Rosalie LO, PsyD Senior Clinical Psychologist Certified Traumatologist. Corporate Clinical Psychology Services Hospital Authority Hong Kong

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1 1 Rosalie LO, PsyD Senior Clinical Psychologist Certified Traumatologist Corporate Clinical Psychology Services Hospital Authority Hong Kong 1

2 2 Introduction Service Needs Service Planning Service Delivery Model Training Psychological Support to Service Providers Way Forward

3 3 Significant correlation between 1. Quality of overall emergency responses 2. Responses to affected people s psychosocial and mental health needs Human rights Well-designed service responses to people s psychosocial and mental health needs Psychosocial and mental health care services should be fully integrated into all major incident plans.

4 4 Building psychosocial resilience of individuals, families and communities Adequate support the impacts of challenging events and emergencies Responsibility of all concerned parties

5 5 Meta-analysis of 60,000 disaster victims 102 different disasters Consequences of disaster: 18% : very severe impairment 21% : severe impairment Conclusion: Disaster do have implications for mental health for a significant proportion of persons who experience them. (Norris et al, 2002)

6 6 Medium-term disorder: 20-40% Long-term disorder: 0.5 to 5% Conclusion: Risk to develop a mental disorder or other psychological morbidity and dysfunction in the medium- or long-terms. Range of services required by people who suffer these problems are disproportionately high. (NATO, 2009)

7 7 Resilience relatively mild and short-lived disruptions initial, brief spike in distress Recovery: Moderate to severe initial elevations in psychological symptoms Decline gradually Chronic Dysfunction: More sustained or persistent distress associated with dysfunction and/or impairment PTSD: 5%-10% Delayed Reactions: Absence of overt signs of distress/ symptoms initially Eventually manifest in delayed reactions (Bonanno, 2005)

8 8 Children, adolescents, older people, women Pre-existing health problems & disorders Socially disadvantaged Disabled persons Rescuers, emergency responders Staff of health and social care services Personnel of humanitarian aid and armed forces

9 9 High perceived threat to life and safety Uncontrollable and unpredictable circumstance Possibility of recurrence of disaster Physically injured Exposed to dead bodies and grotesque scenes Multiple losses Higher degrees of community destruction Disproportionate distress Limited social support History of mental disorder

10 10 Major incident plan: fully coordinated and integrated psychosocial and mental health service response to disasters

11 11 1. Corporate governance 2. Service Delivery 3. Delineation of roles and responsibilities 4. Training 5. Psychological support to service providers

12 12 1. Corporate governance Strategic planning, preparation and leadership 2. Service Delivery --Stepped care model Basic services non-specialized but focused services specialized services Based on knowledge of people s needs Acute medium long term support 18

13 13 I. Preparedness (1). Strategic planning: Planning, preparation, training and rehearsal of the full range of service responses (2). Prevention services: Develop the collective psychosocial resilience of communities In advance of disastrous events

14 14 II. Public Psychosocial Care (3). Support from families, peers and communities (4). Assessment (screening, triage) Interventions Other responses that are based on the principles of psychological first aid by first responders by trained lay persons supervised by the staff of the mental healthcare services

15 15 III. Personalized Psychosocial and Mental Health Care (5). Access to primary mental health care services for assessment and intervention services (6). Access to secondary and tertiary mental health care services Suffer from mental disorders Require specialist intervention (Williams & Kemp, 2008) 22

16 16 3. Delineation of roles and responsibilities Execution of psychosocial and mental health care plans For all rescuers, responders and staff involved Clear, practical and realistic Meet professional standards of care and responsibility

17 17 4. Training All involved staff Basic training Ongoing training Support and supervision Additional training: roles and responsibilities in the psychosocial stepped care model

18 18 4 Tier Model: Tier 1: General training Core knowledge, attitudes and skills All professional responders Tier 2: More advanced training Psychological first aid Basic psychological therapies Assessment Tier 3: Specialist training Staff provide more specialized services Training to supervise staff

19 19 Tier 4: Advanced specialist training Professionals :provide advice to major incident response commanders Training in disaster psychosocial and mental health care, major incident management, consultative skills etc Training should be tested through exercising Rehearsal (NHS, 2009) Drill

20 20 5. Psychological support to service providers Service Needs: First responders are vulnerable to the psychosocial and mental health consequences of disasters Through their work on disasters and major incidents. Through their own losses of loved ones, colleagues and homes Aim: reducing the psychosocial impacts on them Standard of care

21 21 Exposure to: Events On-site dangers Affected people s suffering Feelings of powerlessness inability help

22 22 Lack of skills or training Lack of supplies and equipment Poor role definitions and unclear expectations Poor organization of work Lack of support at work Unnecessarily poor conditions Poor scheduling of work Lack of opportunities for rest/recreation Unnecessary agency policies and practices Poor leadership and/or management practices Conflict and mistrust within and between teams Poor communications.etc

23 23 Aim: reducing the psychosocial impacts on them inherent stressors as far as possible non-inherent stressors Training and support to staff Strategic planning, preparation and leadership Provision of real-time supervision and support for staff Psychological first aid Specialized services: staff with sustained psychosocial problems Support in the recovery phase

24 24 Central Committee on Disaster Psychosocial Services Quality disaster psychosocial services: formulate policy, steer strategic direction, advise service development Fortify the preparedness and professional competency of HA s workforce Lead and coordinate management of disaster psychosocial services Develop Disaster Psychosocial Response Plans for local disasters and Emergency Response Operation Outside Hong Kong (EROOHK)

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