Thursday, June 18, 2009

Paramedics for the Mind

Last weekend, a glider crashed on takeoff from an airfield in Unadilla Township, Michigan, which is in Livingston County, or the next county over from Ann Arbor, if that means anything to you. A passenger was killed and the pilot seriously injured.

When something like this (and by this I mean any kind of messy event such as a car crash, a suicide, or an industrial accident) happens, EMS and fire and police descend upon the scene. Physical injuries are given first aid and people taken to the hospital. The authorities conduct their investigation. And then those affected -- the victims themselves, the people nearby, the businesses, the neighbors -- are left to their own devices.

I don't know whether crisis intervention services were given to the employees of that airfield, where they have had five crashes, two of them fatal, in the last three years, or to the people who live near the airfield. I also don't know if they needed them. But they sure might have.

Many communities these days have Critical Incident Stress Management (CISM) teams that work with civilians. CISM got its start with first responders, and that's still the setting where it is implemented the most systematically, but more and more towns, cities, counties and states are recognizing a need for early crisis intervention in the community. The Monday Morning Crisis Quarterback herself serves on the Traumatic Event Response Network (TERN) for Washtenaw County, Michigan.

However, if your community is like my community, the team doesn't get notified of every event, and we don't "chase cases." We respond when we're asked to. Which requires that people know about us. And I'd venture to guess that if you grabbed 100 people off the street in our county and asked them about crisis response teams, at least 95 of them wouldn't have a clue what you were talking about. In practice, this means that we respond to events where someone involved is or is close to a first responder, where first responders are very much affected and their team (which is coordinated out of the same office) contacts ours, when someone on the team is close to the situation, or when someone knows there must be resources out there, and starts asking around.

This is emblematic of how we think about mental health in our society. Mental health care is not seen as a necessity unless the situation is life threatening. Even those with good insurance tend to have lousy mental health insurance. Traumatic stress is seen as an after-effect, not a primary injury, and so early intervention is not the norm -- we wait to see how people are doing.

Can you imagine if we treated blows to the head the way we treat traumatic stress? We would say, "well, it's possible that you'll have some problems if you have a concussion, so go home and if you don't feel right later, go see a specialist. Your insurance probably won't cover it, by the way." Can you imagine the lawsuits when people started to die? We understand that head injuries need to be evaluated immediately because they can lead to life-threatening problems. Why don't we understand the same about traumatic exposure?

Last month I was sitting in an airport waiting for a plane to go to a conference of the International Critical Incident Stress Foundation (ICISF). I was chatting with a man nearby, having the usual, "why are you traveling" discussions. I told him that I am a school administrator and I respond to schools following traumatic events, and he of course made the connection to Columbine. He said, "I don't know what the point of responding is. You just have to say, these kids were crazy, get over it." Then he paused and said, "If you actually saw those shootings, it would mess you up for the rest of your life."

This, too, is the problem with how we look at traumatic stress. We view prevention and/or early intervention as pointless, we tell people to "get over it," and then we accept permanent damage to the psyche as inevitable. Can't we do things a different way?

I envision a world where 911 dispatches CISM the way they dispatch the fire department to a known fire -- if the incident is at all traumatic, someone from the CISM team goes and evaluates the need for a response. Not everything needs it, just like sometimes the fire department shows up and the fire's already out. But couldn't we make it available to everyone, somehow? People like those folks who work at or live near the airfield should not think for a moment they need to go it alone.


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Naomi Zikmund-Fisher
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