L1: INTRO TO MHDRM

Disaster

Refers to any event that happens suddenly, which cause damage, disruption to ecological balance, loss of human and animal lives, deterioration of health and health services on a scale that is sufficient enough to call on assistance outside of the community.

Disastre

Disaster came from the french word:

Aster

Meaning “star”

Des

Meaning “bad”

Serious disruption of the functioning of a community or a society

Disaster is also a ______

• Human

• Material

• Economic or environmental

Disaster involves widespread ___ losses and impacts which exceeds the ability of the affected community or society to cope using its own resources.

Natural disasters

Happen because of the naturally occurring processes that operate through history.

Humans

Natural disaster is a phenomenon that could not be controlled by ___

TRUE

T or F: Disaster are not foreign experience to Filipinos, particularly those that are classified as hydrological kind or those that include movement distribution and management of water on earth

20

According to PAGASA, there is an average of ___ tropical cyclones that enter the Philippine Area of Responsibility

5 ; 6 ; typhoons

About ___ become storms, ___ become tropical depressions, and the rest turn into

• Sieges

• Mine and oil spills

• Individuals caught in a crossfire

Beyond natural disasters, human-induced disasters would include:

1. Geophysical

2. Meteorological

3. Biological

4. Climatology

Kinds of Natural Disasters

Geophysical

A disaster because of the phenomena beneath the surface of the earth such as earthquakes, landslides, mudflows, and volcanic eruptions.

Meteorological

Conditions are caused by extreme weather such as floods, cyclones, thunderstorms, tornadoes, lightning, etc.

Biological

Natural scenarios caused by disease, disability, or death, on a large scale basis, among humans, animals and plants

Microorganisms like bacteria, virus or toxins

Biological disasters might be due to ___

1. Pandemic

2. Insect/animal Plagues

Examples of biological disaster

Climatology

Hazard caused by long-lived, meso to macro scale atmospheric processes ranging from intra-seasonal to multidecadal climate variability

1. Extreme temperature

2. Drought

3. Wildfire

4. Glacial lake outburst

Examples of Climatology

Short-term (sudden), extreme weather

Difference of Meteorological disasters to Climatological disasters

Long-term (gradual) climate patterns and variability

Difference of Climatological disasters to Meteorological disasters

1. Technological

2. Industrial

3. Warfare

Man-made Disasters

Technological

Failure or breakdown of systems equipment, engineering standards that harms people and the environment.

Structural collapses of bridges, mines, and buildings

Examples of technological disasters

Industrial

Disaster caused by industrial companies, either by accident negligence or incompetence such as in case of chemical and nuclear explosion.

Warfare

Disaster caused by socio-political conflict that escalate into violence, such as war and intra-society conflicts.

• Realizes one's own abilities and potentials

• Copes adequately with the normal stresses of life

• Displayed resilience in the face of extreme life events

• Works productively and fruitfully

• Able to make positive contribution to the community

Mental Health is defined as a state of wellbeing in which the individual:

Capacity Development

Process by which people, organization and the society systematically stimulate and develop their capacities over time to achieve social and economic goals

Disaster risk

Potential disaster losses, lives, health statues, livelihoods, assets and services, which could occur to a particular community or as society over some specified future time period.

Disaster risk management

The systematic process of using administrative directives, organization and operation skills and capabilities to implement strategies, policies and improved coping capacities in order to lessen adverse impacts.

Disaster Risk Reduction

The concept and practice of reducing disaster risks through systematic efforts to analyze and manage the causal factors of disaster.

• Reduced exposure to hazards

• Lessened vulnerability of people and property

• Wise management of land and the environment

• Improved preparedness for adverse events

Disaster risk reduction includes:

DRR Plan

Document prepared by an authority, sector, organization or enterprise that sets out goals and specific objective for reducing disaster risk together with related actions to accomplish these objectives

Hazard

A dangerous phenomenon, substance human activity or condition that may cause loss of life injury or other health impacts, proper damage loss of livelihood and services, social and economic disruption or environmental damage

Preparedness

The knowledge and capacity developed by governments and professional response and recovery organization, communities and individuals to effective anticipate, respond to and recover from the impact of like imminent or current hazard.

Prevention

The outright avoidance of adverse impacts of hazards and related disasters

Recovery

The restoration and improvement where appropriate, of facilities, livelihoods and living conditions of disaster-affected communities, including efforts to reduce disaster risk factors.

Resilience

The ability of a system, community or society exposed to hazards to resist, absorb, accommodate, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions.

Response

The provision of emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety, and meet the basic subsistence needs of the people affected.

Risk

The combination of the probability of an event and its negative consequences

Vulnerability

The characteristics and circumstances of a community, system or asset that make it susceptible to the damaging affects of a hazard.

