24th Sept 2013 Outline Mental Health in Post-Disaster/Crisis : Systematic Approach 1. Worldwide Increase in Disasters 2. Disaster/Crisis Event in Thailand 3. Disaster/Crisis Mental Health Surveillance System in Thailand 4. Disaster/Crisis Preparedness in Community Pitakpol Boonyamalik, M.D., Ph.D., M.B.A. Worldwide Increase in Disasters I. Worldwide Increase in Disaster Over 18,000 mass disasters in the world from 1900 to present �
24th Sept 2013 Psychological Impacts of The 2011 Great Flood Victims � Severe flooding started at the end of July 2011, monsoon season in Thailand and persisted in some areas until mid- II. Disaster/Crisis Event January 2012 � Sixty-five of Thailand's 77 provinces in Thailand were declared flood disaster zones � 815 deaths (with 3 missing) � Department of Mental Health together with Office of Public Health for mental health cared and enhanced community resilience A cohort of the victims in the 2006 floods/mudslides Proportion of Victims, in Uttaradit province, northern Thailand with Mental Health Problems Background � Flash floods and mudslides hit Uttaradit province, northern Thailand, after a heavy monsoon rains in May, 2006 Stress, 6% � Northern Thailand's worst floods in 60 Depression, years killed at least 30 people and left 7.75% nearly 100 missing � Department of Mental Health together with Uttaradit Office of Public Health launched a one-year continuing psychological support for a group of Source: Department of Mental Health victims �
24th Sept 2013 Background (Cont.) Incidence of Mental Health Problems among the Cohort of Mudslide Victims (Post 3 months) � One village each in 3 affected districts, Lub Lae, Tah Pla, and Mueang 70.69 68.87 districts, were selected. 80 70 � One village in a non-affected 52.52 60 district, Thong San Khun was 50 selected as the control. % 40 � All of the villagers (892 persons) in 23.66 30 selected villages were screened 20 for mental disorders at 3 months 10 after the incident. 0 � The victims with mental health Tha Pla Lub Lae Mueang Control problems were followed up 3 times every 3 months . Incidence of PTSD among the Cohort of Incidence of Mental Disorders among Mudslide Victims the Cohort of Mudslide Victims (Post 3 months) (Post 3 months vs. Post 12 months) 1 5 .3 4 � � � � � � 1 1 .8 9 1 1 .8 9 1 0 .6 9 1 1 .2 7 � � � � 9 1 0 .6 9 9 .2 � � � � 7 .8 % 7 .4 6 � 6 .6 1 � % � 4 .4 6 4 .6 5 � 3 .2 5 � 2 .9 8 2 .4 5 1 .9 1 � 81 .2 2 0 .9 1 .8 6 � 0 0 .4 6 1 .0 1 0 0 0 0 .9 3 0 .9 8 0 .4 9 � 0 � T a h P la L u b L a e M u e a n g C o n tr o l � A ll d istr ic ts T a h P la L u b L a e M u e a n g C o n tr o l P T S D M D D S u ic id e A lc o h o l u se d iso r d e r O th e r s P o st 3 m o n th s P o st 1 2 m o n th s �
24th Sept 2013 Psychological relief efforts for the victims Incidence of Mental Health Problems among 2004 Tsunami Victims in Phung Nga, Krabi, and Phuket of 2004 Indian Ocean Tsunami Background 33.6 35 30.2 30 25.1 • 2004 South Indian Ocean Earthquake caused 25 25.7 PTSD 18.9 one of deadliest Tsunami on December 27, 20 Stress 2005. Depress 15 9.5 15.1 Anxiety • Affected 6 southern provinces in Thailand: 10 4.7 5 Phuket, Phung Nga, Krabi, Ranong, and Satun. 0 • Causing 5,392 deaths, 3100 missing, and Post 2 months Post 9 months 8,457 injured. Source: From Department of Mental Health conducted by Using SF-36, HSCL-25, HTQ Background Psychological care for the victims of the violent events in the 4 southernmost provinces � Southernmost area (Pattani, Yala, Narathiwat, and some parts of Songkla) have faced continuous violence problems since 2001. � Mental health services system is not well established due to a scarcity of mental health professionals in the affected area. � Shortage of psychiatrists in the southern border province (Pattani, Yala, Narathiwat). �
