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Tuesday November 10, 2009
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VIEWS: STEVEN CRIMANDO
Lessons for Pandemic Planning
A Special Report from
Extreme Behavioral Risk Management
A Division of ALLSector Technology Group Inc.
by Steven M. Crimando, MA, BCETS
and Cynthia L. Simeone, CBCP, PMP
[Feb 14 2009]
There are significant similarities between the current global financial crisis and a pandemic disease outbreak. These similarities are particularly pronounced in the area of human factors, specifically in the psychosocial response to adverse events that involve elements of uncontrollability, unfairness and loss. The sudden and dramatic onset of the economic crisis resulted in many organizations suspending their pandemic preparedness efforts in order to focus on the dire threat at hand. As the economic situation transitions from a "sudden crisis" to "smoldering crisis", business continuity planners and others charged with an organization’s pandemic influenza preparedness may benefit from identifying, understanding and benchmarking these dynamics to inform policies, plans and preparedness efforts for a pandemic.
Effective pandemic planning must be predicated on accurate assumptions about the individual and collective response to the threat. The global economic crisis, viewed as "pandemic-light", offers a unique opportunity to practice and prepare for the actual event. It may turn out to be the best test of pandemic preparedness possible, if approached in a thoughtful and structured manner.
Pandemic: From Greek "pan" (all) and "demos" (people): Occurring over a wide geographic area and affecting an exceptionally high proportion of the population.1
While the current financial crisis may have diverted the attention of business leaders, continuity planners and emergency managers away from pandemic influenza planning, the risk of a possible pandemic has not diminished. In recent weeks, avian and human influenza activity in the United Kingdom, China and India have thrust the flu back into the spotlight. As of January 27, 2009, the World Health Organization (WHO) has updated its statistics and now reports 403 human cases of the avian influenza, resulting in 254 deaths worldwide. The H5N1 virus responsible for these deaths is particularly powerful, proving lethal in more than 50% of the known cases. Each new human case heightens the possibility for the virus to make the critical leap in mutating to a deadly pandemic strain.
The H5N1 virus has several significant similarities with the influenza virus that swept the globe during the Great Pandemic of 1918. Not only has the pandemic influenza threat not abated, but communities, organizations and nations may be at even greater risk if the pandemic were to emerge during such vulnerable economic times.
The current economic crisis may in fact have a potentiating affect on the pandemic risk. A standard pandemic planning assumption is that possibly 30-40% of the nation’s workforce may be offline at any one time, due to illness or death, or remaining home out of fear or to care for the ill. If an organization is forced to layoff a substantial number of employees and is already operating with a depleted workforce in a down economy, further diminishing the remaining workforce by another 30-40% during the pandemic may have a paralytic - if not fatal - affect on the organization.
The current economic downturn has resulted in a continued reduction in the Gross Domestic Product (GDP) in the United States and in other industrialized countries. The arrival of a pandemic influenza in the midst of the global financial crisis would represent a "perfect storm" scenario resulting in potentially unimaginable consequences for the global economy, as well as individuals and families, communities and organizations.
Sudden and Smoldering Crises
Sudden crises tend to produce acute stress reactions in individuals, families, communities and organizations. These events can be said to have "bookends", in that it is clear when the event began, when it ended and whether one was directly impacted. A smoldering crisis often lacks these clear markers by beginning slowly, with many of the early warning signs remaining below the radar. Once the crisis begins, it is difficult to know exactly when it will end. It can also be difficult to determine exactly how badly one is affected since they are dynamic and shifting in degrees of severity over time. Smoldering crises tend to result in chronic stress reactions. They exhaust individual, organizational and possibly national resources. A pandemic that circles the globe in two or three "waves" of illness over the course of 12 months or longer may begin with a sudden realization that the outbreak has begun, that it is real and it is bad, but would generally be considered a smoldering crisis. Likewise, the economic crisis, though beginning with the initial "subprime" calamity, reached the sudden crisis phase on one specific weekend in September 2008, but will most likely be remembered as a long, complex and smoldering crisis.
The global economic crisis may be viewed as "pandemic-light", while there is pain and psychosocial disruption, but without the body count.
The national strategy for surviving a pandemic and an economic crisis hinges on three key actions:
□ Stop, slow, limit spread of crisis
□ Mitigate impact, suffering and permanent damage (or death)
□ Sustain infrastructure/economy and functioning of society
Comparing the economic crisis to a pandemic can surface many interesting similarities that may inform pandemic preparedness efforts in both the public and private sectors. These similarities can be found in the areas of event dynamics, impact, response, planning and recovery. To demonstrate the similarities between the economic crisis and influenza pandemic useful to planners and decision-makers, the overlapping elements have been delineated in several categories.
Both the economic crisis and a potential influenza pandemic share many features, including the twenty identified below:
□ Global reach
□ Few, if any, are immune
□ Contributing factors identified long in advance of the onset of crisis
□ Small pool of experts warned of impending doom
□ Threat not fully recognized until reaching dramatic, irreversible levels
□ General public had little awareness of the risk
□ Highly technical/exotic factors triggered onset
□ Slow-moving but unstoppable once in motion
□ Long, complex crises
□ Progress in waves or cascading sequence
□ Disagreement among experts about best way to handle the situation
□ Remedy or vaccine not readily available, must be developed quickly
□ Initial attempts to "treat" the problem prove to be insufficient
□ Intensity and duration of crisis exhausts resources
□ Distinct social, economic and emotional consequences
□ Raise many ethical dilemmas
□ Characterized by loss
□ Contain aspects of both "sudden" and "smoldering" crises
□ Increases distrust of authorities
□ Create a sense of helplessness or powerlessness
The impact and response to "sudden" and "smoldering" crises differ. A sudden crisis has a definitive beginning and end and while shocking, the human impact is more easily compartmentalized because of the definitive timeline. With smoldering crises, the effects are usually more insidious and difficult to overcome because the emotional and behavioral cycles associated with the crises repeat over a sustained period of time. Recovery from a smoldering crises is often more complicated.
However, both events are characterized by loss and dread. While a loss of life is more likely in a catastrophic disease outbreak, other losses associated with the financial crisis may result in similar emotional and behavioral reactions, possibly further complicating response and recovery.
These losses include, but are not limited to the loss of:
□ Sense of community; belonging
□ Status and role
□ Beliefs or faith (i.e., patriotism, religious beliefs, etc.)
□ Future and purpose
In Time Magazine reporter Amanda Ripley’s latest book, "The Unthinkable: Who Survives When Disaster Strikes-and Why", she isolates "dread" as a significant factor influencing the human response to threatening events. She has gone as far as developing a "dread formula" to explain these dynamics. Some, if not all, of the elements in this formula are equally present in both the economic crisis and most pandemic scenarios. Ripley’s dread equation is:
+ Scale of Destruction
One can assign each of the elements of the dread formula to some aspect of both the economic crisis and a pandemic. Many commentators have been liberal in their use of the terms "unimaginable" and "unthinkable" in their descriptions of the financial meltdown. It is likely that those same labels would be recycled and applied to a devastating public health crisis as well.
The impact of both events can potentially reach all corners of the globe and all spheres of our personal and professional lives. Both in the home and in the workplace, there is a foreseeable range of affects, including:
In the workplace
A great deal of time, effort and money has been spent in the U.S. and abroad over the past several years developing plans and procedures to mitigate the effects of a pandemic on the workplace. While a pandemic strain of influenza has yet to emerge, the current financial crisis has triggered many of the same workplace dynamics anticipated by pandemic planners, including:
□ High levels of stress and fear
□ Diminished or depleted workforce
□ Significant reduction in productivity
□ Loss of capital and/or access to capital
□ Supply chain disruption (i.e., cargo stacked up or waiting off shore at sea ports)
□ Drastic decline in retail, travel, entertainment, construction and many other economic sectors
□ Escalating unemployment
□ Consolidation among businesses within certain industries
□ Disruption or closure of financial markets and institutions
In the household
The 2008 American Psychological Association (APA) "Stress in America" survey revealed that 8 of 10 Americans identify money matters as a leading source of daily stress (APA, 2008). Since that study was released in mid-2008, the economic climate has darkened substantially. The Conference Board’s January 27, 2009 Consumer Confidence Index documented a steady slide into despair, with the consumer confidence level reported at an all-time low. People are feeling stressed and anxious about their financial future. Many are unsure how they will handle a recession or more economic bad news.