Clinical and Administrative services

In a major disaster, effective mental health response requires the delivery of both ___ and ___ in ways that differ from services typically provided by mental health professionals.

Restore community equilibrium

The primary objective of disaster relief efforts is to:

TRUE

T or F: Disaster mental health services, in particular, work toward restoring psychological and social functioning of individuals and the community, and limiting the occurrence and severity of adverse impacts of disaster-related mental health problems

Normal

Disaster mental health services are primarily directed toward ____ people responding normally to an abnormal situation, and to identifying persons who are at risk for severe psychological or social impairment due to the shock of the disaster

TRUE

T or F: Aspects of disaster intervention services are similar to the crisis work of mental health agencies and practitioners, and include the evaluation and treatment of persons whose preexisting psychiatric disorders are exacerbated by the stress or trauma of disaster

Non-clinical settings

However, most of the work of disaster mental health professionals occurs in ____ for more intensive clinical evaluation and care.

1. Shelters

2. Disaster application centers

3. Schools

4. Community centers

Example of non-clinical settings

1. Stress management education

2. Problem solving

3. Advocacy

4. Referral of at-risk or severely impaired individuals

Disaster mental health professionals delivers work in the form of:

Defusing and Debriefing

Two commonly used disaster mental health interventions that may be unfamiliar to mental health clinicians

Disaster mental health

Involves services to people who often are not seeking mental health assistance, who may be ambivalent about receiving such help, or who may be outright resistant to any form of mental health service.

Service setting

May be chaotic, and lack privacy, quiet, or comfort—for example, a service center waiting line, a street curb, or a cot in a shelter

TRUE

T or F: Administrative decisions about health services often change several times each day, requiring clinicians to frequently change their routines, locales, and the type of survivors they serve

“Instant” rapport and rapid assessment

Necessary with many people who are experiencing extreme, but normal, stress reactions (e.g., exhaustion, irritability, grief)

10-30 minutes

At most, __ can be spent with any individual, who is generally not seen more than once by the same clinician.

Address pragmatic concerns while using psychoeducational techniques

Mental health workers will not be doing “therapy” in the immediate wake of disaster. Rather, they _____ to teach survivors about stress reactions and stress management methods

Survivors - Emergency Phase

• Protect

• Direct

• Connect

• Triage

• Acute Care

Helpers - Emergency Phase

• Triage/Assess

• Consult

• Defusing

• Debriefing

• Crisis Intervention

• Referral (When appropriate)

Community - Emergency Phase

• Information

• Dissemination

Organizations - Emergency Phase

• Consultation

• Needs Assessment

• Service Development

• Support Employee (Assistance programs)

Survivors - Early Post-Impact Phase

• Outreach services

• Assessment

• Referral

• Psychoeducation presentations

• Initial debriefings

• Follow-up debriefings

• Assistance with death notification

• Activities in large (Group settings and vigils)

Helpers - Early Post-Impact Phase

• Assessment

• Consults

• Initial debriefings

• Referral when appropriate

• Follow-up debriefings

• Sites of Interventions

1. Work sites

2. Rest sites

3. Home office

Sites of intervention in helpers early post-impact phase

Community - Early Post-Impact Phase

• Psycho

• Interviews

• Reports

• Brochures about stress reactions & stress management

• Sites of Interventions

• Newspaper

• Radio

• TV

• Internet

• Community centers

• Business association

Sites of interventions in community early post-impact phase

Organization - Early Post-Impact Phase

• Phone and on-site consultation to management

• Ad hoc counseling program design and implementation

• Support employee

• Sites of interventions

1. Work sites

2. Corporate offices

Sites of interventions in organization early post-impact phase

Survivors - Restoration

• Outreach services

• PTSD Assessment

• Referral

• Psychoeducational presentations

• Debriefings

• Material and Commemoration

• Clinical services

• Crisis intervention

• Consultation with schools; school programs

• PTSD and psychosocial assessment, individual, couples, family and group counseling

Helpers - Restoration

• Assessment & referral as appropriate

• Consultation

• Follow-up debriefings

• Referral when appropriate

• Commemoration planning

Community - Restoration

• Psychoeducational articles, interviews reports, brochures about stress reactions & stress management

• Needs Assessment survey

• Group education presentations

• Commemoration planning

Organization - Restoration

• Phone & on-site consultation

• Needs assessment surveys

• Education presentation

• Consultations and training with Employee

• Assistance programs

1. People are resilient

2. Clarifies that even though most people do not develop psychiatric illness after exposure to disaster trauma, most people will experience at least some emotional distress

3. One size does not fit all for survivors of disasters, and some people may develop psychiatric disorders after exposure to disaster trauma

