Disaster Mental Health Response Research Articles

'Profound personal and professional impacts': A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires.

To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019-2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia. A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW. Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019-2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia. An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis. Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response. Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography

ABSTRACT Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare’s approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users’ needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries’ disaster mental health response and to invest in quality care, particularly for marginalized groups.

Surviving the Immediate Aftermath of a Disaster: A Preliminary Investigation of Adolescents' Acute Stress Reactions and Mental Health Needs after the 2023 Turkey Earthquakes.

On 6 February, southeastern Turkey and parts of Syria were struck by two powerful earthquakes, one measuring a magnitude of 7.8 and the other, nine hours later, at a magnitude of 7.5. These earthquakes have been recorded as some of the deadliest natural disasters worldwide since the 2010 Haiti earthquake, impacting around 14 million people in Turkey. For trauma survivors, the stressors associated with an event can lead to the development of acute stress disorder (ASD) or other psychiatric disorders. Trauma experiences during adolescence can impact development and affect adolescents differently than adults. Although ASD in adults has been addressed in several studies, there is much less information available about how younger populations respond to acute stress. The aim of our study was to assess the occurrence of ASD among individuals seeking help at the Şanlıurfa Mehmet Akif İnan Research and Training Hospital Child and Adolescent Outpatient Clinic following the 2023 Turkey Earthquakes and the factors associated with acute stress reactions. A child and adolescent psychiatry specialist conducted psychiatric interviews with the adolescents, and the individuals were also asked to complete 'The National Stressful Events Survey Acute Stress Disorder Short Scale' (NSESSS) to evaluate acute stress symptoms. ASD diagnoses were established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results showed that 81.6% of the participants (n = 49) were diagnosed with ASD, and drug treatment was initiated in 61.7% of the cases (n = 37). It was determined that ASD rates did not differ according to gender, and patients without physical injury had higher acute stress symptom scores (p > 0.05). According to the logistic regression models, paternal educational levels and adolescents' own requests for psychiatric assistance were predictors of acute stress disorder (OR 10.1, β = 2.31, p = 0.006 and OR 16.9, 95 β = 2.83, p = 0.001, respectively). Our findings revealed striking results in demonstrating the need for careful evaluation of adolescents without physical injury in terms of acute stress disorder and the need to pay close attention to the psychiatric complaints of adolescents willing to seek mental health assistance. Moreover, our study suggests that the proportion of adolescents experiencing acute stress symptoms after earthquakes might be higher than previously reported. Estimation of the incidence rate and symptoms of psychiatric distress in the short-term period following a disaster is important for establishing disaster epidemiology and implementing efficient relief efforts in the early stages. The outcomes of this study have the potential to yield novel insights into the realms of disaster mental health and emergency response policies, as well as their pragmatic implementations.

Disseminating early interventions for disaster mental health response using the ECHO model.

Extension for Community Healthcare Outcomes (ECHO)-based telementoring was evaluated for disseminating early disaster interventions, Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR), to school professionals throughout rural, disaster-affected communities further affected by COVID-19. PFA and SPR complemented their Multitiered System of Support: PFA complemented tier 1 (universal)and SPRtier 2 (targeted) prevention. We evaluated the outcomes of a pretraining webinar (164 participants, January 2021) and four-part PFA training (84 participants, June 2021) and SPR training(59 participants, July 2021) across five levels of Moore's continuing medical education evaluation framework: (1) participation, (2) satisfaction, (3) learning, (4) competence, and (5) performance, using pre-, post-, and 1-month follow-up surveys. Positive training outcomes were observed across all five levels, with high participation and satisfaction throughout, and high use at the 1-month follow-up. ECHO-based telementoring may successfully engage and train community providers in these underused early disaster response models. Recommendations regarding training format and using evaluation to improve training are provided.

