Increased sleep disturbances

· Irritability

· Poor concentration

· Be easily startled

· Behavior from earlier life stages

Children experience trauma differently. It is difficult to tell how many will develop mental health problems. Some trauma survivors get better with only good support. Others need counseling by a mental health professional.

If, after a month in a safe environment:

· Children are not able to perform normal routines

· New symptoms develop

Then, contact a health professional.

Some people are more sensitive to trauma. Factors influencing how one may respond include:

· Being directly involved in the trauma, especially as a victim

· Severe and/or prolonged exposure to the event

· Personal history of prior trauma

· Family or personal history of mental illness and severe behavior problems

· Lack of social support

· Lack of caring family and friends

· On-going life stressors such as moving to a new home, or new school, divorce, job change, financial troubles.

Some symptoms may require immediate attention. Contact a mental health professional if these symptoms occur:

· Flashbacks

· Racing heart and sweating

· Being easily startled

· Being emotionally numb

· Being very sad or depressed


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