ADDRESSING MENTAL HEALTH ISSUES IN ADDRESSING MENTAL HEALTH ISSUES IN EMERGENCY AND HUMANITARIAN EMERGENCY AND HUMANITARIAN

SITUATIONS SITUATIONS –– HOW CAN WE CONTRIBUTE HOW CAN WE CONTRIBUTE AND WHAT IS THE EVIDENCE?AND WHAT IS THE EVIDENCE?

Dr Frances Hughes, RN, Dr Frances Hughes, RN, DnursDnurs, ONZM, ONZMWHO WHO PIMHnetPIMHnet facilitator facilitator Principal Advisor Office of Director of Mental Health NZPrincipal Advisor Office of Director of Mental Health NZAdjunct Professor Adjunct Professor –– University of Technology University of Technology --SydneySydney

PRESENTATION OUTLINEPRESENTATION OUTLINE

Promoting recoveryPromoting recovery--interventionsinterventionsHealth professionals role, principles Health professionals role, principles and competenciesand competenciesStagesStages-- acute, rehab, post recoveryacute, rehab, post recovery

Mental Health in Emergency Mental Health in Emergency and Humanitarian Situationsand Humanitarian Situations

Psychological reactions to emergencies Psychological reactions to emergencies varies according to a range of factorsvaries according to a range of factorsEffective mental health interventions in order Effective mental health interventions in order to promote recovery importantto promote recovery important

December 26, 2004

SIX ASIAN AFFECTED COUNTRIESIndonesia MyanmarIndia Sri LankaMaldives Thailand

Psychosocial consequences: Psychosocial consequences: SARS as an exampleSARS as an example

Psychosocial interventions to Psychosocial interventions to promote recoverypromote recovery

Individual BehaviorIndividual BehaviorFamiliesFamiliesOrganisationsOrganisationsCommunitiesCommunitiesSocietySociety

The mental health response in a disaster should The mental health response in a disaster should based on five core principles (IASC, 2006): based on five core principles (IASC, 2006):

Human rights promotion and protection: Human rights promotion and protection:

Participation: Participation:

Multilayered support: Multilayered support:

Do no harm: Integration:Do no harm: Integration:

Promoting recoveryPromoting recovery

Plan for and promote normal recovery Plan for and promote normal recovery for majorityfor majorityPromote basic forms of support Promote basic forms of support --emphasis on natural recovery process:emphasis on natural recovery process:

survival, safety, shelter, reunificationsurvival, safety, shelter, reunificationFormally intervening may be Formally intervening may be inappropriate inappropriate -- for the majority this is not for the majority this is not requiredrequired

Health professionals can be optimally Health professionals can be optimally prepared for a disaster of any type by prepared for a disaster of any type by being aware of community hazards and being aware of community hazards and vulnerabilities, as well as being familiar vulnerabilities, as well as being familiar with the community health care system with the community health care system and its level of preparedness.and its level of preparedness.

Competencies include:Competencies include:

CommunicationCommunicationProblem solvingProblem solvingManagementManagementAssessmentAssessmentCritical thinkingCritical thinking..

Specific skills that will be required by health Specific skills that will be required by health professionals responding in these situations professionals responding in these situations

in relation to mental health are:in relation to mental health are:

psychological first aidpsychological first aidstress managementstress managementanxiety managementanxiety managementCopingCopingadvocacyadvocacytriage for mental health survivorstriage for mental health survivorsemergency careemergency careempowering survivorsempowering survivorsmental health educationmental health educationnetworking.networking.

Nursing Roles: Nursing Roles: Providing supports for Providing supports for meeting basic needsmeeting basic needsWorking with and Working with and supporting community supporting community processesprocesses-- building building resilienceresilienceMobilizing and supporting Mobilizing and supporting nurses nurses Providing direct nursing Providing direct nursing service/care service/care Providing psychosocial Providing psychosocial supports supports Providing advocacy Providing advocacy

Acute and Early InterventionsAcute and Early InterventionsDuring acute emergency phase, interventions During acute emergency phase, interventions should be mostly should be mostly socialsocialA number of issues need to be taken into A number of issues need to be taken into account regarding account regarding psychological interventionspsychological interventionsduring the acute phaseduring the acute phase

Social interventionsSocial interventionsEstablish and disseminate credible flow of Establish and disseminate credible flow of informationinformationFamily tracingFamily tracingOrganiseOrganise sheltershelterBrief volunteers about typical grief reactionsBrief volunteers about typical grief reactionsConsult community regarding reConsult community regarding re--establishment establishment of activitiesof activitiesEncourage reEncourage re--establishment of normal events establishment of normal events --religious, schools, recreationalreligious, schools, recreational

Psychological interventionsPsychological interventionsManaged within primary health careManaged within primary health careEnsure availability of essential psychotropic Ensure availability of essential psychotropic medications , but use BP guidancemedications , but use BP guidanceThose with urgent mental health problems will Those with urgent mental health problems will likely have prelikely have pre--existing conditionsexisting conditionsSome people will seek mental health treatment Some people will seek mental health treatment because of extreme stressors of emergency because of extreme stressors of emergency --best managed without medication / formal best managed without medication / formal psychological interventionpsychological intervention

