Limit your TV / ‘net exposure: Christchurch quake 22 February 2011

My stomach sank when I woke up at 4am in London and checked my mail. I heard about the 6.3 quake in Christchurch. I heard the reports and saw some of the footage. I know it will be hard in the hours and days that follow, but I would strongly recommend anyone, especially those in the area in NZ, to limit the viewings of this footage. Yes, I understand you want to know what is going on, and you want to find out about people you care about. But we know from the evidence of coverage of other disasters that repeated viewing of graphic footage of the event (a) adds no further understanding in terms of pure information, and (b) carries a risk of possible psychological difficulties later on.

Try to limit your exposure to imagery on TV and on the internet. Check in once in a while to see if there is anything new. Probably best to stick to radio, but be careful who else might be listening (small children might get even more upset).

Take care out there.

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A Guide for Emergency Response Workers and their Managers

Although we are two weeks on from the triggering event, engaging in response efforts in the wake of a crisis event like the Canterbury earthquake and the aftershocks is inevitably stressful for those involved in the emergency response. While the work is personally rewarding and challenging, it also has the potential for affecting responders in harmful ways. The long hours, breadth of needs and demands, ambiguous roles, and exposure to human suffering can adversely affect even the most experienced professional. Too often, the stress experienced by responders is addressed as an afterthought. With a little effort, however, steps can be taken to minimise the effects of stress.

Stress prevention and management should be addressed in two critical contexts: the organisation and the individual. Adopting a preventive perspective allows both workers and organisations to anticipate stressors and shape responses, rather than simply reacting to a crisis when it occurs.
Organisational Approaches for Stress Prevention and Management

  1. Provide effective management structure and leadership. Elements include:
    • Clear chain of command and reporting relationships.
    • Available and accessible supervisors.
    • Disaster orientation for all workers.
    • Shifts of no longer than 12 hours, followed by 12 hours off.
    • Briefings at the beginning of shifts as workers enter the operation. Shifts should overlap so that outgoing workers brief incoming workers.
    • Necessary supplies (e.g., paper, forms, pens, educational materials).
    • Communication tools (e.g., mobile phones, radios).
  2. Define a clear purpose and goals.
  3. Define clear intervention goals and strategies appropriate to the assignment setting.
  4. Define roles by function.
  5. Orient and train staff with written role descriptions for each assignment setting. When a setting is under the jurisdiction of another agency, inform workers of each agency’s role, contact people, and expectations.
  6. Nurture team support.
  7. Consider creating a buddy system to support and monitor stress reactions. Promote a positive atmosphere of support and tolerance with frequent praise.
  8. Develop a plan for stress management. For example:
    • Assess workers’ functioning regularly.
    • Rotate workers among low-, mid-, and high-stress tasks.
    • Encourage breaks and time away from assignment.

I compiled this from information issued by http://www.samhsa.gov

You can also download the information from a fact-sheet I developed here.

The Canterbury earthquake and the effect it may have on families: Part two

Yesterday, I posted about some of the short-term effects that emergency events like earthquakes and the cumulative stress of aftershocks can have. Today, I’ll continue to describe some the medium to long-term effects, helpful things to do, and some indicators as to when you might need to find help.

Medium term effects

Some families cope well with the crisis and immediate aftermath. Changes which are not obviously related to the crisis may occur some weeks or months after the incident.

  • Routine and work patterns, ambition or motivation in the affected member or others in the family may change; work efficiency and concentration may be reduced.
  • Spouses/parents may be short tempered, irritable or intolerant, leading to friction in relationships and misunderstanding between themselves and their children.
  • Children or teenagers can be clingy, attention seeking or disobedient – this usually indicates they are anxious or fearful.
  • Teenagers may become more rebellious or demanding, or through other behaviour, demonstrate a need to have a sense of control over their lives.
  • Child or adult family members may be overly concerned to help. They may try hard not to do anything wrong and postpone their own needs to support the affected member.
  • Family members’ feelings for each other may change by becoming more detached, uninvolved or preoccupied with personal problems as each member tries to cope with their own reactions.
  • Spouses may experience changes in their sexual relationship.
  • Children and teenagers’ school performance and concentration may be lowered; they may lose former interests.
  • Family members may lose interest in leisure, recreation, sport or social activities.
  • Teenagers may turn outside the family for emotional support from peers or other adults.