Both the economic crisis and a pandemic will result in the closures of many businesses, lost earnings and many other hardships. In both instances, individuals and households may suffer great financial difficulties, such as:
□ Little or no household income
□ Depletion of savings
□ Increased dependence on credit cards to replace income
□ Risk of default on loans or mortgages
□ Potential for crisis-related financial scams
□ Increase of a overall financial stress/distress
Emotional responses can range from simple distress to diagnosable mental health conditions, including:
□ Extreme fear and anxiety
□ Sadness and depression
□ Anger, blame
□ Helplessness, hopelessness
□ Increased rates of suicide
□ Traumatic stress reactions
□ Complicated grief and bereavement
Trauma and Grief
Grief has been described as our reaction to something (or someone) "good" leaving our lives, while trauma is our response to something "bad" coming into our lives. In the instance of a worker losing a job, baby boomers losing 40% or more of their retirement savings or a family losing their home, loss is loss and our minds and bodies do not necessarily distinguish between loss related to a health crisis or an economic disaster.
Behavioral reactions tied to our appraisal of the situation can lead to:
□ Increased alcohol and drug use
□ Increased irritability
□ Difficulty concentrating, problem solving and/or decision-making
□ Increased risk-taking
□ Increased emotional-eating (esp. sweet, salty and high-fat foods)
□ Social isolation, withdrawal
□ Change in sleep patterns
Many behavioral reactions affect interpersonal relationships in the home and workplace. These can be manifested as:
□ Increased conflict
□ Diminished communications
□ Difficulty parenting or supervising workplace subordinates
□ Poor spousal/partner and/or peer relations
Much can be done to reduce and/or mitigate many of the negative consequences identified above through conscientious planning in the home, workplace and community.
Planning in the Workplace
Guidance in pandemic influenza planning has focused on several areas of concern that are equally relevant in the financial crisis. These include ensuring critical processes, communications, physical and mental health issues, ability to travel to or attend work and, finally, developing organizational resilience. Successful consequence management through the economic pandemic will require attention to many of the same concerns.
In planning for a pandemic, it is important to ensure critical processes can continue with a reduction of workforce. If, during the economic crisis workforce reduction is necessary, insure the remaining workforce still retains the core skills and knowledge (corporate memory) to assure essential business functions can be accomplished, or make sure critical processes are documented so unskilled laborers can perform the required function.
"Crisis-sizing" the Workforce
"Crisis-sizing" or temporarily adjusting the size and configuration of an organization’s workforce due to economic pressures rather than illness may be a necessary part of a survival strategy in the face of this new threat. Pandemic planning guides have suggested that leaders should explore creative workforce restructuring for survival. Several businesses have recently received applause for implementing creative alternatives to layoffs, including reduced hours for all rather than lost jobs for some. Other cost-saving alternatives have included shifting some employees to working from home and job sharing to reduce their office space requirements and other fixed overhead costs. These strategies have been discussed in the context of pandemic flu planning as ways to cope with a workforce downsized by disease.
Changes in the workforce and financial health of critical vendors must also be assessed. If the organization is reliant on external resources or services, leaders should conduct business risk and impact assessments to identify critical suppliers, identify alternative sources and negotiate contract terms in advance of any potential disruption.
Immediately, organizations can provide the most value to their employees by communicating their priorities and survival strategies. In the workplace, survival is a shared responsibility. Clarity regarding roles and responsibilities during a crisis is crucial. To reduce anxiety, leaders should provide employees with two-way communication vehicles. During the financial crisis, as in pandemic preparedness, leaders should let employees know what the business is doing to mitigate risk. If there are serious concerns, it is not only much better from an ethical standpoint to openly communicate these challenges, there is a legal obligation documented in the Worker Adjustment and Retraining Notification (WARN) Act that indicates companies must provide 90 days’ notice prior to plant closure or mass layoffs, so affected employees can be as prepared as possible for negative outcomes.
Employees may better prepare financially and emotionally for a reduction or loss of income with some degree of advanced notice rather than following a surprise or sudden reduction of work force. Warning enhances a sense of controllability and whenever possible proactive communications are recommended.
Proactive communications may also involve the development of draft "shelf-kits" by creating internal and external communication templates and having them pre-approved by corporate communications officers to help speed the delivery of timely communications for different contingencies. Establishing a "hot-line" can empower employees to ask questions and/or make suggestions to help stabilize their workplace environment.
Many organizations active in pandemic planning had initiated training programs for executives and supervisors, as well as internal crisis management and first responder teams, to raise awareness of the unique physical and mental health challenges associated with an influenza outbreak. Such programs were designed to help decision-makers predict and prepare for a pandemic using accurate information about the disease and its likely impact on society, as well as the organization. Specialized training focused on the unique challenges associated with the financial crisis may be equally important. Understanding the human factor in both a pandemic and financial crisis can give planners an advantage in recalibrating business contingency plans appropriately for the current threat environment.
Sources of Emotional Support
We have previously discussed the concepts of trauma and grief as they relate to both a pandemic and the financial crisis. It is foreseeable that there may be an increased need for psychological support programs for workers and their families. Establishing or enhancing Employee Assistance Programs (EAPs) or community outreach programs can aid and educate employees with financial planning or other related services. A lesson learned is that natural support systems, in the home, community and workplace tend to be the most helpful in other smoldering crises. Promoting peer support programs and other mechanisms for employees to both give and get emotional support may prove invaluable in a long-haul scenario.
Just as it is important for leaders to communicate in the workplace, providing family members with information goes a long way toward an effective response and recovery. The emotional demands of both a pandemic and the financial crisis can erode relationships in the home during a time when the support of loved ones is most needed. Sharing information about the affects of smoldering crises on homes and families can be beneficial and may help those affected anticipate the likely emotional traps that characterize long-term stress situations.
Employers can also provide additional assistance in financial planning and household money management. Those not yet seriously impacted by the financial crisis can modify the home budget and identify ways to curtail unnecessary spending. It is helpful to enlist all family members to watch spending. Even young children can understand the concept of saving for future benefit. Planning ahead will be necessary to ensure that basic needs will be met. Prudence and pragmatism will be of equal importance in both the current financial crisis and a possible pandemic in the future.
Tracking and Benchmarking Through a Smoldering Crisis
There is very little, if any, empirical research from the "Great Influenza Pandemic" or the "Great Depression" that can be applied to predicting human behavior in a smoldering health crisis or financial crisis. So what else can be done by organizations to utilize the lessons learned from the past to address the financial pandemic at hand?
Some organizations have begun to track the impact that employee benefit or wellness programs, such as weight reduction, smoking cessation and exercise programs, have on an organization’s bottom line. It would be beneficial to also document other human factors issues (absenteeism, performance, morale, conflict, others) in the home, business and community as we move through the various phases of the financial crisis. Such tracking can help leaders gain a better understanding how prolonged adversity impacts the "worried well" (those who are still employed or not otherwise derailed by the financial crisis) to inform pandemic flu policies, plans and exercises. Organizational benchmarking of human factor issues can be invaluable in developing the type of accurate behavioral assumptions that will be necessary to sustain productivity and the bottom line during a pandemic or other smoldering crisis.
