ADDRESSING MENTAL HEALTH ISSUES IN ADDRESSING MENTAL HEALTH ISSUES IN EMERGENCY AND HUMANITARIAN EMERGENCY AND HUMANITARIAN SITUATIONS – – HOW CAN WE CONTRIBUTE HOW CAN WE CONTRIBUTE SITUATIONS AND WHAT IS THE EVIDENCE? AND WHAT IS THE EVIDENCE? Dr Frances Hughes, RN, Dnurs Dnurs, ONZM , ONZM Dr Frances Hughes, RN, WHO PIMHnet PIMHnet facilitator facilitator WHO Principal Advisor Office of Director of Mental Health NZ Principal Advisor Office of Director of Mental Health NZ Adjunct Professor – Adjunct Professor – University of Technology University of Technology - -Sydney Sydney
PRESENTATION OUTLINE PRESENTATION OUTLINE � Promoting recovery � Promoting recovery- -interventions interventions � Health professionals role, principles � Health professionals role, principles and competencies and competencies � Stages � Stages- - acute, rehab, post recovery acute, rehab, post recovery
Mental Health in Emergency Mental Health in Emergency and Humanitarian Situations and Humanitarian Situations � Psychological reactions to emergencies � Psychological reactions to emergencies varies according to a range of factors varies according to a range of factors � Effective mental health interventions in order � Effective mental health interventions in order to promote recovery important to promote recovery important
December 26, 2004 SIX ASIAN AFFECTED COUNTRIES Indonesia Myanmar India Sri Lanka Maldives Thailand
Psychosocial consequences: Psychosocial consequences: SARS as an example SARS as an example � �
Psychosocial interventions to Psychosocial interventions to promote recovery promote recovery � Individual Behavior � Individual Behavior � Families � Families � Organisations � Organisations � Communities � Communities � Society � Society
� 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 recovery Promoting recovery � Plan for and promote normal recovery � Plan for and promote normal recovery for majority for majority � Promote basic forms of support � Promote basic forms of support - - emphasis on natural recovery process: emphasis on natural recovery process: � survival, safety, shelter, reunification � survival, safety, shelter, reunification � Formally intervening may be � Formally intervening may be inappropriate - - for the majority this is not for the majority this is not inappropriate required required
� 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: � Communication � Communication � Problem solving � Problem solving � Management � Management � Assessment � Assessment � Critical thinking � Critical 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 aid � psychological first aid � stress management � stress management � anxiety management � anxiety management � Coping � Coping � advocacy � advocacy � triage for mental health survivors � triage for mental health survivors � emergency care � emergency care � empowering survivors � empowering survivors � mental health education � mental health education � networking. � networking.
Nursing Roles: Nursing Roles: � Providing supports for � Providing supports for meeting basic needs meeting basic needs � Working with and � Working with and supporting community supporting community processes- - building building processes resilience resilience � Mobilizing 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 Interventions Acute and Early Interventions � During acute emergency phase, interventions � During acute emergency phase, interventions should be mostly social social should be mostly � A number of issues need to be taken into � A number of issues need to be taken into account regarding psychological interventions psychological interventions account regarding during the acute phase during the acute phase
Social interventions Social interventions � Establish and disseminate credible flow of � Establish and disseminate credible flow of information information � Family tracing � Family tracing � Organise � Organise shelter shelter � Brief volunteers about typical grief reactions � Brief volunteers about typical grief reactions � Consult community regarding re � Consult community regarding re- -establishment establishment of activities of activities � Encourage re � Encourage re- -establishment of normal events establishment of normal events - - religious, schools, recreational religious, schools, recreational
Psychological interventions Psychological interventions � Managed within primary health care � Managed within primary health care � Ensure availability of essential psychotropic � Ensure availability of essential psychotropic medications , but use BP guidance medications , but use BP guidance � Those with urgent mental health problems will � Those with urgent mental health problems will likely have pre- -existing conditions existing conditions likely have pre � Some 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 intervention psychological intervention
Psychological interventions Psychological interventions � Single session psychological debriefing � Single session psychological debriefing not advisable not advisable during acute phase during acute phase � Any intervention should be preceded by planning for � Any intervention should be preceded by planning for local context local context � Interventions should involve collaboration with � Interventions should involve collaboration with Government and NGOs Government and NGOs � Accessible to whole community � Accessible to whole community
Support health professionals Support health professionals who are the initial responders who are the initial responders to emergency to 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 community arrive about the needs of the community � Ensure that they have realistic objectives � Ensure that they have realistic objectives � Ensure cultural and religious sensitivity � Ensure cultural and religious sensitivity
Skills required: Skills required: � Knowledge of people � Knowledge of people’ ’s psychological reaction s psychological reaction in emergency situations - - ability to ability to in emergency situations differentiate between ‘ ‘normal normal’ ’ responses and responses and differentiate between emergence of serious mental illness emergence of serious mental illness � Techniques for working with � Techniques for working with traumatised traumatised people people � Recognising � Recognising own response to emergency own response to emergency situation situation
Rehabilitation and Post Rehabilitation and Post Recovery Recovery � Key issues � Key issues � Mental health � Mental health promotion promotion framework framework � Long term � Long term approach approach � Responding to people who develop a � Responding to people who develop a mental health problem problem mental health
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