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Psychosocial Crisis Management: The Unexplored
Intersection of Crisis Leadership and Psychosocial
Support
Michel L. A. D€
uckers , C. Joris Yzermans, Wouter Jong, and Arjen Boin
Epidemiological research has documented the serious health issues that can affect the victims of
disasters and major crises. Yet, the psychosocial dimension of crisis has received little attention
in crisis management literature. This paper integrates psychosocial principles with a model of
strategic crisis management. The resulting model of psychosocial crisis management (PCM)
describes how the tasks of strategic crisis managers can be guided by psychosocial support
principles. This PCM-model helps public leaders, at society and local community level, to better
understand typical psychosocial dynamics and obstacles as the crisis life cycle evolves. Although
crisis management insights and psychosocial support principles stem from different disciplines
and research traditions, integrating them helps to reduce foreseeable problems in the response and
recovery phases.
KEY WORDS: crisis management, disaster health effects, psychosocial support
心理社会式危机管理:危机领导和心理社会支持间未被探索的交集
流行病学研究记录了能影响灾难受害者和大型危机受害者的严重健康问题。然而,危机管理
文献中却很少关注危机的心理社会层面(维度)。本文将战略性危机管理模式和心理社会原
则进行了整合。得出的心理社会危机管理(简称PCM)模型描述了心理社会支持原则如何引导
战略性危机管理者完成任务。PCM模型能在危机生命周期逐步发展时从社会和当地社区的层面
上帮助公共领导者更好地理解心理社会的动态和障碍。尽管危机管理的见解和心理社会支持
原则都源于不同准则和研究传统,将二者进行整合能够在危机反应阶段和恢复阶段帮助减少
可预见的问题。
关键词:危机管理,灾难健康影响,心理社会支持
Introduction: The Forgotten Dimension of Crisis Management
Communities everywhere can be confronted with crises and disasters, events
that disturb the normal order of everyday life. A crisis often entails undesirable
circumstances, which are characterized by a widely perceived threat to core
Risk, Hazards & Crisis in Public Policy, Vol. 8, No. 2, 2017
94
doi: 10.1002/rhc3.12113
#2017 Policy Studies Organization
values, deep uncertainty, and time pressure (Boin, ’t Hart, Stern, & Sundelius,
2016; Brecher, 1993; Rosenthal, Charles, & ’t Hart, 1989; Rosenthal, Boin, &
Comfort, 2001; Stern & Sundelius, 2002). We define crisis management as the set
of efforts aimed to deal with the consequences of crises, “before, during and after
they have occurred” (Shrivastava, Mitroff, Miller, & Miglani, 1988, p. 287; also see
Boin et al., 2016).
Crises can have substantial consequences for the well-being, functioning, and
health of those affected by them (this also applies to complex emergencies in
conflict areas; Salama et al., 2004). Typical effects include stress, fear, uncertainty,
physical symptoms, and trauma-related mental health problems. Disaster health
effects have been studied extensively, and in recent decades with an emphasis on
mental health and post-traumatic stress disorder (PTSD) (e.g., Bonanno, Brewin,
Kaniasty, & La Greca, 2010; Bonde et al., 2016; Galea, Nandi, & Vlahov, 2005;
Herbert et al., 2006; Moline, Herbert, & Nguyen, 2006; Norris et al., 2002;
Yzermans, Van Der Berg, & Dirkzwager, 2009).
Although such effects yield psychological dynamics and influence social
interactions within affected communities (D€
uckers, 2017), and thus demand a
response from public leaders, the psychosocial dimension of crises has received
little attention in crisis management literature. The aim of this paper, therefore, is
to integrate psychosocial principles, relevant to anticipating the well-being,
functioning, and health of people confronted with potentially impactful events,
into crisis leadership theory. We focus on public leaders and crisis managers at
national or local level: public officials at the strategic apex of public organizations
with a formal responsibility to manage the disaster response and recovery
network. In the context of crisis management, these leaders will have to deal with
a set of strategic crisis management challenges and tasks. After briefly discussing
the crisis leadership tasks, we explore the degree of integration between the tasks
and psychosocial support principles as described in the literature. As a final step,
we present a model of effective psychosocial crisis management (PCM).