As with event, impact and response factors, the likely psychosocial challenges in the long-term recovery from both pandemic flu and the economic crisis are similar. In a typical disaster, the behavioral response cycle can quickly shift from neighbor-helps-neighbor to neighbor-fears-neighbor to neighbor-compete-with-neighbor as fear escalates. During the recovery period, the cycle gradually returns from self-preservation back toward community cohesion and support. In fact one of the lessons learned in other smoldering crises is that the natural support systems within the home, business or community become the most important and dominant source of help. Knowing this, families, businesses and communities should take every opportunity to bolster and promote cohesion in the early phases of a crisis, since it will become increasingly important as time goes on.
Personal and organizational resilience is essential to the recovery from a smoldering crisis. Resilience is often defined as the "human capacity and ability to face, overcome, be strengthened by, and even be transformed by experiences of adversity."
The potential for resilience can be and should be nurtured. Smoldering crises are best approached by applying the discipline and strategy of the marathon runner, not the sprinter. Everyone wants out of a tough situation sooner, rather than later, but both the financial crisis and a pandemic are challenges of endurance. Those who have survived and thrived through smoldering crises in the past identify three common tactics:
□ Face the sources of their stress directly
□ Learn from past experiences
□ Reach out for and use resources
There will be numerous challenges in the wake of the financial crisis, as there certainly will be in a pandemic. These include, but are not limited to:
□ Overcoming loss or guilt from having survived through the storm
□ Taking inventory and examining the current state of one’s personal and professional affairs
□ Addressing both the physical and psychological consequences of the crisis
□ Developing a reconstruction plans to rebuild or recoup losses
□ Reaching out to friends and the community to give and get support
Pandemic planning should remain a priority during the financial crisis. It can be particularly useful to revisit pandemic plans to see what elements can be recalibrated or repurposed for the current financial crisis.
The authors suggest that the current financial crisis may be one of the most realistic and productive pandemic influenza planning exercises business and community leaders may have in that both events are smoldering crises with many similar human factors and economic consequences. While recognizing that a catastrophic disease outbreak could result in a tremendous loss of life, therefore becoming a disaster of a whole different magnitude, there are enough similarities to allow business continuity and emergency management planners to track, benchmark and use their observations of the financial crisis to inform pandemic planning efforts. Likewise, prior pandemic planning efforts may also inform strategy and decision-making in the current financial crisis.
Lastly, it is important to reiterate that the pandemic risk is not diminished. This threat is still lurking in the shadows while the world turns its attention to the urgent financial situation. A weakened global economy may in fact leave nations, businesses, communities and families that much more at risk to a public health disaster.
Economic Stress and Holiday Stress Collide
[Nov 26 2008]
A 2004 poll from the American
Psychological Association (APA) found that 61% of Americans identified money
issues as the leading cause of stress during the holidays. Oh, for the good
ol' days of 2004! Participants in that survey listed lack of money, lack of
time, the pressures of gift giving and credit card debt as significant
sources of strain. One in five Americans surveyed expressed concerns about
their physical health and many reported increased eating or drinking to cope
with the stress.
The Root of Anxiety
Cognitive dissonance - a term in the field of social psychology - is when one feels uncomfortable or anxious due to juggling two contradictory ideas or beliefs. Dissonance occurs when people experience an inconsistency or a gap between their ideas of how things should be and how they really are. Theorists suggest that the greater the gap, the greater the degree of anxiety, guilt, shame, anger or embarrassment. People can by haunted by the "tyranny of the shoulds": "I should have been able to get better/more gifts for people"; "I should feel happy, it's the holidays"; "I should have handled my money/career differently", etc. While one might believe that they should feel joyous during the holidays, this may contradict the reality that portfolio values are slashed, jobs are on the line or that many people are struggling to hold onto their homes.
Cultural norms, family traditions, office rituals and other forces may shape the individual's or group's expectations of how the holidays should be. From gift- giving to the annual bonus, there are many holiday- related activities that may require severe modification during the current economic downturn. Living up to holiday expectations can be tough, but this year they may be even tougher.
The Big Three: Sources of
2. Compartmentalize: Allow yourself your emotions and then let it go. Whether you are angry, anxious, sad or disappointed, permit yourself to have those thoughts and feelings and then turn them off. This takes some practice, but compartmentalizing allows you to pick and choose when you will deal with these emotions, rather than them controlling you. Find a time and place before a holiday gathering to get in touch with these feelings, but set a limit and when the time is up, leave them there and go onto festivities at hand. You can always go back to that physical and/or emotional place when the event is over.
5. Let People Know What Would Help: Try to tell those around you what you really need, since they may not know how to help you, and ask for their understanding if you decline an activity. People may even avoid you if they feel uneasy or unsure what to say or how to help. During a time when emotional support and contact can be so helpful, don’t let a lack of communication create unnecessary barriers.
[Nov 10 2008]
Resilience is the ability to
bounce back from adversity. It allows us to recovery from change or
hardship, as individuals, families, communities and organizations.
Resilience encompasses both strength and flexibility. It is associated with
elasticity, buoyancy and adaptation. All of the attributes of resilience
would seem essential in the current climate given market volatility and the
unpredictability of global economic conditions. This issue of the Behavioral
Risk Bulletin will focus resilience, its importance and strategies for
building and enhancing resilience in times of crisis.
This concept, known as "neuroplasticity" suggests that despite earlier ideas that our habits, thoughts and beliefs are set in stone, that in fact you can teach old dogs new tricks. The brain continues to grow, change and adapt to challenges across our entire lifespan. Our thoughts shape our brains as much as our brains shape our thoughts. This relationship is now known to be a two-way street. We can use this knowledge to promote resilience in ourselves and in our organizations.
What Does Resilience Look
These may sound like personality traits and some may be, but that does not mean that individuals cannot develop resilience. By identifying and practicing these behaviors individuals can build or bolster resilience in themselves and support resilience in others around them.
Ten tips for building resilience
Becoming more resilient is a
process and requires conscious effort and a degree of patience. Fostering
resilience as an element of an organization's culture requires even greater
patience and consistent positive reinforcement from leaders. These efforts
can pay off in meaningful ways but you are not likely to be able to reap the
rewards of resilience without some significant effort. These tips can help
you move to a higher degree of resilience in the face of current and future
[Oct 24 2008]
bearer of bad news is never pleasant. Whether it is delivering the message
at work or at home, finding the right way to share bad news can be tricky.
It is known that how bad news is shared can greatly affect the emotional and
behavioral response of those on the receiving end. Studies around the
delivery of extremely bad news, like death notifications for example,
demonstrate that the way the message is delivered influences both short- and
long-term reactions and recovery.
The 5 T's of Breaking Bad News
of human response to a crisis or disaster is both phase-specific and hazard-
specific. How we react to a threat, real or perceived, varies from hour- one
to day-one to week-one and so on along the time line of the event. Likewise,
how we react to a hurricane is different than a disease outbreak and
different yet than an economic crisis that may too threaten our security and
Step at a Time
[Oct 17 2008]
In 1908, psychologists Robert Yerkes and J.D. Dodson developed a model of understanding the affects of fear and stress on performance. The "Yerkes-Dodson Law" dictates that to a degree fear and stress can motivate and drive performance, but that a tipping point is reached where performance greatly diminishes. This concept is widely used in sports psychology to help elite athletes find and stay in their "zone" of peak performance. Most of us have experienced this on some level and have a sense of where our own point of diminishing returns is set.
A far more eloquent and useful model to help us understand the type of fear generated by the current financial crisis is "crisis decision theory." Crisis decision theory helps us predict the responses people will choose to negative circumstances. Since a negative life event is largely subjective and shaped by our individual perception, crisis theory can be applied to a wide range of adverse events, from losing your wallet to losing your home. Crisis theory sets out to address two questions that may be helpful in anticipating the emotional and behavioral responses to the current crisis:
Although the current discussion is limited to the financial crisis, crisis decision theory can also be applied to disaster scenarios, such as the factors involved in choices about evacuation, personal and family disaster preparedness and reporting to or remaining at work during a crisis or disaster. Business continuity planners and emergency management professionals should consider incorporating some of the important concepts of crisis decision theory into their response and recovery models.
