
6 minute read
INDEPTH After the floods
When the floodwaters recede and the mud has been hosed away, that’s when the work of mental health trauma-focused nurses Iris Vukelic and Allison de Tina, kicks in.
About this time last year much of South-east Queensland was up to its knees in mud and debris.
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Like many parts of the state, it wasn’t the first time in recent years the region had flooded.
In fact, in the past decade there’s barely been a community anywhere in Queensland that hasn’t faced the aftermath of floods, bushfire or cyclone.
But nothing prepared us for that three-day rain bomb that dumped almost 16 Sydney-harbour’s worth of water on Brisbane in one hit.
The Queensland Reconstruction Authority estimates the cost of that one weather event at $7.7 billion, and while the physical clean-up and damage to infrastructure was significant, the biggest cost was the intangible, often lifelong health and social costs –estimated at a huge $4.5 billion.
QNMU members Iris Vukelic and Allison de Tina understand exactly what’s meant by ‘intangible social and health costs’.
The pair are part of a multidisciplinary Disaster Flood Team which launched in November, to look after the health of people affected by that South-east Queensland flooding.
The team, which also includes a social worker, psychologist, peer worker, psychiatrist and administration officer, responds to disaster-related trauma, loss and psychological and emotional distress. They help people manage the financial, relational and emotional stress resulting from the floods.
They provide a stepped care, outreach model of recovery support and assistance, and cover all the Metro South areas affected by last year’s flooding.
Transformational nursing leadership
The structure and scope of the Disaster Flood Team is an excellent example of a program with strong nursing input.
Nursing sits at its heart, drawing on Iris and Allison’s capacity to deliver not only highly specialist trauma-focused therapies and community engagement, but also to attend to the physical heath aspects of recovery.
“It’s like symbiosis, I guess,” Iris said.
“We embrace two spheres of nursing – the psychotherapeutic and then general, physical health nursing.”
Both Iris and Allison bring impressive skill sets and decades of mental health and trauma nursing experience to their work.
They are both trained in psychological intervention and able to deliver a range of different psychological and behavioural therapies.
Allison has worked with trauma for more than 20 years including many years as a forensic nurse examiner in mental health and addiction.
She took up the Clinical Nursing Consultant role with the Disaster Flood Team after a 12-month stint in community work and case management, and says she loves the diversity of her role and the opportunity to stretch the definition of nursing to its full potential.
“I really enjoy a nursing role that has a point of difference to general nursing,” she said.
“I really like working in those high acuity, trauma environments, it’s really rewarding work, so in a lot of ways this feels very natural for me.”
Iris who is currently ADON at the MSAMHS (Metro South Addiction and Mental Health Service) Disaster Flood
Team has been a mental health nurse her entire career and has worked in previous disaster teams responding to Ex-Tropical Cyclone Debbie (Southeast Qld,2017) and the more recent COVID-19 pandemic.
“It sounds quite weird when I say it, but I really love working in the world of disasters,” she says.
“I have a real passion for it because it’s one of the few spaces where you experience tangible sense of hope and you have connection with the grassroots, with the community.”
Supporting survivors
Iris and Allison’s practice covers both individual post-disaster recovery support and community level, predisaster resilience building.
Their therapeutic work with individuals is not age-specific which means they can be dealing with children, the elderly and everyone in between, requiring flexibility and agility to respond to their client’s different needs and developmental or life stages.
“We are seeing children who are experiencing rain phobia or becoming quite anxious around different weather events.
“We have that middle-aged 40-60 group who have got more responsibilities with mortgages and children (whereby the flooding) has compounded the general stress they have in their lives,” Iris said.
“So, it’s not always about big mental health issues or disorders. Quite often it’s about normalising human reactions to loss and the distress associated with it.”
“Being nurses of course we always wear a clinical hat, but we do not pathologise normal grief experiences.”
“We try to build coping strategies around how people react to all consuming feelings of loss and grief – that’s what builds their self-esteem and self-confidence to function in the world again.”
Iris and Allison help people reduce anxiety by teaching them grounding and stabilising techniques and encouraging them to incorporate mindfulness into their everyday lives.
The one-on-one work also involves helping people build or rebuild their social ties – strengthening their connections with the community, and within their family and peer circles.
“There is a huge wealth of resources out in the community, and we are in a position to support individuals to link into those resources,” Iris said.
“We are also driving the link with the primary care, with GPs and other (health services).”
Community resilience building
The second, and broader focus, of the Disaster Flood Team’s work is community engagement.
While the team usually have about 20 individual clients on their books, they engaged in an impressive 73 community activities in February alone – seeing more than 400 people.
The emphasis at this level is on collaborating with external agencies and driving capacity building.
“This creates quite a different and strategic narrative for our work because we are shifting the attention to risk reduction – to pre-disaster resilience building,” Iris said.
This includes the team delivering resilience building programs to schools across the four Local Government Areas primarily affected by the SEQ 2022 floods – Brisbane, Logan, Redland and the Scenic Rim.
Allison, who delivers the community engagement initiatives said the school program, for example, focuses on change, grief and loss.
“It’s a small group work – four to six students and it’s delivered at their level, to children in those communities that were significantly flood affected,” she said.
“These groups are for primary school children where we talk about understanding change –understanding the feelings that come with change and how we manage, those feelings.”
Allison also taps into community organisations, developing partnerships with the likes of neighbourhood centres and community hubs to deliver resilience training.
“I love the outreach work in the community, meeting people where they are and doing group work - it’s really exciting for me to be able to do this sort of (preventative psychosocial) work – it’s not very common in a nursing role.”
Physical health care
While the Disaster Flood Team’s support response emphasises mental health care, one of the strengths of the strong nursing contingent is the added capacity to identify and treat emerging physical health issues.
These include respiratory conditions due to mould exposure, and conditions such as hypertension or cardiac problems brought on by stress or grief.
“We know there are links between stress and the exacerbation of chronic disease symptoms,” Allison said.
“For example, we know when people are stressed, anxious or depressed, they’re more sedentary, less likely to get up and be active and do the things they used to.”
“They might neglect to fill scripts or go to their GPs because they are too anxious to leave the house or are afraid to drive their car.”
“I actually just saw somebody last week who used to be a very active man relative to his age, but he’s no longer as active and has noticed a decline in his physical strength… and a worsening of his chronic disease symptoms.”
Allison said physical health can also be affected by changes in living circumstances after a disaster.
“They might not have the gardens they were out mowing, or they are not doing those little incidental things like carrying a basket downstairs to hang the washing out because they no longer have a washing line… and these are all important aspects to maintaining physical wellbeing.”
Positive outcomes
Despite the service being operational for only few months both Iris and Allison say they have already seen many of their clients make important progress.
“That’s the part I enjoy,” Alison said.
“I love seeing the progress people make, you know, small gains like being able to go and get a haircut without having a panic attack. I had a gentlemen do that just recently and he actually went out of his way to ring to tell me and to thank me because he felt good.”
For Iris, there is nothing more rewarding than seeing people’s lives improve.
She said the positive outcomes are evidence that nurses have right skills and are well placed to deliver high-level care if they are given an opportunity to work to the full scope of their practice.
“I think there is an attitude that anything trauma-related or disasterrelated requires professional counsellors or professionals other than nurses,” she said.
“But hopefully we will continue to be recognised for the post-disaster mental health skills that we have and that people in the broader community will recognise the value nurses bring into this space.”
The Disaster Flood Team, is jointly funded by the Commonwealth and Queensland governments under the DRFA Category C and operates as part of the Metro South PostDisaster Mental Health Recovery Service. It is currently funded through to June 30 next year.