A crisis is a time to react and let your training kick in. There is little opportunity to ponder who the audiences are and how best to reach them. Emotions run high, and many decisions have to be made quickly and without complete information. This is why it’s critical to have a comprehensive communications plan in advance – when you have time to be thoughtful about messaging, consider what groups or types of people might be impacted by particular events. Ensure you’re communicating the right information, in substance and spirit, to the people who need it.
For events like natural disasters or mass violence, among many others, the one thing you can be sure about is that at least some of the people listening to your message will be traumatized. A trauma-informed approach will enable you to create messaging to meet the needs of a wide range of constituents, identify how to craft the right messages, and understand the best timing for messages.
From the perspective of a disaster recovery or business continuity professional, responding to a crisis is your job. You’ve read about dealing with crises, created detailed plans, practiced the response – from tabletop to full-scale exercises – and may have experienced other crises firsthand. To a certain degree, you are ready. From the perspective of the individuals caught up in the crisis, this may be the worst thing that ever happened to them. In most cases, they never saw it coming.
That’s the lesson I learned at 2:49 p.m. on April 15, 2013, when two bombs exploded within 12 seconds of each other near the finish line of the Boston Marathon. The first blast was directly across the street from me.
That moment of detonation, the entire world around me collapsed. I had tunnel vision, seeing only the scene in front of me — rising smoke, people running away from the site of the explosion. I was frozen in place, feeling no sensations, hearing nothing but the bombs.
There were hundreds, if not thousands, of people on or near Boylston Street that afternoon who saw or heard the bombs or missed being at ground zero by minutes. This included runners, spectators, family, friends, EMS, police officers, volunteers, reporters, photographers, and medical personnel. There were others involved, too, though not present on Boylston Street at the moment of tragedy, such as dispatchers, hospital personnel, and ambulance drivers. The physical results were apparent immediately – dozens of people severely injured, three people killed – and were the focus of news coverage, official response, and the primary messaging (outside the search for the perpetrators).
The psychological aftermath, though not visible, was just as real for those who experienced it. It was not part of the messaging from media or our leaders who provided information and updates from behind the podium. Because I left the scene without any physical injuries and no one seemed to be talking about experiences like mine, it never crossed my mind that I had been wounded when the bombs exploded.
A key step in planning a trauma-sensitive response is considering who is likely to be affected by a particular crisis. The exact audience depends on the crisis, of course. Planning ahead may require creating a general message and also breaking down messaging or categories for different kinds people and events.
In many types of crises, like a fire, an industrial accident, or a school shooting, it is relatively easy to recognize the audiences at the center: people displaced or with physical injuries, those killed, and their families. Yet, because we still don’t tend to think of the mental health affects as injuries, we do not always pay attention to the people who are lucky enough to walk away without physical wounds. We do not see many who may be traumatized and need support:
- witnesses to the event
- first responders
- first receivers
- neighbors or community members
- employees and visitors
- friends and close colleagues of people physically injured or killed
- the larger community or region where the incident occurred
Trauma is a known quantity after tragedy. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes the majority of injuries or trauma in most disaster settings are psychological – from 4 to 50 for every person with a physical wound. Any communications which don’t take this into account are missing a critical element of the response.
For most people, the distress reaction after the event is transient, lasting from a few weeks to a few months. The level of exposure to the traumatic incident matters. The effects are on a continuum – those closest to the event, physically, or by connection to an individual killed or physically injured – are likely to have more difficulty. For family, witnesses, survivors, community members, rescue workers, first responders, first receivers, it is natural to see mild to moderate stress reactions in folks exposed to the trauma.
Most people will recover their pre-event functioning within the first two years without any intervention. The speed of recovery is based on many factors, including natural resilience level, past traumas, social support systems, socio-economic status, being part of an already marginalized community, etc., and whether or not the person affected recognizes the validity of their response.
Practically everybody walks away from a tragedy or disaster like this with some level of trauma. That is a normal human reaction to an abnormal event which puts our lives in danger. Most people don’t get a diagnosable condition, like post-traumatic stress disorder (PTSD) or acute stress disorder. According to the National Center for PTSD, about 7-8% of adults in the U.S. will have PTSD in their lifetime. From 6-20% of military personnel who spent time in a war zone will be diagnosed with the disorder.
Specific events cause varying levels of PTSD and diagnosable conditions, and it is hard to predict in the moment. After the Joplin Missouri EF 5 tornado in 2011, 7-15% sought formal mental health treatment to recover from their stress. After 9/11, studies show increased alcohol and substance abuse in the aftermath.
Many individuals will experience a sub-threshold condition, where their distress doesn’t meet the technical definition of a disorder like PTSD. This shows up in the form of issues like substance abuse, physical illness, loss of work productivity, or breakdown of the family. There are no statistics which reveal these conditions, as they can be hard for even those experiencing to trace to the cause. Yet these individuals are not able to live their best lives because of their exposure to trauma.
