Disaster Mental Health Disaster Mental Health Response in Incidents - PowerPoint PPT Presentation

Disaster Mental Health Disaster Mental Health Response in Incidents of Response in Incidents of Massive Size and Scope: Massive Size and Scope: Lessons Learned Lessons Learned April Naturale, LCSW, ACSW Omaha, NE July 12-14, 2006 4th Annual Nebraska Disaster Behavioral Health Conference 1 1

2 2 DISASTERS OF GREAT MAGNITUDE

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Multiply Multiply # of Persons targeted per # of Persons targeted per Type of Loss Type of Loss Number Number At- At -Risk Risk Loss Category Loss Category by ANH by ANH Missing or Dead 4,544 2.62 100% 11, 905 800 2.62 100% 2,096 Hospitalized 7,985 2.62 90 18,829 Non-hospitalized Injured Homes Destroyed 100 4,500 2 50 4,500 Homes “Major Damage” 15 Homes “Minor Damage” 327,00 Disaster Displaced Employed & 2.62 50 428,370 0 Unemployed Others, WTC Emergency & Recovery 17,859 2.62 100 46,791 Workers 5,456 2.62 100 14,295 WTC Evacuees 40,000 2.62 90 94,320 WTC Workers Absent at Time of Attack 2.62 School Children & Teachers in 7 Schools 9,151 100 23976 Evacuated in WTC Attack 1,932,0 Pre-school and School Age Children 40 772,800 00 6,584,1 Global Outreach 10 656,420 96 TOTAL ESTIMATED PERSONS IN NEED OF CRISIS COUNSELING 2,074,302 7 7 SERVICES:

Category I # of Indiv. Est. % PTSD Est. #PTSD A) Individuals 8,000 1 40% 5 3,200 trapped/rescued Category II B) First 2400 police + 30% 6 720 responders firefighters (NOPD; NOFD) A) Superdome 25,000 30% 8 7,500 evacuees B) Convention 30% 8 19,000 5,700 Center evacuees C) Trapped 30% 9 4,000 1200 hospital personnel and pts D) Non-exposed 59,500 2 30% 10 17,850 family members of other Category I individuals 8 8

Category III 24% 11 A) Other evacuated 8,000 1,920 persons (not Category I A, B, or C) in Orleans area 300 3 24% 12 B) Professional 72 caregivers (within impact area) of individuals in Categories I and II Category IV 550,000 1 15% 13 Displaced persons 82,500 with damage to homes or businesses Category V 500,000 1 10% 13 Displaced persons 50,000 with no damage to homes or businesses Category VI 1,799,000 4 5% 13 Non-displaced 89,950 persons outside of impact area TOTAL 260,612 2,976,300 9 9

Emergencies can provide ‘cover’ that brings out the good in people and organizations. Opportunities abound to show empathy, compassion, willingness to collaborate, and flexibility. They can greatly facilitate the process of assembling an effective public health, mental health and substance abuse response enabling people to rapidly overcome the typical bureaucratic obstacles to mounting any new program, and be less risk-averse. OR NOT 10 10

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The Estimate of Mental Health Needs Following . Hurricane Katrina-Sept. 3, 2005 Severity of Impact % Of Clinically % Of Sub Clinical Distress Significant Distress but Need Some Additional Support Moderately 5-10% 5-10 % Exposed Areas Very Severely 25-30% 10-20% Exposed Areas Fran Norris, Ph.D. Patricia Watson, Ph.D. 12 12 National Center for Post-Traumatic Stress Disorder

PROJECT LIBERTY: Accomplishments � Develop and implement local Plans of Service (NYC and ten surrounding counties all with separate governmental and mental health authorities) via the NEEDS ASSESSMENT. � Initiate contracting process with approximately 200 agencies. � Develop mechanisms for payment and reimbursement (new contracts, cost-based budgets in counties, fee-for-service budgets in NYC). � Develop curriculum and operationalize a structure for Staff Training and Provider Technical Assistance. � Develop, educate, and distribute Public Education materials in many different languages. � Develop and rollout Media campaign. � Initiate and sustain Data Collection and Evaluation modules. 13 13

Project Liberty: Accomplishments (cont.d) � Over 1,012,170 unique individuals have been served through Project Liberty crisis counseling and public education services. � Over 632,533 Project Liberty crisis counseling and public education sessions have been provided. � Over 160 mental health agencies have participated in delivering Project Liberty services. � Over 4,800 workers have been trained in outreach-based disaster mental health counseling and public education techniques in over 125 separate training sessions. � Project Liberty providers have offered services in over 37 different languages with many dialects. 14 14

