Routines are integral to stabilising emergency event disruption

Article

Exposure to emergency events can have life-changing consequences. Although the majority of community members make a full recovery following an emergency, a common theme is of disruption to pre-existing routines. Various aspects of life can be affected as ‘normal’ routines are replaced with improvised crisis routines. Individuals are at risk of compromised health and wellbeing while community cohesion may be reduced. For those involved in providing psychosocial recovery services, it is important to assist affected community members to recognise, minimise and adapt to the effects of emergency event disruption. This article examines the role of routines in stabilising emergency disruption with reference to the epidemic thunderstorm asthma event that hit Melbourne in November 2016.

Routines form an integral part of everyday life. They contribute to a lived experience that seems predictable, secure and safe. Routines enhance individual health and wellbeing. When an emergency occurs, for example the epidemic thunderstorm asthma event that struck Melbourne on 21 and 22 November 2016, routines are disrupted and pre-existing stable functions of daily life may be compromised.

The inherent threat of the emergency facilitates heightened levels of stress and, even after the threat has passed, a reduced sense of predictability and safety may persist. In turn, normal routines are disrupted often without awareness that this is even occurring. Over time individuals are at risk of developing ill-health side effects and communities may experience less cohesive functioning. For community members, these are unexpected consequences of an emergency. It is therefore important that psychosocial recovery processes assist people to recognise, minimise and adapt to the effects of emergency event disruption.

While participating in a series of epidemic thunderstorm asthma community information sessions held throughout Melbourne in February 2017, it became apparent that there was a range of experiences among attendees. Some had a very frightening, potentially life-threatening experience, others encountered a rapid change in their asthma symptoms that were manageable through significant effort, and a third group thought little of the event at the time it was occurring. Regardless of the severity of effect, the majority of attendees I spoke with reported some level of disruption to normal life in the days, weeks or months following the storm.

Routines and habits

To understand the role of routines it is important to recognise the relationship with habits. Habits can be thought of as actions that are triggered automatically in response to certain cues in a person’s environment (Neal et al. 2012). An example of a habit is pouring milk over one’s breakfast (action) having filled a bowl with cereal (environmental cue).

However, Clark (2000, p. 128) defines routine as ‘a type of higher-order habit that involves sequencing and combining processes, procedures, steps or occupations. Routines specify what a person will do and in what order and therefore constitute a mechanism for achieving given outcomes and an orderly life’. Consider a parent who awakens in the morning, gets dressed, makes breakfast for their children, helps the children get ready for school, packs lunches, drives the children to school, goes shopping at the supermarket, returns home, unpacks the shopping and responds to emails from the prior day. The process is then repeated multiple times during the following weeks and eventually it becomes a routine; a sequence of ordered tasks arranged according to priority and performed within a set period of time.

The benefits of routines are well identified. They help bind life together in a series of prioritised sequences. When these sequences are repeated a sense of predictability is created and this allows mental energy to be redirected elsewhere. With predictability comes a feeling of certainty, safety and security. This is evidenced by the fact that people make plans for their future and remain reliant on routines to get them there. Rarely is consideration given to the potential that something unexpected might occur and disrupt their automatic flow.

Importantly, routines are also associated with health and wellbeing. For instance, having good eating, sleeping and exercise routines have all been linked to positive physical and psychological health outcomes (Anderson & Whitaker 2010, Callaghan 2004, Haines et al. 2013). In an interesting study by Williams (2000) of 72 elderly people, it was found that those with fewer routines reported higher levels of distress when experiencing ill health and negative life events. These effects were not present for those who had more routines in daily life. Routines also contribute to child development and family functioning. For example, they assist children to anticipate what will occur during the course of a day. This provides opportunities to learn, try new activities and build self-confidence. In regards to families, various studies have shown that the existence of routines improve health outcomes (Anderson & Whitaker 2010, Denham 2003, Fiese 2007).

Just as individuals benefit from routines, so do communities. In fact, stable and effective community functioning is reliant upon routines. When we examine social structure we can see that people are bound together in community by common social elements (location, activities, resources, services, facilities, industry, attitude and interests) and that belonging to more than one community (education, business, sport, work, culture) is not uncommon. An example is a parent who works at a community bank and is also a member of the local football club. Every weekend they take their children to watch a match where they meet up with friends, support the players, purchase lunch from a fundraising barbeque and talk to some regular customers of the bank. In other words, the common social elements of community that bind people together are embedded in routines and, even at a community level, provide predictability, certainty and a sense of safety.

But what impact does an emergency event have on individual and community functioning? Although the answer is usually complex and dependent on the unique features of the event and the effected community, the common theme is of disruption. The pre-existing ‘normal’ patterns of living are interrupted due to the immediate or ongoing threat, and there is a ripple effect that flows out into life for a period of time afterwards causing stress and anxiety. Normal routines are replaced with improvised crisis routines and the social fabric that provides certainty and security is destabilised.

During the epidemic thunderstorm asthma community sessions, one attendee spoke of the two weeks she took off work to care for her son who was hospitalised. Not long afterwards she became unwell with a stress-related condition and more time off work was needed. Another participant, whose asthma symptoms were triggered by the storm, described persisting fear of going outside. A family I spoke with explained that the father had become very unwell very quickly and they rushed him to the local hospital. The children had witnessed the incident and were continuing to express worry that the same could happen again.

Although the majority of people made a full recovery, there are those whose lives remain disrupted. When providing psychosocial recovery services, it is crucial to help individuals recognise, minimise and adapt to the effects of disruption. People can be assisted to understand the important role that routines play and encouraged to return to pre-emergency routines gradually.

Unfortunately for some it will not be possible for life to return to the way it was before the emergency. In such instances flexible adaptation, a key resilience contributor, can play a vital role. Approaches that activate and strengthen this ability will be helpful. In some cases a referral to a health service might be needed. However, regardless of the psychosocial recovery techniques devised and implemented the key message is that routines contribute to a more predictable life that feels safer, more secure and leads to better health outcomes for individuals as well as communities.

References

Anderson SE & Whitaker RC 2010, Household routines and obesity in US preschool-aged children, Pediatrics, vol. 125, pp. 420-428.

Callaghan P 2004, Exercise: a neglected intervention in mental health, Journal of Psychiatric and Mental Health, vol. 11, pp. 476-483.

Clark FA 2000, The concepts of habit and routine: a preliminary theoretical synthesis, The Occupational Therapy Journal of Research, vol. 20, pp. 123-137.

Denham SA 2003, Relationships between family rituals, family routines, and health, Journal of Family Nursing, vol. 9, pp. 305-330.

Fiese BH 2007, Routines and rituals: opportunities for participation in family health, OTJR Occupation Participation Health, vol. 27, pp. 41S-49S.

Haines J, McDonald J, O’Brien A, Sherry B, Bottino C, Scmidt ME & Taveras EM 2013, Healthy habits, happy homes: randomized trial to improve household routines among pre-school-aged children, JAMA Pediatrics, vol. 167, pp. 1072-1090.

Neal DT, Wood W, Labrecque JS & Lally P 2011, How do habits guide behavior? Perceived and actual triggers of habits in daily life, Journal of Experimental Social Psychology, vol. 48, pp. 492-498.

Williams J 2000, Effects of activity limitation and routinization on mental health, The Occupational Therapy Journal of Research, vol. 20, pp. 100S-105S.