Immediate post crisis responses may persist or sometimes begin to appear for the first time.

Long term effects

Sometimes problems become evident for the first time, months or years after the event.

  • The memories of the traumatic event may come back for family members involved in another crisis, although it was dealt with at the time.
  • Family members, including children, often need to go over the events again when they grow into new stages of maturity and develop a capacity for greater understanding.
  • People may find future crises harder to handle, particularly when similar feelings are aroused, even if for different reasons.
  • Family members may cover up or cope with difficult feelings until all the fuss is over and things have returned to normal, and only then show their distress.
  • Any of the immediate or medium term effects may occur as delayed reactions or may become habits.
  • Problems often appear in the form of everyday frustrations. Retracing the way they have developed and examining connections to the crisis often makes the cause clearer. It is wise to assume that a major change or problem in family members in the next few years has some relationship to the crisis.

These problems are all normal reactions to an abnormal event that has touched the lives of the whole family. It is important not to blame each other. Try to understand how members affect each other. It is part of a changed pattern of family life arising from the crisis.

Helpful things to do

A few simple things will help families recover from crisis.

  • Keep communicating: Talk about what is happening, how members feel, what they need from each other. This avoids feeling alone, isolated and not understood. Don’t leave communication to chance, make opportunities for it to happen.
  • Share information: Communicate with children, teenagers and toddlers. They know something is going on and a painful reality is easier to deal with than the unknown worry of fear.
  • Do things together: Ensure time is reserved for recreation, enjoyment and rewarding experiences. Shared pleasure carries a family through many difficulties.
  • Keep family roles clear: Don’t allow children to take too much responsibility for too long, even if they want to care for a distressed parent. Help members preserve their role and position in the family and support them. Don’t overprotect children or adults. Be understanding if a member cannot fulfil their role for a time and talk about how they will resume when they are ready and able.
  • Be active: Tackle problems, seek help, seek information and don’t let small issues build up. Whatever the cause, stress leads to further problems. Stress factors don’t add up, they multiply and make everything feel worse than it is.
  • Look back: From time to time take stock of how each member has changed since the crisis. Look for the ways the crisis has influenced everyone for better or worse.
  • Allow expressions of emotions: Support distressed family members and allow them time to find their way through their feelings. They may express distress many times before it diminishes. Suppressing emotions places them outside control and therefore outside recovery.
  • Use other people: Keep in contact with support groups, other family, friends, neighbours, and workmates. Make sure the family doesn’t become isolated and too involved with itself. Share the experience with those you trust. Most families have the ability to grow through crisis. But understanding its effects and actively dealing with them is necessary.


When to seek help

There are a number of signs that recovery may not be proceeding in a helpful way:

  • Communication in the family is breaking down
  • Parents do not understand their children’s (or each other’s) behaviour
  • Things are not improving over time in the family
  • There is evidence of deteriorating physical or emotional health in any family member
  • Family members are not able to enjoy being together.

If you are concerned about yourself, your spouse, children or parents do not hesitate to contact someone trained to assess the situation and advise you. A little early help from a trained person can avoid long-term difficulty and give family members back confidence in themselves and each other.

I have adapted this from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

When someone you know has been through a traumatic experience

So far in this blog, I’ve mainly written about those people  – the majority of people – who will be upset and distressed by their experience through the earthquake and aftershocks. However, I thought it would be worth putting up a post that focuses upon those who are, or may be, more profoundly affected in a negative way.

The  Canterbury earthquake was certainly distressing and threatening, and may have been experienced as so intense that it can temporarily disrupt a person’s ability to come to terms with it. Thinking you might die, seeing others injured (or killed – but thankfully not in this case), intense fear, abuse or being forced to do things out of your control are all traumatic experiences. While traumas occur all the time, they only affect to a few people. The reactions of those affected often cause those close to them to be confused and unsure about what to expect or how to help. People who have been traumatised can respond in ways that may seem unusual, make things worse for them or they may be concerned about things that seem unreasonable.

The effects of trauma

A traumatic experience can temporarily shatter basic assumptions about life or other people such as trust, safety, predictability. The feelings caused may be so intense that unlike normal distress, they do not fade with time, but either continue the same or get worse after a while.