Strategic Crisis Management Challenges and Tasks
The challenges of strategic crisis management are daunting (for detailed
overviews see Boin et al., 2016; Boin & ‘t Hart, 2011). To overcome these
challenges, strategic crisis managers must focus on a set of tasks (Boin et al.,
2016). Research suggests that the effective organization and implementation of
these tasks helps strategic crisis managers to impose order in the network that is
charged with responding to disaster. The following six tasks are distinguished:
The sense-making task requires crisis managers to diagnose unfolding crisis
situations adequately, often making use of scarce and ambiguous information.
The core of the decision-making task is to identify critical decisions that can and
should only be made at strategic level. The coordination task refers to the
alignment of key actors in a response network, during and after the crisis (Boin &
Bynander, 2015; D€
uckers, Rooze, & Alexander, 2014; Heller, 2010). Coordination
is about allocating capacity and limited resources to facilitate the cooperation
D€
uckers et al.: Psychosocial Crisis Management 95
between particular organizations and groups. Meaning making is about providing
a convincing narrative, an explanation of a crisis and its causes, its implications,
the response, and the envisioned roles of different actors. Account giving refers to
the democratic duty to clarify and accept responsibilities, without engaging in
scapegoating. Learning requires crisis management actors to critically assess their
own functioning and to draw lessons from it to enhance their future performance,
both during and after a crisis (Alexander, 2012; Smith & Elliott, 2007; Stern, 1997).
Exploratory Literature Review
To get an impression of how PCM has been discussed in recent literature, we
carried out an electronic search in Medline, PsycINFO, Cochrane, ProQuest
(combined search of PILOTS and Sociological Abstracts), and Web of Science.
These databases contain publications from broad fields such as sociology,
psychology, public health, political science, and public management. The search
was conducted on May 20 2016 using the following string of search terms:
(psychosocial OR “psycho-social” OR psychologic) AND (“crisis management”
OR “disaster management” OR “emergency management” OR “crisis leader-
ship”). We did not use a date restriction and selected relevant publications
written in English, German, and Dutch based on an assessment of titles and
abstracts. After removing duplicates, our search resulted in 436 publications,
which we then reviewed. As our interest is primarily restricted to public crises
and disasters, we excluded studies about the workplace, corporate crises, medical
crisis interventions, suicide, and health disorders. We mostly found guidelines,
discussion papers, and reflections, presenting primarily qualitative findings,
which meant the material did not allow for formal meta-analysis.
Our literature study shows that crisis leadership and psychosocial support
generally form two distinctive streams with limited unification or integration,
despite their evidently shared area of interest. The study of crisis management is
only moderately concerned with the psychosocial dimension of crises. Studies of
crisis-related psychosocial support focus more on the impact on affected
individuals—particularly the development of trauma-related mental health prob-
lems—than on crisis management dilemmas and problems. Numerous publica-
tions are devoted to particular models, interventions, or approaches that are
suggested to be helpful in addressing trauma-related problems in individuals and
groups (e.g., Clark & Volmann, 2005; Everly, 2000; Hammond & Brooks, 2002;
Mitchell & Everly, 2006). However, because of a lack of evidence contemporary
international evidence-based guidelines do not recommend early preventive
measures that go further than the strengthening of social support, provision of
information, and timely detection of serious health problems (Australian Centre
for Posttraumatic Mental Health [ACPMH], 2013; Bisson et al., 2010; Juen et al.,
2015; Te Brake & D€
uckers, 2013; World Health Organization [WHO], 2013).
The studies differ in their timeframe orientation. Several authors focus on the
early phase of the crisis (Burkle, 1996; Van Loon, 2008), others take a longer term
view (Buckle, Brown & Dickinson, 1998; Weaver, 1995). The few publications that
96 Risk, Hazards & Crisis in Public Policy, 8:2
explicitly speak of PCM use it as a synonym for psychosocial support in crisis
situations (e.g., Beerlage & Helmerichs, 2011; Bering, Elklit, Schedlich, & Zurek,
2009; Hannig & Harks, 2009; Uhle & Haubner, 2005). Van Loon (2008) views PCM
as “primarily aimed at ‘normalizing’ and gaining control over more or less
increased levels of commotion during and after a calamity” (p. 115).
We found many topics that are relevant from a PCM-perspective, but we did
not find an integrated model combining principles from crisis leadership and
psychosocial support. Before we can produce such a model, we first need to
describe the main building blocks. The crisis management tasks grounded in the
work by Boin and ‘t Hart have already been discussed. In the next section, we
integrate the findings from the exploratory review into an overview of psychoso-
cial support principles. Subsequently, we make a synthesis between the principles
and the set of general crisis management tasks.
