Mental preparation and building resilience for crisis

MS Plus acknowledges the traditional custodians of the land this podcast is recorded on, the Wurundjeri people of the Kulin Nation. We pay our respects to their Elders past, present and emerging.

Jess: As Australians, we are all too familiar with the threat of natural disasters, particularly in summer with the hot conditions increasing the chances of bushfires. The Australian and New Zealand Council for Fire and Emergency Services has released their annual seasonal bushfire outlook for the summer of 2023, which states that this summer, we are facing a higher than average risk for increased numbers of significant bushfires.

And while most preparation for disasters really focuses on the physical aspects of an emergency, how can we prepare our minds? Research suggests that if people are mentally prepared for crisis, they are more likely to remain calm and confident during a disaster, have less stress, and it also has a positive impact on recovery times?

So today I'll be speaking with Michael and Catherine, MS Plus social work advisors, about how people, specifically people living with MS, can mentally prepare for emergencies.

Okay, Catherine and Michael, thank you both so much for speaking with me today. Why is preparing emotionally or psychologically helpful or important, and how can it help people deal with crisis?

Michael: When we originally thought about the topic, we talked about how often we don't speak about crisis. We don't raise the big questions. We don't think about the future from a point of view of prevention, and because of that, we thought this is very important to raise.

Catherine: As we approach the Australian summer, it is a time when our thoughts do turn more towards natural disaster type events, whether it be fires or floods or storms. But it doesn't have to be that in particular, our conversation does provide general advice, so whether it be heat waves, which is really relevant for people living with MS or pandemics which affect us, regardless of where we live. The information we're going to give you we hope can be adaptable to deal with whatever the universe is going to throw at us.

Even with crises that can't be avoided, like natural disasters, we can lessen the negative impact, and it's not just a loss of physical items like property to consider, but it's how we psychologically cope with these changes.

And the key is to build up the components that make up our resilience. Now, by this we mean our capacity to adapt to change situations. It's essentially how well we deal with situations that are out of our control. A lot of information about crisis preparedness focuses on the practical preparations. So, in fact, most crises, such as disasters or the pandemic, for example, are measured by physical cost.

But today we're going to be focusing on the psychosocial aspects that are part of the key components of overall preparedness. And often these ones aren't front of mind when we first think of preparing for a crisis.

Michael: Crisis is something that happens to most of us. It doesn't always happen when we think it will, sometimes it's a surprise, sometimes it is something that you can predict, but if you're prepared, it's usually easier, it usually doesn't take as much of a toll, and it's usually easier to recover from.

If you think about it, we see crisis on the news, we see it in social feeds, we definitely see it in movies, almost anywhere. And that is in some ways artificial, but that is also really important to acknowledge that we see crisis and most crisis, as if it happens to somebody else, to the other.

But when it happens to us, we don't always associate what we see and have we prepared with the crisis that happens to us, and that can catch us unprepared. So changing that is very important.

Catherine: So that's why we want to put this topic together, is to put in place some strategies around how crises can feel, how we can prepare against them and minimize the impact, so, when they occur, they can feel very personal and very overwhelming. It can occur to a person, a family, a community group, but in all situations, people will need to draw on their resilience to cope, whether it's actually a potential crisis, whether it actually happens and the associated changes.

Jess: Okay, while we're talking about natural disasters and crisis, can you explain how a crisis might start for someone and the impact that it could have?

Michael: Well, for a crisis, you need a catalyst. You need something to start the fire. It can be psychological, physical, financial, environmental, political. Almost any severe event can cause a crisis that is either personal, family, community, the whole country.

Now, that's something that catalysts causes a vulnerability. Usually, we know how to cope because one of our days looks like the next looks like the next, but the catalyst usually throws us out of our comfort zone. It makes it difficult for us to adjust quickly and sometimes makes it impossible for us to believe that we can adjust. Any of these things can throw us into a loop that we don't necessarily know how to deal with.

But whatever it is, anxiety usually spikes at that point. Sleep can become difficult, and what we find is, nuance is harder and harder for people to both understand and act in. So black and white coping, black and white thinking is usually part of the crisis situation.

