Disaster Mental Health Care

Educational Objectives

The goal of this program is to improve disaster behavioral health care. After hearing and assimilating this program, the clinician will be better able to:

1. Recognize the benefits of training in disaster behavioral health. 

2. Participate in crisis response interventions to benefit first responders and survivors of disasters. 

Summary

Importance of disaster behavioral health: symptoms exhibited in first 30 days after disaster not always predictive of psychological sequelae; early behavioral health interventions can positively alter course of disaster-triggered mental disorders; 30% to 40% of general population and 10% to 20% of first responders experience new-onset mental health issues after disasters

Effort coordination: efforts to include behavioral health in emergency medical response at state and federal levels continue; experience of past disasters and research have shown that including behavioral health in incident command training helpful

Targets for disaster behavioral health: survivors, first responders, and individuals with existing behavioral health issues

Goals: manage hospital surge when disasters occur; place behavioral health workers trained in disaster response at forefront to help support families and friends searching for loved ones; ensure viability of long-term care facilities (eg, support for people who need dialysis)

Preparedness: Hurricane Katrina (2005) prompted significant changes in mental health care during disaster; among them was initiation of dialogue among leaders of major organizations to delineate roles

Psychological First Aid (PFA): 2-day training program; relies on concept of human resilience; emphasizes community and family support; volunteers without advanced degrees in mental health care can train in PFA; does not ask survivors to discuss or relive traumatic events; volunteers trained on how to talk to affected individuals

Mental Health First Aid: designed in Australia; adopted by US first responder community; similar to PFA, but categories of mental illness explored more deeply; 8-hr training; includes specialized training (targeting, eg, children, first responders); helpful in reducing stigma associated with mental illness; does not require advanced degree in mental health care; ALGEE action plan — assess risk for suicide, listen without judgment, give reassurance, encourage professional help, and encourage self-help and other support strategies

Critical incident stress management (CISM): “crisis intervention toolbox” created in 1983 by Jeffrey Mitchell, who became interested in response to traumatic events among first responders while working as paramedic and firefighter; Mitchell had observed that first responders lacked skills to cope with stress of traumatic events, and he thought about enlisting fellow first responders to process feelings or reactions; system used in first responder community, then in aviation disaster setting, and later adopted by health care organizations and private businesses; model holds that early psychological intervention after highly traumatic event is helpful, warranted, humane, appropriate, evidence-informed, and evidence-based; mental health professionals needed at meetings, but peers play important supportive role; CISM is comprehensive integrated system; requires specialized training because of strategic nature; can cause harm if not used with right audience, at right time, with adequate training; goal — keep first responders healthy and in service; consists of debriefing, one-on-one sessions, defusing, or crisis management briefings

PsySTART: START stands for “simple triage and rapid treatment,” and “psy” refers to psychiatric component; incident management system that connects individuals to further care; does not necessarily measure emotional response; strategy for rapid mental health triage and incident management during disasters and terrorism events; considered first evidence-based triage system for disaster mental health; first responders prompted to ask certain questions; immediate referral to mental health crisis workers required if risk of harm to self or others identified; other cases that require referral include death of family member or pet, delayed evacuation, and unaccompanied child; system used during Hurricane Sandy and Ebola crisis in Africa

Listen, Protect, Connect: another approach to PFA; teaches how to work with the surge of people needing help during disaster

Suggested ReadingsAcknowledgments

Dr. Konkle and Mr. Richardson were recorded at the 2018 Indiana Psychiatric Society Fall Symposium, presented by the American Psychiatric Association in joint providership with the Indiana Psychiatric Society, and held December 1, 2018, in Carmel, IN. For information about future CME activities from the Indiana Psychiatric Society, please visit Indianapsychiatricsociety.org. The Audio Digest Foundation thanks the speakers and the sponsors for their cooperation in the production of this program.

Readings

Fullerton CS et al: Posttraumatic stress disorder and mental distress following the 2004 and 2005 Florida hurricanes. Disaster Med Public Health Prep. 2019 Jan; 8:1-9; Jacobs GA et al: Disaster mental health and community-based psychological first aid: concepts and education/training. J Clin Psychol. 2016 Dec;72(12):1307-17; Müller-Leonhardt A et al: Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare. Accid Anal Prev. 2014 Jul;68:172-80; North CS, Pfefferbaum B: Mental health response to community disasters: a systematic review. JAMA. 2013 Aug 7;310(5):507-18.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Mr.Richardson was recorded at the 2018 Indiana Psychiatric Society Fall Symposium, presented by the American Psychiatric Association in joint providership with the Indiana Psychiatric Society, and held December 1, 2018, in Carmel, IN. For information about future CME activities from the Indiana Psychiatric Society, please visit Indianapsychiatricsociety.org. The Audio Digest Foundation thanks the speakers and the sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PG080502

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.