Principles of Psychosocial Support
The literature describes a variety of psychosocial support principles. We
clustered them into three categories:
– consideration of needs, problems, risks, and existing capacities;
– provide a supportive context;
– evaluate and implement lessons.
Consideration of Needs, Problems, Risks, and Existing Capacities
Assess Needs and Problems. The needs and problems of affected populations, which
response and recovery planners should consider, can cover a variety of issues
such as: shelter, safety, food, drinking water, first aid, and medication (basic aid);
information about what has happened, about the fate of loved ones, and about
possible stress reactions (information); comfort, a listening ear, recognition of grief,
compassion (social and emotional support); legal and financial problems, establish-
ing a household again (practical help); and mental and physical health problems
(health care)(D
€
uckers & Thormar, 2015). The psychosocial needs and problems of
people affected by disasters tend to change over time. These changes in
psychosocial needs are related to the deterioration of social support (Amaratunga,
2006; see “consider risk and protective factors”). Rao (2006) states that support
efforts should be “modulated according to the phase of recovery following the
event occurrence because each phase will highlight different needs. (...). In the
initial phases, the emphasis is placed on social intervention that can be delivered
by community-level workers. In the later phases, the psychological issues that
emerge necessitate the services of trained professionals” (p. 501).
The large range of problems mentioned demonstrates the need for flexibility
and improvisation skills among psychosocial care providers (Van Loon, 2008).
Stress is considered a normal reaction after a potentially shocking event.
According to Van Loon (2008), psychosocial care providers involved in the
D€
uckers et al.: Psychosocial Crisis Management 97
provision of immediate psychosocial help to affected people, should not (only)
focus on the possible development of event-related mental health problems (like
PTSD) among victims. Putting emphasis on the treatment of psychological
problems is considered too narrow given the extent of the needs and problems
associated with the psychosocial well-being of affected people (Van der Velden,
Van Loon, Kleber, Van Uhlenbroek, & Smit, 2009).
Consider Risk and Protective Factors. Effective psychosocial support requires an
understanding of who is at risk within an affected population (e.g., vulnerable
groups such as people displaced, children, and the elderly, but also first
responders and other helpers). Typical risk factors linked to the prevalence of
mental health complaints and a limited capacity for self-recovery should guide
psychosocial support. Studies refer to risk factors such as lower socio-economic
status, female gender, lack of social support, exposure to death and loss, and
existing mental health problems (Bonanno et al., 2010; Brewin, Andrews, &
Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003). Additional stress is caused by
actual or potential “resource loss,” the loss of anything that matters to a person
(Hobfoll, 1998), for instance, in terms of relations, possessions, work, someone’s
role in society and status. A risk reduction approach should incorporate
addressing additional sources of stress linked to resource loss and other stress
factors (Van der Velden et al., 2009).
Social support is a key component of community resilience (Norris, Stevens,
Pfefferbaum, Wyche, & Pfefferbaum, 2008) and—if absent—a well-known risk
factor for the development of trauma-related mental health problems and,
possibly, the attribution of physical symptoms from experiencing the event.
Social support can vary if a person’s life circumstances change, for instance, if
someone moves to a new location, or if circumstances are altered by the
disaster itself. Levels of social support, as perceived by affected citizens, tend
to deteriorate in a disaster’s aftermath (Kaniasty & Norris, 2004; Kaniasty,
Norris, & Murrell, 1990). Collective emergencies can dramatically impact
interpersonal social dynamics and the availability of community resources
(Bonanno et al., 2010). The disaster stages model (Raphael, 1986; Yzermans &
Gersons, 2002) illustrates the psychosocial impact of crises as an “emotional
timeline.” The “impact” phase is followed by a “honeymoon” phase with
extensive levels of social support (sympathy, compassion, and attention from
family members, friends, coworkers, community actors, governments, and
media). In the “disillusionment” phase, in the weeks or months after a crisis,
social support diminishes as the survivors and the bereaved pick up the thread
of normal life. Raphael (1986) speaks of a “second disaster” when individual
and community adaptive capacities reach a minimum. Gradually, the amount
of social support is expected to regrow, with likely fall-backs, as an affected
person overcomes the impact and enters a phase of “reintegration.”