4. Emphasizes the need to identify psychiatric disorders and provide appropriate treatment for them

5. Posttraumatic stress disorder (PTSD) is usually the most common psychiatric disorder to develop after exposure to disaster trauma

6. New alcohol and other drug use disorders do not regularly commence after disasters

General Principles for Disaster Mental Health

Principle 1: People are resilient

In efforts to identify mental health problems to be addressed, it is easy to overlook the resilience of the majority who do not develop psychiatric disorders, even after exposure to severe disaster trauma. Some people may even experience personal growth or have other positive outcomes

Principle 2: Clarifies that even though most people do not develop psychiatric illness after exposure to disaster trauma, most people will experience at least some emotional distress

There are more opportunities to assist disaster survivors with distress than with disaster survivors with psychiatric illness, because distress is far more prevalent

Emotional distress

Normative after exposure to disasters and a normal response.

Intrusive memories and hyperarousal symptoms

Are particularly common manifestations of emotional responses to disasters

Distress not meeting criteria for a psychiatric disorder

Is important and may benefit from psychosocial interventions.

Principle 3: One size does not fit all for survivors of disasters, and some people may develop psychiatric disorders after exposure to disaster trauma

It is important to differentiate emotional distress from psychopathology, because different interventions are required for these two different entities.

PTSD or any other psychiatric disorder

is never normal, even if it occurs in relation to a disaster; diagnosis and treatment of psychiatric disorders is indicated.

Principle 4: Emphasizes the need to identify psychiatric disorders and provide appropriate treatment for them

Psychiatric disorders developing in the wake of disasters deserve formal assessment and treatment just as in other settings.

Accurate diagnosis

Is essential, because it determines the most appropriate type of intervention.

Principle 5: Posttraumatic stress disorder (PTSD) is usually the most common psychiatric disorder to develop after exposure to disaster trauma.

PTSD usually develops quickly after disaster exposure (within the first few months), and it is often chronic, lasting many months to years. It is usually accompanied by other psychiatric disorders and often medical illness.

Avoidance and numbing symptoms

Are less common than intrusive memories or hyperarousal symptoms and are markers of risk for PTSD.

Posttraumatic Stress Disorder (PTSD)

a conditional diagnosis, based on sufficient exposure to a qualifying traumatic event. In other words, people who are not exposed to trauma (according to DSM-5)—by physical endangerment, directly witnessing others being endangered, injured, or killed, or by having a close associate who was exposed—cannot be candidates for a diagnosis of this

Major depression

The second most common diagnosis is usually ____. Unlike PTSD, this may develop even in people without trauma exposure, for example, in people who experience loss of valued possessions or economic losses

Principle 6: New alcohol and other drug use disorders do not regularly commence after disasters

Although alcohol and drug use may increase in some groups after certain disasters, this occurrence does not regularly translate into new substance use disorder

TRUE

T or F: Following a disaster, administrations are faced with the challenge of having to quickly become familiar with disaster protocols (grant applications) and resources (natural and other aid) while meeting rapidly emerging and changing disaster-precipitated needs.

Powerful real-world contingencies

Disaster mental health responses efforts are continuously subject to ___

TRUE

T or F: All disasters become political events

Previously established networks and relationships and political pressure

This shapes the disaster response

Rare; Rapidly

Consensus among agencies and organizations about matching resources with survivors is ____. The disaster setting is in constant flux as information and resources change ______

Crisis intervention to Ongoing aid and assistance

Administrators also must begin preparation to shift services from ____, because as early as one month after the disaster, the major federal grants are reviewed, funded, and operationalized for ongoing disaster mental health services

24-72 hours

All preparation shifts begins within a period of ___ after the onset of disaster, leaving little time for information gathering and reflection

1. Adventuresomeness

2. Sociability

3. Calmness

4. System savvy

5. Therapeutic Acumen

Key Characteristics and Helping behaviors of Disaster MH Workers

Adventuresomeness

The inclination toward curiosity and learning from experience as well as the willingness to develop creative solutions to complex problems is necessary for disaster work.

Overwhelmed and adrift

The person who relies upon routine with minimal uncertainty is likely to feel

Regularity and certainty

Disasters require establishing ____ amidst intense turmoil, hence a major aspect of the adventure is creating structure in the face of chaos.

Sociability

Working with people who may be experiencing extreme stress and maintaining a stance of a sensitive, observant listener and helper requires not just a professional commitment to others, but also the capacity to enjoy and find the best in others. However, it does not mean over-involvement or pseudo-friendliness

Ethical and clinical responsibility

Disaster mental health professionals have the _____ to maintain clear and appropriate professional and personal boundaries with survivors and workers.