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

CHAPTER IV: When to Refer for Mental Health Services

Workers should make referrals to mental health and other healthcare professionals when they encounter survivors and family members with severe physical or emotional reactions. Some may have preexisting physical or psychiatric conditions that have worsened because of traumatic stress. The following reactions, behaviors, and symptoms signal a need for the worker to consult with his or her supervisor and, in most cases, refer the person for assessment and more specialized assistance. In all instances, when in doubt, consult.

Disorientation: The person is dazed and unable to give date or time, location, and events of the past 24 hours, or understand what is happening.
Anxiety and Hyperarousal: The person is highly agitated, restless, jumpy, and on edge; is unable to sleep; has frequent disturbing nightmares, flashbacks, and intrusive thoughts; or broods over circumstances surrounding the event.
Dissociation: The person exhibits pronounced emotional disconnection, an incomplete awareness of the traumatic experience, a sense of seeing him/herself from another perspective, a perception that the environment is unreal or that time is distorted.
Depression: The person exhibits pervasive feelings of hopelessness and despair; unshakeable feelings of worthlessness, guilt, or self-blame; frequent crying for no apparent reason; withdrawal from others; or inability to engage in productive activity.
Mental Illness: Symptoms include hearing voices, seeing things or people that are not there, delusional thinking, appearing out of touch with reality, and excessive preoccupation with an idea or thought.
Inability to Care for Self: The person does not eat, bathe, or change clothes; is apathetic, isolated from others, and unable to manage activities of daily living.
Suicidal or Homicidal Thoughts or Plans: The person makes statements like "I can't go on," "I just want to end this terrible pain I'm feeling," "I wish that I had died," "I want to join my husband in heaven," or "I'm going to get even." The person feels pervasive self-blame or sense of responsibility for another person's death.
Problematic Use of Alcohol or Drugs: The person makes references to getting drunk, getting high, or not being able to stop drinking; blocks out pain with mood-altering substances; relapses from previous abstinence; misses work or other obligations due to alcohol or drug use; or expresses concern about a family member's substance use.
Domestic Violence, Child Abuse, or Elder Abuse: The person mentions instances of inappropriate anger or violence toward family members.

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