Strengthen and Utilize Existing Capacities. A core principle in the psychosocial
support literature in disaster settings refers to strengthening and utilizing
98 Risk, Hazards & Crisis in Public Policy, 8:2
resilience, that is, adaptation or recovery capacity and resources available to
individuals, communities, and societies (Bonanno et al., 2010; D€
uckers, 2017;
Norris et al., 2008). Well before the current popularity of resilience theory in
disaster mental health research, Omer and Alon (1994) noted that “the continuity
principle stipulates that through all stages of disaster, management and
treatment should aim at preserving and restoring functional, historical, and
interpersonal continuities” at the level of “individual, family, organization, and
community” (p. 273). The dominant perspective in the international literature is
that the vast majority of people confronted with a potentially shocking event are
capable of dealing with the psychological impact and capable of self-recovery
(Bonanno et al., 2010). Some individuals will develop problems they cannot
overcome themselves. While some authors focus on the capacity to adapt and
interventions at individual level, others stress the importance of community-
level resources/capacities, interventions, and programs (Basu et al., 2013;
Comfort, Siciliano, & Okada, 2011; Dudley-Grant, Mendez, & Zinn, 2000;
D€
uckers, 2017; Kapucu, Hawkins, & Rivera, 2013; Norris et al., 2006, 2008;
Vernberg, 2002; Vymetal, 2006).
Provide a Supportive Context
Experts agree upon the importance of providing affected people with a
“supportive context,” which may include offering a listening ear, support and
comfort, and being sensitive to immediate practical needs; offering practical and
up-to-date information about the event; mobilizing support from one’s own social
environment; facilitating reunions with family and keeping them together; and
reassuring people who are displaying stress reactions that their reactions are
normal (Te Brake & D€
uckers, 2013). The notion of such a supportive context—
which can be realized nationally or locally by government, businesses, and civil
society actors—is reflected in three psychosocial principles:
– provision of information and basic aid;
– promote a sense of safety, calmness, self- and community efficacy, connected-
ness to others, and hope;
– social acknowledgment.
Provision of Information and Basic Aid. Information about the crisis, causes, and
consequences, especially those killed, missing, or relocated, but also information
on the status of response and recovery processes, practical guidance, and possible
health reactions, is highly valuable for people confronted by a disaster. The same
applies to direct basic needs such as safety, emergency first aid, shelter, water,
and food, and reunification with loved ones, friends, and family members (Bisson
et al., 2010; Te Brake & D€
uckers, 2013).
Promote a Sense of Safety, Calmness, Self- and Community Efficacy, Connectedness to
Others, and Hope. Hobfoll et al. (2007) identified five essential psychosocial
D€
uckers et al.: Psychosocial Crisis Management 99
support principles, relevant for anyone who interacts with people exposed to
crises. It is necessary to promote a sense of safety, calmness, self- and community
efficacy, connectedness to others, and hope.
Social Acknowledgment. Maercker and M€
uller (2004) defined social acknowledg-
ment as “a victim’s experience of positive reactions from society that show
appreciation for the victim’s unique state and acknowledge the victim’s current
difficult situation. The term social here not only includes the (...)victim’s
[closest social network] (e.g., family, friends), but also significant persons (e.g.,
local authorities, clergy), groups (e.g., at the workplace, fellow citizens), and
impersonal expression of opinions (e.g., media) about the experiences of the
victims or survivors” (p. 345). Social acknowledgment is low if people affected
experience societal disapproval, misunderstanding, criticism, rejection, or a lack
of support. This can be problematic because it is social support that they are
seeking.
Evaluate and Implement Lessons
The psychosocial support principles described above under “consideration of
needs, problems, risks, and existing capacities” and “provide a supportive
context” can be seen as assignments for the many different actors that are involved
in the different stages of planning and the delivery of services to affected
individuals and communities. In the principles under the third category, they can
contribute to closing the learning loop and service optimization. From a quality
improvement perspective, the challenge is to approach each unique disaster
context with the same series of quality improvement steps (plan–do–study–act)
and to integrate (mental) health research into post-disaster management planning
(D€
uckers & Thormar, 2015; Greenberg, Rubin, & Wessely, 2009; Reifels et al.,
2013). First, collect information, rigorously and rapidly, about the needs, problems,
risks, and (a lack of) adaptive capacities of the people exposed, also to verify
whether expectations and assumptions are correct. Ideally, the psychosocial needs
of the public, first response team, support staff, and volunteers will be assessed
before advancing to the next stage of the disaster timeline (Amaratunga, 2006).