Three case studies of community behavioral health support from the US Department of Veterans Affairs after disasters

BackgroundCommunity disaster resilience is comprised of a multitude of factors, including the capacity of citizens to psychologically recover. There is growing recognition of the need for public health departments to prioritize a communitywide mental health response strategy to facilitate access to behavioral health services and reduce potential psychological impacts. Due to the US Department of Veterans Affairs’ (VA) extensive experience providing trauma-informed behavioral healthcare to its Veterans, and the fact that VA Medical Centers (VAMCs) are located throughout the United States, the VA is well situated to be a key partner in local communities’ response plans. In this study we examined the role the VA can play in a community’s behavioral health response using case studies from three disasters.MethodsThis study investigated experiences of VA employees in critical emergency response positions (N = 17) in communities where disasters occurred between 2017 and 2019. All respondents were interviewed March–July 2019. Data were collected via semi-structured interviews exploring participants’ experiences and knowledge about VA activities provided to communities following the regional disasters. Data were analyzed using thematic and grounded theory coding methods.ResultsRespondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans. The majority also described the VA supporting community recovery. Specifically, three recent events provided key examples of VA’s involvement in disaster behavioral health response. Each event showed VA’s integration into local response structures was facilitated by pre-existing emergency management and clinical relationships as well as prioritization from VA leadership to engage in humanitarian missions. The behavioral health interventions were provided by behavioral health teams integrated into disaster assistance centers and non-VA hospitals, VA mobile units deployed into the community, and VA telehealth services.ConclusionsRecent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond to mental health needs, thereby fostering resilience. Building relationships with local VAMCs can help expedite how VA can be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated disaster mental health response would benefit from involving VA as a partner during planning.

Phases of psychological response in COVID-19: A preliminary heuristic.

To explore the putative phases of the psychological response to disaster: preimpact, impact, heroic, honeymoon, disillusionment, and recovery, and make recommendations for corresponding interventions. Disasters such as the COVID-19 pandemic are often characterized by chaos and uncertainty. As a result, public health disaster planning and response represent formidable challenges. Although disasters can result from a wide array of hazards, regardless of the agent at work, they may follow a rather predictable trajectory of psychological phases. A heuristic of those phases can provide an opportunity for a more organized disaster mental health response and more efficient utilization of scarce resources.

Disaster psychiatry and homelessness: creating a mental health COVID-19 response

Homeless individuals across the globe live in a constant state of crisis Yet, during times of societal crisis such as COVID-19 that affect all populations, disaster planning has rarely included this high-risk group The high burden of co-occurring physical, mental, and substance use disorders, absence of reliable shelter, scant access to health information, and scarcity of financial, transportation, and nutritional resources all create unique vulnerabilities for this population These factors restrict the ability of people experiencing homelessness to respond and adapt to public health recommendations before and during a disaster In particular, the mental health needs of people who are homeless during disasters have received minimal attention (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Mental health workers perceptions of disaster response in China

BackgroundThe post-disaster mental health crisis intervention (MHCI) system in China remains immature and unsystematic. We aim to report the perceptions of a large sample of MHCI workers and government administrators and provide recommendations for developing a national mental health disaster response management plan in China.MethodsAn in-depth qualitative study was conducted, collecting data from 20 focus-group discussions and 25 key stakeholder interviews. These recruited participants who had been involved in different types of disaster rescue across 7 provinces/cities where disasters have recently occurred. We used thematic analysis to analyze the data and relevant findings were extracted for policy recommendation.ResultsMental health workers’ perspectives were examined in detailed according to four core themes: forms of organization, intervention pathway, intervention strategy and technique, and public health information. Post-disaster MHCI should be approached in teams that are integrated with emergency medicine systems, and be led by unified command management. All levels of local health and family planning commission should prepare post-disaster MHCI work plans and build response teams/emergency centres. Future training for MHCI workers should focus on: building a sense of trust within the team; clarifying each member’s role; strengthening the screening, assessment and referrals training for psychological professionals; and providing psychological intervention training for Chinese psychiatrists. It is necessary to set up guiding principles for disaster research ethics, mental health rehabilitation and media interaction.ConclusionsThrough exploring and analyzing the perceptions of current disaster response mental health workers and government administrators, our findings provide essential recommendations for developing a national to county level post-disaster MHCI emergency management plan and can guide the formulation of relevant laws and regulation in China.

