Symposium- Understanding community psychosocial needs after disasters: Implications for mental health services

School of Psychiatry, University of New South Wales and Centre for Population Mental Health Research, Sydney South West Area Health Service, Australia.
Journal of Postgraduate Medicine (Impact Factor: 0.86). 12/2006; 52(2):121-5.
Source: PubMed


The psychosocial impact of disasters has attracted increasing attention. There is little consensus, however, about what priorities should be pursued in relation to mental health interventions, with most controversy surrounding the relevance of traumatic stress to mental health. The present overview suggests that acute traumatic stress may be a normative response to life threat which tends to subside once conditions of safety are established. At the same time, there is a residual minority of survivors who will continue to experience chronic posttraumatic stress disorder (PTSD) and their needs can be easily overlooked. The ADAPT model offers an expanded perspective on the psychosocial systems undermined by disasters, encompassing threats to safety and security; interpersonal bonds; systems of justice; roles and identities; and institutions that promote meaning and coherence. Social reconstruction programs that are effective in repairing these systems maximize the capacity of communities and individuals to recover spontaneously from various forms of stress. Within that broad recovery context, clinical mental health services can focus specifically on those psychologically disturbed persons who are at greatest survival risk. Only a minority of persons with acute traumatic stress fall into that category, the remainder comprising those with severe behavioural disturbances arising from psychosis, organic brain disorders, severe mood disorders and epilepsy. Establishing mental health services that are community-based, family-focused and culturally sensitive in the post-emergency phase can create a model that helps shape future mental health policy for countries recovering from disaster.

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    • "The Italian and Japanese disaster responses highlighted that efforts to promote a positive recovery environment required literacy in the social and contextual dimensions of resilience and recovery (Silove & Steele, 2006). More specifically, the Italian earthquake response underlined the important place of community-level and self-help initiatives that needed to be recognised and fostered within disaster response planning alongside more formal psychosocial support strategies (Ajdukovic, 2004). "
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    ABSTRACT: At the 13th meeting of the European Society for Traumatic Stress Studies in 2013, a symposium was held that brought together international researchers and clinicians who were involved in psychosocial responses to disaster. A total of six disasters that occurred in five countries were presented and discussed. Lessons learned from these disasters included the need to: (1) tailor the psychosocial response to the specific disaster, (2) provide multi-dimensional psychosocial care, (3) target at-risk population groups, (4) proactively address barriers in access to care, (5) recognise the social dimensions and sources of resilience, (6) extend the roles for mental health professionals, (7) efficiently coordinate and integrate disaster response services, and (8) integrate research and evaluation into disaster response planning.
    Full-text · Article · Dec 2013 · European Journal of Psychotraumatology
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    • "Noted changes among new patients after OCL were a prompt increases in diagnosis of acute stress disorder (ASD), followed by posttraumatic stress disorder (PTSD) in the first 6 months, and depression and other anxiety disorders thereafter (the former mostly for the older age group and the latter for younger); multiple diagnoses were also common. While trauma related stress often subsides weeks after the precipitating event, [27,28] diagnosed ASD is a recognized predictor of psychiatric sequelae [29]. PTSD, depression and other mental disorders are common in contexts of conflict and displacement, linked to cumulative lifetime traumatic events, modulated by adversity and daily life stressors [1,3,4,6,30]. "
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    ABSTRACT: Background There is growing recognition of the psychological impact of adversity associated with armed conflict on exposed civilian populations. Yet there is a paucity of evidence on the value of mental health programs in these contexts, and of the chronology of psychological sequelae, especially in prolonged conflicts with repeated cycles of extreme violence. Here, we describe changes in the psychological profile of new patients in a mental health program after the military offensive Cast Lead, in the context of the prolonged armed conflict involving the Gaza Strip. Methods This study analyses routinely collected program data from a Médecins Sans Frontières mental health program in the Gaza Strip spanning 2007–2011. Data consist of socio-demographic as well as clinical baseline and follow-up data on new patients entering the program. Comparisons were made through Chi square and Fisher’s exact tests, univariate and multivariate logistic and linear regression. Results PTSD, depression and other anxiety disorders were the most frequent psychopathologies, with 21% having multiple diagnoses. With a median of nine sessions, clinical improvement was recorded for 83% (1122/1357), and more common for those with separation anxiety, acute and posttraumatic disorders as principal diagnosis (855/1005), compared to depression (141/183, p<0.01). Noted changes proximal to Operation Cast Lead were: a doubling in patient case load with a broader socio-economic background, shorter interval from an identified traumatic event to seeking care, and a rise in diagnoses of acute and posttraumatic stress disorders. Sustained changes included: high case load, more distal triggering events, and increase in diagnoses of other anxiety disorders (especially for children 15 years and younger) and depression (especially for patients 16 years and older). Conclusion Evolving changes in patient volume, diagnoses and recall period to triggering events suggest a lengthy and durable effect of an intensified exposure to violence in a context of prolonged conflict. Our findings suggest that mental health related humanitarian relief in protracted conflicts might need to prepare for an increase in patients with changing profiles over an extended period following an acute flare-up in violence.
    Full-text · Article · Oct 2012 · Conflict and Health
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    • "They are stigmatizing, posing stress on the community and services; securing equitable and effective treatment and support is an ongoing human rights challenge (WHO 2001; Psychosocial Working Group 2003a, 2003b, 2004; Prince et al. 2007). Attention has been devoted to mental health and wellbeing in the aftermath of violent conflict, reflecting awareness of increased rates of psychosocial problems and mental disorders accompanying such crises (Baingana et al. 2005; Silove and Steel 2006), together with a perception that additional support and services are required for those who have experienced 'trauma'. Intensified interest of donors and international nongovernmental organizations (NGOs) is often present, albeit typically for the short term (Stockwell et al. 2005; De Vries and Klazinga 2006). "
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    ABSTRACT: Mental disorders and psychosocial problems are common, and present a significant public health burden globally. Increasingly, attention has been devoted to these issues in the aftermath of violent conflict. The Solomon Islands, a small Pacific island nation, has in recent years experienced periods of internal conflict. This article examines how policy decisions regarding mental health and wellbeing were incorporated into the national agenda in the years which followed. The study reveals the policy shifts, contextual influences and players responsible. The Solomon Islands' experience reflects incremental change, built upon longstanding but modest concern with mental health and social welfare issues, reinforced by advocacy from the small mental health team. Armed conflict and ethnic tensions from 1998 to 2003 promoted wider recognition of unmet mental health needs and psychosocial problems. Additional impetus was garnered through the positioning of key health leaders, some of whom were trained in public health. Working together, with an understanding of culture and politics, and drawing on external support, they drove the agenda. Contextual factors, notably further violence and the ongoing risk of instability, a growing youth population, and emerging international and local evidence, also played a part.
    Full-text · Article · Nov 2010 · Health Policy and Planning
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