People affected by trauma may feel fear even when it is quite safe. They may be constantly on edge and not respond to normal reassurance or opportunities to relax. Their tiredness may continue on for much longer than seems reasonable. They may have periods of appearing numb or detached and not wanting contact. This may be followed later by over-excited behaviour and a need to cling to family or familiar things. They may feel they failed or did the wrong thing at the time (even if this is not true). Usually they remember a combination of very intense fragments of the event that do not go away, combined with important gaps that make them feel uncertain about what really happened.

Recovery from trauma

Most people recover from traumatic experiences, but it usually takes them longer than would be expected for non-traumatic crises. It is common for there to be an initial period of several days with strong emotions of fear or distress, and a constant preoccupation with the events. Many people then feel a need to get back to normal and put it out of their minds. Although this can often be beneficial in the short-term and help recovery from normal crises, it often only postpones problems for people who have been through traumas. Sometimes they can maintain normal routines for some time (although those around them often see that all is not well) and eventually something happens that brings it to the surface again. This can happen months after the event.

The important thing about recovery from trauma is to go back over what happened so the feelings fade and the person can come to terms with the event, realise it is in the past and how they can be safe again. But this has to happen at a time and rate that is comfortable for the individual. Other people are the most valuable support for recovery, but it is often difficult for them to be confident about what to do. Uncertainty and the wish to avoid distress can make those close to the affected person keep away from the experience or from them. It is usually best to ask how you can help and to let them know they can talk if they want to.

Helping someone who has been through trauma

  1. Spend time with the stressed person, without judging or demanding, their recovery will occur in its own time.
  2. Offer support and a listening ear: talking is one of the best things they can do to work things out; but they may need to go over things many more times than you expect. Try to be interested in what they want to say; avoid giving advice or trying to solve the problems. The talking itself is important and helps to make it fade. Remember though, this is likely to happen at their pace, not yours.
  3. Help with practical tasks and chores as this enables more of their energy and time to be given to the recovery process.
  4. Give them time, space and patience: don’t take it personally if at times they are irritable, bad tempered or want to be alone. These are a natural part of the stress response and will pass as they recover.
  5. Don’t try to talk them out of their reactions, minimise the event or say things like “you’re lucky it wasn’t worse,” or “pull yourself together,” or try to get them to look on the bright side; stressed people need to concentrate on themselves at first; they will feel supported if you let them know you are concerned, want to help and are trying to understand. They will see your viewpoint as they recover.


When to seek additional help

Sometimes it is important for people to know when their own recovery activity requires additional help. Personal recovery may need to be supported by specialist knowledge to ensure stress does not linger unnecessarily or lead to later health problems. Stress problems respond rapidly with professional advice and information.

Indications for this are:

  • if recovery has stalled or does not seem to be proceeding
  • if physical or other symptoms are causing concern
  • if there is no one to talk to or relationships are being affected by the stress
  • if there is continuing emotional numbness, depression or anxiety
  • if there is continued disturbed sleep and nightmares
  • if they are unable to handle the intense feelings or physical sensations
  • if they are becoming accident prone or increasing use of drugs and alcohol.

Looking after yourself

Don’t forget that to have a loved one, friend or colleague go through a trauma can be very stressful for you as well and you may find that you have strong reactions of anger that it happened, sadness for them, fear for yourself, changes in how you see life and the world, nightmares or general moodiness. Often the best thing may be to seek support from others for yourself so you can be more available to your loved one for the time it takes them to get over it.

Information and counseling

Counseling with someone trained in trauma is often helpful not only to talk about the trauma, but to give a better understanding about what is happening and how to get over it. Sometimes the person who has had the trauma may not be willing to seek help for a time. In this case it may be beneficial for those close to them to seek professional advice and this often helps them take the step themselves.

I have adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

Recognising and dealing with cumulative stress after the earthquake

A few days ago, I wrote about how we can sometimes put ourselves into an ’emergency state’ when we try deal with problems and cope with fear after an emergency events like the Canterbury earthquake and subsequent aftershocks.

This short article describes the sorts of signs of stress you may be able to identify in yourself or others if you’ve been in this state of emergency stress for too long, and what you can do about it.

Common stress symptoms

Thinking

  • trouble thinking clearly
  • planning
  • making decisions
  • can’t concentrate or remember details
  • low attention span
  • can’t stop thinking about the issues all the time
  • keep thinking about bad times in the past
  • not speaking clearly, slurring words, forgetting names.