Crisis Decision Theory
Let's explore a few of the central concepts in crisis decision theory. There are three stages of crisis decision-making delineated in crisis decision theory. These include:
Applied to the financial crisis, individuals, families and businesses are still trying to assess the impact of recent events. One individual may know with certainty that they have lost their job, another may be sure that they have suffered serious financial loses in their investment portfolio, college savings plan or retirement account, but as the market undulates from 700 points up to 700 points down in a single day, they maybe unclear about how much of a loss the have truly suffered. For the small- or medium-size business owner, having their line of credit curtailed may mean trouble meeting this week's payroll and perhaps losing employee confidence or perhaps losing the employee who can not afford to come to work if pay day is not a sure thing. This phase of a crisis event can be chaotic and ambiguous, so as straight forward as this initial stage of crisis decision theory may seem, assessment often can not begin until the smoke clears.
Since there are so many unknowns in the current financial environment, employers should enhance efforts to communicate with key stakeholders, including employees, about the company's financial position and provide reasonable warning if any difficulty is foreseen. Transparency about such issues can improve employee loyalty and mitigate rumors that can impact safety and performance.
From a crisis decision theory perspective, the financial crisis holds some unique challenges, specifically that when a threat (physical, emotional, financial or otherwise) is so extreme, it may overwhelm people and paralyze their progress though later stages. The authors of crisis decision theory (primarily Kate Sweeney at the University of Florida), depict this potential in an inverted "U." If a crisis is not sufficiently scary, people may not be motivated to act in any way, and conversely, if the situation is extremely frightening, it can immobilize people and impede any meaningful action.
There are several other factors that help shape people's perception about how bad a crisis really is. These include:
___There will be great variation in how individuals respond to the financial crisis. Although it may appear that two employees have sustained similar loses, their reactiona may be very different. Reaction to loss is influenced by dozens of factors, including temperament and culture.
Weighing Response Options
After sizing up the problem, the next question is usually, "What can I do about it?" The two critical determinants in choosing a response option are the individual's perception of control over the crisis and the resources available to them to tackle the problem. Someone faced with a diagnosis of cancer may be presented a whole range of treatment options from doing nothing to a radical or high-tech treatment. If this person does not have sufficient financial resources and/or insurances, many, if not all of the options may be off the table. Another person may have great financial resources, but the nature of their illness is such that there are no viable treatments, perhaps in a late stage of a disease. All of the money in the world would not be helpful in such a bind. So, options and resources are closely linked.
This all boils down to controllability. People are more successful in dealing with crises that they feel they have some control over and when they believe they have the necessary resources. Unfortunately, in the case of the financial crisis, the activity of the markets and world governments is well outside most people's control and the loses experienced in the market melt-down can reduce the resources people might otherwise use to deal with a challenge.
Making a Choice
In a disaster planning scenario, employers may ask what factors help determine if workers will stay at their posts or come in to work during a crisis; who will perform the best and what can we do to encourage people to stick to the roles and responsibilities assigned to them in the organization's disaster plan? Crisis decision theory helps clarify how people weigh the pros and cons of their potential response. This theory suggests that three broad considerations are involved such decisions. They are:
Crisis decision theory is one of the models that helps us predict how people will behave in disasters, emergencies and other crisis events. Such a theory can also help us improve how people respond, therefore improving safety, performance and continuity of operations. In our recent white paper, "From Bourbon Street to Wall Street," we apply disaster psychology principles to help us understand the human factor in this unpredictable climate. As we move forward through the financial crisis, XBRM will continue to offer insight and guidance in predicting and preparing for the emotional and behavioral challenges to come.
STEVE CRIMANDO & CYNTHIA L. SIMEONE
A Special Report from
[Oct 17 2008]
Like natural disasters, a sudden financial crisis can result in uncertainty, loss, and anxiety about the future. Much of what is known about the emotional and behavioral response to other types of disasters can be helpful in managing the psychological consequences of the financial crisis. Left unchecked, these consequences can further complicate individual, community and organizational recovery. Lessons learned and strategies for coping developed in other disasters can be employed in financial crises to mitigate the emotional and behavioral consequences of the situation.
It’s a Disaster
The terms “loss”, “grief”, and even “trauma”, can be applied to communities ravaged by the recent hurricanes and the financial communities in major cities around the world. Some of the core concepts in impact and coping with natural disasters can be helpful across a range of different types of crisis situations. It has been said that grief is our response to something good going out of our lives, while trauma is our response to something bad coming into our lives. In many disasters and crisis events, both grief and trauma are present and powerful forces to be reckoned with. Unfortunately, many individuals, communities and organizations have become too familiar with, and too practiced at dealing with the emotional consequences of natural disasters. A February 2008 Oxfam International study documented a quadrupling of natural disasters over the past two decades, from approximately 120 to more than 500 worldwide each year. But the type of crisis affecting the financial industry today has been a relatively rare, but not completely unprecedented event.
With the increase in other types of disasters, there has evolved a growing body of knowledge about how sudden, shocking and threatening events affect us, along with best-practices in "psychological consequence management." Much of what we know about the emotional response to other types of disasters can be applied to and helpful in dealing with the psychological challenges of the current financial crisis. The noted statistician, George Box was credited with saying that, "all models are wrong, but some are useful." While there is not a one-to-one comparison to surviving a hurricane and a financial crisis, many of the front line lessons in disaster response do apply.
What is Lost?
In major disasters there are unfortunately many instances when individuals and families truly do lose everything. Losses can include loved ones, a home, pets, irreplaceable keepsakes and more, including a sense of community or safety. Deeply-held personal or religious beliefs can be shaken. In many situations and specifically in financial disasters, those loses can be somewhat imperceptible and not obvious to others. A financial crisis can result in a loss of:
•Identity and belonging
•Security, financial and otherwise
•Status and role
•Future or purpose
Grief reactions, similar to those experienced after other types of losses, such as the loss of a loved one, are not uncommon. As stated, grief is our response to something or someone good leaving our lives and mourning these losses can be tricky. Survivors (and sometimes others around them) of financial disasters often don’t compare themselves to those who have experienced natural or technological disasters. However, loss is loss, and we are finding that this is a fair and useful comparison.
Phase-specific, Hazard-specific and Individual Responses
How individuals react during a crisis varies from hour-one, to day-one, to week-one and out along the timeline of the event. To help individuals and organizations predict and prepare for the emotional fallout from a financial crisis, a basic disaster-behavior timeline can be helpful. This timeline is marked by several foreseeable phases or stages, each representing its own challenges and perhaps, opportunities.
1. Impact: The initial phase of any disaster or crisis event is characterized by disbelief, fear and uncertainty. Fear of the unknown is a universal source of anxiety and the early phase of a crisis is often filled with ambiguity and a lack of information or clarity. Early emotional reactions often appear as shock and numbness.
2. Inventory: Once the smoke clears, people generally get a sense of how the disaster or crisis has personally affected them. It becomes increasingly clear what was damaged or lost and some of the initial shock often gives way to anger and blaming, sadness and feelings of powerlessness.
3. Disillusionment: It seems that many people slide into a period of disillusionment after a major trauma or loss, but to what degree varies with the situation and the individual involved. This phase is characterized by resentment, hopelessness, anger and sometimes shame or guilt. Often people report just feeling “stuck” and unable to make any forward progress in rebuilding their career or life. In work-related crises, this can be tied to perceptions of unfairness over pay and severance; difficulty finding a new job; and recognition of the permanence of change in lifestyle or work.
Disillusionment can also be compounded and prolonged by a cascade of secondary stressors, such as mounting financial pressures in the home or problems in relationships. This is a phase in which some people have great difficulty seeing the light at the end of the tunnel. It can seem bleak and hopeless for some and good emotional support becomes critical during this phase.
