Community

Community

in Crisis:in Crisis:

Bowen Chung MD, MSHS Bowen Chung MD, MSHS UCLA Semel InstituteUCLA Semel Institute

UCLA/RAND NIMH Center for Health Services Research UCLA/RAND NIMH Center for Health Services Research and Media and Medicine for Communitiesand Media and Medicine for Communities

UCLA DARNet Information ExchangeUCLA DARNet Information ExchangeMarch 4, 2006March 4, 2006

Relieving the Burden of Relieving the Burden of Depression and DisasterDepression and Disaster

BackgroundBackground

Mental disorders affect the health and Mental disorders affect the health and well-being of all well-being of all

Underserved communities face Underserved communities face disparities in access to and quality of disparities in access to and quality of mental health caremental health care

These communities have little voice in These communities have little voice in programs that affect their own healthprograms that affect their own health

This situation is worsened by disastersThis situation is worsened by disasters

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What can we do?What can we do?

What we will share:What we will share:What we will share:What we will share:

How improving quality of care can reduce How improving quality of care can reduce depression burden and disparitiesdepression burden and disparities

What the nation can do to relieve mental health What the nation can do to relieve mental health suffering of Katrina survivorssuffering of Katrina survivors

Partnership approach to reduce depression Partnership approach to reduce depression burden in communities of colorburden in communities of color Witness for WellnessWitness for Wellness Supporting Wellness for Katrina survivorsSupporting Wellness for Katrina survivors

The role the entertainment industry can play in The role the entertainment industry can play in public understanding of the issuespublic understanding of the issues

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Clinical Depression Has Clinical Depression Has Major Societal Effects Major Societal Effects

Leading cause of disability worldwideLeading cause of disability worldwide--Early onset disrupts work and family--Early onset disrupts work and family--$51 billion yearly in U.S. --$51 billion yearly in U.S.

Affects 1 in 20 Americans Affects 1 in 20 Americans --All age and cultural groups--All age and cultural groups

80% respond to treatment80% respond to treatment

Most do not get needed care, Most do not get needed care, especially underserved minorities especially underserved minorities

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The Many Faces of The Many Faces of Clinical DepressionClinical Depression

““You feel so You feel so worthless and worthless and you’re in so much you’re in so much pain you just want pain you just want the pain to be the pain to be over.”over.”

““I could no I could no longer function longer function at my job and at my job and had to take a had to take a sick leave.”sick leave.”

““I just wanted to I just wanted to end it all.”end it all.”

““No one under-No one under-stood why I stood why I couldn’t be ‘Super couldn’t be ‘Super Mom’ and ‘Super Mom’ and ‘Super Wife’ anymore.”Wife’ anymore.”

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Source: Gresenz and Sturm (2000)Source: Gresenz and Sturm (2000)

HealthyHealthy

Physical Health Condition OnlyPhysical Health Condition Only

ANY MENTAL HEALTH DISORDERANY MENTAL HEALTH DISORDER

50%

75%

100%

< 35 35 - 54 55+ years old

Older individuals with mental health problemsOlder individuals with mental health problemsare less likely to have any savingsare less likely to have any savings

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Supported bySupported bythe National Institute of Mental Health and the the National Institute of Mental Health and the Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality 77

0 10 20 30 40 50 60 70 80

% receiving appropriate care at 1 year

Programs Increased Programs Increased AppropriateAppropriate Care for AllCare for All

QI programsprogramsUsual care

African African AmericanAmerican

LatinoLatino

WhiteWhite

88

Intervention Effects Over Two Years Intervention Effects Over Two Years Compared to usual care:Compared to usual care:

1 - 2 additional months free of symptoms 1 - 2 additional months free of symptoms of depressionof depression

$450 more in health care costs $450 more in health care costs

1 additional month of employment 1 additional month of employment

99

% recovered at 5 years

Interventions Reduced Long-Term Interventions Reduced Long-Term Outcome DisparitiesOutcome Disparities

Interventions Reduced Long-Term Interventions Reduced Long-Term Outcome DisparitiesOutcome Disparities

QI programsQI programs

WhiteWhite

African African AmericanAmerican Usual care

LatinoLatino

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Mental Health Responses Mental Health Responses for Storm Survivorsfor Storm Survivors

People are resilient, but psychological People are resilient, but psychological reactions and mental disorders are reactions and mental disorders are common responses that eat at the common responses that eat at the fabric of community life and slow fabric of community life and slow recoveryrecovery

– DepressionDepression– Post-traumatic stress disorderPost-traumatic stress disorder– Grief reactionsGrief reactions– Substance abuseSubstance abuse

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What are the challenges?What are the challenges?