Physical

  • bodily tension, stress and tightness in muscles
  • weak feelings, tiredness, loss of energy and enthusiasm
  • headaches, trembling, sweating, nausea, aches and pains
  • lack of appetite, increased desire for stimulants, sugar, alcohol, tobacco or coffee
  • feeling tired but cannot sleep, disturbed sleep, dreams and nightmares.


Feelings

  • feel detached from things
  • don’t care any more
  • irritable, bad-tempered, impatient and restless
  • unable to relax or keep still
  • feeling overwhelmed
  • everything seems too hard or difficult
  • tearful for no reason
  • easily upset or hurt
  • oversensitive to what others do and say
  • insecure – wanting to stay in familiar places with routines
  • feeling very emotional
  • experience waves of anger or worry that are not reasonable.


Relationships

  • feel others are to blame for stress
  • tendency to get things all out of proportion
  • can’t feel happiness enjoyment or affection for loved ones
  • moody and gloomy
  • feeling sad and hopeless as though the emergency will never end
  • changed relationships with those close to you
  • don’t want to be with family or friends or always need them around
  • have to talk about the emergency all the time
  • feel others don’t understand or don’t seem to care.

Cumulative stress

The same effects can occur if the emergency is not dramatic, but a series of smaller problems that go on for a long time. If it is not possible to unwind and relax between the problems stress builds up. This might apply especially in this case where we can expect the aftershocks to the earthquakes to be going on for some time.

The stress cycle

If stress has been ongoing, a pattern of stress may form. As a result, stress reactions cause more problems and this causes more stress. This is called the stress cycle. Once established, stress can become a lifestyle. Long term stress will undermine health and may cause illnesses. Getting over stress means breaking the stress cycle.

Breaking the stress cycle
Step 1. Recognise you are stressed
People often don’t recognise their own stress because they are too focused on the problems. Listen to others who may see you more clearly than you see yourself.

Step 2. Get to know your stress cycle

Try to see how the stress symptoms cause more stress and put you in the stress cycle.

Step 3. Make a decision to break the stress cycle
Although there are lots of things about your life you cannot change there a real ways some that you can, but you have to decide to do it.

Step 4. Reduce stress activities
Check your routines and life style to see where you can reduce the stress. Where possible stop doing things that keep stress high.

Step 5. Increase relaxation and positive activities
Build activities into the daily routine which break the stress cycle and give you a reward or good feeling, even if only a small one. Put a little effort in to enjoying yourself.

Looking after yourself

There are plenty of things that anyone can do which will help to break the stress cycle and reduce tension. Many simple pleasures will make a big difference to stress. Enjoyment is the best antidote to stress.

Physical

  • Do regular rhythmic physical exercise such as walking, swimming, cycling
  • Make an effort to reduce or at least not to increase your intake of stimulants such as alcohol, tobacco and sugar as they keep the stress cycle going
  • Eat regular, well-balanced meals even if they are small.


Relationships

  • Keep regular contact with people you like to be with
  • Ask for help when you need it, many people enjoy giving help
  • Make time to be with your family or friends
  • Talk to people you trust about yourself and what is happening so you can get it into perspective.

Relaxation

  • Do regular relaxation exercises such as deep breathing, listening to quiet music, meditation
  • Do something about bodily tension such as massage or exercises
  • Rest regularly, even if you can only do it for a short time
  • Try to find something that will make you laugh sometimes.

Attitudes

  • Accept that it will take time to get out of the stress cycle and keep trying
  • Be careful of accidents – concentration and judgement may be impaired under stress
  • Try to be organised and efficient so you have some time to yourself.

I have adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

More on supporting children through the earthquake, aftershocks and adjusting to life

Last week, I posted a quick entry to help orient you to some of the ways that children may be experiencing the earthquake, aftershocks and life after the quake. It will certainly never be the same. Even if there is potential for growth and gain through this in the medium-to-long term, it will certainly be different. And for most, the current situation is probably disorienting and confusing – as we try to make sense of what has happened, and what will happen next.

Children have their own ways of dealing with crisis according to their stage of development. Often their response is not what may be expected and may not show up for some time. Parents and others often worry and frequently are not sure of the best way to help them. Today, I’m posting more detailed information on how children tend to react to experiences like this, their likely needs, and how you can help.