4. Reconstruction: Rebuilding a career, a lifestyle and a sense of optimism can take time, like rebuilding a home or community in the wake of a disaster. Everyone moves through these phases in their own time and on their own terms. There is no best way or specific timeframe in which people move through these phases. Moving through the phases and reconstructing a professional and/or personal life is very individualized. For some the process can be weeks or months long, for others it may take years. Establishing a “new normal” requires patience and persistence from everyone involved.
5. Integration: For the survivors of any crisis, the process of integration involves weaving the crisis into one’s overall life story. We never forget the crisis or disaster, but it becomes an important milestone or even a battle scar, rather than an obstacle or preoccupation that dominates our daily lives. In summary, it becomes a story, rather than the story, in our personal history.
And then there are specific personality traits, cultural influences and community norms (such as within the organizational culture, the community of financial professionals, etc.) that all come into play. Simultaneously, there are somewhat predictable responses to a financial crisis and totally unique responses that are not necessarily foreseeable or expected.
Exposure and Duration
In response to any real or perceived threat to our safety, survival or way of life, the degree of exposure and the duration of the threat are critical influences. Exposure can be thought of in degrees, first, second and third, much like a burn.
First degree exposure is experienced by those directly impacted by the event, in this instance, those executives, brokers and traders employed in the financial industry. The radical and sudden restructuring of the financial services environment has pulled the rug out from under tens of thousands of employees who face the loss of their livelihoods and stock value. Of course, the spouses, partners and children of those financial professionals are also directly affected as household incomes drop and economic security of the family becomes the dominant theme in everyday life.
Those who are not employed in the financial sector, but may experience significant losses in investments or are dependent on the financial industry for their incomes, would be considered secondary victims or having second degree exposure to the situation. With countless jobs evaporating in New York, London and elsewhere, the restaurants, retail establishments and service industry catering to the financial districts will also suffer substantial and perhaps irreversible losses. Many small businesses will also cease to exist with the sudden exodus of so many jobs.
As the ripple effect of the crisis widens and moves out from its epicenter, the circles become larger. Third degree exposure potentially applies to the wider U.S. and international community already anxious about instability in housing, credit, commodities and energy. This is the “Main Street to Wall Street” connection the current U.S. presidential candidates frequently reference. Many people will not personally know of someone working in the financial sector or in a business serving the financial community, but they are concerned and vigilant on a day-to-day basis about the price of gas, milk, heating oil and housing. For those with third degree exposure, the vulnerability of financial giants, such as Lehman Brothers, Merrill Lynch and AIG can heighten a sense of personal vulnerability, “If firms with literally billions of dollars in assets can’t make it, how can we?”
Obviously, how the crisis affects any one individual, family or organization is a function of their relationship, proximity and exposure to the event or situation. The closer you are to the fire, the greater the potential injury. Likewise, the longer the threat exists, the greater the impact. In many instances, natural disasters are sudden and devastating, but the initial event can end as quickly as it began. Tornados are devastating, but fast moving. Certainly it can take months, years or a lifetime to rebuild after a tornado strikes a community, but the initial threat passes quickly.
Typically, the longer a threat persists, the more damaging it is from a psychological and social standpoint. The financial crisis is in some ways both acute and chronic. The news of the Lehman Brothers collapse and sale of Merrill Lynch may have been sudden and unexpected by some, especially with the news of what is being referred to as "Bloody Sunday” being sprung on a weekend when the public’s attention is not usually on the markets.
But at the same time that the news was sudden and dramatic, many of the current economic problems that caught up with Lehman and Merrill Lynch have been creating instability in the markets for some time. Chronic stressors tend to exhaust us, some believe leaving us more vulnerable to additional risks. We seem to be much better suited to manage sudden, but short-term crises. But when a crisis is both sudden, shocking and prolonged, it can result in more complex and challenging emotional reactions. Every disaster is unique and at the same time, may have many similarities to other disasters. The current situation is unlike anything we have ever seen and yet bears a strong resemblance to many previous financial crises.
For several reasons, individuals experiencing distress related to the financial crisis may not reach out for help in meeting the emotional challenges. Not wanting to appear weak or worried in front of family members or colleagues; intolerance of our own fear or anxiety; and the need to appear in control, can all become barriers to seeking assistance or admitting that the situation is taking an emotional toll. It is useful to note that even following natural catastrophes, most people don’t go running for psychological support. There is typically a delay in seeking assistance, at least through the impact and often into the inventory phase. Most people facing a financial disaster, including layoffs or the disappearance of an entire industry similar to what may be experienced in large-scale natural disasters, don’t go on to become psychologically-damaged goods. Most people experience some degree of emotional distress, considered natural, expected and even helpful in surviving the challenges they face.
Across different types of disasters and crisis events, it is common for those individuals directly affected, as well as those in their immediate circles, to experience a range of reactions. And while these are natural and normal responses, they can certainly be unpleasant and add to one’s overall discomfort. Such reactions include physical, emotional, cognitive and behavioral changes that in some instances can complicate the situation and become barriers to coping with the challenges ahead.
- Shock-like reactions
- Depression, anxiety
- Thrill-seeking, risk-taking
- Clinging, isolating
While these reactions are widely seen in response to natural and technological disasters, they are common in other interpersonal crises where there is an element of threat. Threat to one’s survival due to a financial crisis is no different. Most of these reactions are short‐lived and self‐resolved as the individual moves along the timeline of the event. For some, these reactions can be more pronounced and prolonged. There may even be instances in which, in a more extreme form, one or more of these reactions may represent the symptoms of a medical or psychological emergency.
Chest pains, arrhythmias or heart palpitations, as well as respiratory distress and acute abdominal pains may be the signs of something more serious and require medical attention. While potentially stress‐related, these reactions should not be ignored or thought to be "just in your head." Likewise, suicidal and/or homicidal thinking, as well as serious mental disorganization or disorientation may the signs of psychological emergencies and should be assessed by medical or mental health professionals.
Emotional Consequence Management
The concept of "consequence management" is widely accepted by business continuity professionals across most industries (e.g. risk mitigation and planning impacts risk consequence). Managing the emotional and psychological consequences of any disaster, natural, technological or economic, is critical to the recovery of the individual and their family, as well as the community and organization. The psychological impact of the current financial crisis should not be ignored or minimized. For many people this crisis represents substantial losses and a threat to personal and professional survival. This should not be underestimated in any way.
During a time of increased personal and professional demand, the impact of sleep problems, poor concentration, depression, apathy and increased use of alcohol and other substances can become serious obstacles to problem-solving and decision-making. Problems in personal relationships can create tension and distance from those who might be most helpful and supportive. The emotional consequences can be significant and difficult to address if not taken seriously and proactively.
There are coping strategies and techniques that can be helpful for individuals and families, as well as organizations. Many of these are similar to those being used today to assist the survivors of the recent spate of tropical storms and hurricanes.
Here are some useful suggestions for coping with the stress and anxiety stemming from the financial crisis:
- Limit your exposure to news
stories and constant alerts about the situation
- Communicate with friends,
family and supporters; let people know how they can help
The great risk communications expert, Peter Sandman advises that, "Action binds anxiety." Doing something is almost always more psychologically helpful than doing nothing. Past financial crises have demonstrated that investors tend not to fight or flee but rather to freeze. In natural disasters, there can be irrational fighting and fleeing, but in most instances people find purposeful "next steps" that actually make the situation better. Individuals and organizations would do well to heed Dr. Sandman’s advice. Getting people active in support groups and social networks, as well as practical hands-on activities is important. We know that people who actively participate in rescue and recovery tasks during disasters fare much better, physically and mentally, than those who withdraw, become passive or apathetic. Keeping busy, focused and productive during stressful times is essential to counteracting feelings of helpless and fear.
