We live in a world of change and tumult. Natural disasters are increasing on a worldwide scale. Domestic violence and social unrest appear to be increasing. Terrorist attacks number in the thousands every year. Both social science and psychiatry have informed us that there is an adverse psychological impact associated with tragedy, trauma, and disaster. From a public health perspective, we know there is an increased surge in demand for mental health services in the wake of disaster.
Largely through the notable efforts of the American Red Cross and the disaster consortium National Volunteer Organizations Active in Disaster (NVOAD), the field of disaster mental health was founded in or around 1991-1992. The formation of this field was largely in recognition of the adverse psychological consequences almost universally attendant to tragedy and disaster, as well as the need to offer some form of psychological support thereafter. Somewhat later, there emerged a recognition that those in the helping professions might be vulnerable to “compassion fatigue,” vicarious trauma, and burnout in the acute aftermath of repeated exposure to human suffering. At the time there were few standardized psychological crisis intervention protocols. In addition, there were even fewer formalized training programs in psychotraumatology and disaster mental health.
Critical Incident Stress Management (CISM), as used herein, refers to a specific corpus of knowledge relevant to the fields of psychological crisis intervention, sometimes referred to as “early psychological intervention,” and disaster mental health. The CISM, of which we speak, was developed by Dr. Jeffrey Mitchell in the 1980s working at the University of Maryland, Baltimore County (UMBC), as a means of recognizing and mitigating acute distress as commonly experienced by first responding emergency services personnel, first receivers such as those working in emergency medical and trauma venues, and disaster response professionals. CISM has shown relevance to military applications and the workplace, as well. CISM is not a technique, per se. CISM is best thought of as an integrated multi-component continuum of psychological care to be considered for provision in the wake of acute adversity, trauma, and disaster on an as needed basis to appropriate recipient populations. CISM is not a treatment for acute stress disorder, posttraumatic stress disorder, posttraumatic depression, or bereavement and grief. CISM is but one approach for the stabilization and mitigation of acute psychological distress, but it is clearly a model that has gained some degree of international acceptance and utilization having been taught in over 29 countries and having been adapted for use by the United Nations for its own field personnel.