Among the various factors influencing the effective delivery of mental health services/support n rural areas, the sense of individualism and spirituality of rural inhabitants are mentioned in George W. Doherty’s upcoming book
Crisis In The American Heartland: Disasters & Mental Health In Rural Environments (Loving Healing Press, 2011). After my previous interview with George about psychological support for the elderly folk in rural areas, I found it both interesting and important to learn about the relation between individualism, spirituality, and disaster mental health services in rural places. Following is a Q&A with George on this topic.
Ernest: George, how does the sense of individualism in rural communities in America differ from the same in urban settings?
George: Traditionally, ranchers and farmers have tended to form small close communities that supported their way of life and provided for mutual support. Depending on their cultural heritage, they maintained values and attitudes congruent with their way of life. Some groups have tried to maintain cultural heritages. Amish people, European groups, and others have been generally successful keeping their cultural heritages intact while also attempting to adjust to changes in US society.
Individualism, self-reliance and hard work are some of the necessary characteristics for survival in rural areas. In urban environments, reliance on social service organizations, fears of certain groups and corporate organizations is more prevalent. A sense of independence and self-determination is more common among rural than urban or suburban residents. Many rural residents tend to view themselves and their communities as possessing a higher quality of life and more realistic, down-to-earth lifestyles than urban counterparts. Family, close friendships, and a highly developed sense of community, combine to create a sense of self-sufficiency that persists even in the most difficult of circumstances. In times of disaster, these values are often demonstrated when family, friends, and community members provide mutual support, shelter, and care to one another.
It is important to keep in mind that such comparisons between rural and urban characteristics are general and can vary from group to group. Different communities, large or small, vary in types of individualism and values. It is always important to develop an understanding of the community or communities impacted rather than using generalizations that may not always apply. It is helpful to integrate disaster mental health principles and methods into existing systems, organizations, and practices.
Ernest: So how does this collective feeling of individualism in rural areas relate to the psychological support offered or available in times of disaster?
George: Rural people may not actively seek help or be aware of available services or how to access them. They may think the process is too cumbersome or intrusive. Farmers/ranchers or a small business owners may not apply for assistance due to pride, underestimation of loss, or belief that others are more in need of help. If a decision is made to apply for assistance, the process may be particularly difficult for someone unaccustomed to admitting need and seeking assistance. Asking for help can be difficult for those who are used to relying on their own resources.
Rural areas often find it more difficult to plan and mobilize for disaster preparedness and training for response. Confusion and disorientation can be minimized through disaster planning and identification of a cadre of disaster response experts willing to assist when requested. It is important for responders and mental health professionals in rural areas to train together and get to know one another prior to responding to events. Such contacts often help de-stigmatize mental health. Emphasis on post-disaster feelings, thoughts, physiological responses, and other reactions to traumas can be addressed as “normal responses to an abnormal event”.
Crisis Counseling Programs that were successful with rural outreach to farm families were those that had the assistance of organizations experienced in dealing with farm families and farm issues.
Ernest: How should disaster mental health services best be provided to rural communities?
George: Disaster mental health services must be provided in a manner that recognizes, respects, and builds on the strengths and resources of survivors and their communities. It is critical to assist communities in planning, designing, and implementing culturally competent disaster mental health services for survivors of natural and human-caused disasters of all scales.
Teams of counselors dispatched to mass casualty disaster sites can, at times, be an overwhelming presence. Sensitivity to cultural needs and desires are necessary to provide appropriate and desired services. Peoples’ reactions to disaster and their coping skills, as well as their receptivity to crisis counseling, differ significantly because of their individual beliefs, cultural traditions, and economic and social statuses in their community. In order to respond effectively to the mental health needs of all disaster survivors, crisis counseling programs need to be sensitive to the unique experiences, beliefs, norms, values, traditions, customs, and language of each individual, regardless of his or her racial, ethnic, or cultural background.
Ernest: Are there kinds of first responses from the target community that may hinder effective delivery of mental health services?
George: Initial contact may reveal a person or family caught in an angry reaction to a multitude of aggravations. Doors may be slammed and workers may bear the brunt of yelling and abusive language. While forcing the issue is never appropriate, contact later in the program may reveal a completely different temperament. A person who was completely closed at a prior point may, in a few short days or weeks, be open to contact and appreciative of services. Phases of recovery shift and change. As trust begins to develop, people gradually become receptive to the efforts of outreach workers. Over the long haul, outreach workers gain respect for their willingness and tenacity from the people they have attempted to serve. Some critical steps for responders to keep in mind include establishing rapport, communicating clearly, listening carefully, understanding feelings, and identifying, defining and focusing on the problem.