Use Available Resources
Many firms offer Employee Assistance Programs (EAPs) or Wellness programs that include stress management and support services. Such programs often extend their services via hotlines as well and many of these employee support call centers have already begun to experience noticeable increases in utilization. But many affected by the financial crisis, such as those with second and third degree exposure, do not necessarily have access to such resources. There are non-profit organizations, such as those affiliated with the National Mental Health Association, that provide no-fee helpline support, often 24 hours a day, as well as referrals to support groups and mental health professionals with expertise and experience in dealing with acute stress reactions. These resources are made available to communities struggling with the emotional impact of natural disasters and violence and they can be useful in a financial crisis as well. If reaching out to an EAP or Wellness Program is not an option, you can locate a nearby affiliate of the National Mental Health Association online or contact them by phone at (800) 969-6642.
No One is Untouched
Deborah DeWolfe, Ph.D., author of one of the first field guides developed for disaster mental health response stated, "No one who experiences a disaster is untouched by the event." This is not to say that everyone is traumatized or damaged in some way, but a sudden, shocking and threatening event takes its toll. It is estimated that almost 9,000 employees lost their jobs in the Bear Stearns restructuring. Ultimately, job losses may be in the tens of thousands across the financial industry and countless more in service jobs that rely on financial sector workers as customers in the restaurants, bars and boutiques in and around the financial districts. A storm, earthquake or act of mass violence resulting in tens of thousands of lost jobs would certainly be called a disaster. Make no mistake, the life-changing events of the past several weeks in the global financial system are also a disaster and no one is left untouched.
Cynthia L. Simeone, PMP, CBCP, is a New York City-based consultant, specializing in business continuity and organizational effectiveness helping clients understand and navigate the complex environments, relationships, and controls that their businesses must master to survive and thrive.
Contact: Cynthia L. Simeone
Over the past several months, pandemic influenza planning has been a
serious endeavor, consuming a great deal of time and energy for
those tasked with continuity planning and disaster recovery in
organizations around the world. Experts tell us that the risk of an
influenza pandemic is very real, even though media coverage of new
cases in birds, animals and humans is only a fraction of what it was
a year ago. Despite the reduced news coverage, the H5N1 avian flu
continues its march around the globe, with non-human cases now in 60
countries and human cases in 10. As of November 29th, there have
been 258 people diagnosed with avian influenza and 154 people have
died from the disease.
In most business environments, the term "behavioral" is typically associated with the mental health, wellness or employee assistance programs (EAPs) that address a range of emotional and psychological needs for employees and perhaps their families. From the perspective of those charged with crafting your organization’s disaster response and recovery plans, it is important that the planning efforts be accurately informed with empirical evidence about how employee behavior before, during and after a disaster can significantly increase or decrease the success of your emergency operations.
This guide was developed as an introduction for anyone who participates in the disaster preparedness and response discussion, in both the public and private sectors. It explains three useful behavioral response types and 10 important behavioral planning assumptions to assist planners in accurately informing their decision-making process across all phases of disaster and emergency management. These are evidence-informed assumptions, based on a thorough review of current research and literature, expert consensus, and field experience in disaster and terrorism response and planning. It is hoped that this guide will provide organizations around the world with some insights on effectively predicting and preparing for the likely human response to disasters, terrorism and other threatening events.
Accurate behavioral assumptions should be a standard part of overall disaster response and recovery planning. Nothing in this guide should be interpreted as suggesting that planners embark on an all-new way of approaching their jobs. Rather, inclusion of these ideas can fortify and enhance existing or evolving plans in critical ways that increase their effectiveness and value to the organization.
Emotional vs. Behavioral Responses
For the sake of clarity, it is important to understand the distinction between emotional and behavioral responses to disasters. In this context the emotional response refers to what is typically thought of as "mental health" issues. For example, the numbers of those with either diagnosable and sub-diagnosable depression, anxiety, posttraumatic stress and other mental health problems are likely to increase following a disaster that results in a tremendous loss of life and/or disruption of personal, professional, and social functioning. In most disasters research suggests that only about 11-15% of those exposed go on to develop such long-term mental health problems. The majority of people will experience short-term emotional distress and rebound in their own time and on their own terms.
Human resources professionals and health, medical and EAP providers understand and anticipate "post-disaster" reactions, and there are typically many resources available to those experiencing the emotional consequences of a critical incident.
Disaster behavioral responses occur on a continuum from purposeful and productive to potentially harmful and counterproductive. The range of positive reactions includes heightened levels of motivation, greater attention to detail and increased group cohesion, but there are many potential "tipping points" within various disaster scenarios that can quickly influence individual and group reactions toward negative response behaviors.
Such negative reactions, at the low end of the continuum, are represented by unfocused, illogical or irrational behavior, such as panic, hoarding supplies, non-compliance with vaccination or quarantine orders, and so on. They are not the signs or symptoms of a mental illness, but rather significant behavioral alterations that may cause further harm to the individual, the community and/or to the larger society.
Where Emotion and Behavior Intersect
While a line has been drawn between emotion and behavior for planning purposes, emotion clearly influences behavior and that there are behaviors that will certainly increase or decrease emotional response. Two important concepts for planners, illustrating the inseparability of emotion and behavior during actual emergencies, are the cognitive and physiological responses to stress and fear.
A long-held and still valid concept in basic psychology addresses the relationship between stress and performance. Developed by psychologists Robert M. Yerkes and J. D. Dodson in 1908 and grounded within the discourses of biopsychology and neuroscience, this concept can be applied to the performance of the organization’s disaster planners, first responders, executives and general employee population, as they may operate in a high-stress scenario.
Simply put, the Yerkes-Dobson research demonstrated an empirical relationship between arousal (stress) and performance. Their research supported the common observation that low and moderate degrees of stress can pique performance, but that at some point stress overwhelms functioning and performance rapidly and dramatically drops off. The bottom-line finding:
There is an optimal level of arousal for a given task. While this concept can have day-to-day applications in our lives, it can take on much greater meaning for those working in high-stress and/or high-consequence environments.
Useful to planners is the idea that the "tipping point" is unique to the individual and the circumstance. In assigning roles and responsibilities in the planning process, it is important to have knowledge of the individuals’ skills, temperament, and even home-life situation as it "pulls" or creates "person/role conflict" during an actual disaster response. Planners are often surprised at the differences in the performance of personnel during drills and exercises, and real-time events, since it is very difficult for most people to simulate the high levels of fear or stress that are present in an actual disaster. The absence of realistic behavioral role-playing in drills and exercises unfortunately skews planning efforts from the largest government-run emergency management drills to drills in the school environment.
Much of what occurs in our basic fear response is deeply physiologically-driven. It is immediate, powerful and for many, seemingly uncontrollable. Like stress, fear can play a positive role. It is a necessary part of our basic survival kit. Also like stress, any potential positive reactions influenced by fear can pass a similar "tipping point" and begin to work against us.
There have been many empirical studies of the effects of fear on performance that can realistically inform planners about behavior in disasters and emergencies. Some studies have successfully used physical indicators, such as heart rate, as milestones to mark behavioral "tipping points" and identify the conversion from positive to negative or counterproductive fear responses.
There is, of course, a range of variation in such models that is dependent on the unique characteristics of both the individual and situation, but one important concept is that physical conditioning does not change this equation. The underlying neuroanatomy and neurochemistry that drive "exercise-induced arousal" (i.e., heart rate, blood pressure, respirations, etc.) during intense exercise, and the mechanisms that drive "fear-induced arousal" are essentially two different systems that produce two different results. There is also a growing body of evidence that the "fear-induced" process is primarily responsible for post-disaster mental health problems, which further demonstrates how tightly linked the emotional and behavioral responses truly are.
The following three planning scenarios further distinguish these emotional and behavioral responses, incorporating both the individual and group responses.
Three Important Planning Scenarios
As a discipline, public emergency management is laced with certain behavioral assumptions that arise from a "game theory" model. As events have forced a closer partnership between public and private organizations in disaster and emergency management, much of this thought has saturated planning efforts within the business environment as well. The sort of "game theory" most of us are familiar with may have been introduced by the film, "A Beautiful Mind", about Nobel Prize winning mathematician John Nash.
