Transcript Mental Health in Disasters Speaker: Capt Dr. Geoffrey Oravec

Central Asia Regional Health Security Workshop
George C. Marshall European Center for Security Studies
17-19 April 2012, Garmisch-Partenkirchen, Germany
Mental Health in
Disasters
Geoffrey J. Oravec, MD, MPH, MALD
Capt, USAF, MC
Center for Disaster and Humanitarian Assistance
Medicine
19 April 2012
Introduction
• What is a disaster?
• Why is mental health important?
• Affected populations
• Interventions
What is a Disaster?
• A serious disruption of the functioning of a
community or a society causing widespread human,
material, economic or environmental losses which
exceed the ability of the affected community or
society to cope using its own resources. - UN 1992
• A situation or event which overwhelms capacity,
necessitating a request to a national or international
level for external assistance. Meets at least one of
the following criteria:
– 10 or more people killed
– 100 or more people affected
– Declaration of state of emergency
– Call for international aid
– Center for Research on the Epidemiology of Disasters
What is a Disaster?
Disaster Risk
=
Hazard
x
Vulnerable Population
Preparedness
Disaster Trends
Affected
Disasters
Killed
Types of Disasters
Individual
Exposed =
Trauma
Unintentional
Intentional
Psychological Problems:
• greater number
• longer duration
• more complex
Community
Exposed =
Disaster
Unintentional
Natural
Disasters
Technological
Intentional
War and
Terrorist
Attacks
Why Mental Health is Important
• Mental health is the leading cause of disability in the
world
• Major economic and social costs
• Increasing demands on the health system following
disaster
• Decreased resources following disaster
• Decreased ability to respond, recover and rebuild
Causes of Stress Reactions
• Violence
– Experiencing or witnessing destruction, death, injury, illness,
disability, killing, torture, atrocities
• Loss
– Family and friends
– Physical capacity
– Self: Identity, independence, confidence, role in family
– Security: safety, education, job, finances
– Home and social institutions/support
– A future
• Threat of Violence or Loss
Reactions to Danger
• Physical
– Fight or flight, ↑ heart rate, ↑ breathing, ↑ blood pressure,
muscle tension, trembling
• Emotional
– Fear, anxiety, aggression, strong emotions, hopeless,
helpless, alert
• Psychological
– Confusion, difficulty concentrating, numbness, disbelief
• Behavioral
– Restless, acting without a plan, inaction, non-adherence to
recommendations, over-dedication
Following Disaster
• Physical
– ↓sleep, ↑startle response, hyper-arousal, tension, fatigue,
irritability, aches and pains, nausea, change in appetite,
change in libido, low energy
• Emotional
– grief, anxiety, guilt, anger, numbness, helplessness,
hopelessness, shame, decreased interest, decreased
pleasure, depressed mood
• Psychological
– nightmares, poor concentration, unwanted memories, reexperiencing of disaster, confusion, disorientation,
indecisiveness
• Behavioral
– withdrawal, isolation, avoidance, numbing behavior
(drugs/alcohol), distrust, conflict, irritability, social and
occupational problems, decreased intimacy
Following Disaster
Normal
Following Disaster
• Problematic:
– Duration is too long
– Social or occupational functioning impaired
Following Disaster
• Distress (normal reaction)
• Behavior Change (normal or problematic)
• Disorder (problematic, specific symptoms, illness)
Distress
Responses
Sense of vulnerability
 Insomnia
 Irritability, distraction
 Smoking
 Alcohol
 Over dedication
Behavioral
Changes
Psychiatric
Illness
 PTSD
 Depression
Complex Grief
Center for the Study of
Traumatic Stress
Following Disaster
Affected Groups
• Victims
• Responders
• Population at Large
Victims
• Ensure basic needs are met (food, water, shelter)
• Re-establish social structures and support services
• Promote community mobilization, cohesion,
participation, psychosocial programs
• Avoid critical incident stress debriefings
• Employ Psychological First Aid (PFA)
– Expert-consensus based approach
– Not only for professionals
– Look, Listen and Link
• Medical treatment for disorders
Psychological First Aid Core Principles
1. Safety
2. Calming
3. Connectedness
4. Self-Efficacy
5. Hope/Optimism
Responders
• Primary traumatic stress
• Vicarious traumatic stress
• Compassion fatigue
• Burnout
• Withdrawal, isolation, lack of support
• Mental disorders
How to Prevent Responders from
Becoming Victims
• Selection
• Training
• Resiliency
• Clearly defined role
• Organizational support
• Adequate work/rest cycle
• Diet and exercise
• Connection to other workers, social support
• Opportunity to talk
Population
• Good Risk Communication
– Clear message
– Early information
– Credible Sources
– What the public should do / not do
– Dispel rumors
• Social support for those who need it
• Return to normalcy
Psychological Timeline
Honeymoon
(Community Cohesion)
Reconstruction
“Heroic”
A New Beginning
Pre-disaster
Disillusionment
Warning
Threat
Impact
Inventory
Zunin/Meyers
Trigger Events and Anniversary
Reactions
1 to 3 Days -------------------TIME-------------------------------1 to 3 Years
Questions
Questions?
Geoffrey J. Oravec, MD, MPH, MALD
Capt, USAF, MC
[email protected]
301-294-1470