Mental Health Disaster Relief with Dr. Grant Brenner

george grombacher 0:02
Dr. Greg Brenner is a psychiatrist, therapist, consultant, psycho analyst, a disaster mental health responder, author and speaker. Welcome back to the show, Dr. Grant.

Dr. Grant Brenner 0:14
Thanks, George. Good to be back. And thanks for having me on again.

george grombacher 0:18
Yeah. Glad to have you back on refresh your memory, even though it hasn’t been that long. Tell us about your personal lives more about your work, why you do what you do?

Dr. Grant Brenner 0:27
Yeah, absolutely. Well, so I wanted to do this from a young age, I wanted to be a scientist and a psycho analyst, or a shrink is people say, you know, and I, and here I am. A few decades later, my interest was piqued at a young age and psychology, philosophy, as well as science. And so as a psychiatrist, I am trained as a psychoanalyst. I can cover bases. I got into disaster work a little bit before 911. And I’m currently on the board of vibrant emotional health that runs the 988 crisis line for suicide and mental health crisis, as well as a program called the crisis emotional care team where we were an interdisciplinary team that does disaster mental health response. And I’m on the board of languages of care. And we translate different mental health resources for crises and disasters into multiple languages that was started by my colleagues, Sandra Kaufman and his his colleagues, after the Russian invasion of Ukraine. In my writing, I talk about relationships and personal development in a few different books that I’ve co authored. And most recently, I’m working on a project with center Nishizaki Marcia chinny chin and James Delon Navy. I hope I got your name, right, James, looking at how generation Z’s attachment style influences participation in the workplace, and how managers can work better across generations.

george grombacher 1:52
I appreciate that. So we’re having this conversation on August 24. Obviously, we’re Maui has had the wildfire and going through the process of disaster relief there. So I was hoping that we could talk about your work as a mental health responder, in regard to disaster. There’s so much, obviously. And so I’d love to hear when, when somebody like you enters the equation, how does that kind of the steps of disaster relief? How does that work?

Dr. Grant Brenner 2:30
Yeah, well, there’s two things, you know, to think about first, before going into detail. One is that although there are certain similarities among disasters, we really highlight that if you’ve been to one disaster, you’ve been to one disaster, every gesture is unique, although some principles carry forward. The other thing is that it’s quite different to be local, and working as one of the affected population, then to approach an affected area from another place, and that factor vary so much from location to location. So it’s quite different to think about when I went to Baton Rouge after Katrina, then when we consulted in Mumbai after the shootings, or Sri Lanka after the tsunami or working with Japanese people, educationally. So there’s many, many different, you know, permutations, generally speaking, we have to be very adaptable in disaster mental health, although we follow kind of a general set of guidelines, the first thing we do is assess and triage. What What, if anything, can we do and at what stage, one thing we really wanted to avoid doing is being sort of imperialism like coming in and trying to impose a way of working, we have to really be respectful that the community has its own resources. And really, the idea is to empower communities over time. In disaster mental health, we’re not generally coming in to provide clinical treatment, for example. And the analogy to an individual patient is like a consult. So it’s more like we would consult for some period of time, and then try when we when we withdraw to, you know, leave those groups stronger and better equipped. In the case of the Maui fires, we have a very senior colleague there, Dr. Lesley keys, who is an award winning pioneer in disaster psychiatry. And so, you know, we’re supporting her with some materials that she’s using for local trainings, but but by and large right now, we don’t have a strong role to play there. But we’re fortunate that there’s local expertise and someone who can organize them. In other situations, we might come in and help organize and do trainings. We worked with Afghan refugees on military bases stateside, and provided a lot of organizational consulting, as well as training in disaster mental health principles, and then, you know, some guidance on how to bridge certain cultural gaps that you might see. So it’s highly variable. I think with Maui, there’s a lot of specific factors that I’m not as familiar with, but, you know, which I’m reading about. And, you know, we may or may not become more involved as the acute phase kind of settles down into more of a recovery phase. And the impact phase, settles down into an adaptation and then recovery and hopefully, growth phase.

george grombacher 5:47
I don’t know that I would have, it makes sense when you say when if you’ve been to one disaster, you’ve been to one disaster, and that it makes sense now that I hear it. I’m a person that likes frameworks and protocols. But, you know, that’s, that’s just, you know, just because I like that doesn’t mean that the disaster is going to need that, in fact, quite the opposite. You just need to be able to adapt and provide what’s what’s what’s what’s needed, necessary and useful.