Disaster Communication, Posttraumatic Stress, and Posttraumatic Growth following Hurricane Matthew

Disaster survivors may experience a range of mental health reactions that can include posttraumatic stress (PTS) and posttraumatic growth (PTG). The current study examines the associations between citizen disaster communication, PTS, and PTG among individuals in North Carolina communities impacted by Hurricane Matthew, approximately six weeks following the event. Participants who communicated more frequently following the hurricane exhibited more PTS and PTG. Communication activities focused on connecting with loved ones and cognitively restructuring the disaster experience were associated with PTS and PTG, whereas communication activities confirming disaster reports and assisting with disaster recovery were associated solely with PTG. Results illustrate the need for robust disaster communication ecologies to facilitate public disaster mental health response and coordination.

Preparedness Helps MH Professionals Cope With Hurricane Florence

No one waited for the slow-moving storm and its heavy rainfall to arrive before taking action to help patients with mental illness.

Decision Making Regarding Key Elements of Korean Disaster Psychiatric Assistance Teams Using the Analytic Hierarchy Process.

Objective The purpose of this study was to determine the key components of Korean disaster psychiatric assistant teams (K-DPATs), to set up new mental health service providing system for the disaster victims. Methods We conducted an analytic hierarchy process (AHP) involving disaster mental health experts, using a pairwise comparison questionnaire to compare the relative importance of the key components of the Korean disaster mental health response system. In total, 41 experts completed the first online survey; of these, 36 completed the second survey. Ten experts participated in panel meetings and discussed the results of the survey and AHP process. Results It was agreed that K-DPATs should be independent of the existing mental health system (70.1%), funding for K-DPATs should be provided by the Ministry of Public Safety, and the system should be managed by the Ministry of Health (65.8%). Experts shared the view that K-DPAT leaders would be suitable key decision makers for all types of disaster, with the exception of those involving infectious diseases. Conclusion K-DPAT, a new model for disaster mental health response systems could improve the insufficiency of the current system, address problems such as fragmentation, and fulfill disaster victims’ unmet need for early professional intervention.

Principles of Mental Health Intervention for Survivors of Major Disasters

No part of the world is immune from major disasters—be they natural disasters, industrial and technological accidents, or intentional human-caused incidents including acts of terrorism. Therefore, disaster preparedness is of paramount importance for all communities everywhere. Several decades of mental health research regarding disasters have generated essential data informing community response to the mental health needs of survivors of disaster. This research has generated principles for disaster mental health response and informed the development of operationalized procedures for the response using an established framework for emergency and medical response to mass casualty incidents. This article first reviews the research foundation for these principles and operationalized procedures and then summarizes recommendations for conducting an organized disaster mental health response. [ Psychiatr Ann. 2017;47(3):124–127.]

Responding to Trauma at Sea: A Case Study in Psychological First Aid, Unique Occupational Stressors, and Resiliency Self-Care.

The U.S. Navy deploys Special Psychiatric Rapid Intervention Teams (SPRINT) to sites of military disasters to assist survivors and the command. SPRINT functions primarily as a consultant to help commands effectively respond to the mental health needs of their service members following a traumatic event. Utilizing the principles of psychological first aid, the overall goal of SPRINT is to mitigate long-term mental health dysfunction and facilitate recovery at both the individual and unit level. We present a case study of a SPRINT mission to a deployed U.S. Navy ship in response to a cluster of suicides and subsequent concerns about the well-being of the remaining crew. Throughout this mission, important themes emerged, such as the impact of accumulated operational stressors and the subsequent development of mental health stigma. Also, this case study demonstrates the potential effectiveness of introducing resiliency self-care meditation training to remote environments that lack ready access to mental health resources. From here, SPRINT can provide a model for immediate disaster mental health response that has potential relevancy beyond the military.

Toward the way forward: building an emergency mental health system for Israel.

A number of related changes have evolved over the past 25 years: the development of a truly national disaster mental health service in Israel; progress in the science of risk, resilience and evidence base care for those suffering from traumatic stress related disorders; and the development of conceptual models of population level disaster mental health response in the context of emergency management systems such as the Incident Command System.In a recent IJHPR article, Bodas, et al. report on the dynamic history of disaster mental health response in Israel, which informed by the all too numerous real world events affecting the region. What is most striking is that the system now in place reflects true “lessons learned” in that problems and issues identified in incidents informed deliberative planning, and the current system reflects many iterations of “lessons observed and learned”. There appears to be commitment across sectors of government in Israel that the mental health consequences of disasters and terrorism are important and a priority. This is advanced thinking and sound policy.As the system in Israel continues to evolve, additional possibilities are offered for further consideration, based on the author’s US-centric experience, to advance emergency response systems in Israel, the Middle East and around the world.