The family

The family is the most important part of a child’s life (this changes for adolescents – see my advice sheet here). Parents give them their security and confidence. What trauma means to children depends to a large extent on how their parents react to it. Often this is more important than what happens to the children themselves. Parents can help their children by sorting out their own reactions and feelings. Do not be surprised if children’s reactions seem out of keeping with their experiences, they may be reacting to family members’ distress. Children (even infants and toddlers) always know more than adults give them credit for. They are aware of many things they cannot put into words for us. Children think about things a great deal even when they are not talking about them, but they can only put them in perspective with adults’ help.

Children need to make sense of things that happen. Children often don’t have all the facts and their thinking is not yet mature so they use imagination to fill the gaps. Often this results in misunderstandings, which they may keep to themselves, especially if they are frightening. What they imagine is usually more frightening than what really happened.

The child’s experience

Don’t assume that you know what the child understands about the earthquake or aftershocks, but find it out by talking and listening to the child and observing their behaviour. According to their stage of development, children may only take in some aspects of the situation. Their understanding is often limited, fragmentary or even distorted.

Reassurance is important, but does not help until the child has an accurate idea of the event and its causes, and their misconceptions have been corrected. Parents also need to find out what reassurance the child needs. This is not always what children ask about at first.

When someone they know is involved in a crisis, children may be distressed and imagine how it would have been for them to be involved in the crisis, but they usually express these feelings indirectly. They may feel their own security is threatened and that it could happen to them, however unlikely this may be. Sometimes, the crisis makes it harder to deal with other ordinary problems. Children don’t usually tell adults about these things because they may feel too self-conscious, are afraid or can’t put them into words. This can lead to misunderstanding or conflict between adults and children.

Children’s reactions may appear at the time of crisis or later. Sometimes they manage very well when the trauma is in everyone’s mind and only later start to worry, become difficult or feel as though they cannot handle their responsibilities. It can take months for things to build up to the point where parents or teachers realise a child may be having problems or needs extra help. By this time the event may seem less significant to adults. It is common for children to hold back their own needs and difficulties until they sense their parents are over the worst, and it feels safe for them to relax and start reacting.

Children’s reactions

These are some of the changes that can be seen in infants and children under stress:

  • sleep problems, nightmares, reluctance to go to bed or get up
  • changes in dressing, eating and toilet habits
  • irritability, uncooperative, listless or bored
  • clinging to family or familiar things, needing objects for security
  • unable to cope with change or ordinary problems
  • reverting to immature behaviour or habits they had previously grown out of
  • changes in relationships with parents, becoming more demanding, possessive, withdrawn, or uncommunicative
  • relationships with brothers, sisters and peers become more difficult. Often there is an increase in conflict, competition, aggression or withdrawal within these relationships
  • preoccupation with the trauma; wanting to talk about it, playing it out, wanting to see where it happened
  • excessive concern for others; holding back their needs to protect adults and anxiety about loved ones
  • reduced school performance, concentration or ability to play constructively
  • overactive behaviour, restlessness or dissatisfaction
  • small ailments or injuries are exaggerated or used to get comfort and security
  • transitions such as from preschool to school may be more difficult. Often there are problems at the start or end of daily activities
  • exaggerated reactions to small crises. This may be an expression of their distress about the incident which often they don’t fully understand.

How to help

  • It is better to tell children what has happened. Giving them the facts (but without unnecessary detail) helps prevent their imagination taking over.
  • Encourage them to express emotions. Fear and sadness are their way of coming to terms with what has happened. Hold them or stay with them, offer support while they are upset and then talk about it afterwards.
  • Keep communication open by asking questions to find out what they are thinking or imagining. Tell them how adults feel and what the actions of adults under stress mean. This will prevent children blaming themselves.
  • Reassure them about the future, especially the small details of life which are such an important part of their world.
  • Encourage them to continue to be children, to play, explore and laugh when they want to, even though the adults may not feel like it. Children are often able to take their minds off the crisis and its effects better than adults.
  • Maintain routine and familiarity to help children see that life is secure and predictable.
  • Reduce change of any type to a minimum. When change is necessary, take time to prepare children for it.
  • Keep them informed of how their recovery is going and what to expect.
  • Don’t make this the time to correct bad habits, don’t overreact to unusual misdeeds or bad behaviour. Talk about the behaviour with the child; they may need to let their tension out somehow.
  • Give children time to sort themselves out with your support, don’t expect it to be over quickly.
  • Keep track of the child; remember what she or he does and says, try not to let lasting changes in temperament and behaviour creep up without noticing.
  • Make time for just being together. Take time out and reestablish recreational activities and outings as soon as you can. Pleasure is an important part of healing.
  • Re-involve the child in chores and responsibilities as soon as they are ready to cope with them again.
  • Take seriously all their concerns, complaints and questions. They may be trying to express something important which they don’t have the right words for.
  • Parents need to get support to work through their own reactions, so they can help their child.