One of the reasons that preparation is so important is that it can allow body memory, muscle memory, and the practice of what we've prepared to take over at a time where we need that the most.

I would also say that crisis is time limited. It sometimes is as simple as, well, you have an earthquake, you do what you prepared for that, and it's over, and hopefully, no buildings collapse, nothing major happened, you're okay. The crisis was taken care of by you.

But if that did not happen, if a building collapsed or somebody got hurt, then that crisis can continue. And I think it's important for us to try and be as adaptable as possible. And I'm not saying is easy, but I'm saying that it may be possible to prepare for.

Catherine: And I think it's important to mention that we're not designed to be in continuous crisis. And so, when we have those sort of situations that are really quite intense, we are at risk of a system overload and, with that, some sort of physical or emotional fracture or failure.

Michael: Because the possibility of damage from crisis, either, long term or short term, it then is important to understand that resilience is a combination of factors. It's not just one thing. It’s part of this preparation, the other one is innate abilities and skill sets, but also, but also depends on circumstances and resources.

Jess: Okay. So, are there natural responses that people typically have to a crisis?

Michael: Usually, it's one of three things. You have fight, flight or freeze. The fight reaction is obvious, you believe that you can do something, and you go and do it. If there is a fire coming towards your house, you may activate a disaster plan and go with that.

Flight, well, that's also self-explanatory, in that we may run. We may run from the fire, we may run from disaster, and that's not always a bad thing. Because if something is overwhelmingly dangerous for ourselves or our loved ones, to run away or retreat, strategically or non strategically, to live another day, is the goal. So that may be the best solution of the time.

The third one is freeze, and you may think of deer in headlights, but we actually do that all the time. If we're either unprepared and overwhelmed, we freeze, or we are very consciously aware that freezing is the best thing. For instance, for some predecessors, their eyesight is not very good. Us, moving would allow them to zero in on us, but us, not moving, would actually allow them to lose us and move away.

So, if we look at it, every kind of response is both right and wrong, depending on the situation that you are faced with.

Jess: Right. So, with these bodily responses that are automatically happening, is there any negative impact on the body, specifically for people with MS, to being in crisis for an extended period of time?

Catherine: That's a good question. The fight, flight, freeze responses are all reactions to the immediate stress of a crisis, and our bodies fill with adrenaline to perform, and that's absolutely necessary.

However, if prolonged, people in crisis mode are more likely to have unexplained physical symptoms compared to when they're not in that state. So, we're thinking things like headaches or brain fog, fatigue, upset guts is a common one. Now, if you're already living with a health condition such as MS, then you do want to consider the impact about how this is going to affect your overall health and, ability to then do what you need to get done. This is why taking these steps to build your own capacity is so crucial ahead of time.

Jess: So how can someone build their resilience or mental capacity to potentially better manage a crisis? You know, are there certain strategies or things for them to consider?

Michael: I think it's very important to both understand what you have around you, what you have within you and also to understand what needs to happen and what is missing. So, I would suggest making a list of sorts to try and see where do you think your vulnerability is?

Is it financial? Is it around memory? Is it around physicality? Where do you think, you will need to have more input from somebody else, or from something else to be able to make a difference for you?

Catherine: I'd also like to add that, confidence is a key part of our resilience, but MS is really going to shake a person's confidence, as we need to be able to trust our body and we need to be able to trust our thoughts and our mind.

So, again, this is why we keep stressing that message of, preparation can do wonders, in so much as the very least of helping us to feel more confident. Even if a crisis situation doesn't actually eventuate, we are going to be in a much better state to deal with it, either in that lead up time, or should it happen, and that's really, really important.

Michael: So, it's almost like you can defeat yourself by thinking that you are defeated, and the point of this is, try to see a positive, even when it looks like things are not as easy.

Jess: Okay, right. And what about people who maybe have already had an experience with natural disaster or crisis and maybe lived through something already? Are there different considerations for these people?

Catherine: If you've experienced a particular crisis event before and, the threat of it is happening again, you might actually feel more confident about what needs to happen. That might not be the case.