The Role of Mental Health The Role of Mental Health 50% of the 5,000 crisis counselors and 25% 50% of the 5,000 crisis counselors and 25% of the managers and supervisors in the NY of the managers and supervisors in the NY 9/11 response were mental health 9/11 response were mental health professionals. professionals. The remaining 50% were indigenous The remaining 50% were indigenous community workers, paraprofessionals and community workers, paraprofessionals and cultural brokers. cultural brokers. 15 15

The Role of Mental Health The Role of Mental Health • Apply epidemiological approach to the disaster Needs Assessment • Evaluate the social factors of the health and mental health problems post disaster • Determine the appropriate interventions • Plan and implement service delivery • Conduct program evaluation 16 16

17 17 WHAT WE’VE SEEN

What We’ ’ve Seen ve Seen… … What We � 11 Years post Oklahoma City, the American Red 11 Years post Oklahoma City, the American Red � Cross is still providing mental health services for Cross is still providing mental health services for first responders first responders � 5 Years post 9/11, survivors are first accessing 5 Years post 9/11, survivors are first accessing � mental health services mental health services � In three previous large scale disasters in the In three previous large scale disasters in the � U.S., mental health staffs moved out of U.S., mental health staffs moved out of response due to compassion fatigue response due to compassion fatigue 18 18

Event reactions in New York experienced by more Event reactions in New York experienced by more than 20% of persons served than 20% of persons served 50% 46% 45% 39% 40% 35% 28% 30% 26% 25% 21% 20% 15% 10% 5% 0% S adness, Tearful Feeling Anxious, Irritability, Anger S leep Difficulties Difficulty Fearful Concentrating 19 19

10% 15% 20% 25% 30% 35% 40% 45% 50% 0% 5% Intrusive thoughts 19% or images Event reactions experienced by Event reactions experienced by 10% to 20% of persons served 10% to 20% of persons served E xtreme change in 18% activity level 18% Hyper-vigilance 17% Distressing dreams 15% Isolation/withdrawal 14% Headaches 13% Fatigue/exhaustion Feels emotionally 12% numb, disconnected 12% Despair, hopeless Reluctant to leave 11% home Difficulty making 20 20 10% decisions

What are the gender and age characteristics of persons What are the gender and age characteristics of persons receiving individual crisis counseling services? receiving individual crisis counseling services? Age Characteristics Gender Characteristics Adolescents Male Ages 12-17 Not Supplied Children 44.2% 5.7% 0.8% Ages 6-11 2.1% Preschool Ages 0-5 0.3% Not Supplied 0.4% Older Adult Adults Age 55+ Ages 18-54 Female 14.6% 76.9% 55% 21 21

Ethnicity of Persons Receiving Crisis Counseling Services (*= data processed as of 09/10/03) Unknown 0.4% Other 1.7% Native American/Alaska 0.2% Native Middle Eastern 1.6% Asian/Pacific Islander 9.6% Black 30.7% Hispanic Origin 24.9% 30.5% White 0.3% Missing English = 82.1% Spanish = 7.9% Chinese = 6% Other = 0.15% Preferred Languages : Not Supplied = 0.55% 22 22

Service Recipients at Risk for Service Recipients at Risk for Post Traumatic Stress Disorder (PTSD) Post Traumatic Stress Disorder (PTSD) Based on the presence of 2 or more Persons With Reactions Suggestive of PTSD: of the following reactions: 27% Distressing dreams � Intrusive thoughts or images � Hyper-vigilance � Emotional numbness or disconnection � OR Hyper-vigilance alone � (Derived from four item primary care � Remaining Service PTSD screen, National Center for PTSD) Recipients: 73% 23 23

Service Recipients at Risk for Depression Service Recipients at Risk for Depression Based on the presence of 4 or Persons With Reactions more of these reactions: Suggestive of Depression: 20% Change in activity level � Sadness/tearfulness � Despair/hopelessness � Sleep disturbances � Difficulty eating � Fatigue/exhaustion � Difficulty concentrating � Difficulty remembering � things Difficulty making � decisions Remaining Service Suicidal thought � Recipients: 80% OR 24 24 Suicidal thoughts alone �