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Many Christchurch emergency and rescue workers, police, ambulance, fire and hospital staff traumatised by the initial events and efforts following February 22's earthquake are still struggling a year on, according to a group of counsellors.
The Durham Centre in Christchurch has reported emergency workers were re-experiencing the original events, suffering exhaustion, feeling remorse they didn't do enough and an overwhelming feeling that the sterling service they provided had gone by unrecognised.
The centre today said rescue workers were pushed to their limits and had difficulties processing the experiences they were exposed to.
``Some had unrealistic expectations regarding their rescue work and are suffering ongoing feelings of guilt. Some are still suffering chronic fatigue and struggle to carry on with their daily work and family commitments,'' the centre said.
The Durham Centre is run by counsellors Valerie Attrill, Bev Mason, Karin Schaeper, Sharon Wilson and Bryan Wright.
They said it could be years before the full psychological impact of Christchurch earthquakes emerges.
Australian psychologists dealing with floods and bushfires found the full psychological effect of the disasters took two years to emerge. There was a difference between bushfires and floods in that once they were over they did not come back. The centre said there was no known model for ongoing earthquakes, but it was likely that the difficulties would be even more marked.
``We see an increasing number of people who are exhausted. They are doing their best to protect their family and personal interests but find dealing with normal everyday events increasingly difficult,'' the centre said.
``We are seeing more evidence of delayed grief and more people recognising they are 'feeling broken'. The royal commission findings are bringing up emotions for people, particularly anger. There are multiple layers of stress caused by complex Earthquake Commission / insurance issues. And we still have ongoing concerns about the possibility of another sizeable shake.''
The people of Christchurch could be vulnerable to an outbreak of mental health disorder that could be difficult to cope with.
``Especially as mental health services in Christchurch are under-resourced. Symptoms of anxiety, depression, chronic fatigue and hyper-vigilance can be protracted if not recognised and counselling intervention has not taken place earlier on.
``Due to people's immediate needs - housing, safety, finances - still not stabilised, people are very much focused on coping strategies to meet their immediate daily needs to deal with the ongoing uncertainties on multiple levels - psychological aspects are just one aspect of that.''
Last year's earthquakes exposed a vast number of people to the risk of long-term trauma and people were still focused on self preservation, the counsellors said.
However due to major decision-making delays people were becoming more stressed and frustrated. This could result in relationships being affected by anger and irritability. Due to ongoing powerlessness, the risk of the development of depression has increased.
``Just before December 23 last year, people were weary due to the effects of a stressful year. Decreased seismic activity gave us a false sense of safety again and a little hope that the 'worst was behind us'. That all changed when those two big quakes struck just before Christmas. Burnout has become an issue as people did not get the Christmas break they needed because of December 23.
``In future when people are settled and have regained a sense of safety some will only then have the capacity to process their quake experiences and what it has meant to them. This could lead to more post traumatic stress disorder (PTSD) symptoms emerging and people will hopefully seek out more intervention.''
The centre said people who were in the CBD when the February 22 hit were exposed to witnessing the devastation, at times death and destruction. People in the eastern suburbs were subjected to a different traumatic experience: their homes submerged, liquefaction everywhere and the loss at times of all services. Due to the west of the city being less affected, some in the east felt and were still feeling a lack of compassion and understanding, leading to frustration and anger.
Many people who were referred to the centre complained of nightmares, terrifying flashbacks, sleeping difficulties, fear, eating disorders, concentration problems, sexual / relationship issues and increased alcohol use.
Everyone in Christchurch has experienced extremely traumatic events and large aftershocks, insurance and recovery problems had resulting in a huge increase in people seeking free counselling.
Many Christchurch children - already worn down by 10,000 unnerving shakes - had become afraid. The centre said often parents were shaken and did not know how to help their children.