So, depending on how it went for you in previous situations, you might experience the opposite. It might be fear or trauma that's bringing on emotional distress and it's really important to look at any potential trigger that might be arising for you, and that in itself is a really valid preparation.

You might be really stressed that your body might not be up to the tasks that you need to do. And again, really, really relevant for people with MS that you have to think about more so than other people in the population.

For those who have had previous experience with a particular crisis situation, just reliving some of those thoughts might be really heightening your anxiety.

So, what I want to raise is that our risk perception is going to be different for everyone, and it will vary by how much information or awareness or experience a person has. So, someone who is blissfully unaware might not be so worried beforehand, but being unprepared they might have a bit more of a difficult time afterwards.

But on the flip side of that, someone who is overly consumed about a potential crisis, or a situation, might over obsess about how they might act or collecting the information, and that in itself might lead to just not being able to switch off the brain, having difficulty sleeping, being a bit snappier in relationships and being more tense, and having some of those negative health symptoms that are related to stress.

So, the message I'm trying to say here is that the balance is about being prepared, trusting your preparation, so that you have that confidence. And the key to that is that you're able to live your life even with the thought that a crisis could happen. Whether it does or not is different, but you have that sort of psychological preparation that you're going to be able to manage even if it does.

Jess: So, if people do end up experiencing a crisis or natural disaster event, what would help with coping in these situations?

Michael: One of the things that we mentioned earlier was the fight, flight, freeze response. One of the best values of knowing that that's something that we as humans do is concerned with this question about, what to do during crisis? If we know that's what we're most likely to do, what is the most likely one of these things to help us? Is it time to fight, to walk away, or to just stop? Stop and think, stop and see if what's happening will just go away on its own. And sometimes it does, sometimes it doesn't.

I think it's very important then to bring people in, if you need other people in this, or bring things in, if that's what's important for you. And if neither, and just phrasing, waiting, and regrouping afterwards is what's required, that's what's worthwhile doing.

Who is here for you? What is here for you? I mean, is it about friendships? Is it about community? Is it about government support? What is it that will be most useful?

And sometimes, what you need is to talk about what happened to somebody, either within your family or completely unrelated to you. Sometimes that's the absolutely wrong thing and you might need some time to recover and process on your own. Sometimes it is about a financial support, sometimes it is about the NDIS or My Aged Care or hospitals or insurance.

Whatever it is, it's about consciously, when you can, work out a plan that you know is most likely to work for you.

Catherine: And another key part of exploring our resilience in the face of a crisis is, following, whether a potential crisis or, whether it actually happened is, we have been challenged, with our internal resources and we need to look at, am I still maintaining that hope for the future, even if it's not how I initially planned it, can I see a different picture? Do I have the pieces of that puzzle to put it back together? Again, even if it's not looking how I first imagined, am I finding meaning in where I'm heading, why I'm waking up in the morning.

If that's missing, then, it's really important that you start to seek some help, whether it be from family and friends, or if it's something that's impeding your ability to function on a day to day basis, or professional help to help process what's going on and get in place some new strategies.

Jess: Do you think that there are situations after a crisis when the dust is settled and people are saying, there are probably hundreds of other people in very similar situation to them that might be struggling. And do you think there's this thought that, “Oh, I don't want to be a burden. I don't want to reach out for support. There are people who are far worse off than me. I don't want to be a drain on resources. And, there's always someone more deserving of help than me.”

How do people overcome that, and reach out for support when they do need it?

Catherine: I think following a crisis you've been so focused on in that moment and just getting through the particular incident that happened, and so you've potentially lost that vision for where to from here and now what does my future look like? And that future might have changed from what it looked like before the crisis. It might be a little bit, might be a direction that is completely new. So, you might be asking yourself, well, I need to put these pieces back together and you might say, “Yep. I'm good. I know how to do that” or you might be completely feeling at a loss to say “well, how do I make sense of this? How do I find the meaning and what happened and sort of where to from now?”