Dr. Grant Brenner 6:13
Yeah, so I mean, there are frameworks that, you know, that we use. And within those frameworks, it’s, you know, the mathy term is a complex adaptive system. And so, you know, over the last couple of years sparked by actually, because early in 2020, early and 2020, I co chair, a committee on disaster trauma and global health, with the group for the advancement of psychiatry. And so we were meeting for our spring 2022 meeting, sorry, I’m getting my years mixed up, because the COVID thing is kind of like hazy. Sure, in terms of effects your sense of time, I call that the lost years or dissociated years, it was in March of 2020, we were meeting and the pandemic was, was just, you know, really becoming obvious to everyone. And though I had anticipated back in January, I remember saying to a friend, this is gonna be really bad. And he said, Don’t be so dark. It was more like being prepared. That’s a big part of disaster mental health is, is being clear eyed about what you’re dealing with denial can be comforting. Avoidance can be comforting. So in that March of 2020, our committee was meeting. I want to say, you know, I don’t remember whether it was in person or virtual, which is really strange. And the wildfires in California were just hitting. And we said, you know, we need a model that accounts for like multiple overlapping events that occur at different times, and have a different time course. And some of them may be a single impact event. Like, you know, an earthquake, though earthquakes can have aftershocks, or some of them may be rolling disasters, like a pandemic, or wildfires, which we just know, we’re just going to keep coming and coming. And so we developed a chronic cyclical disasters model that now is available. If people want to look at it, it’s chronic cyclical disasters dot info. This was developed through vibrant the grip for the advancement of psychiatry, and a decision point healthcare systems. So coming back to that question, you know, there are frameworks and that’s true in medicine, if you’re a surgeon, and you’re going to, you know, someone has appendicitis, and they need to have their appendix removed, you know, how to remove an appendix, and I did general surgery for two years, you know, back in the day, still, you don’t know what you’re gonna get, even if you have really good imaging studies, when you open up when you open up someone’s belly, and you see what’s actually there, then you have to respond to that situation. And so there’s a lot of principles of sort of emergency medicine that are part of disaster mental health. So that balance between knowing what to expect and being prepared and then being prepared for the unexpected is that is the critical harmony.

george grombacher 9:02
That makes a lot of sense. Chronic cyclical disaster. That is a that’s a lot of letters right there grant,

Dr. Grant Brenner 9:11
CCD M

george grombacher 9:14
All right. So what are what are some characters? What are some characteristics of somebody who is successful in this role? Obviously, you need to be calm and be a good communicator.

Dr. Grant Brenner 9:30
You have to be well trained. You have to be able to think in terms of systems as well as individuals and groups. You have to be able to step back and you have to be able to step in, you know, depending on the role, so if we have, you know, our volunteer cadre isn’t necessarily involved in running responses. I’ve been involved in direct response as well as in planning and implementation. If you’re a disaster risk Under there’s there’s many groups, one can volunteer with, you know, the Red Cross our crisis emotional care team. There’s an organization called national volunteer organizations active in disasters, battle letters, and VO ed. So there are a lot of volunteer organizations, their Citizen Corps, there’s world cares, there’s, there’s plenty of ways to volunteer as both a professional as and as the lay person. So when we just have our kind of clinician volunteer, they’re trained in disaster mental health response. And often we’ll be doing kind of consultation and triage with individuals and families. Sometimes, for a psychiatrist, we don’t prescribe medications. You know, people have a lot of conceptions about what psychiatry is nowadays, in disasters, we don’t go around medicating people. If there’s someone who doesn’t have their medication and is starting to get into trouble, we might provide them with a short term supply of medications and try to help bridge them to a referral. I encountered that numerous times in in shelters in Katrina, where people didn’t have like antipsychotic medications. And we’re starting to show signs of psychosis. And if you can imagine having one individual, one person who’s becoming psychotic, in, you know, an auditorium with 100 beds in it, it’s really important to the whole system to help manage that person. Or another example would be someone with a traumatic reaction with underlying personality problems. They don’t need to be medicated. But they do need someone to provide psychosocial support, both at the moment to help de escalate them, but also to train the staff who’s going to stay on to help manage those situations, because those staff, again, I’ll use Katrina, as an example, may not be mental health professionals, many of them were like retired oil workers, and they’d expect it to be involved for like a week, maybe, and now is going on three or four weeks. And so we also might provide training. And so our typical volunteer might do all of those things, often with guidance from afar. Another principle that we have is we always work with at least a buddy, because the impact on you know, the the volunteer can be can be considerable.

george grombacher 12:25
I can only imagine being in your shoes, just thinking about in that fictitious auditorium, whatever it might be, where there’s hundreds of people who are, you don’t know, maybe there’s a quarter of them, or a percentage that have existing mental health issues or problems or conditions. And then a lot of people that don’t, but are experiencing them because of what’s happened and trying to manage through all that would be would certainly be a lot.