Current research and recent breakthroughs on the mental health effects of disasters.

A large existing academic disaster mental health literature provides a foundation to help guide disaster mental health response. Recent studies, however, have indicated that reconceptualization of certain mental health aspects of disasters may be indicated to guide further research to inform the planning and implementation of disaster mental health interventions. In particular, there is need to more carefully measure specific postdisaster disorders and syndromes using full diagnostic assessments, differentiate pre-existing from incident (new) postdisaster psychopathology, appropriately consider disaster trauma exposure groups in assessing psychopathology, and conduct prospective follow-up assessments over time from the acute postdisaster period to the long term. Further descriptive and longitudinal research is needed to better characterize the occurrence and course of fully-assessed psychiatric disorders after different disasters, clarify the role of disaster trauma exposures in the development of postdisaster psychopathology, and deconstruct confounding effects in determination of causalities in mental health consequences of disasters.

N.Y. Psychiatrists Learn Difficult Lessons in Storm’s Wake

N.Y. Psychiatrists Learn Difficult Lessons in Storm’s Wake

Rethinking Disaster Mental Health Response in a Post-9/11 World

This In Review features 2 articles that examine different aspects of mental health interventions in disaster settings. The article by Dr Anand Pandya1 describes mental health interventions provided in New York City after the September 11, 2001 (9/11), terrorist attacks on the World Trade Center. The article by Dr Betty Pfefferbaum and me2 addresses principles of disaster mental health interventions for children. Both articles1·2 consider fundamental conceptual issues about disaster mental health that have crystallized in the decade since the 9/11 terrorist attacks.Because the 9/11 terrorist attacks constituted a disaster of unprecedented scope and magnitude, this disaster created a watershed in the conceptualization of disaster mental health.3·4 It stimulated more thorough examination of different categories of trauma exposures and their relation to posttraumatic stress disorder (PTSD) and also presented the problem of how to most effectively assess PTSD in circumstances of large-scale chaos and catastrophe. In the post-9/11 setting, disaster responders faced complexities never before encountered in the delivery of services; authorities charted new territory in their efforts to assess and respond to mental health needs of broadly affected populations. Dr Pandya's review1 details the efforts of providers to meet the profound mental health consequences and the many creative solutions they applied in overcoming the difficulties they encountered in delivery of interventions.These 2 articles1,2 articulate 4 overarching principles for the provision of disaster mental health interventions: trauma exposure is of central importance in conceptualizing mental health outcomes within affected populations; valid and accurate measurement of mental health outcomes are essential for informing interventions; psychiatric disorders must be distinguished from normative distress; and different types of interventions are needed for psychiatric illness than for normative emotional distress. Attention to all 4 of these principles is needed in the approach to provision of appropriate and adequate postdisaster mental health interventions.The first of these disaster mental health intervention principles - conceptualization of disaster exposures - is essential for successful application of the other 3 principles. Before the history-changing 9/11 terrorist attacks, categorizing the disaster exposures of survivors was relatively straightforward: people were either in the disaster and thus directly exposed, or they were elsewhere and hence not exposed. Among exposed survivor groups, those with the highest exposure levels are generally expected to suffer the most severe mental health sequelae.5 The disaster exposure issue is pivotal for assessing the diagnosis of disaster-related PTSD, which, by definition, cannot occur in the absence of a qualifying exposure to disaster trauma.4It follows that the second principle of disaster mental health intervention - measurement of outcomes (specifically, the diagnosis of PTSD) - requires application of the first principle. PTSD is generally the most prevalent diagnosis after disaster, so consistently that it is considered a signature psychiatric diagnosis of disaster. Because PTSD cannot be diagnosed without a qualifying trauma exposure, the selfreport symptom scales that are popular for assessment of PTSD - largely because they are relatively easy to administer - are inadequate for accurate diagnosis of PTSD in individuals as well as for PTSD prevalence estimates in populations. Symptoms measured outside the construct of psychiatric diagnosis in disaster survivors largely represent measures of emotional distress. Many studies examining the mental health effects of the 9/11 attacks used symptom scales to measure PTSD and estimate its population prevalence. However, a study6 using full diagnostic assessment methods found that 35% of the people most highly exposed (that is, those in the World Trade Center towers and within 1 block of the site during the attacks) developed PTSD in the first 2 to 4 years after the attacks. …