Game theory assumes a level of cooperation between individuals that moves everyone toward a better response. Evidence of behavior in disasters suggests this is true in many instances, but not all, and when it is not true, it can so radically change the course of events, that planners must have a much broader view of the range of potential reactions.
Type I Response
The most common and/or foreseeable response to a disaster or crisis is a "neighbor-helps-neighbor" response. People look out for each other, help each other, follow instructions that they believe will help themselves and those around them. They do not panic, loot or impede emergency operations. This, of course, is the best case scenario, and in most instances, this is the response your organization’s disaster planners are banking on.
Type II Response
In some instances, particularly those that are perceived to be threats to health or security, a "neighbor-fears-neighbor" response is predictable. In most instances your neighbor or co-worker would gladly run over to lend a hand during and after a disaster, but if they believed that you might be sick and contagious, or in some other way a threat to them, then all bets are off. Obviously, as we perceive that others around us in the workplace or in the community are now part of the problem, we become more defensive and less likely to pitch in to the collective response or recovery effort.
For planners, a realistic approach to this response is based on the understanding that some people will cut and run. Research inquiring about behavioral responses to "dirty bomb" and smallpox scenarios suggests that substantial numbers of people would refuse to shelter-in-place or receive vaccinations if ordered, based on such fears. Another recent study indicated that nearly half of all public healthcare workers would stay out of work during an influenza pandemic. Therefore, it would be important to reconsider your available "people power" during Type II situations in which not all your employees may come in, stay in or be able to execute the response and recovery tasks you may be counting on.
Type III Response
A Type III response represents the worst-case scenario. It is statistically unlikely, but must be understood and considered in your general planning efforts. Such a response is characterized by panic. Panic, by definition, arises from two perceptions: 1) The perception of limited opportunity for escape; and 2) the perception of limited availability of critical supplies. The presence of panic changes all the rules; now it is a "neighbor-competes-with-neighbor" situation and becomes much more complex and dangerous. In theoretical form, there is a critical shift from "game theory" to "game theory with non-cooperative players" and everything changes in significant ways.
Planners should no longer count on social or organizational cohesion if such a "tipping point" is reached. Elements of public response to Hurricane Katrina unfortunately illustrate this point too well. Homeland Security officials’ comment that "…they did not foresee that lawlessness in New Orleans" demonstrates narrowness or "lack of imagination" in the minds of planners to incorporate behavioral considerations into disaster plans.
All disaster plans, public and private, are extremely behavior-sensitive. Changes in perception about the risk, the response or your company’s motives before, during and after a disaster can affect every aspect of your recovery. Understanding these behavioral considerations exclusively from a "mental health" standpoint is too narrow and not useful for disaster planning purposes, although it is essential to plan for emotional consequence management with qualified internal and external resources.
The following standard disaster behavioral planning assumptions are offered to help inform disaster preparedness and response efforts. Certainly they are not all inclusive, but may serve as a starting point as you craft new plans and recalibrate existing ones. Factor a realistic range of possible human behavior into your plans, work with partners who understand and can help validate these assumptions in your environment, and leave a flexible margin for variations in this behavior, since so much will be influenced by event-specific factors.
Standard Disaster Behavioral Assumptions
At both the emotional and behavioral level, anyone directly and many indirectly exposed to disasters, violence and other traumatic events experience some sort of impact. How and when this is experienced is very subjective and unique to the individual and can alter performance and behavior relative to disaster recovery operations. Understand and anticipate that even "hardboiled" disaster professionals are subject to this behavioral impact assumption.
Do not rest easy with the idea that the behavioral concerns are someone else’s problem. Yes, EAP or Wellness providers are typically ready and able to address the emotional impact of disasters. Planners should ensure that there are sufficient numbers of such resources, that they are readily accessible, and also validate that their models of intervention are consistent with current "best practices" in the mental heath industry.
The mental health concerns are largely "post-event". Behavioral concerns are present in all phases of emergency preparedness and response. Do not expect that the behavioral concerns can be managed effectively post-event.
Obviously how people respond to the threat of an approaching disaster or crisis is different from their response during and after the event. Fear and anxiety may be the dominant emotional reactions in the early phases of an event, diminishing communication and performance in the workplace. Later phases may be characterized by anger, sadness and hopelessness, impacting productivity and rates of return to work. Each phase holds its own challenges, so understand and incorporate the changing nature of the behavioral response across your response and recovery timelines.
All-hazards planning is an important and necessary advance in disaster management, but there are important scenario-driven behavioral responses that are not captured in the all-hazards approach. For example, plans to address unconventional acts of terrorism, such as chemical, biological or radiological hazards, must be informed with accurate information about how people react to being or believing that they have been exposed to such substances.
Reactions can be immediate, overwhelming and generate such acute levels of fear that prior assumptions about containment and decontamination may be moot. Informing your hazard-specific plans with a "clinical reality" of the behavioral response to such emotionally powerful events is essential. Reach into and outside of your organization and community for credible sources of this clinical information and compare it with your current hazard-specific thinking.
In certain events, the behavioral "footprint" will dwarf the medical and/or physical "footprint" of the event. This is often true when the exact nature of a threat is not fully known, or is difficult to detect. Chemical, biological and radiological risks are again strong examples, since these harmful substances may be odorless, colorless and tasteless. It may be difficult or impossible at the onset of an incident to truly know which individuals or groups have been exposed, and the typical behavioral response is "as if." Therefore, people behave "as if" they have been exposed, by: generating (psychogenic) signs and symptoms of exposure or illness requiring medical attention; over-reacting to their normal stress reactions thereby elevating levels of personal and group fear; potentially triggering panic; and feeling damaged in both the short-and long-terms, potentially affecting many aspects of their personal and professional lives.
Research with those exposed to sarin gas in the Tokyo subways in 1995 and the anthrax postal attacks in 2001 clearly support this assumption, and suggest that especially in the response phase, the numbers of the "worried well" or otherwise experiencing acute behavioral reactions can greatly outnumber those with physical injuries.
It is not necessary to have a stand-alone disaster behavioral response plan. In fact, it would be counterproductive. Behavioral planning should inform, and perhaps saturate planning efforts, but must be integrated, not isolated from general planning activities. From the behavioral standpoint, most disaster scenarios, natural and technological, have somewhat similar emotional and behavioral consequences that can be anticipated and incorporated into overall planning efforts. There is one useful distinction that may clarify if and where different assumptions are indicated, and that is along the dimension of time.
Most disasters can be thought to have "bookends." When the event occurs, you clearly know if you are in or out, when it started and when it ended, and can begin to take inventory in terms of the damage done. Given those dynamics, it is reasonable and empirically sound to assume that the emotional and behavioral response will be acute (short but powerful) and subside relatively quickly over time. It is also scientifically sound to estimate that only a small number of those exposed may need direct mental health support services, especially for the longer term.
In the sort of events discussed in Assumptions 4 and 5, when the threat is less clear, and it has a sense of "future orientation" (i.e. "I may get sick years from now from the chemicals or radiation I was exposed to today"), the impact is more long-term. There is a much greater possibility for chronic, long-term medical and mental health problems following an event that lacks such "bookends."
As the accuracy of your behavioral assumptions increases it is possible to revisit disaster plans with a new realism regarding how employees, stakeholders, and even the markets may behave during certain emergencies. Tempering your planning effort with sound behavioral assumptions can help you sleep a little more soundly as well. If you have developed plans with clear roles and responsibilities for all levels of personnel, it is certainly reassuring to know that people will actually be able to execute critical tasks, come and stay at work, and deal with the challenges that are likely present throughout the event and recovery.
Job 1-A: People’s safety is the first concern in a disaster;
Job 1-B: The bottom-line is a first concern in a disaster.