Public recognition of mental health wounds sends two important messages:
- It reminds people it is normal to be distressed after disaster or tragedy.
- It helps people to understand help is available if they need it.
It’s a nuanced message: find a way to reassure people their feelings are normal and also convey the expectation they will recover, without sensationalizing an event and promoting trauma. This helps people who are able to do so to draw on their own coping strategies and support networks. It normalizes the idea of support for people who need extra help coping, either immediately or down the line.
To be most effective and set up survivors for success, this messaging needs to happen immediately. For one thing, in a crisis we tend to believe the first message we hear, even when more accurate information may follow. People even compare more complete or more accurate information later to the first messages they heard.
The people impacted have common needs in the first hours, particularly with
- physical and emotional security
- recognition – acknowledgment and understanding of their views, beyond tallies of death and physical injury and property damage
At the time it is most important to reach people with these messages, it is also very difficult to do so, even when communicating with the right people.
It is harder to hear, understand, or remember information when we are upset. Mental noise can reduce a person’s ability to process information by more than 80%. We’ve all experienced this at some point in our lives. Not being able to remember what the doctor said after getting a difficult diagnosis, for example, or not really understanding or even hearing the words that come after a spouse says, “I want a divorce.”
Emotional arousal, like anxiety, anger, confusion, fear, or helplessness make it difficult for people to understand the messages you are putting out there after a crisis. Even when people are seeking specific types of information, they may not hear or see it, or remember if they do.
Other factors make it difficult for people to hear or understand your message. People have different attitudes toward mental health, and there is still stigma. If someone thinks you are suggesting they are mentally ill, or could become mentally ill because of what just happened, they will likely have a harder time hearing your message. Also, not everyone trusts authority figures or civic leaders, so they won’t listen to or remember what people such as the mayor, police chief, or your CEO say.
Two things to keep in mind to get over this barrier: quantity and quality.
- Quantity: repetition is good, especially over time as the initial emotional arousal dissipates and people start to realize how they’ve been impacted
- Quality: keep it short and informative
While getting the messaging right, for the right audiences, matters in the long term because the days and weeks after the initial event are particularly critical. Mental health experts know that 4-6 weeks after a traumatic event may be the dividing line between acute symptoms which diminish over time and longer-term problems.
Validation of the experience of all people affected, not just those with physical injuries, is key. This includes having our leaders and media talk about the psychological wounds which are possible after an event. If the news media or our leaders aren’t talking about it, most people may not know about it.
Especially early on, those traumatized by an incident tend not to think of themselves as victims or survivors. Some people may initially not know they have symptoms or deny they have them. Some people have these reactions, but they are delayed. Some may feel since others were killed or hurt physically or more severely, they do not have a right to feel the way they do or to need help. Some people likely fear admitting they need help means they are mentally ill.
In the days, weeks, and months after the bombing I realized the media was not sharing stories about people like me who were there or affected by the events that week who had emotional and psychological wounds. We were invisible.
I knew my life had been harmed by this crime. The people in charge, like our civic leaders and those who had a voice on the world stage such as celebrities and media outlets, were not talking about psychological wounds. In my mind, if they weren’t talking about it, it must not be happening to anyone else; it must only be me. And if I was the only one feeling this way, it must be my fault; I must not be a real victim. But if I wasn’t a real victim, why did I feel so horrible? What was wrong with me that I couldn’t just shake it off?
The lack of public recognition is isolating. In my case, it didn’t stop me from getting the help and support I needed, but that wasn’t true for everyone. Years after the bombing, I continue to meet people who were traumatized and waited years to get help. They either didn’t recognize the distress from the bombing and how it was impacting their lives in the long-term or because they didn’t think the distress they were feeling mattered since so many others were harmed much worse.
Self-efficacy is the ability of people to draw on their own natural resilience, coping strategies, and support networks to meet their own needs. Public education has been shown to promote self-protecting behaviors.
Reassuring people their feelings are normal enables one to understand thoughts and emotions and put them in context. If I know it’s normal to have nightmares after an event or to find myself freezing when I’m in a crowd, maybe those things aren’t as frightening. If I have an expectation I can recover, I’m able to draw on my resilience and coping skills to work through my distress.
Normalizing the experience of trauma enables people to do the following:
- Help themselves, for those who can.
- Understand that having a reaction doesn’t mean they are or will become mentally ill, which is something many people still fear.
- Help each other. If we know our neighbor may have been traumatized, we are likely to reach out and help. Social support is a key to healing.
The keys as you think about crisis communication is to plan your messaging ahead of time; figure out your audiences, the messages of validation, and self-efficacy; how you are going to break through the noise; and when and how often you will communicate with them over the lifetime of the crisis. Then, in the moment of crisis, you can start to build and maintain a connection with those people impacted. This will help encourage healing, build resiliency, and help victims and survivors find a way to work through the trauma and live their best lives.