Second, prioritize the issues that must be addressed and design a practical
approach with clear roles and tasks for the actors involved, as well as required
conditions (“plan”). Third, carry out the activities as planned (“do”). Fourth,
evaluate the result in relation to the original plan and check whether principles are
being put into practice (“study”). The final step, closing the loop, is to adjust the
plan if necessary, to proceed with the plan or to end it (“act”). These steps increase
the chance that affected populations will be served in an effective, efficient, need-
centered, safe, and appropriate way (D€
uckers & Thormar, 2015). Basic “quality”
criteria like these can be used to evaluate psychosocial support (including the
performance of distinctive partners or networks) in positive or negative terms and,
when appropriate, to implement lessons to improve the support of affected people
in the present and the future.
100 Risk, Hazards & Crisis in Public Policy, 8:2
Psychosocial Crisis Management: A Conceptual Model
Bringing Crisis Leadership Challenges and Psychosocial Support Together
The next step is to bring crisis leadership and psychosocial support principles
together in one PCM-model. The strategic crisis management model is thus
enriched with insights from psychosocial literature. The six leadership tasks are
used as the main platform for the development of a PCM-model to better
understand typical challenges related to the psychosocial dimension of crises. In
Figure 1 the crisis leadership challenges and psychosocial support principles are
shown in different rings, linked to each other and centered around the well-being,
functioning, and health of citizens exposed to potentially traumatic events. While
psychosocial support principles are particularly relevant to professionals and
Figure 1. Psychosocial Crisis Management: Crisis Leadership Guided by Psychosocial Principles.
Note. Crisis leadership challenges and psychosocial support principles are shown here in different
rings, centered around the well-being, functioning, and health of citizens exposed to potentially
traumatic events. General leadership challenges, originating from crisis management studies, are
linked to post-disaster psychosocial support principles identified in the literature. While psychosocial
support principles are particularly relevant to professionals and trained volunteers (e.g., rescue
workers, family physicians, mental health professionals, social workers, and clergy), from a PCM-
perspective they also provide meaningful guidance to public leaders with a responsibility for the
well-being, functioning, and health of citizens at national or local community level. The crisis
leadership tasks and the psychosocial support principles are structured anti-clockwise along the stages
in the plan–do–study–act cycle. PCM encompasses different time phases in which public leaders must
overcome several obstacles while shaping sense making, decision making, coordination, meaning
making, account giving, and learning tasks.
D€
uckers et al.: Psychosocial Crisis Management 101
trained volunteers, from a PCM-perspective they also provide meaningful
guidance to public leaders with a responsibility for the well-being, functioning
and health of citizens at national or local community level. Crisis leadership tasks
and psychosocial support principles are structured anti-clockwise along the stages
in the plan–do–study–act cycle in Figure 1.
Sense Making
From a psychosocial perspective, sense making is needed to make an
assessment of the event and its potential effects on the exposed population. This
assessment should identify psychosocial risks, needs and problems, risk factors
(insufficient) capacity to adapt, preferably guided by lessons learned from earlier
situations. In the early phase of a crisis, the PCM-response is hindered by a lack
of information. Public leaders have to access different channels to obtain
necessary information. At individual level this can be done based on informal
conversations with the affected (Jong, D€
uckers, & Van der Velden, 2016a), or
more formally through an investigation or professional diagnosis. At community
or country level it is possible to perform a rapid health and needs assessment
(Korteweg, Van Bokhoven, Yzermans, & Grievink, 2010), a health monitor to
follow the development in time of mental and physical health (Yzermans et al.,
2009; Yzermans, Baliatsas, Van Dulmen, & Van Kamp, 2016), or an analysis of
social media, newspaper, or television broadcasting to understand emotions and
perceived PCM-outcomes within local communities (Back, K€
ufner, & Egloff, 2010;
Griffin-Padgett & Allison, 2010; Jong & D€
uckers, 2016; Jong et al., 2016a).
Although these activities are helpful there is always a risk that sense making
intensifies the crisis (Weick, 1988). Asking people about possible health con-
sequences, may make them believe they are suffering or are going to suffer from
a physical ailment and therefore make them extra aware of symptoms, regardless
of whether these symptoms are linked to exposure.