Public services–severe mental illnessPublic services–severe mental illnessPrivate services–few poor clientsPrivate services–few poor clientsMany survivors: History of discrimination Many survivors: History of discrimination

and distrust of servicesand distrust of servicesGeographic scatter and scope; 1/300 Geographic scatter and scope; 1/300

Americans displaced from their homesAmericans displaced from their homes

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What is needed?What is needed?

Widespread education about common Widespread education about common symptoms and giving reassurance for symptoms and giving reassurance for recoveryrecovery

Emergency assistance for those cut off from Emergency assistance for those cut off from treatmenttreatment

Clinic-plan-community agency partnerships Clinic-plan-community agency partnerships for education, outreach, prevention, and for education, outreach, prevention, and linkage to treatment in the long-runlinkage to treatment in the long-run

Minority providers, community agencies, Minority providers, community agencies, programs responsive to underserved programs responsive to underserved groupsgroups

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What is Needed? (2)What is Needed? (2)

Training for assessment, referral, and Training for assessment, referral, and treatment of common mental health reactions: treatment of common mental health reactions:

– Health professionals of all kindsHealth professionals of all kinds– Community agencies, paraprofessionalsCommunity agencies, paraprofessionals

Consistent and generous insurance for at Consistent and generous insurance for at least 3 years with full parity for mental health least 3 years with full parity for mental health carecare

Public education to reduce stigma Public education to reduce stigma Support for survivors to participate as co-Support for survivors to participate as co-

leadersleaders Federal allocation of about $1 billion to Federal allocation of about $1 billion to

achieve goalsachieve goals1414

How Can We Achieve the Promise?How Can We Achieve the Promise?

““My sense of desperation is gone. I do not My sense of desperation is gone. I do not feel so alone and helpless in combating feel so alone and helpless in combating my day-to-day problems. My anger has my day-to-day problems. My anger has subsided to the point that people see me subsided to the point that people see me differently (because I am different!) and differently (because I am different!) and my relationships with people have my relationships with people have improved dramatically.”improved dramatically.”

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Context for ImprovingContext for ImprovingHealth CommunicationsHealth Communications

Half of all American adults, or 90 millionHalf of all American adults, or 90 million

Americans, have difficulty understandingAmericans, have difficulty understanding

or acting upon health information.or acting upon health information.

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Health LiteracyHealth Literacy

Institute of Medicine defines as:Institute of Medicine defines as:

““The degree to which individuals have the capacity The degree to which individuals have the capacity to obtain, process, and understand basic health to obtain, process, and understand basic health information an services needed to make information an services needed to make appropriate health decisions.”appropriate health decisions.”

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Challenges of Public Health CommunicationChallenges of Public Health Communicationfor Depressionfor Depression

Cultural AppropriatenessCultural Appropriateness

Literacy LevelLiteracy Level

Addressing StigmaAddressing Stigma

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One approach is partner with consumers and communities to determine what they want!

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Hurricane Katrina and Mental HealthHurricane Katrina and Mental Health

Psychological ConsequencesPsychological Consequences

– Grief and BereavementGrief and Bereavement

– Post Traumatic Stress DisorderPost Traumatic Stress Disorder

– DepressionDepression

2020

Supporting Wellness for Katrina SurvivorsSupporting Wellness for Katrina Survivors

How do we talk to Survivors of Katrina about Mental Health?How do we talk to Survivors of Katrina about Mental Health?

• Low Literacy Levels (<6Low Literacy Levels (<6thth Grade) Grade)

• Predominantly African AmericanPredominantly African American

• Avoid Stigma around Mental HealthAvoid Stigma around Mental Health

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Current Partnerships to develop materialsCurrent Partnerships to develop materials– UCLA / RAND NIMH Health Services Research CenterUCLA / RAND NIMH Health Services Research Center– UCLA / RAND Center for Media, Medicine for UCLA / RAND Center for Media, Medicine for

CommunitiesCommunities– Ecumenical Congress of Black ChurchesEcumenical Congress of Black Churches– Healthy African American FamiliesHealthy African American Families– Catholic CharitiesCatholic Charities– L.A. County Department of Mental HealthL.A. County Department of Mental Health– UCLA Department of Media Arts | DesignUCLA Department of Media Arts | Design– Pacificare Pacificare – Partners in Louisiana and MississippiPartners in Louisiana and Mississippi

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