Wayne Dailey outlines the role of mental health action at disasters
Between hurricanes, earthquakes, mass shootings, and deadly viruses, large scale traumatic events have spiked over the past decade.
And with disasters comes trauma.
Our society’s first responders, the firefighters, medics, and police officers, are always at the scene of any trauma. Now, a cadre of mental health responders often join them.
Wayne Dailey, Ph.D, is a recently retired assistant professor of psychiatry at Yale University, the former deputy commissioner of the Connecticut Department of Mental Health, and a clinical psychologist.
For two decades, he ran disaster response teams for the American Red Cross and Connecticut’s Disaster Behavioral Health Response Network.
Dailey has been on the scene helping at the 911 attacks, the Sandy Hook Elementary School shooting, the Boston Marathon bombings, a plane crash, floods, hurricanes, typhoons, fires and more
He spoke with New England Psychologist’s Catherine Robertson-Souter about the role of the mental health disaster responder and how it has evolved.
With the increase in disasters, there must be an increased request for mental health trauma response. Is this what you have been seeing?
We are seeing more hurricanes, tornadoes, floods, and other natural disasters because of climate change. We are also seeing a rise in gun violence in a society where people keep going out and buying more weapons. It feeds on itself and the next thing you know you have shootings at a Buffalo supermarket, shootings at synagogues, shootings at a school in Uvalde, Texas.
What does a mental health response team do?
Our job is to make sure they are in a safe place first, not standing in the middle of a highway screaming with their hands in the air with cars whizzing by. This is an example but it’s not too far off. With a mass shooting or a tornado, people get really undone and don’t have a framework in their own mind to deal with it.
The person may only need stabilization. Something has hit them out of left field and prior to that, they may have had no diagnosed mental illness. This thing is so traumatic that it destabilizes them and they don’t have a mental bucket to put this event in. It may have killed or injured a family member, knocked down their house, created an unemployment situation… depending on the event.
We work with the individual or family or community to help them develop a process to make a plan for what they are going to do in next couple hours or the next day and so on.
There is an immediacy to the planning. Get them to focus on the here and now, not future plans for getting a new job or whatever. Who do you need to contact? Who can you talk to? Take those tiny steps toward stability.
As (people) stabilize their life in these tiny incremental steps, it gives them back a feeling of control over something that maybe a couple hours earlier had felt completely out of control. It helps them to build a sense of strength and confidence.
You were on the leadership team for the Connecticut Department of Health in 2001 when Governor Rowland reached out to ask for help after the World Trade Center attacks. What was the plan?
On September 11th, the governor called the Commissioner of Mental Health to ask the DMH to participate in the mental health aspect of the response. The problem was that we didn’t have a playbook for that, for serving the general population in a disaster.
Prior to that, we had developed the ability to consolidate hospital units to create an emergency influx capacity so we immediately started doing that after 9/11 but within a matter of hours, we realized that we were not going to need it. No one was coming in from lower Manhattan.
And then, in addition to the first responders we sent, there was a cadre of second responders. We had them on train platforms along the I-95 corridor. It was easy enough to figure out who was near the towers because they were covered with soot. But that was not all that successful because they looked at us handing out brochures about how to deal with trauma and all they wanted was to get home and see their spouses, their kids.
That was one of our early moves but we didn’t know what else to do. There was no process to handle this kind of thing. Over next few months, we got federal grant money from SAMSHA and started to set up case management and mental health supports for families of those who were in New York and others affected by the disaster.
After all this, with funding from SAMSHA, we set about creating the Connecticut Disaster Behavioral Health Response Network (DBHRN). The DBHRN became a model used in other states because that kind of capability really did not exist in most cases. We organized five regional teams and set up training for them. And so, for example, when Sandy Hook Elementary happened in 2012, we had people we could send as part of the Department of Health response team.
Did you have a lot of volunteers step up?
We had a lot of interest on the part of clinicians. Still, there were many people who wanted to volunteer whom we did not accept. Our preference was someone already attached to a recognized agency, not someone who floated in. We needed a chain of command recognized by our organization and by public health emergency management and so on. You know they are credentialed. They carry an ID badge and when they show up, it’s not well-meaning but unprepared people.
Because this training isn’t your standard intake process. You’re talking to people who one minute were out, you know, grocery shopping and the next minute the person next to them is severely injured or maybe they lost someone.
How would you recommend a therapist volunteer for disaster mental health care?
I think the Red Cross is the best place to start. Or check with your state but not all states have a team.
It is hard work. You never know when the phone is going to ring and you have to decide if you can be on a flight in 12 hours to who-the-hell-knows-where.
It might be at a wildfire in California or at a shooting in Texas. I used to have a go-kit all set up. The Red Cross would put a notice out: “We need a chief and a number of responders to go to El Paso because someone went in and shot up the Walmart.”
Why is this work important?
We are trying to help maintain the cohesion of families and communities and not let it all go to hell. In the case of terrorism, the purpose is to cause people to distrust government by creating chaos. If you have a mechanism in place that prevents that deterioration, you are doing a lot to preserve your community and the society.
And unless you build the capability in advance, you are not going to be ready and we know that having this sort of capacity helps to dampen the impact in what would otherwise be long-lasting and transformative in a negative way in its impact on the community or the state.
It doesn’t take a rocket scientist to say that when you kill six educators and 20 children, this affects families and communities but also the entire state and beyond. If you are not ready for that, be prepared to have your butt kicked over the goalposts.
To become a volunteer or build a program, the time to do that is now, before the plane crashes at Bradley Airport.