(A293) Critical Incident Stress Management and Mental Health Strategies after the 2009 American Samoan Tsunami

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BackgroundTsunamis are infrequent but devastating natural disasters. Loss of life, livelihood, and property contribute psychological stresses to an affected population, resulting in new psychiatric illness.ObjectiveTo describe post-disaster hospital, Department of Human Services (DHS), and Department of Education (DOE) methods of mental health resource dissemination, and their effectiveness.MethodsA retrospective review of after-action reports, psychiatric clinic charts, and key-informant interviews over a 4 month period was employed. Descriptive statistics were used to evaluate data.ResultsThe September 29, 2009 tsunami claimed 33 American Samoan lives. Hospital Family Assistance Center counselors aided families in the identification of 12 corpses, 9 missing persons, and providing psychiatric referral. Fifty-four hospital staff suffered loss. (Loss of: transportation, n = 13; utilities, n = 15; homes/shelter, n = 2). Coupled with the stresses of providing post-event medical care, the hospital staff was at high risk for psychiatric sequelae. Debriefing sessions for hospital staff were poorly attended due to conflicting work responsibilities, and an unfamiliar discussion format. DHS assembled four teams, each composed of one psychiatrist/psychologist leader and 6 crisis counselors. DOE school counselors utilized DHS mental health teams to screen all school aged children. The hospital psychiatry clinic remained the definitive referral destination. Federal mitigation grants provided funding for two psychiatrists, and two psychologists (including pediatric specialists) to augment hospital mental health capacity. Screening statistics and prevalence of psychiatric disease are further reported. Six month post-event rates of persistent psychiatric disease reflect that reported in recent literature (1-2%).ConclusionHospital critical incident stress management requires culturally acceptable counseling methods and administrative support. Family assistance counselors are key players in identifying the needs of families of the deceased. Student counseling services and collaborative mental health teams provide a novel approach to the dissemination of mental health services within a community.