For Mental Health and Human Services Workers
in Major Disasters

WHEN TO REFER FOR MENTAL HEALTH SERVICES

Referrals to mental health and other health care professionals are made as workers encounter survivors with severe disaster reactions or complicating conditions. The following reactions, behaviors, and symptoms signal a need for the worker to consult with the appropriate professional and, in most cases, to sensitively refer the survivor for further assistance.

Disorientation - dazed, memory loss, inability to give date or time, state where he or she is, recall events of the past 24 hours or understand what is happening

Depression - pervasive feelings of hopelessness and despair, unshakable feelings of worthlessness and inadequacy, withdrawal from others, inability to engage in productive activity

Anxiety - constantly on edge, restless, agitated, inability to sleep, frequent frightening nightmares, flashbacks and intrusive thoughts, obsessive fears of another disaster, excessive ruminations about the disaster

Mental Illness - hearing voices, seeing visions, delusional thinking, excessive preoccupation with an idea or thought, pronounced pressure of speech (e.g., talking rapidly with limited content continuity)

Inability to care for self - not eating, bathing or changing clothes, inability to manage activities of daily living

Suicidal or homicidal thoughts or plans

Problematic use of alcohol or drugs

Domestic violence, child abuse, or elder abuse

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