Integration of Disaster Mental Health Services with Emergency Medicine

Abstract

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and followup; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

Different types of exposure to the 2004 tsunami are associated with different levels of psychological distress and posttraumatic stress

“…However, there is always a portion of survivors who experience long-term distress, and the issue of how and when to identify possible candidates for intervention at a later point in time has become a matter of increasing importance (Connor, Foa, & Davidson, 2006;Litz, Gray, Bryant, & Adler, 2002;McFarlane, 2005;Norris, Murphy, Baker, & Perilla, 2003;Ruzek, Young, Cordova, & Flynn, 2004;Watson & Shalev, 2005;Wessely, 2003). A disaster is a complex event during which individuals with varying degrees of vulnerability to both immediate and long-term psychological distress are exposed to a multitude of adverse experiences.…”

Mental Health Consequences of Chemical and Radiologic Emergencies

“…Assessments should focus on identifying the mental health problems of the disaster-affected groups and any related needs. 44,45 Accurate prevalence measurements of mental health conditions should be obtained through population surveillance as part of a community assessment. 45 This community assessment could then aid the local public health and mental health system in allocating necessary and usually limited resources.…”

“…44,45 Accurate prevalence measurements of mental health conditions should be obtained through population surveillance as part of a community assessment. 45 This community assessment could then aid the local public health and mental health system in allocating necessary and usually limited resources. 44 Those coordinating the response should have baseline knowledge of "the community's mental health, vulnerabilities, and resources and capacities before the disaster."…”

“…44,45 It is advisable for first receivers to identify the most vulnerable populations, such as individuals with comorbid psychiatric illnesses, pregnant women, mothers of young children, children, and evacuees. Initial assessments can be completed during the first 2 to 4 weeks postdisaster.…”

Protecting Health from Climate Change

“…26 Hurricane Katrina has been associated with a high prevalence of psychiatric morbidity. In a telephonic survey of a probability sample of 1043 affected residents, the 30-day prevalence of anxiety-mood disorders was found to be 49.1% and that of PTSD 26.4%.…”