24th Sept 2013 Number of Violent Victims Number of Violent Victims (%), Classified by Province (1,048 cases) with Mental Health Problems Songkla, 4, 0.38% No Risk , 966 cases Depress, Pattani, 328, Narathiwat, PTSD, 2 Cases 31.3% 3 cases 469, 44.75% Yala, 247, 23.57% Risk , 82 cases Source : Violent-Related Mental Health Surveillance (VMS) Report Source : Violent-Related Mental Health Surveillance (VMS) Report The suicide rate of Thai people after The suicide rate in Thailand (Cases per 100,000 population) the Asian financial crisis/ Tom Yam Kung Crisis (1997-2012) in 1997 1 st round of economic crisis 2 nd round of economic crisis Background 1 0 The economic Recovery � � � � � � �� � � � � � � � � � �� � � �� � � 8 � � � � � � � � The crisis began in July 1997, and raised fears of a � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � worldwide economic meltdown due to financial contagion. 6 � Thailand's booming economy came to a halt amid massive 4 layoffs in finance, real estate, and construction that resulted in huge numbers of workers returning to 2 their villages in the countryside and 600,000 foreign workers being sent back 0 to their home countries. � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
24th Sept 2013 Phases of Disaster III. Disaster/Crisis Mental Health Surveillance System � Heroic Warning Impact Disillusionment Reconstruction in Thailand Sources: Johns Hopkins Center for Health Preparedness and Response Pitakpol Boonyamalik, MD, PhD 22 Phases of Psychosocial Support for Phase 1: Pre-disaster (Preparation) Disaster � Policy formulation and planning process � Set up responsible organizations Phase 1: Pre-disaster (Preparation) � Personnel training � Other resource preparation Phase 2: Crisis and Emergency (< 2 weeks) • Phase 2.1: Crisis (< 72 hours) � guideline manuals to drills/tabletop exercises • Phase 2.2: Emergency (72 hours – 2 weeks) � National level � Mental health professionals in Phase 3: Post-disaster (2 weeks – 3 months) psychiatric hospitals � Health professionals in community and provincial hospitals Phase 4: Rehabilitation (> 3 months) Source: Department of Mental Health of Thailand �
24th Sept 2013 Phase 2 : Crisis and Emergency (< 2 weeks) Phase 3: Post-disaster(2 weeks–3 months) � Screening for mental health problems Phase 2.1: Crisis (< 72 hours) • PISCES-18 for adults • Focusing on physical and social supports • Symptoms checklist for children (precaution with the appropriate timing) • Assessment of situation and preparation � Diagnosis and treatments for mental disorders • M.I.N.I • Crisis intervention for the persons with severe Phase 2.2: Emergency (72 hours – 2 weeks) psychological reactions � Surveillance for mental disorders • Psychological first aid • Risk assessment and high-risk group surveillance • Depression , suicide, PTSD and alcohol use disorders � Continued physical and social supports Phase 4: Rehabilitation (> 3 months) � Screening for mental health problems • PISCES-18, Depression/ suicide screening, and PTSD screening for adults IV. Disaster/Crisis • SDQ for children � Diagnosis and treatments for mental disorders Preparedness in Community • M.I.N.I � Continued surveillance for mental disorders • Depression , suicide, PTSD and alcohol use disorders � Psychosocial rehabilitation • Occupation �
24th Sept 2013 Capacity Building for Mental Health GRI. Together with IMH and Others System in Community Partnerships with the Support of Temasek Mental Health Crisis Assessment and Treatment Training 200 community based workers in 4 Team (MCATT) regions of Thailand Established in every district and personal training (Northern, Northeastern, Central and Southern) Training 40 Master Trainers In partnership with IMH to develop curriculum for Building Community Resilience community based workers VIDEO Thank you �
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