Summary: Brief Tips for Parenting after a Disaster

Be a caring parent.
Parents and guardians play a major role in ensuring the safety and well-being of their children. Although you may be under more stress after a natural disaster, it is important to continue caring for your children. Children are strongly affected by your reactions.

Keep your children safe.

You must know where your children are and who they are with at all time.

Establish routines.
Establishing new routines is especially important when normal ones are disrupted. If you are in a shelter and unable to return home, establish routines such taking a family walk, eating meals together, or reading a bedtime story.

Take a time-out.
When you feel overwhelmed, take a time-out. Take a few deep breaths, count to 10, or take a walk alone.

Ask others for help.
Ask trusted friends, family members, and other parents for help if you feel overwhelmed.

When to seek help

The best gift you can offer children is understanding. Don’t hesitate to seek advice if you do not understand any aspect of your child’s behaviour or if you have any concerns. A little help early can save a lot of heartache.

I have adapted from information issued by http://www.samhsa.gov and Queensland Health: Fact Sheets for Psychosocial Disaster Management. This information is also available on a fact-sheet I compiled for the Ministry of Health.

Checklist: Common reactions, positive coping, and when to seek help

A new week is with us. So, here’s a heads-up.

Distress is an understandable and normal response to major disasters. Common causes of distress may be related to having been directly at risk from the earthquake and aftershocks, being concerned about family and friends who may be affected, witnessing injuries and distress to others, or being caught up in the panic and confusion that often follows. In addition, feelings and memories related to previous experiences of disasters or other grief and loss may also resurface. Most people experience acute stress during emergency events and most manage with courage and strength. However, sometimes it is only later when the distressing images are recalled that some of the stressful effects start to show.

While most people will manage with the support of family and friends, there are times when extra help and support may be needed. Those who have feared losing loved ones, have been seriously injured, or are highly distressed by the aftershocks, will often need particular support and care. Our communities have a history of coping with uncertain and troubled times with courage and strength.

There are three important things you need to know:

  • normal reactions to this type of emergency
  • positive ways of coping
  • when to get extra help.

Normal reactions to a disaster like this include:

  • shock and numbness, often fear at first
  • horror and grief when the extent of loss is realised
  • frustration, anger, helplessness and even sometimes despair when it all seems too much
  • sometimes fears or old worries may resurface.

These feelings usually settle over the early weeks.

Positive ways of coping may be:

  • supporting one another, especially in the family and in your community
  • providing emotional support – comforting each other
  • carrying out practical tasks – tackling the jobs that need to be done a bit at a time and counting each success
  • sharing your experience and feelings with others – a bit at a time when it is right for you
  • looking after your own and your family’s general health – rest, exercise, food and company all help (being careful not to drink too much alcohol).

Sometimes, post disaster stress can be ongoing and affect your physical and mental health and wellbeing.

It’s time to ask for help if:

  • your sleep is badly affected
  • you feel very distressed, irritable, on edge or agitated much of the time
  • you feel hopeless, despairing, miserable or that you can’t go on
  • you have trouble concentrating, are distracted and cannot do your usual tasks
  • you feel your health is not so good
  • you have recurrent nightmares or intrusive thoughts about the earthquake
  • you have new symptoms or old problems may seem to have returned, eg. breathing, heart and stomach problems.
  • For children, withdrawal, aggressive behaviours, difficulties at school, problems separating from parents or going to sleep may indicate the need for help.

This is just the brief version. If you want more detail about specific topics, check out the other posts on this blog. The home page will have a list of recent posts in the right-hand column. Or you can click here for the fact-sheets at the Ministry of Health. I compiled these too.