Ernest: You also tell in your book that rural people have a better developed spiritual quality than those living in cities. What do you think is the connection between the sense of individualism, rural life, and spirituality or religiosity?
George: Generally, rural America has had a close relationship with and appreciation of the interactions between nature and land. Farmers/ranchers, often at the mercy of acts of nature, developed a need for, and explanation of, the support that could be offered by religious affiliations. This takes many forms in different areas. Some communities (e.g., Amish groups, Quakers, Evangelistic and traveling preachers, larger and more organized religions such as Protestant and Catholic communities, Nativistic groups, and many others) tended to be more homogenous than others. Each has provided support for their members during and following adversity, crises, trauma and disaster. Many continue to provide assistance following such events. For example, in the east, Amish volunteers assist with cleanup and recovery following major disasters. In the areas other religious organizations often are the first to respond with shelters and feeding.
Response, assistance and recovery efforts by such groups in rural environments has often grown out of the individualism values of self-reliance and group help for family, friends, and neighbors historically present in rural America. The need for such groups in rural areas is often understated due to fewer government resources in these areas, generally. Generally, greater access to such services in urban settings is available. This has contributed to the individual characteristic of self-reliance being more apparent in rural settings.
The importance of explanations about why a disaster has occurred, beyond scientific ones, are best explained to people in rural and in urban settings by Chaplains, Pastors and related persons who can address belief systems within a context that offers comfort and direction for the future.
Spiritual traditions provide the context through which people understand their origin, why they are here, and where they are going. Knowing a person's spiritual context is very important in disaster mental health. Such a personal belief system can aid greatly in the disaster recovery process. In rural communities, churches and other religious institutions provide a valuable resource for finding and serving literally hundreds of people. Collectively, the community they represent is a cross-section of the local social structure with respect to income, education, vocations, and community involvement.
Ernest: And how does this quality of spiritual disposition should be taken into account by those offering psychological support?
George: It is critical for first responders and mental health professionals to develop relationships, networks, and understanding of their roles in disaster response. This is why it is important for them to develop teams and plan responses and train together. Such networking and training together promotes communication and the ability to assess, understand and effectively respond to trauma, crisis and trauma situations. When working in recovery following disasters, for various team members to have relationships, networks and respect for the resources of fellow responders provides opportunities for delivering services and responses in ways that maximize resources and responses. It is important for Chaplains and Pastors to understand and support the role of psychological support and for mental health professionals to understand and support the roles of the Chaplains and Pastors. Developing interactions and relationships between both can be very useful and helpful in fostering the acceptance and help each can provide in recovery. An important aspect in early phases involves an adequate triage for assessing mental health and spiritual needs and making appropriate decisions and/or referrals. A working partnership of these responders can help overcome initial resistance to assistance following disaster or crisis in rural settings.
Ernest: George, you frequently participate in conferences themed on disaster mental health. Do these conferences encourage religious workers in rural areas to participate and contribute toward formulating strategies for post-disaster recovery?
George: It is one of the major goals of the Rocky Mountain Region Disaster Mental Health Institute to provide continuing education workshops, and conferences that focus on disaster, critical incident, crisis and trauma responses and training. We present these in a manner that highlights teamwork in responding. This involves encouraging first responders (e.g., law enforcement, Homeland Security, firefighters, National Guard, nurses, medical professionals, mental health professionals, etc.), Chaplains/Pastors, school and hospital personnel to attend, network and train together in order to be able to respond as teams.
In addition to workshops (e.g., CISM, Chaplain Workshops, Psychological First Aid, online courses, seminars, therapy workshops such as Traumatic Incident Reduction, Cognitive-Behavioral, and others), we also present an annual Disaster Mental Health Conference when we accept presentations from people who have responded to various disasters, crises, critical incidents, etc. They present and provide us with updates on events such as hurricanes, floods, fires, tsunamis, tornados, and many other incidents. Attendees and presenters come from many states around the US and other countries. Proceedings and articles generated by these conferences are published post-conference and are available through the Institute, Amazon.com, and Kindle. Our conference this year will look at aspects of where disaster mental health has come from 20 years ago, where it is today, and where we need to plan for in the future. Those interested in making presentations may visit
http://www.rmrinstitute.org/CALL2011.html].
The 2011 Conference/Workshops will occur in Saratoga, Wyoming June 13-20. The focus of two of our 8-hour workshops is on the role of Chaplains in critical incidents in communities and hospitals. For those attending the Conference and the Workshops, Certificates of Completion and Attendance will be provided indicating the number of hours for Continuing Education. For Law Enforcement, POST Credit will be available.
Ernest: Thank you George for telling more about disaster mental health in rural settings!
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