Decision Making
Crisis leaders must make critical choices, also in relation to the psychosocial
impact and necessary aftercare in the short-term as well as in the long-term. To
ensure that the right principles are reflected in strategic crisis decision making,
crisis leaders must be informed about particular characteristics and challenges
surrounding the psychosocial dimension of crises, including the lessons learned
from earlier disasters and major events (see “learning”). In disaster settings,
(mental) health experts can highlight specific but critical crisis management
aspects. Education and advice on psychosocial principles is also relevant to other
partners, such as disaster personnel and emergency workers, primary caregivers
(e.g., family physicians), welfare workers, clergy and other community actors
(McFarlane, 1984; Powell & Penick, 1983; Raphael, 1984; Van Loon, 2008).
Including psychosocial support knowledge in decision-making processes
enhances the possibility that coordination and meaning making are shaped and
102 Risk, Hazards & Crisis in Public Policy, 8:2
conducted in line with the right principles, strengthening and utilizing resilience,
and anticipating the deterioration of social support.
Coordination
Crisis management and post-disaster psychosocial support have in common
that both are conducted by actors with different tasks, interests, and responsibili-
ties at different levels in a multidisciplinary inter-organizational network (Bisson
et al., 2010; Boin & ‘t Hart, 2011; D€
uckers, Witteveen, Bisson, & Olff, 2015). The
realization of services to affected populations after a disaster requires the
involvement of a variety of government, business and civil society actors
(D€
uckers, 2017). These actors will then be enrolled in what we can call a
psychosocial support program: “a community intervention that can differ in
length (weeks, months, years), scope (variation in themes) and organization
(number of partner organizations at different levels)” (D€
uckers & Thormar, 2015).
Rescue workers, response team, families, volunteers, community workers,
clergy, primary health care-givers, and therapists play a role in providing a
supportive context. The PCM-challenge is to pursue cooperation across social
groups (including groups of survivors and the bereaved), professional disciplines,
organizations, jurisdictions, policy domains, and governmental layers. Without
the alignment of activities and interventions and without the deliberate allocation
of resources (including information), adjusted to different circumstances through
time, PCM is bound to fail in its aim to be responsive to needs, problems, risks
and stress factors, (a lack of) resilience, and to establish a supportive context
reflecting essential principles. Finally, providing information remains a vital
element of PCM. News media must be regularly and appropriately briefed, in
order to use their potential for disseminating information to the survivors,
bereaved families, and the public (Kroon & Overdijk, 1993; Vasterman, Yzermans,
& Dirkzwager, 2005).
Meaning Making
Giving meaning to something can have a positive effect on people’s resilience
and recovery from stressful events (Park, 2016). Benedek and Fullerton (2007)
underlined the relevance of the “essential principles” (Hobfoll et al., 2007; see
“provide a supportive context” in the previous section), but emphasized
something was missing, namely a “vehicle” to bring the principles into practice.
In a reaction, Hobfoll stated that the “passageways and obstacles” for the
essential principles need to be elaborated (D€
uckers, 2013). Public leaders can
serve as the necessary vehicle. In their meaning-making behavior, crisis managers
can provide social acknowledgment and contribute to a sense of connectedness
and hope, for example, just by being there and by using well-chosen words.
The meaning-making task is prone to being amplified by (social) media and
becomes harder when public discussions are dominated by frustration about
unmet expectations, disillusionment and a perceived lack of social support (the
D€
uckers et al.: Psychosocial Crisis Management 103
second obstacle in Figure 1). After the earthquake at L’Aquila, Italy, in 2009, the
public was positive about the initial response and provision of temporary housing
by the government, but then unrealistic promises were made. The government
promised that permission for evacuees to return to their homes would be granted
within a month of the disaster, but the actual repair of homes became a slow,
disorganized process that was dependent on funds that were in very short supply
(Alexander, 2010). When government involvement becomes a problem in itself, it
will become harder for leaders to provide a convincing narrative with explan-
ations and implications.
Psychosocially speaking, meaning making requires crisis leaders to consider
the potential impact of rituals that are routinely employed in the wake of a
disaster. Leaders are expected to play a role in “remembering” the disaster, its
impact on people involved, including responders and communities as a whole.