Dr. Grant Brenner 12:55
You have to remember that most people are resilient. And people with chronic mental health conditions, often when there is a crisis, it actually are quite stable. You know, because their past experience and has, you know, has helped them develop those skills to be sort of calm through a crisis, I think. So it’s not like, you know, there’s dozens and dozens of people decompensating most people sort of don’t, and in general, though, there’s a risk of kind of mass panic, usually that doesn’t happen. That is also about what’s called Risk communication, which is how experts and not just experts, but also community leaders and people who are running shelters, communicate information to help prevent rumors, and to prevent things from getting too heated up in refugee village that I worked in, because of social media, what was happening real time on the ground in Afghanistan, people were looking constantly at live video feeds, and often had people you know, left at home, and were seeing atrocities and sharing it with each other. And you can’t tell people don’t do that at all. But you can offer guidance on how much to sort of regulate that type of activity. And, you know, to work with people where they are, you know, with what they need to do. So, you know, while it can sound sort of overwhelming, you know, you you develop a skill set, it’s it’s like being a traumatologist so you know, you you remain calm and and that helps a lot. Also, a lot of what we do is really very basic psychological first aid. Oftentimes, just meeting basic physical needs is the most important mental health thing. And so, you know, it’s not typically that we’re going in and doing sort of some intense therapy, but we are having a kind of a therapeutic influence at different levels.

george grombacher 14:59
So So, how do you position? I’m not sure what the right what the right question is, I’m sure that there are people that raise their hand and say, I would like to speak with somebody, then there’s people that are going the opposite way, because they’re just not interested. And then there’s the group in the middle that could probably benefit from a conversation.

Dr. Grant Brenner 15:19
Yeah. Yeah. So, you know, I want to highlight that most people don’t have a pathological response is mainly normal reactions. And yeah, a lot of people, when they find out that we’re there, you know, and this happens to me, in my day to day life, to be honest, I think of it as like a cocktail party phenomenon. Right? People ask me, what do you do, and then people will open up or I was, I was actually at the bank the other day, co signing for the film festival that we’re working on, it’s coming up on mental health, which we can talk about. And, you know, the, the banker started talking to me about what was it about, he said, his son had tried to take his own life back in college. And he said, he came from a very challenging culture where, you know, his own personality was like, he doesn’t get like that he doesn’t quite understand it. But he said, Yes, since the pandemic, mental health has become very popular. And so that’s a good example of what you’re describing, people will casually just start talking. And so what we usually do is we usually just hang around, we don’t usually, like set up an office that will have like an office space, if someone needs a formal consultation, a lot of what we do is just hanging out. Sometimes in the past, though, I don’t know that I like this term very much, because it has, it has a funny sound to it. But we sometimes had referred to it as active lurking, which speaks to the sense that we don’t want to stigmatize people by being like, Hey, I’m a psychiatrist, let’s talk. So usually we situate ourselves and kind of just, you know, chat, and people open up by and large. And then there are people who are like, very anti sort of anti, I encountered that with journalists in Mumbai who are kind of tough, like, why do we, why do we need, you know, these, you know, Westerners here, which is totally valid, and then there are other folks who are like, Hey, why don’t I learn a lot? What can you teach us? And then, you know, we will say, Well, I don’t know how much I can teach you. Because, you know, it’s more like you have all this expertise. But here, here’s some things that here’s how we think about it. You know, and medically, we also want to be careful not to impose Western diagnoses on both other cultures as well as, as well as when there’s nothing pathological going on, right? So we’re not looking like to diagnose everyone with PTSD or anything like that, we’re really there to give people a chance to use basic tools. And sometimes that is, is they’ll talk about things and and certainly in every situation I’ve been in, people have told me what they’ve lived through. But we’re not looking to, you know, process trauma. It’s mainly supportive, but we are looking to make it so that if people really are in need of medical or psychiatric care, then you know, they have access to that, in a way which isn’t, you know, pressured. So it’s, it’s a delicate balance.

george grombacher 18:18
Active working is not a great term, but it’s, it’s really appropriate.

Dr. Grant Brenner 18:23
Yeah, I prefer the cocktail party approach. Yeah. We’re sort of like a social butterflies is how I started thinking about it in in the refugee villages is more like it’s more like being you know, kind of like a friendly person who’s around. Yeah, lurking just doesn’t sound right. I didn’t coined the term.

george grombacher 18:43
But, and so it doesn’t surprise me at all that you are, you are present, you are having a water or coffee, you’re available, Hey, what are you working on? And oh, by the way, so then it just gives people the spontaneous opportunity or this serendipitous opportunity to ask a question or to to to engage instead of them walking up to your booth or into your waiting area, which not a very comfortable thing. So I think that that makes a lot of sense. But then there’s just there’s