So, this is again that that concept of resilience and for some people they can make sense of something that's quite significant that's happened. Whereas others are going to find it a little bit more difficult. So, if you're in that group of people that are really finding it difficult to say “where to from here”, then it is really important then to go seek that help, so, it's time to go seek that professional help, to learn those strategies, to look at your confidence, looking at what capacity you have, your strengths, and to help see that way forward again,

Michael: One of the most important things to do after crisis is take your time. I think this is the time to realise that you may not be at your best. When you bring people in, or when they try to knock on your door and be a part of your life, you may also feel very stressed and push back.

Realising that, well, many of them just want to help, is very important. It doesn't mean that you need their help at this point, you don't, let them know that you might get back to them. Make sure not to burn the bridge if there is a worthwhile bridge to have. So, after crisis, as much as you can, as much as your body and mind allow you to, that plan together of where you think you might need the time, need to talk, need the things, and adapt.

And by adapt, I mean you put that plan five seconds after crisis is over, review it in a couple of hours or a couple of days, depending on what fits. It's not about getting it right first time. It is about getting it right over time, or more right than wrong.

Jess: Okay. That's, that's really helpful information. So, what are your top tips then for managing a crisis?

Catherine: Well, I think Michael's made it really clear that connection really is everything. And it is those relationships that we have with other people, it doesn't have to be friends or family, it's ensuring that we're looking in on our neighbours, checking in on how they're going, our community groups, whether it be your Lions Club, your church group, we're not just seeing what they can do for us, but, how we can possibly help other people and that's going to be really powerful for how we move forward.

It doesn't have to be going out there and rebuilding everything with bricks and mortar. It can just be that little phone call, it can be an SMS, just to check in on people, let them know that you're thinking of them, that they're important, and hopefully those gestures are reciprocated as well.

Michael: I think it's interesting about connections, because as Cat said, they don't have to be face to face or family, they don't actually have to be any sort of list of people that you think of first. I had so many people that I've worked with who said, my photography group online is my best connection or, the Reddit group that I'm a part of is fantastic or, the church group that I go to and have gone to for 20 years has suddenly been amazing when I needed the help. Most of the time, I don't. I don't ask, but now I did, and it was amazing.

I think it's important to look as holistically as you can into your relationships to see what's there. But if you identify that as one of your vulnerabilities, then it's also important to see if that network can expand.

Catherine: And sometimes some of those simple messages are really the best, so, keeping a routine is invaluable. So, we're not looking for some sort of magical solution, but making sure that you're eating properly still, that you're maintaining regular sleep, keeping up with those regular activities, keeping up with those connections, taking the dog for a walk, catching up with a particular friend. Nothing that's rocket science, but it really is that, simple advice is often the best.

Michael: One of the most important things to understand is, if you have been through crisis or if you are in crisis, quite often, as Cat said, routines go out the window. What you sometimes want is just to go into something that will give you the news or give you some information and you just get lost in that.

Be careful what information you consume during and after crisis. Because a lot of our news feeds, a lot of our social media is full of negativity, full of things that pit one person against another. And when in crisis or just after crisis, you're likely to be vulnerable. and much more so than when you are at your best, at your strongest.

So be aware of how much, well, stuff, you consume around social media and TV.

Catherine: And I think that the COVID pandemic was a really great example of where people really face that sort of media overload. I think that was a great example. It was a situation that wasn't over quickly. It continued for some time, and so, people kept in the media and the media trying to desperately keep your attention and updating things constantly, we have so much access 24/7, and it became very tiring for people, and it began to affect people's mental health, just for that constant exposure.

And so, Michael raises a really great point about being very aware about something that is meant to be good and should be good and is good, but when overdone can actually have a detrimental effect.

Jess: And what about people with families? Are there specific things to keep in mind? You know, how do we navigate preparing for crisis and going through crisis with young children?

Catherine: If you're a family and if you have kids about, how do we approach talking about crisis situation, either in the lead up or afterwards, with children and, there's no set rule because it's going to change, depending on their age and their maturity. But they are perceptive, and so the recommendation would be that you should involve them at an appropriate level because that is going to ease any worries or concerns that they might have. So, they might be scared to raise it with you so you might have to start the conversation, to allow them to feel comfortable and safe to get the reassurance they need.