Nowadays, societies do not easily allow a disaster to be forgotten. Years after an
event there is still a need—political or not—for commemoration ceremonies and
monuments (Boin & ‘t Hart, 2011; Eyre, 2007; ‘t Hart, 1993). While this may be
functional in terms of the legitimacy of leaders and institutions, and in terms of
connectedness and social support, it could have the opposite impact on survivors
and bereaved families who may feel pressured to share their grief in the public
arena (Jong, 2013).
Account Giving
Investigations and inquiries play a role in aiding or inhibiting recovery (Eyre,
2004). In the accountability phase of PCM, social acknowledgment and evaluation
of leadership come together. To what degree were psychosocial support
principles followed in the response and recovery phase? In practice, PCM can be
judged using a broad range of evaluation terms (see “learning”). Crisis managers
must render an account of their decisions and handling of response and recovery.
This account giving should be broadened to include how PCM was organized. If
that is not done, or not done properly, the legitimacy of responsible leaders and
public institutions may well suffer as a consequence. The effective implementa-
tion of psychosocial principles enhances the fate of leaders in the wake of crisis.
For instance, 6 years after the Bijlmermeer plane crash disaster in Amsterdam,
health complaints escalated, ending in a highly contentious parliamentary
investigation procedure, which threatened the ruling coalition (Boin, Van Duin, &
Heyse 2001; Yzermans & Gersons, 2002).
Learning
During a crisis, we expect public leaders and crisis managers to take into
account feedback that suggests the proposed course of action is not working as
envisioned—they can optimize PCM by applying the plan–do–study–act quality
improvement model. Learning from a crisis implies that lessons are remem-
bered in the management of the psychosocial impact of a new crisis (this type
104 Risk, Hazards & Crisis in Public Policy, 8:2
of plan–do–study–act cycle is shown in Figure 1). Evaluation of PCM can be
complicated because of the potential variation in normative viewpoints among
stakeholders with respect to needs, problems and capacities of individuals and
communities (with in-group and between-group differences), the multi-faceted
composition of community programs, and relevant contextual differences
(possibly connected to community or society-level characteristics) that justify
another approach.
Moreover, as changes through time matter psychosocially, the evaluation
strategy should be responsive to the different challenges crisis leaders have to
solve at different time stages. If the response is too passive or too active, the
evaluation will be negative (D€
uckers & Thormar, 2015). Negative-passive PCM-
evaluations are expressed in terms of neglect, disregard, and a lack of insight,
involvement, capacity, or opportunity. People can feel abandoned or ignored.
The aftermath of the earthquake at L’Aquila (Alexander, 2010) and the
Bijlmermeer plane crash disaster in Amsterdam (Boin et al., 2001; Yzermans &
Gersons, 2002) can be seen as examples. Negative-active PCM-evaluations
reflect over-attention and wasted resources. Things were done, but probably
not the right things. After the Bijlmermeer disaster the mental health
interventions made available to many victims were much too short to achieve
any lasting result, did not follow an explicit protocol and, in many cases, did
not prove to be effective even in the short-term. These and other experiences
from the Bijlmermeer plane crash were used to implement an improved
program after the Enschede fireworks disaster, almost 10 years later (Yzermans
& Gersons, 2002). This example illustrates how lessons can be implemented in
a new cycle of sense making, decision making, etc.
PCM and Health
A Two-Way Relation
Although psychosocial support and crisis management insights stem from
different disciplines and traditions, integrating them can reduce foreseeable
problems in the response and recovery phases. A key assumption in this line of
reasoning, present in the body of knowledge brought together in this article, is
that a relation exists between PCM on the one hand, and the well-being,
functioning and the health of those affected on the other. This relation works in
two directions and this is where the two research disciplines differ in their
emphasis.
Psychosocial support literature is mostly interested in how PCM influences
the health of affected people. Norris et al. (2008) describe this type of relation
explicitly at community level: “[if] management systems (...) function effectively
to protect lives, reduce injuries, minimize damage to public utilities, and connect
community members to necessary services, it is reasonable to expect the
population to remain well” (p. 133). Psychosocial support literature contains
descriptions of interventions and programs, but so far provides little evidence on
D€
uckers et al.: Psychosocial Crisis Management 105
the health effects of such interventions and programs, nor on the health effects of
leadership behavior.