Dr. Grant Brenner 19:16
going to be like a medical area with with someone who provides those formal services, and usually not usually will always identify ourselves. Hey, I’m right. My name is Grant Brenner. I’m a psychiatrist. I work with vibrant emotional health. We’re here to provide support. And then a lot of times, you know, you quickly see like we’re Oh, we were psychiatrists, do you? You know, are you analyzing me? Right? Are you think I’m crazy? What do you think so, you know, and it depends on the group, because some some groups to people not to overgeneralize but you know, some as you as you said earlier, it particularly some professions are less sort of psychologically open. It also may be that they are wary of any kind of psychologist. I’m not saying psychologist but any kind of mental health because in certain, like first responder groups, particularly people, you know, who are who are uniformed services or law enforcement, there can be a problem with psychologists, because if they’re sort of afraid that they’ll be deemed unfit for duty, they can be taken out of the field. And so we make it clear that that’s not our role, either. We’re outside of that system. Obviously, so many layers, we’re looking to prevent harm, you know, so if if anyone you know, in a disaster situation was, you know, aggressive or unstable, we would try to prevent them from hurting anyone, but we’re not there to, you know, take away guns, or put people behind the desk.

george grombacher 20:49
Right, right. It’s like from those old cop shows where, yeah, you get taken off, put on desk duty, grant. So many layers from a cultural standpoint, and everything that you’ve been talking about. Fascinating. So

Dr. Grant Brenner 21:05
exactly, it’s incredibly complicated.

george grombacher 21:08
How, how long is, well, is there an actually training program for this for for? Or is it just based on your experience, and we’re gonna get you up to speed.

Dr. Grant Brenner 21:22
There’s a lot of different training programs, I’m actually wrapping up. I’m chuckling because it’s been, it’s been a bear, but I’m co editing a second edition of disaster psychiatry readiness, evaluation and treatment. And one of the chapters that we’re working on is on disaster education. There’s many, many trainings. So if you volunteer with different programs, they’ll have their own training. So Red Cross has its own training crisis, emotional care team, we have our own training. A lot of times when there is an event, though, people will spontaneously volunteer, and we’ll do what’s called just in time training. And that might be a few hours, a lot of times, it’s digital now, so people can do it offline. We did just in time trainings at the beginning of Russia’s invasion of Ukraine with a large group of Ukrainian mental health responders. Canadian disaster psychiatry Association has an online training. And recently the the Center for the Study of traumatic stress, through the committee on the psychiatric dimensions of disaster, released a free eight hour online training through the American Psychiatric Association offered by Kurt West and Joshua Morgan, Stern, who are both, you know, highly, highly qualified and accomplished colleagues in this area. So there’s lots of different trainings available, but there isn’t like a standardized training. And there’s also many academic programs in disaster management, though they don’t usually focus on mental health. One thing was interesting, I presented, we presented the chronic cyclical disasters model multiple times over the last several months. So I presented it and VOAD, the national volunteer organizations active in disasters, that was in St. Louis, and there are hundreds of organizations there. And the majority of them focused on something operational or logistical like providing clothing or food, or you know, management, that kind of thing. It’s understood that mental health is important, but it’s not as prominent. And so my talk was, was well received and well attended. And, and one of the first years I think, where there’s really been as much interest in mental health and, you know, to that point, COVID that the banker made, you know, mental health issues had been gaining attention for a long time, but COVID really accelerated it on many levels. There’s also been, you know, a proliferation of of companies, which are offering mental health services much more excessively, and rising rates of suicide, the CDC reported that the estimated suicide toll in 2022 is 47,000 plus, and the last time they checked a few years ago was 44,000. And so it’s rising as a source of mortality, particularly among younger adults, but across the boards too. And then this 988 line, you know, was made available, there were always hotlines, but now there’s a three digit number, and not that many Americans have heard of it. I think it’s important people, like know that it’s there. But over time, like 911, you know, people will, will know what, what, who to call when there’s a mental health crisis.

george grombacher 24:30
Got it. Oh, Grant, thank you so much for coming back on where can people learn more about you? How can they engage?

Dr. Grant Brenner 24:37
My website is Grant H breader md.com. And I’m on social media with at Grant H. BRENNER MD. If people are interested in the film festival, we’re going to be screening we have over 100 movies that we’re sorting through and judging right now. That’s the urban dreams mental health Film Festival. And I invite people to reach out and let me know if you have any questions or comments.

george grombacher 25:00
Excellent. If you enjoy this as much as I did, so get your appreciation and share today share with a friend who also appreciates good ideas go to grant H Brenner md.com It’s gra nthbrennermd.com. And also check out the urban dreams mental health Film Festival and find grant on social media. I’ll link all those in the notes of the show. Thanks again grant.

Dr. Grant Brenner 25:27
Thanks, George.

george grombacher 25:28
Till next time, remember, do your part by doing your best