Alise Bartley, a private practitioner in Ohio, and Carol Klose Smith, then a doctoral student at the University of Iowa, met under extraordinary circumstances — both volunteered to be American Red Cross disaster mental health providers in the devastating aftermath of Hurricane Katrina. The two American Counseling Association members were deployed to western Mississippi and became close friends while on the Gulf Coast, working and meeting at night to decompress and debrief with each other during their two-week deployment. They shared their daily struggles, frustrations and inspirations. They even managed to share laughs, despite the despair and destruction they sometimes encountered.

Both Bartley and Smith realized the experience would be life changing. Upon returning home, they decided they would help educate other counselors on the realities — some harsh, some surreal, some heartening — of being a disaster mental health volunteer, including presenting on the topic at the ACA Convention in Detroit.

Think before committing

Many people watching the cable news networks during and immediately after a crisis feel the urge to help, but counselors need to determine carefully whether volunteering to deploy is the right choice for them. Smith and Bartley recommend that counselors consider the following aspects before jumping into a commitment.

Family preparedness/support

• Will your family be supportive of your decision?
• Will deploying cause financial strain?
• Will your employer allow you to take the time off?
• Can someone else handle your day-to-day family responsibilities (e.g., picking up the children from school and soccer practice)?

Skills

• Do you possess excellent listening skills and a solid knowledge of mental health issues?
• Aside from American Red Cross training, do you have other crisis or trauma counseling experience?
• Do you have an outgoing personality? Can you strike up conversations with strangers?
• Are you willing to seize the initiative?
• Do you mind doing work that is not related to mental health counseling (e.g., passing out supplies and water)?

Self-awareness

• Are you mentally in a positive place where, as a volunteer, you can be the most beneficial to those in need?
• What are your strengths, limitations, assumptions and prejudices?
• Are you able to set firm boundaries and recognize the signs of compassion fatigue/secondary trauma?
• Are you prepared to be out of your “creature comforts” zone (e.g., sleeping in tents, using chemical toilets, working in extreme weather conditions)?

“The reality of the actual work of a mental health volunteer can be jarring,” Bartley says. “In the course of providing services to traumatized individuals, mental health providers are in a position to share the emotional burden of the trauma.”

Smith agrees, saying she sometimes found the experience very difficult, especially as she saw people struggling to meet even their basic needs, such as shelter and food.

Close quarters

Accommodations for volunteers vary greatly depending on the severity and type of disaster, as well as the time of deployment after the disaster. Bartley and Smith were deployed seven weeks after Hurricane Katrina and stayed at the Naval Seabee Base in Gulfport, Miss. More than 1,000 volunteers were housed in four large storage facilities on the instillation. For two weeks, Bartley and Smith slept on cots surrounded by 600 other volunteers. The coed sleeping area was cramped, with beds only 2 to 3 feet apart. Lights were turned off at 10 p.m. and on at 6 a.m.

Still, considering that they were comforting people who had lost everything they owned in some instances, Bartley and Smith found ways to look on the bright side and enjoyed meeting new people. “I had the privilege of sleeping next to a female retired nurse on one side and a male Vietnam veteran on the other,” Bartley says. “The situation was similar to going away to college. People were from all over the country, and no one knew anyone else.”

Large fans muffled the sounds of late night conversations, snoring and individuals tossing and turning, but Bartley says volunteers occasionally awoke to others having nightmares. Having earplugs or an inexpensive Walkman with earbuds may help volunteers get a better night’s sleep.

Outside the barracks were 75 chemical toilets (Port-O-Jons) and trailers rigged with private showers. Most mornings, the two counselors waited for almost an hour to use the shower, but they soon relished those few minutes of privacy and hot water.

So much chaos, so little structure

During Bartley’s first day in the field, her supervisor drove her toward the waterfront and explained their responsibilities. They were to stop when they saw people and identify themselves as volunteers, talk with them and connect them to community resources if necessary or available, offer them supplies and then be on their way. The debris and destruction increased exponentially the closer they got to the water.

