Transcript Briefing Template for RAND Health Dark Background

Relieving the Burden of
Depression and Disaster
Bowen Chung MD, MSHS
UCLA Semel Institute
UCLA/RAND NIMH Center for Health Services Research
and Media and Medicine for Communities
UCLA DARNet Information Exchange
March 4, 2006
Background
 Mental disorders affect the health and
well-being of all
 Underserved communities face
disparities in access to and quality of
mental health care
 These communities have little voice in
programs that affect their own health
 This situation is worsened by disasters
What can we do?
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What we will share:
 How improving quality of care can reduce
depression burden and disparities
 What the nation can do to relieve mental health
suffering of Katrina survivors
 Partnership approach to reduce depression
burden in communities of color
 Witness for Wellness
 Supporting Wellness for Katrina survivors
 The role the entertainment industry can play in
public understanding of the issues
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Clinical Depression Has
Major Societal Effects
 Leading cause of disability worldwide
--Early onset disrupts work and family
--$51 billion yearly in U.S.
 Affects 1 in 20 Americans
--All age and cultural groups
 80% respond to treatment
 Most do not get needed care,
especially underserved minorities
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The Many Faces of
Clinical Depression
“You feel so
worthless and
you’re in so much
pain you just want
the pain to be
over.”
“I just wanted to
end it all.”
“I could no
longer function
at my job and
had to take a
sick leave.”
“No one understood why I
couldn’t be ‘Super
Mom’ and ‘Super
Wife’ anymore.”
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Older individuals with mental health problems
are less likely to have any savings
Source: Gresenz and Sturm (2000)
100%
Healthy
Physical Health Condition Only
75%
ANY MENTAL HEALTH DISORDER
50%
< 35
35 - 54
55+ years old
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Supported by
the National Institute of Mental Health and the
Agency for Healthcare Research and Quality
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Programs Increased Appropriate
Care for All
QI programs
Usual care
African
American
Latino
White
0
10
20
30
40
50
60
% receiving appropriate care at 1 year
70
80
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Intervention Effects Over Two Years
Compared to usual care:
 1 - 2 additional months free of symptoms
of depression
 $450 more in health care costs
 1 additional month of employment
9
Interventions Reduced Long-Term
Outcome Disparities
African
American
QI programs
Usual care
Latino
White
0
10
20
30
40
50
60
70
80
90
% recovered at 5 years
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Mental Health Responses
for Storm Survivors
 People are resilient, but psychological
reactions and mental disorders are
common responses that eat at the
fabric of community life and slow
recovery
– Depression
– Post-traumatic stress disorder
– Grief reactions
– Substance abuse
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What are the challenges?
 Public services–severe mental illness
 Private services–few poor clients
 Many survivors: History of discrimination
and distrust of services
 Geographic scatter and scope; 1/300
Americans displaced from their homes
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What is needed?
 Widespread education about common
symptoms and giving reassurance for
recovery
 Emergency assistance for those cut off from
treatment
 Clinic-plan-community agency partnerships
for education, outreach, prevention, and
linkage to treatment in the long-run
 Minority providers, community agencies,
programs responsive to underserved
groups
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What is Needed? (2)
 Training for assessment, referral, and
treatment of common mental health reactions:
– Health professionals of all kinds
– Community agencies, paraprofessionals
 Consistent and generous insurance for at
least 3 years with full parity for mental health
care
 Public education to reduce stigma
 Support for survivors to participate as coleaders
 Federal allocation of about $1 billion to
achieve goals
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How Can We Achieve the Promise?
“My sense of desperation is gone. I do not
feel so alone and helpless in combating
my day-to-day problems. My anger has
subsided to the point that people see me
differently (because I am different!) and
my relationships with people have
improved dramatically.”
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Context for Improving
Health Communications
Half of all American adults, or 90 million
Americans, have difficulty understanding
or acting upon health information.
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Health Literacy
 Institute of Medicine defines as:
“The degree to which individuals have the capacity
to obtain, process, and understand basic health
information an services needed to make
appropriate health decisions.”
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Challenges of Public Health Communication
for Depression
 Cultural Appropriateness
 Literacy Level
 Addressing Stigma
One approach is partner with consumers and
communities to determine what they want!
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Hurricane Katrina and Mental Health
 Psychological Consequences
– Grief and Bereavement
– Post Traumatic Stress Disorder
– Depression
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Supporting Wellness for Katrina Survivors
 How do we talk to Survivors of Katrina about Mental Health?
• Low Literacy Levels (<6th Grade)
• Predominantly African American
• Avoid Stigma around Mental Health
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 Current Partnerships to develop materials
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UCLA / RAND NIMH Health Services Research Center
UCLA / RAND Center for Media, Medicine for Communities
Ecumenical Congress of Black Churches
Healthy African American Families
Catholic Charities
L.A. County Department of Mental Health
UCLA Department of Media Arts | Design
Pacificare
Partners in Louisiana and Mississippi
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