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Refugees will need help in coping

The folks who survived Katrina with front row seats, riding out the hurricane, are now in survival mode. And refugees arriving in Utah from the storm are apt to be in that mode for some time.

Later, on varied schedules depending on their individual emotional makeup and circumstances, they will begin to move through stages of grief, anger, frustration and fear as they begin to rebuild their lives, according to Utah crisis experts who are preparing to help with the recovery process.

Reactions — now and stretching into the future — are likely to include anxiety, irritability, depression, anger, "all the emotions, intensified," says Richard Hatch, director of adult services for Valley Mental Health, who is also a crisis counselor. "Maybe guilt. I survived and friends and family members haven't. Why did I survive and not others?"

Some victims of the hurricane are likely to deny all feelings, simply trying to block them off. Or have unpleasant flashbacks of things they endured. Sleep disturbances, poor concentration, loss of memory, confusion, inability to act and think may occur, he says. And there will be a host of physical symptoms, including nausea, headaches, numbness, chest pains and heart palpitations.

Some will have — likely are having — panic attacks. This level of stress can lead to increased colds and flu. "The body is dealing with so much stress, such pressure, it's susceptible to illness," Hatch said.

Most are likely fairly numb and shocked right now. Some are likely "hypervigilant," nervous about danger and fearful of more trauma to come. Mood swings are common, say Cathie Delewski, a crisis social worker at University Hospital, and Janina Chilton, spokeswoman for the state Division of Substance Abuse and Mental Health.

Some of the first steps are finding food, shelter, clothing and attending to the basics. That's where others can be most helpful to them right now, Hatch says. It's also important to allow people who have been through a cataclysmic event to express their feelings. That's a way to begin to regain a sense of control.

Part of being there for those who are traumatized is knowing what not to say — perhaps one of the most important ways people can help, Chilton says.

It's OK to tell someone you understand why they feel as they do but not to tell them how to feel. You can assure someone his reaction is normal: "It's normal be feel upset and confused." It's OK to say: "Things won't ever be the same, but they will get better."

On the taboo list are statements like "I know exactly how you feel," a bold statement that no one can claim because even two people in similar situations react differently. Don't say: "Things could have been worse," or "You're lucky because. . . . " Put the brakes on second guessing what the person should have done. And never say, "You can always get another pet . . . house . . . whatever."

Don't trivialize or minimize what someone's missing or suffering, Hatch warns.

The Department of Human Services is mobilizing crisis counselors who will be ready for anyone who arrives, says Carol Sisco, spokeswoman for the department. They are trained to deal with traumatic events and people in crisis as a result of it.

Coping will also, in some cases, likely involve substance abuse counseling. "Substance abuse can go up," Hatch said. "For many, substances are a mechanism to cope. And stress may increase the desire to utilize substances."

It's important to remember, he adds, that people with mental illness or substance abuse issues "also have the same basic needs we all have" and those must be dealt with.

Even people who witnessed the events from afar are suffering, Delewski says, perhaps with "feelings of helplessness, not knowing what they can do, feeling very badly about what's happening to fellow communities and having some anxiety."

The most intense anxiety among observers is likely being experienced by those who lived near the hurricane and know that such storms, with their fiercely demonstrated violent outcomes, could impact their own communities as well, she says. But even those farther away may adopt the anxiety and translate it into something locally plausible, like an earthquake.

All those reactions are normal, Delewski adds. Even the reaction of those who are trying to find someone to blame, pointing to who decided to build the levees that way in New Orleans or those who didn't leave when they were told to evacuate or the president for sending National Guard troops overseas, where they can't help in this crisis. Those are a few examples of the finger-pointing that is already occurring.

"The whole issue of trying to blame someone is a way of trying to get some control. People don't know where to put and what to do with their emotions," she said. "If you can put the responsibility on someone else, find a target, it helps control emotional responses."

The approach to crisis counseling has changed a bit since 9/11, Delewski says. Counselors then encouraged people to discuss everything they saw and felt and smelled. "We're moving away from that." Now the focus is on identifying an individual's strengths and the resources they have and how they can be used to help cope.

"We talk about how you normally cope and how you can apply those to this situation."

Mostly, she says, people need to understand that there is no set time frame for people to recover. "Everyone responds differently, based on their emotional makeup, support resources, and financial and outside resources coming in to help."

Oddly, she notes, people with mental health-related issues may do better than some others in mass casualties. "For some reason, in the immediate situation, when it's occurring, they may pull themselves together in a way that is pretty astounding. It's afterwards . . . some people return to the same mental health status as before, others may decompensate, again depending on their resources," she says. People who were already in crisis or experiencing chronic illness or major depression, for instance, may see it exacerbated.

And what about the worried well, those of us who are thousands of miles away aching to make things better but also fretting that such a catastrophe (though not a hurricane, certainly) could happen here?

Delewski recommends people do what they can to be prepared for a disaster, because no one is immune from one. They should have a plan, have supplies on hand, do what they can to be as ready as they can. But they shouldn't dwell on their fears. People can't control the weather or accidents or even terrorist attacks. They can only be as prepared as possible.

That's something experts hope Utahns will do. Mariann Geyer, CEO of the Greater Salt Lake Chapter of the American Red Cross, believes Utahns in the aftermath of Katrina should take stock of their emergency preparedness and beef it up. Buy supplies. Make a plan and share it with your family. Practice. But don't be obsessed with worry.

And for those who rode out the storm and those who merely watched helplessly, Hatch suggests working together. Utahns will have an opportunity to help problem-solve, if the refugees come here as expected.

By all means, help with some concrete issues, he says. "Help problem-solve" things like housing or finding a job, "but don't take over the problem. When someone has a host of things, it helps to break it down into more manageable steps. Make plans and problem-solve one issue, and move on from there."

That helps in any crisis, he says.