On their way to the shoreline, they passed several people. When Bartley pointed this out and asked if they should stop, her colleague simply said, “Not yet.” Bartley became frustrated as they continued to pass by people who obviously needed help. She began to feel overwhelmed as she thought about the amount of loss and pain with which the survivors were dealing. “It was too much,” she says. “Finally, I cried. Later, in retrospect, I realized that it was important that I was first flooded with the destruction so that I would be able to focus on the people in the community and their needs and not respond to my own issues.”

After taking a few minutes to compose herself, Bartley and her partner finally made their first stop of the day. “We saw things we just could not believe,” she says. “The amount of devastation, the minimal living situations and the inequitable distribution of resources were incredible. No mental health training prepared me for this experience. It’s going to be 20 years before you (stop seeing) the scars of what happened. This was a community where there weren’t a lot of resources before the hurricane hit; after, there was just so little. It was so hard. You had to really watch your personal boundaries because you wanted to sell everything you owned to give them money but knew you couldn’t do that.”

The next day Bartley arrived at the field office and was surprised to find out that she was now considered a seasoned worker after only one day. Her supervisor from the day before was leaving, and Bartley would be in charge of orienting the newest volunteer — Smith. Bartley took Smith toward the waterfront and repeated the “flooding” experience she had undergone the day before. Smith had a similar reaction. Then they were off to work.

Reaching out to survivors

“There is research out on critical incident stress debriefing, and they’ve found that it’s actually more traumatizing, so we offered psychological first aid,” Bartley says. According to the Center for the Study of Traumatic Stress, psychological first aid creates and sustains an environment of safety, calmness, connectedness to others, self-efficacy or empowerment and hopefulness (see sidebar, “Psychological first aid).

Smith adds that volunteers should allow individuals to share their stories without structuring or guiding the conversation, allowing them to decide what’s important to talk about. Volunteers should also respect those who do not wish to talk, she says.

Both counselors say it is easy for disaster mental health volunteers to begin feeling discouraged and helpless in the face of so many survivor needs. When that happens, there is little sense of accomplishment at the end of the day. To avoid becoming engulfed in that mind-set, Bartley and Smith suggest that counselors instead focus on helping one person at a time. “If you start looking at the entirety of the situation, you become so overwhelmed,” Bartley says. “You have to look at the smaller system. Your role isn’t to fix the larger issues and concerns; your role is to help individual needs.”

Bartley and Smith spent much of their time passing out cold drinks and supplies such as work gloves, sleeping bags, pillows and duct tape, and then simply listening. The days were long and physically demanding (as well as emotionally demanding), so they recommend that volunteers pack comfortable jeans and T-shirts/sweatshirts and bring a good pair of work boots or other shoes with sturdy soles. Before deploying, research the area’s average weather conditions and pack accordingly, Bartley adds.

Many individuals who have lost everything in a natural disaster feel like they no longer have control over their lives. When meeting with survivors, Bartley tried to help them reestablish some semblance of control — however small — by simply allowing them the power of choice.  “I always tried to make sure there was some variety for people to choose from — as simple as Pepsi or Coke — even if it meant me going to a store and purchasing items with my own money,” she says. “That’s what I chose to do. So many times when someone needs help, we give them what we think they need rather than what they think they need.”

When Bartley arrived in Mississippi in late October, the weather was beginning to cool and people were in need of blankets. She learned that two types of blankets were available in the supplies for volunteers to hand out: warm yet scratchy wool blankets and soft, summer-weight cotton blankets. “Initially, I offered survivors a choice between the two. However, everyone selected the white (cotton) ones,” she recalls. “When the people picked up the white blanket, they would stroke it like a cat. Some even brought it up to their faces and gently rubbed it in on their cheek. There were few things left in the community that were soft and comforting.”