Again, they don't need high level details. What you might find is that they just want to know what's going to happen to the dog, if you need to stay somewhere temporarily and, if they can get the answer to that then, they're fine, off they go, their minds at ease and they're not going to be having sleepless nights or nightmares.

Michael: I think Cat raised an excellent point here. Quite often when we're in crisis we are more self-centred, literally because we're not coping so well and we need that understanding of what's happening to us. When we're self-centred, we're not other centred, which means that if you've got kids, loved ones, people who are closest to us, they're usually neglected a little bit, and sometimes a lot.

Especially around kids, kids usually want to be a part of things. They want to understand, they want to be safe, they want to, I guess, know that it's not their fault and what Cat was talking about is extremely important. Bring them in to, again, according to their capacity and their age, but bring them in, ensure that they're able to feel that safety and feel that inclusion and those are very important to them.

Catherine: This is again, a little bit more left of field, but it's something that I really want to mention as well is that, be mindful of those who are going to then try and profit from a crisis situation.

So, it's sad to have to say it, but we've seen it increasingly over the past few years that, when you've got a million things on your mind that you're trying to juggle just to keep your day to day functioning, if someone sends you a text, saying that they're from the government about a relief payment, click on this link.

People that are not paying full attention are more likely to fall victim to scams or opportunities from people to exploit these disaster situations, so just keep it there back in your mind that, particularly when you're busy, when you're really stressed, that's when you really need to be paying extra attention to slowing down, stopping, thinking and, and being very vigilant to those who might be exploiting a situation.

Jess: Okay. And so, with more practical strategies, what tips can you give for people?

Michael: Well, I think it's important to first look at the people closest to us. So family, friends, neighbours, school, church, have a look at who is around you, but also who can be around you. I've worked with so many people who thought that their family has been distant and wouldn't be able to assist them, and then when they suddenly said, you know what, I'm in trouble, half the family came out and said, absolutely, what do you need? Same thing around friends, same thing around neighbours. I think, although it's important to know who you have, it's also important to know who you may have.

Catherine: I think people are afraid to ask, but if they do, people actually want to help, they just don't know how to, and they're so fearful of maybe overstepping the mark, or interfering that they stand back thinking that they're doing the right thing, but if you ask for a little bit of help, people really they feel included and they're generally quite receptive to making sure, no one wants to see you having a hard time, so that they're receptive to trying to make your situation a little easier.

Michael: I think Cat, that's an excellent point. The reason I think it's an excellent point is that, when people don't know how to help, they err on the side of not helping, because they don't want to step on your toes, they don't want to interfere with your life. So, one of the things that I ask people in crisis or after crisis to do is to imagine how will this person be able to help in a limited way, so that that limitation allows them to come in for only the one or two things that you need them to do.

And that helps them to understand that no, you don't want them forever, and no, you don't want them for everything. But yes, you do want them for something that they can assist you with. It's almost like an informal contract that usually works out very well.

Jess: That's a really good point. And so, what about people who have high support needs or more complex health needs?

Catherine: For those people that do have higher support needs, we can talk about planning, but the anxiety still might be there around if a situation escalated quite quickly, what would they do?

So I want to tell you about a vulnerable persons register that exists, for people who live in regional areas who are considered isolated and who would have difficulty leaving an area to get to safety because of a physical or cognitive impairment. Now, when a person joins a vulnerable persons register, it means that they're flagged with emergency service providers in their local area who will make sure that they provide assistance as a high priority.

To be part of it, you need to speak to the agencies that are providing you with the services that you're currently receiving. If they look at you blankly or they're not too familiar with it, my recommendation is to speak to your council who can then either get you on the list or link you in the right direction to how to get on it.

If you are looking at preparing an emergency plan and you don't know where to start, because we're not all experts if we haven't had to do it before, there are plenty of templates and guides online. It might be through the Red Cross or the CFA. If online is not your thing, I would encourage you to contact your council or your local CFA branch and ask them for some advice which they can give you over the phone or I'm sure they'll have some resources that they can provide you with.