These are not mutually exclusive concerns by any stretch. The business organization has obligations, moral, ethical and legal, regarding the safety of its people and in the immediacy of a pending or breaking disaster, life safety trumps all other concerns. Beyond the obvious humanitarian considerations, this makes perfect business sense. Machines and technologies do not continue, maintain or recover businesses during or after disaster; people do. And once a business is perceived to care more about the bottom-line than its people, damage has been done that can be costly in many ways and for a long time to come.
At the same time, the business has similar obligations to its employees, stakeholders and others to maintain the business. Once the initial impact of the disaster is absorbed, the single greatest source of stress for most individuals and communities is the residual economic damage. Financial stresses stemming from a disaster continue to wear on people even years after the event and often become much more detrimental to overall recovery than the initial trauma of the event. One of the most responsible things the business can do is develop and maintain robust disaster response and recovery plans. Plans that are sensitive to the emotional and behavioral concerns are advantageous, but simply having and using a plan addresses some of people’s basic needs: to survive and to have a job to come back to when it’s over. The lesson: Job I-A and I-B are the same job. Don’t let anyone tell you otherwise.
Although this concept has been hinted at throughout several earlier assumptions, it is helpful to clarify the phased approach to planning. For the purpose of optimal interoperability between private and public organizations during disasters, the National Response Plan advocates for the use of the Federal Emergency Management Agency’s "All-Hazards" model. This time-tested approach to emergency management is based on a federal planning document known as "State and Local Guidance 101" which has long dictated that emergency management officials plan consequence management activities across four discrete phases or stages of disasters. These phases are defined as mitigation, planning/preparedness, and response and recovery.
Within your organization, emergency planning may exist in different formats, using different terminologies. That’s fine. From the behavioral planning assumption standpoint, it is important to remember Assumption 3, in that behavioral reactions are phase-specific. Therefore, as you work with your planning templates and timelines, imagine the likely behavioral response to each phase and thoughtfully consider effective countermeasures to address those foreseeable reactions before, while, and after they occur.
In many organizations there are pockets of expertise with varying degrees of familiarity with the emotional and behavioral response to disasters, violence and other traumatic events. These may exist in some unlikely places, and individuals with such insight do not often make it to the table for disaster planning activities. The same can be said of the community around you. Academic institutions of all types and sizes, community mental health centers, private practitioners, and others can be helpful as advisors.
It is extremely important to qualify your sources for such critical and sensitive information. As discussed, accurate disaster behavioral planning begins with a clear distinction between the emotional (mental health) issues and the behavioral issues specific to disasters. Most mental health professionals will have a working knowledge of the mental health side of this equation. Few will have empirically sound advice about the behavioral concerns. The advisors best able to help will have a balanced view of both, a depth of actual disaster experience and training, and affiliations with the relevant professional groups associated with disaster response work (ex: American Psychological Association’s Disaster Response Network, etc.). In this niche, it is not enough to be a licensed, practicing mental health professional. Your resources will require a higher level of sophistication.
Not Just for Planners
Hopefully this knowledge will be useful for the Business Continuity Planner as well as human resources, legal and medical staff and others in your organization concerned with mitigating the entire range of disaster-related consequences. The emotional and behavioral reactions to violent or threatening events, whether naturally occurring or human-caused, factor greatly into all aspects of emergency management in public and private settings. Whether your current planning activities are focused on pandemic preparedness or the next storm season, understanding and incorporating accurate behavioral planning assumptions into your efforts can help take your disaster recovery plans to a whole new and more effective level.
By Steven M. Crimando, MA, BCETS
Extreme Behavioral Risk Management LLC
New York, NY
Copyright 2006 © Extreme Behavioral Risk Management.
All Rights Reserved.
The Emotional and Behavioural Consequences of CBRN Events and Other Complex Public Health Emergencies: Part II [Mar 17 06]--In Part I of this article, the point was made that CBRN events (with the E for explosives purposefully left out of this discussion) were unlike other types of disasters in the psychosocial impact. Due to the prolong and ongoing threat of long-term health problems, exposure to CBRN agents is more likely to result in a chronic stress reaction, rather than the acute stress reactions typically associated with natural and man-made disasters, including acts of conventional terrorism using high-yield explosives.
In a nut shell, Dr. Roz Lasker and her colleagues sampled a significant number of U.S. citizens via random phone dialing to inquire how they would behave in two different emergency scenarios. The first was a dirty bomb detonation; the second was a smallpox outbreak.
In the first scenario about ¼ of all respondents said that regardless of what they were told by officials about sheltering-in-place or other life safety precautions, they would not stay put. Those individuals were willing to risk contamination and the problems of trying to travel during movement restrictions to get home to loved ones. In the smallpox scenario, roughly 2/5 of those surveyed said they would not get vaccinated even if mass vaccinations were ordered.
This sort of behavior can serious complicate the emergency and public health response to the emergencies at hand, and point to the fact that it should not be assumed that people will necessarily follow official directions.
There is a significant number of individuals
in any community who struggle day-by-day with serious and persistent mental
illnesses, such as schizophrenia and bi-polar disorder (manic depression).
Those individuals deprived of their medications and support systems are
likely to decompensate and begin to experience a resurgence of psychotic
symptoms, such as hallucinations and delusions. The same interruption in
medications and treatment for those afflicted with severe depression or
anxiety may exacerbate these conditions and result in increases in suicidal
and/or homicidal thoughts and acts.
During the SARS outbreak, the inability of families to see their loved ones in hospital, or to say, “good-bye” if they were dying, greatly complicated the grief and bereavement process. Inability to quickly get bodies back for funerals and other rituals also added to the angst of many surviving family members. The manner in which corpses may be handled en masse during a pandemic may also add insult to injury for many, especially if bodies are where housed due to shortages in caskets, burial plots or availability of crematory services.
There are myriad emotional and behavioral
responses to a pandemic that will greatly impact upon all aspects of
emergency management, public health and first responder activities. The
affects of fear, anxiety and prolonged stress on healthcare and hospital
workers, as well as others on the frontlines of this crisis must be
anticipated and integrated into all phases of pandemic planning. While much
is not known about the exact psychosocial consequences of pandemic
influenza, there is enough known from our global experience with other
disasters, CBRNE terrorism, SARS, HIV/AIDS and other serious threats to
extrapolate and inform the planning process. Pandemic plans that do not
fully incorporate the emotional and behavioral consequences of the crisis
are deficient and risky. Now is the time to reach out to those in your
academic, medical and behavioral health care communities to seek input and
advice about the unique characteristic of your region’s emotional and
behavioral risks and resources. This is not a facet of planning that can in
anyway be ignored.
The Emotional and
Behavioral Consequences of CBRN Events and Other Complex Public Health
Emergencies: Part I [Feb 24 06]--Author’s notes:
The following material is intended as a primer on the unique psychosocial
reactions to CBRN events. Part II of this series will focus on the
anticipated emotional and behavioral reactions to a possible pandemic
influenza. The reactions to such public health emergencies are complex and
atypical in comparison to other disaster mental health reactions.
Furthermore, how individuals, families and communities behave in such
emergencies will either greatly facilitate or obstruct public health and
emergency management efforts (ex: polio quarantine revolt of 1916, Oyster
The emotional aftermath of a CBRN attack may be far greater than the physical response and even more disruptive to individual lives and business operations. A critical factor in operational assurance is a working knowledge of the psychological consequences of these unique hazards.
No one is immune from the acute fear and anxiety that follow such incidents and everyone who may be part of the response and recovery effort should be well briefed on the psychological aspects of CBRN terrorism.
Likewise, everyone can be part of the
solution, by managing the emotional response as best possible and reaching
out to their co-workers and neighbors in their home, at work and in the
community with support and a willingness to allow others to share their
thoughts and feelings about the situation.
In the chaos that will likely follow a CBRN attack; the learning curve related to the psycho-social impact of the event will be very steep indeed. The time to learn about and plan for the emotional consequences of unconventional terrorism is now, when community and business leaders can thoughtfully predict and prepare for the aftershock of bioterrorism and other emerging risks.
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