Bartley and Smith acknowledge there is little structure or guidance on how to help those in need after one is deployed. They just took the initiative and did what needed to be done at that moment. For instance, because of numerous clothing drives after the hurricane, Bartley says the shelters couldn’t store all the donations. Enormous piles of clothing were simply left outside at major intersections, on tennis courts or beside car washes. On one occasion, she and her partner for the day dug through the piles searching for sweaters, coats and warm clothing to give to migrant workers and others in need.

Caring for the caregiver

One of the responsibilities of the disaster mental health volunteers is to be on call at the volunteer shelters in the evenings and throughout the night in case of an emergency. “We would work all day in the field on a variety of issues — some uplifting, some difficult,” Smith says. “Then we would go back to the Seabee base and help the other Red Cross volunteers process what they had seen that day and what they were going through.”

The counselor on call would place a bike flag at the end of his or her cot so those volunteers who needed help would know where to go. But even without the flag, many disaster response volunteers sought out Bartley and Smith for support during their stay. To connect with those who were more withdrawn, Bartley and Smith chose to eat each night with someone who was dining alone at the camp. They would first ask permission to sit with the person and then try to build a rapport in hopes that the volunteer might open up and talk about his or her experiences.

“The hours and the tremendous need really made self-care difficult,” Smith says. “The mental health volunteers would try to catch up with each other and debrief when we could.” She says they also learned the importance of disaster mental health workers knowing their limitations and being firm in not trying to exceed them. The volunteers looked to one another for support, Smith says, and also recharged with phone calls home to their families.

“You have to find ways to decompress at night,” Bartley says. “This is a life-changing experience — let it be one for the better.”

Aside from monitoring their own mental health, counselors also need to be vigilant about their physical safety. On one occasion, Bartley was informed that she would be going into a community alone. She was apprehensive initially but decided she was up for the challenge.

“There had been a shooting in Biloxi (Miss.), and I was asked to check on the pastor who had been shot,” she says, adding that the pastor had been helping to set up electricity at a local community center when he was shot in the head during a drive-by. Luckily, the bullet had only grazed him, and all he required was stitches.

“The (American Red Cross) volunteers indicated that there had been an increase in gang activity over the last few weeks trying to gain control over that area in the community,” Bartley says. “As they were telling me this story, I realized that I was the only female volunteer from the Red Cross in the area. I knew I had to get out of there immediately. I called headquarters to say I would be returning and what had happened. Security personnel were unaware of the shooting, so I would need to meet with them when I got back. Once I hung up, I pulled over and began to cry. I had put my life in danger without considering the consequences.” The situation served as a powerful reminder to Bartley that volunteers need to watch out for their own safety and needs before focusing on the needs of others.

Going home

Both counselors agree that leaving the disaster area is a process in and of itself. Volunteers may feel torn between wanting to do more for those remaining in the disaster area and their obligations back home. “That pain of wanting to do more was still strong,” Bartley says. “But I knew it was time to give someone else the opportunity to help and have the same life-changing experience.”

Once back home, the two had very different reactions. Upon returning, Smith didn’t want to talk about her experience, at least not right away. Bartley, on the other hand, wanted to share her experience but felt alone because her family couldn’t truly relate to what she had been through. Her family was happy to see her but seemed even happier that they could finally get back to their normal routine.

“Coming back was difficult for me,” Bartley says. “You’ve seen and done these incredible things. The people at home are glad you’re back and they want to hear about it a little bit, but they also want to move forward, and you are still trying to process everything. I felt very isolated.”

Bartley says her friendship with Smith ultimately helped her deal with the letdown she experienced after returning and inspired her to help others prepare for the challenges of being a disaster mental health volunteer.  “People didn’t understand, and I had this need to reach out and educate people — let them know about the experience and continue helping,” she says. “It’s been part of the healing process for us to take our experiences and share them with others so they can make an informed decision on whether or not they are going to do this. All of us had our heartstrings pulled when we heard about Hurricane Katrina, but do you really have what it takes to be able to go down there in this type of situation?”