ADDRESSING MENTAL HEALTH ISSUES IN ADDRESSING MENTAL HEALTH ISSUES - - PowerPoint PPT Presentation

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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, Dnurs Dnurs, ONZM , ONZM WHO WHO PIMHnet PIMHnet facilitator facilitator 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

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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

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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

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December 26, 2004 SIX ASIAN AFFECTED COUNTRIES Indonesia Myanmar India Sri Lanka Maldives Thailand

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

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Psychosocial interventions to Psychosocial interventions to promote recovery promote recovery

• Individual Behavior

Individual Behavior

• Families

Families

• Organisations

Organisations

• Communities

Communities

• Society

Society

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• 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:

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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 inappropriate -

• for the majority this is not

for the majority this is not required required

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• 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.

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Competencies include: Competencies include:

• Communication

Communication

• Problem solving

Problem solving

• Management

Management

• Assessment

Assessment

• Critical thinking

Critical thinking.

.

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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.

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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 processes-

• building

building 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

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Acute and Early Interventions Acute and Early Interventions

• During acute emergency phase, interventions

During acute emergency phase, interventions should be mostly should be mostly social social

• A number of issues need to be taken into

A number of issues need to be taken into account regarding account regarding psychological interventions psychological interventions during the acute phase during the acute phase

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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

• f activities
• f activities
• Encourage re

Encourage re-

• establishment of normal events

establishment of normal events -

• religious, schools, recreational

religious, schools, recreational

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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 likely have pre-

• existing conditions

existing conditions

• 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

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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

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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

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Skills required: Skills required:

• Knowledge of people

Knowledge of people’ ’s psychological reaction s psychological reaction in emergency situations in emergency situations -

• ability to

ability to differentiate between differentiate between ‘ ‘normal normal’ ’ responses and responses and 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

• wn response to emergency

situation situation

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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 mental health problem problem

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Mental health promotion Mental health promotion

• Focus 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 problems health problems

• Mental health is determined by a wide range of social

Mental health is determined by a wide range of social and environmental factors and environmental factors

• There are effective public health interventions (

There are effective public health interventions (eg eg minimising exposure to violence) that can be used in minimising exposure to violence) that can be used in emergency situations emergency situations

• Whole of community approach

Whole of community approach

• Relies on strong

Relies on strong intersectoral intersectoral collaboration collaboration

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Long term approach Long term approach

• Response 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 response predictor of long term response

• Continued mental health interventions

Continued mental health interventions from acute phase from acute phase

• Provides an opportunity to restructure

Provides an opportunity to restructure existing mental health system existing mental health system

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

• Most of population

Most of population will not develop a mental will not develop a mental health problem health problem – – but health professionals will but health professionals will need to assess and support those that do need to assess and support those that do

• Health 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 emergency should be developed prior to the emergency

• Role will also depend on the availability of

Role will also depend on the availability of specialist mental health services specialist mental health services

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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 post education 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)

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

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Summary Summary

• Psychological and social well

Psychological and social well-

• being are integral parts of health

being are integral parts of health

• When psychosocial and emotional functioning is adaptive, the

When psychosocial and emotional functioning is adaptive, the ability to carry out tasks of physical recovery is increased ability to carry out tasks of physical recovery is increased

• Conversely , 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 les carried out, people tend to feel better, more in control and less s

• verwhelmed
• verwhelmed
• Expect normal recovery in disasters and emergencies

Expect normal recovery in disasters and emergencies

• Revise knowledge and understanding re normal grief

Revise knowledge and understanding re normal grief reactions reactions

• Identify vulnerable group and ensure support

Identify vulnerable group and ensure support

• Do no harm avoid early formal interventions

Do no harm avoid early formal interventions

• Support community resilience through basic support

Support community resilience through basic support

• Natural recovery process may include some fluctuations but

Natural recovery process may include some fluctuations but watch for prolongation watch for prolongation

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THANK YOU

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