MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM: A FIELD GUIDE

CHAPTER I: Key Principles for Mental Health Intervention

Workers assisting survivors and family members may find the following key principles helpful, as they frequently are used by seasoned crime victim assistance and disaster mental health professionals:

No one who witnesses the consequences of mass criminal violence is unaffected by it.
Mass violence and terrorism result in two types of human impact-individual and community.
Mental health, crime victim assistance and other human services must be uniquely and individually tailored to the communities they serve. Cultural competence is essential.
While most traumatic stress and grief reactions are normal responses to extraordinary circumstances, a significant minority of survivors experience serious, longterm psychological difficulties.
Most survivors and families respond to active, genuine interest and concern. However, some will reject services of all kinds.
Mental health assistance is practical, flexible, empowering, and respectful of survivors' needs to pace their exposure to harsh realities resulting from the event. First and foremost, providers must do no harm when intervening.
Procedures and protocols used by emergency services, law enforcement, medical examiners' offices, and the criminal justice system can confuse and distress survivors. Clear, sensitive explanations are helpful.
Support from family, friends, and the community helps survivors and families cope with trauma and loss.

When mass violence occurs, innocent and unsuspecting people are caught by surprise in the course of their daily routines. These people usually are well-functioning and resilient. They have the capacity to cope with the profound psychological demands and losses they experience. Communities, families, and social support systems pull together to comfort and support those most impacted.

Workers providing emotional support take a practical, down-toearth approach. They reach out to survivors and respectfully offer reassurance, a listening ear, a warm beverage, concrete information about what will happen next, and practical assistance with immediate tasks. Survivors and families may gather at designated sites such as community centers, schools, employment settings, local places of worship, and disaster relief centers. They may not think they need "psychological counseling" or "mental health services" but may welcome genuine concern and help to cope with the stress. "Mental health support" can even take place over a cup of coffee.

Communities vary in their cultural, racial, and ethnic compositions including: the presence of refugee or immigrant groups, the primary languages spoken, and demographic and socioeconomic characteristics. A particular group may have been the target of violence due to prejudice or hate. If the alleged perpetrators are from a particular country or group, U.S. citizens and residents with similar physical characteristics or origins may be at risk for harassment and retaliatory violence. Crisis mental health support must help each affected group in the community.

Tailor Support to Community Needs

Be culturally sensitive.
Provide information and services in the appropriate language.
Understand the disaster's specific impact on affected cultural groups.
Collaborate and consult with trusted organizations and community leaders to serve all members of the community.

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