This piece was originally published in Psychology Today's To Heal and Carry On on August 22, 2016.
"It's been intense here. People have been rescued from rooftops, trees, just about anywhere. The flood came so quickly. People have lost everything. There is devastation all around and people are hurting,” shared Baton Rouge, Louisiana clinical psychologist, Andrew Yarborough, Psy.D., of The Well Clinic.
According to recent reports, the Louisiana flood is the worst natural disaster to strike the United States since Superstorm Sandy.
Many flood survivors will bounce back after the flood with support of their loved ones and community. However, some will struggle more than others and may need to be referred to a professional mental health professional for care.
Following are some basic guidelines for when, where, and how to refer someone you care about for mental health services.
A private practice I use to work at had a sign in the waiting room that read, “Normal…a setting on a washing machine.” The director of the counseling center had placed it front and center to remind clients and providers that there is no one “right” way to respond to distress.
Be mindful that survivors are normal people acting normally in an abnormal situation. It is common for disaster survivors to experience emotional (e.g., feeling sad, anxious, irritable), cognitive (e.g., memory problems, confusion, slowness of thinking), behavioral (e.g., change in activity, difficulty communicating, inability to rest), physical (e.g., increased blood pressure, upset stomach, change in appetite), and spiritual stress (e.g., questions faith, anger at God, lack of meaning).
Survivors are more likely to become impaired when they experience multiple stress reactions simultaneously and intensely.
The good news is that for a lot of people these common stress reactions to disasters have limited long-term effects. Humans are very resilient creatures with abilities to cope and transform for positive outcomes. But, when our natural resources are strained too far, having the help of a professional perspective can be invaluable.
When to refer
It is important that you recognize when a disaster survivor may need additional follow-up services from a licensed mental health professional.
If your loved one’s stress symptoms seem really intense, don’t seem to go away with time, start to interfere with everyday life, or appear much later (further removed from the event) than you expect, you should start to be concerned. Look for signs of serious symptoms like extreme emotional reactions, impulsive or risky behaviors, and self-medicating with drugs or alcohol as well. These sorts of behaviors are all “red flags” indicating professional support may be needed.
Moreover, listen for signals that your loved one might be contemplating harm to self or someone else. Be alert to survivors talking or hinting about self-harm or harming others. Make sure you are not ignoring a potential cry for help. You have an obligation to refer a loved one who may be considering self-harm or harming someone else.
Don’t be afraid to ask questions about harm
It should also be noted that it is against current suicide intervention best practices to either minimize or deflect such feelings of self-harm. Instead empathy and active listening are essential until response can be made by a trained suicide interventionalist.
Some people fear that asking if someone is thinking about harming oneself or someone else is more likely to make something bad happen. This simply is not true. In fact most people who are experiencing significant distress report that they felt relieved when directly asked.
Here are a few sample questions that can be helpful getting a better read on where your loved one is emotionally: Have you thought about hurting yourself or someone else? Do you have a plan for hurting yourself or someone else? Do you have the means (e.g., capability or resources) for hurting yourself or someone else?
Keep in mind you are not trying to do a formal assessment, nor are you assigning a diagnosis—leave that up to the pros. The goal here is instead to try and understand the experience of what your loved one is going through in order to determine if a referral is warranted.
Where to refer
Following are some examples of organizations we’ve been told are providing disaster mental health services (e.g., counseling, referral assistance) for those affected by the flood:
- SAMHSA’s National Helpline (Treatment Referral Routing Service): 1-800-662-HELP (4357)
- National Alliance on Mental Illness (NAMI) HelpLine: 1-800-950-NAMI (6264)
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- National Red Cross: 1-800-733-2767 (1-800-RED-CROSS)
- Local Red Cross (Louisiana Capital Area): 1-504-620-3105
- Local Red Cross (Southwest Louisana): 1- 337- 478-5122
- Local Red Cross (Acadania): 1-337-234-7371
- Divisional Headquarters Salvation Army: 1-601- 969-6868
- Local Salvation Army (Baton Rouge): 1- 225-355-4483
- Local Salvation Army (Lafayette): 1-337-235-2407
- Baton Rouge General: 1-225-763- 4000
- Baton Rouge Behavioral Hospital: 1-225-300-8470
- Baton Rouge Mental Health Clinic Hotline: 1-225-924-3900
- Jefferson Oaks Behavioral Health: 1-225-927-5624
- Seaside Health System: 1-225-522-4076
- The Well Clinic (Prairieville, Louisiana): 1-225-692-4113
How to refer
It’s important to let your loved one know that you care for them as you make the referral.
As best as you can, try and protect the person’s privacy when you prepare to tell them that you think they could benefit from professional help.
Share with them a few specific reasons why you think they might need to talk to a licensed mental health professional. Be concrete, and focus on some specific behaviors you or others have observed. The goal is not to confront your loved one. Instead emphatically and compassionately let them know your concern for their well-being.
Most people will appreciate your concern and won’t take offense. However, that’s not always the case. Be patient with your loved one and give space for the person to respond. If your loved one seems like they will be safe without immediate additional services, you might give them a little bit of space and try again after they’ve had a chance to reflect on your suggestion.
If there is the possibility that your loved one might be an immediate danger to self or others you need to make a referral right away independent of their consent. That is, you need to proactively get in touch with a licensed mental health professional, proper authorities (e.g., police), or call 911. More resources on when and how to refer are available at apa.org or counseling.org.
Jamie D. Aten, Ph.D., is founder and director of the Humanitarian Disaster Institute and Disaster Ministry Conference at Wheaton College in Illinois. His latest books include, as co-author, the “Disaster Ministry Handbook” and, as co-editor, “Spiritually OrientedPsychotherapy for Trauma.” Follow him on Twitter at @drjamieaten or jamieaten.com.
Laura Shannonhouse, Ph.D., is an assistant professor in the College of Education and Human Development’s Department of Counseling and Psychological Services. She is a Licensed Professional Counselor (LPC), a National Certified Counselor (NCC) and an Applied Suicide Intervention Skills Trainer (ASIST).
Copyright Jamie Aten & Laura Shannonhouse