Michael: If you're a part of Centrelink, you may be able to get an extra payment, or if you need a no interest loan even if you're not a part of Centrelink, but, under their threshold, you may be able to get up to $2000.00 for things that you need to replace. Obviously if it was a national disaster, Australia is also very generous and there may be centres that you may be able to apply for. So have a look at what's around you to see what's possible.

Catherine: And again, you don't have to be an expert in knowing all the resources and where to go. So, in the event of a disaster type situation or a crisis that's affecting your community, organisations like the Red Cross or the Salvation Army, they are actual specialists in this kind of situation. And there are plenty of agencies and organisations that are familiar with this, even if you're not. And if you're confident and you're not too embarrassed to ask for help, and I really can't stress that enough, asking for help really is important, that help is available.

Michael: It's also important to remember that your GP can initiate other supports that may be able to assist. For instance, a mental health plan would allow you to have up to 10 sessions a year with a counsellor. So, if that's the way to go, that's important. A psychologist or someone you have talked to before that would really be useful, and sometimes it's important to speak to a professional because you can leave what you're talking about in that room.

You can walk away from it. And having that break that this provides is sometimes all that you need for a good night's sleep and a good night's sleep is invaluable, especially around crisis time.

Catherine: And sometimes you might feel that you're doing okay until you're not, so something has triggered a response that's causing you some stress.

So don't forget that we really are very fortunate to have support, like phone lines or chat services that are free and available 24/7, that if something has been brought up, again, whether the crisis actually happened or whether it's just that threat of it was enough, phone lines like Lifeline, like Beyond Blue and again, traditionally they have been just those phone lines, but you can do chats now if that's more comfortable or it's, 10 o'clock at night and they've got those trained counsellors on the other end to just talk through what's causing you angst and just to give you that sense of peace. It might be enough just that, or it might be enough to get you through until you can link back in with your more formal supports. But the help is there.

Michael: One thing that I just wanted to mention and that is timelines. We talked about how our brains can mask situations or to allow us time to adapt. And I think it's important to talk about sometimes those masking, or those sort of cushions can last for days, weeks, or even years.

I've talked to a lot of people who, years down the track would react to a crisis that happened, and they thought that everything was over. If you feel like your situation is changing and you start understanding that it was from a long time ago, in a situation that you thought was completely forgotten, it's okay. Seek help for that, if that's what's needed. Let the people that are closest to you know that something's happening for you that needs to be resolved. I think it's important to understand that crisis is not just there and now and gone. It may never come back, but if it does, know that it's a possibility.

Jess: So, if someone's feeling really overwhelmed and thinking, do I fit the vulnerable person's register? Who would I turn to first? What suits my particular situation?

Would the MS Plus social work service be an option for support?

Catherine: It'd be amiss of us not to give a plug for our own support at MS Plus, the Social Work Advisors. We are a phone support service that we can have a chat to you around some concerns that you have, some basic tips for preparation and then where to go to for more help, so we're free.

You ring in through Plus Connect 1800 042 138 and we're more than happy to have that chat with you and answer any questions or any concerns that are on your mind and, and help you feel prepared.

So, preparation really does go a long way to sort of help us improve our ability to adapt to change. But we can't prepare for every detail of every potential situation, so taking a few of these general tips, we hope will give you enough confidence to lessen any impact should a crisis situation occur.

Jess: Great. Thank you both so much. That's a really good point, Cat. And I want to thank you both, Catherine and Michael, for joining me today and speaking with me and sharing those really helpful tips and strategies for people to consider. And certainly, looking at the importance of being mentally and physically prepared for the summer ahead.

For more information on anything we have covered today, please get in touch with MS Plus Connect on free call 1800 042 138 or email [email protected]. You can find the Ms Plus podcast on your favourite podcast player such as Apple, Spotify, Google Play, Overcast, or you can just access the podcast directly on the website. Go to www.ms plus.org au.

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