Mental health is seen as an important aspect in the community response to crisis and disaster. Research offers limited guidance to what interventions are likely to be effective in preventing postdisaster mental health problems. This article reviews recommended elements of mental health responses to community disasters. Different factors influencing response are illustrated by using 9/11 and Hurricane Katrina as examples. Clinical suggestions for community planning and actions of individual psychologists conclude the article.
For many years clinicians have been ceptualizations of these borderlines states puzzled by those nonpsychotic but severely dis-reflects the sense of urgency that many cliturbedpatients referred to as "borderline." Recent n i c i a n s feei abOut this puzzling, seemingly work in object relations theory has suggested that f o r m l e s S j b u t v i r u i e n t disorder. Unfortuborderhne conditions are the result of a failureof integration of the basic personality, leading to J / T . . . *nr<,\ IT a major distortion in the patient's sense of self. consensus (Knight, 1953). However, recent Because most of this investigative work is relatively investigations by object relations theorists, recent, many clinicians are unfamiliar with current most notably Kernberg (1967, 1968, 1972, theory and clinical observations on the subject. 1975a,fr, 1976), have stimulated the emer-Failure to comprehend these patients' dynamics gence of a greater understanding of the nature can lead to treatment catastrophes, whereas un-of borderline conditions. Kernberg redirects derstanding of these phenomena may be helpful Our attention away from patterns of sympin dealing with a wide variety of borderline and tomatology and toward an examination of the other clinical problems. Here we present an overs t r u c t u r e a n d organization of personality. view of borderline dynamics and a discussion of w h e n v i e w e d m ^ m a n b o r d e r l i n e d o e s three major sequelae of these patients distorted r , . , c. , sense of self: "as-if" phenomenon, diffuse sexual n o t r e f e r t 0 t h e Periphery of some recognized identity, and overwhelming aloneness.pathology (e.g., borderline schizophrenia).
Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.
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