Literature on crisis management stresses the implications of disaster health
issues for the leader’s position. The general well-being of citizens is not an explicit
crisis management objective. Authors emphasize the emotional well-being of
society primarily with regard to the accountability and responsibility of public
leaders (‘t Hart, 1993), and the impact on their support from constituencies (Boin
& ‘t Hart, 2003; Fairhurst & Cooren, 2009; Griffin-Padgett & Allison, 2010; Jong,
D€
uckers, & Van der Velden, 2016b). In the end, the care for “victims and
survivors” tends to be instrumental: a lack of well-being results in declining
support from voters and political and institutional turmoil. At the same time, in
order to politically survive the crisis, public leaders are more or less obliged to
serve the interests of their citizens and to be responsive to their needs. In an ideal
situation this shared interest functions as an institutionalized PCM-“safety valve,”
that is, the self-interest of the leader stimulates to take good care of the interest of
disadvantaged citizens. What makes matters complicated is that, post-disaster,
public leaders will have to deal with different groups and differing interests
within those groups.
Causal Attribution Problem
The term disaster health effects implies causality between a person’s
condition and an external source of exposure. Methodologically, verifying a
causal relation between the two is vastly complex as actual exposure levels are
difficult to ascertain retrospectively while controlling other relevant factors.
Causal attribution is a typical problem in disaster health research (Yzermans
et al., 2009). Even in case of personal doubts concerning the plausibility of a
causal relation, effective PCM requires public leaders to deliver a trustworthy
and supportive meaning-making performance. Whether causality can be
verified or not, when it is real in the subjective perceptions of affected
individuals and they define it as such, it is real in its consequences, and
demands serious attention from crisis managers while shaping the various
PCM-tasks. This classical Thomas theorem (Thomas & Thomas, 1928) confronts
public leaders with the challenge of finding a balance between social
acknowledgment (meaning making) and confirming responsibility or entitle-
ment to compensation (account giving).
Conclusion
Crises are disruptions with a potential psychosocial impact. In this paper, we
explored the intersection between crisis leadership and psychosocial support. We
identified a lack of integration of the two disciplines in the literature, and
presented a PCM-model linking typical crisis leadership challenges to the
well-being, functioning, and health of individuals in relation to their social
environment.
106 Risk, Hazards & Crisis in Public Policy, 8:2
By combining insights from both knowledge domains, the scope of PCM can
be better delineated as a distinctive crisis management theme. PCM stretches out
over different time stages, from sense making, decision making, coordination,
meaning making, account giving to learning, confronting public leaders with
predictable obstacles in their challenge to integrate the psychosocial support
principles into crisis leadership. Clearly, PCM should not disappear from the
radar of political-administrative elites when the operational phase of the crisis is
over. The PCM-model can assist crisis leaders and researchers to better
understand and to evaluate the psychosocial dimension of crisis management.
PCM can only be effective if it is integrated into every stage of crisis
management.
This paper offers a study model and several angles to formulate and test
hypotheses. We encourage more empirical research on the realization of
PCM-principles by leaders in different phases of a crisis, and under different
circumstances. Particularly interesting topics are: the extent to which
PCM-principles are recognized and translated in practice; relevant characteristics
and factors explaining the success or failure of PCM (e.g., individual, role,
governmental, societal and external sources; Wittkopf, Jones, & Kegley, 2007); and
the nature of the two-way relation between PCM and well-being, and how it can
be influenced. Systematic assessments of topics like these have the potential to
enhance the forgotten psychosocial dimension of crisis management, and can
therefore strengthen crisis management in general.
Michel L. A. D€
uckers is program coordinator at Impact—National Knowledge
and Advice Centre for Psychosocial Care Concerning Critical Incidents, 1112 XE
Diemen, The Netherlands and senior researcher at NIVEL—Netherlands Institute
of Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, The
Netherlands [m.duckers@nivel.nl].
C. Joris Yzermans is senior researcher at NIVEL—Netherlands Institute of Health
Services Research, Otterstraat 118-124, 3513 CR Utrecht, The Netherlands.
Wouter Jong is researcher at INTERVICT, Tilburg University, PO Box 90153, 5000
LE Tilburg, The Netherlands and crisis consultant at the Dutch Association of
Mayors (Nederlands Genootschap van Burgemeesters), Nassaulaan 12, 2514 JS,
The Hague, The Netherlands.
Arjen Boin is Professor of Public Institutions and Governance at the Institute of
Political Science, Leiden University, 2333 AK Leiden, The Netherlands.
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