EUNAD IP National Workshop - Germany
"Psychosocial Intervention of people with mental disabilities in disasters"
The national workshop about "Psychosocial Intervention of people with mental disabilities in disasters" took place on the 8th of September 2016 in Cologne. Workshop was held with 17 participants working in the field of psychiatry, psychology, social work with mentally disabled individuals but also crisis intervention and research about mentally disabled. In the following paragraph you find the results of all three workshop- groups.
Workshop- group 1: Psychotraumatology of mentally disabled
People with mental disability are a high risk group due to:
- early life time events e.g. emotional neglect, bullying, instable attachment, maltreatment, sexual abuse
- mentally disabled might not be able to inform about personal needs, high risk of to much cognitive demands
- mentally disabled might get in contact physically (to promote need of connectedness)
- prevalence of posttraumatic stress disorders among people with mental disability?
- do mentally disabled show posttraumatic stress reaction such as hyperarousal, avoidance/ emotional numbness, intrusive distressing recollections, dysfunctional cognition in the same way?
Research with mentally disabled: Hazard of misdiagnosis, distinguish between behavioural disorders associated with mental disability and posttraumatic stress reactions:
- Screen for changings in behavioural patterns (e.g. appetite, sleep, refusal, mutism, stereotypes)
- medical history by proxy seems to be necessary
- mental disability is a very heterogenic term limitations in cognition and amount of behavioural disorders depend on the severity of mental retardation
Psychotherapy and communication with mentally disabled should focus on:
- promote self-efficacy, independence, feeling of control and security
- develop appropriate skill for emotional regulation
- verbalization can be difficult, other more appropriate approaches should be used, need for research what works well
- relaxation techniques seem to be very helpful
- use easy language with short sentences
- get in contact with attachment figures
- SEO (diagnostic tool for emotional development) should be used to screen individual emotional development of mentally disabled individuals
- confrontation with trauma in psychotherapy can be difficult when the sense for e.g. time, emotions are limited
Mental disability could be seen as protective factor due to:
- already existing structured services (e.g. residential home, carer, custodian)
- strict daily routines
- protected from media/public
- reduced memory, optimism, hope
Workshop- group 2: Acute psychosocial intervention for mentally disabled
- mentally disabled do have the same needs in crisis but they might need other ways to cope
- to promote the feeling of self-efficacy mentally disabled should be personally addressed but not there caregivers only
- caregivers could be used to mediate as mentally disabled trust them and often do have a good contact to them
- in terms of preparedness a few best practices were mentioned by participants, e.g. regular emergency training and an individually created first aid-kid (with blanket, teddy-bear) for mentally disabled living in residential homes but also naming a mentally disabled "safety-representative" who is responsible for safety of mentally disabled in a residential home could promote the feeling of preparedness, security and self-efficacy
- First-responders have to be trained
- Avoid open questions, e.g. "what do you need" rather give concrete options, e.g. "want something to drink?"; "want to call your parents?"; "want a blanket?"
Workshop- group 3: Mid- and longterm psychosocial intervention
- Lack of psychotherapist for mentally disabled due to: Apprehension / uncertainty about mental disability
- Lack of training in the curricular/ education of professionals working in psychosocial Intervention
- Lack of guidelines, for a long time mentally disabled were assumed to be unable to profit from Psychotherapy
- Lack of institutions to be consulted, due to the UN-convention of the rights of disabled Germany installs competence centre for disabled (e.g. www.ksl-duesseldorf.de www.lvr.de/de/nav_main/kliniken/heilpdagogischehilfen/institutkonsulentenarbeitkompass/institutkonsulentenarbeitkompass_1.jsp) this might be a helpful opportunity for professionals to get advices in the future
- Mentally disabled would not proactively ask for treatment/ psychotherapy usually
- Professionals working with mentally disabled in e.g. residential homes should be trained in techniques of stabilization to integrate stabilization in the daily life of potentially traumatized mentally disabled, in Germany so called "Trauma-pedagogy". To focus on training for those professionals might be more sufficient than training of professionals of psychotraumatology due to the fact that mentally disabled need more repetition to consolidate psychological input.
- Mobile psychotherapy, with therapist visiting the mentally disabled to promote the feeling of security could be helpful
- A list of psychotherapist who feel able to treat mentally disabled should be collected and published.