Bigger and Better: Expanding in Reviews and the Electronic Era

The Canadian Psychiatric Association (CPA) has announced that a new Editor-in-Chief will be appointed for fall 2014, when my mandate ends. I am grateful to the CPA for this exciting job. In recent years, The Canadian Journal of Psychiatry (The CJP) has focused on original research and systematic review papers in all areas of psychiatry. The In Review series, which I helped to develop in 1997, is the most frequently referenced. The topics are chosen by the Editorial Board, and Guest Editors invite experts to review the literature. Readers of this section will note how much psychiatry has progressed, but also how much it still has to learn - research methods are only beginning to illuminate clinical issues, and many treatment methods have not yet been shown to be effective. In 2013, the January issue will focus on Psychosis in 3 In Reviews (specifically, risk of psychosis, prodromal symptoms, and social causes) and the February issue will have 2 In Reviews on Gene-Environment Interactions (relating to major depressive disorder and posttraumatic stess disorder) and Neuroplasticity (that is, schizophrenia as a neuroplasticity disorder). Future issues will deal with Disaster Mental Health Response, Melancholia, Behavioural Additions, Cognitive Remediation, Depression Psychotherapy, and more.The Editorial Office received nearly 200 manuscripts in 2012. While the quality of the submissions has risen, only about one-third make it to print, and a rapid publication policy has kept our time-to-publish rate down to less than 10 months in 2012 - only 2011 was faster at less than 9 months. The CJP's impact factor is stable at 2.4, above the median and ranked 62 of the 129 psychiatry journals listed in the Journal Citation Report.The new Editor-in Chief will need to guide The CJP into an electronic era when all articles will eventually be online only. As a first step, the cyberCJP was launched in 2012, providing CPA members with electronic access to the full issue, cover to cover. In 201 3, subscribers will also be given access. The print version will continue to be published, but readers have the option of receiving the cyberCJP alone.The CJP could not function without the devoted work of Virginia St-Denis (Director, Scientific Publications), and I am fortunate to have worked with Virginia for most of my mandate. A special thanks goes to the dedicated staff: Sylvia L Pollard (Senior Copy Editor), Candace Taylor (Copy Editor), Smita Hamzeh (Advertising and Production Manager), and Elizabeth Payne (Desktop Publisher). As I do every year, I would like to thank all of our peer reviewers, as well as our hard-working Editorial Board. Special thanks go to Deputy Editor Dr Roger Bland and Associate Editors Dr Paul Grof (Book Review Section), Dr Alain Lesage (French Submissions), Dr Glenda MacQueen, Dr Scott B Patten, and Dr David L Streiner (Statistical Consultant). …

Disaster mental health preparedness and response: Asia‐Pacific perspectives

Disaster mental health preparedness and response: <scp>A</scp>sia‐<scp>P</scp>acific perspectives

Lessons Learned From the New York State Mental Health Response to the September 11, 2001, Attacks

In the aftermath of the September 11, 2001, attacks on the World Trade Center, the public mental health system in New York City mounted the largest mental health disaster response in history, called Project Liberty. The successes and challenges of Project Liberty are evaluated. The development of Project Liberty is summarized and analyzed from the perspective of the New York State and New York City officials and scientists who led the disaster response. Lessons learned that have implications for mental health support in future disaster responses are offered. A high level of interagency collaboration, engagement of nongovernmental organizations to provide services, media education efforts, and ongoing program evaluation all contributed to the program's successes. Mental health professionals' limited experiences with trauma, options for funding treatment, duration of clinical program, and existing needs assessments methodologies all proved challenging. Project Liberty was a massive and invaluable resource during the years of rebuilding in New York City in the wake of the attacks. Challenges faced have led to lessons of generalizable import for other mental health responses to large-scale events.