Psychological interventionsPsychological interventionsSingle session psychological debriefing Single session psychological debriefing not advisablenot advisableduring acute phaseduring acute phaseAny intervention should be preceded by planning for Any intervention should be preceded by planning for local contextlocal contextInterventions should involve collaboration with Interventions should involve collaboration with Government and NGOsGovernment and NGOsAccessible to whole communityAccessible to whole community

Support health professionals Support health professionals who are the initial responders who are the initial responders

to emergencyto emergency

May come from outside the community May come from outside the community ––so need good information before they so need good information before they arrive about the needs of the communityarrive about the needs of the communityEnsure that they have realistic objectivesEnsure that they have realistic objectivesEnsure cultural and religious sensitivityEnsure cultural and religious sensitivity

Skills required:Skills required:

Knowledge of peopleKnowledge of people’’s psychological reaction s psychological reaction in emergency situations in emergency situations -- ability to ability to differentiate between differentiate between ‘‘normalnormal’’ responses and responses and emergence of serious mental illnessemergence of serious mental illnessTechniques for working with Techniques for working with traumatisedtraumatisedpeoplepeopleRecognisingRecognising own response to emergency own response to emergency situationsituation

Rehabilitation and Post Rehabilitation and Post RecoveryRecovery

Key issuesKey issuesMental health Mental health promotionpromotion frameworkframeworkLong termLong term approachapproachResponding to people who develop a Responding to people who develop a mental healthmental health problemproblem

Mental health promotionMental health promotionFocus of interventions are on promoting mental Focus of interventions are on promoting mental health of a community health of a community –– not just treating mental not just treating mental health problemshealth problemsMental health is determined by a wide range of social Mental health is determined by a wide range of social and environmental factorsand environmental factorsThere are effective public health interventions (There are effective public health interventions (egegminimising exposure to violence) that can be used in minimising exposure to violence) that can be used in emergency situationsemergency situationsWhole of community approachWhole of community approachRelies on strong Relies on strong intersectoralintersectoral collaborationcollaboration

Long term approachLong term approachResponse to trauma varies over time Response to trauma varies over time ––immediate response is not a good immediate response is not a good predictor of long term responsepredictor of long term responseContinued mental health interventions Continued mental health interventions from acute phasefrom acute phaseProvides an opportunity to restructure Provides an opportunity to restructure existing mental health systemexisting mental health system

Responding to people with Responding to people with mental health problemsmental health problems

Most of population Most of population will not develop a mental will not develop a mental health problemhealth problem –– but health professionals will but health professionals will need to assess and support those that doneed to assess and support those that doHealth professionals need skills in Health professionals need skills in assessment and treatment assessment and treatment –– ideally these ideally these should be developed prior to the emergencyshould be developed prior to the emergencyRole will also depend on the availability of Role will also depend on the availability of specialist mental health servicesspecialist mental health services

Developing a network on Developing a network on disaster prevention in Japan disaster prevention in Japan Japan has confronted a wide range of disasters of the Japan has confronted a wide range of disasters of the last 3 decades including earthquakes, floods, typhoons last 3 decades including earthquakes, floods, typhoons and incidents at nuclear power stations. The Japanese and incidents at nuclear power stations. The Japanese Nurses Association has established a network on Nurses Association has established a network on disaster prevention and disaster nursing that supports disaster prevention and disaster nursing that supports education and posteducation and post--disaster restoration in Japan and disaster restoration in Japan and abroad. They have responded to the psychosocial stress abroad. They have responded to the psychosocial stress experienced by nurses by establishing workshops to experienced by nurses by establishing workshops to assist nurses to share their feelings with other nurses assist nurses to share their feelings with other nurses who have been involved in disaster nursing (Minami, who have been involved in disaster nursing (Minami, 2005)2005)

ICN Position Statement. Nurses and ICN Position Statement. Nurses and Disaster Preparedness. Disaster Preparedness. www.icn.ch/psdisasterprep01.htmwww.icn.ch/psdisasterprep01.htm　　

SummarySummary

Psychological and social wellPsychological and social well--being are integral parts of healthbeing are integral parts of healthWhen psychosocial and emotional functioning is adaptive, the When psychosocial and emotional functioning is adaptive, the ability to carry out tasks of physical recovery is increasedability to carry out tasks of physical recovery is increasedConversely , when tasks of physical recovery are able to be Conversely , when tasks of physical recovery are able to be carried out, people tend to feel better, more in control and lescarried out, people tend to feel better, more in control and less s overwhelmedoverwhelmedExpect normal recovery in disasters and emergenciesExpect normal recovery in disasters and emergenciesRevise knowledge and understanding re normal grief Revise knowledge and understanding re normal grief reactionsreactionsIdentify vulnerable group and ensure supportIdentify vulnerable group and ensure supportDo no harm avoid early formal interventionsDo no harm avoid early formal interventionsSupport community resilience through basic supportSupport community resilience through basic supportNatural recovery process may include some fluctuations but Natural recovery process may include some fluctuations but watch for prolongationwatch for prolongation

THANK YOU

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