Redefining the Management of Mental Health Issues in Disasters: Experiences from Belize. Eleanor Davis Bennett, MMHPS Psychiatric Nurse Practitioner

Transcription

1 Redefining the Management of Mental Health Issues in Disasters: Experiences from Belize Eleanor Davis Bennett, MMHPS Psychiatric Nurse Practitioner

2 Mental Health Psychosocial Support The mental health and psychosocial wellbeing of survivors is affected With time, most of those affected will manage to recover on their own Others will need more attention, care, and treatment. 2Mental Health and Psychosocial Support in Disaster Situations in the Caribbean (PAHO)

3 Mark 3Van Ommeren, WHO, Geneva

4 Objectives of Mental Health Care and Psychosocial Support in Emergencies To eliminate or reduce the risk of suffering psychosocial injury; To reduce distress among the population; To contribute to prevention and control of the range of social problems arising among the population, especially among those most affected; Mental Health and Psychosocial Support in Disaster Situations in the Caribbean 4(PAHO)

5 Objectives of Mental Health Care and Psychosocial Support in Emergencies Cont d To prevent, treat, and rehabilitate the mental disorders occurring as a direct or indirect consequence of the disaster or emergency; To provide support and psychosocial care for the members of the response teams; To ensure the psychosocial recovery of the population affected by the disaster after the acute phase. 5 Mental Health and Psychosocial Support in Disaster Situations in the Caribbean (PAHO)

6 Belize Mental Health Program Human Resource: 18 Psychiatric Nurse Practitioner (PNPs) 2 Psychiatrists 1 Psychologist 1 social worker 12 Psychiatric Nurses Aides 6

7 Facilities One Mental Health Clinic in each of the urban areas of six Districts (Belize city has 2) total of 9 clinics 1 Day Hospital/Drop-in center (Belize City) Long-term psychiatric care facility for 38 residents (Belmopan City) Psychiatric Beds at General hospital Community Treatment Team CTP (Belize City) 7

8 Mental Health Services/Activities 8 Hospital services Emergency Consultation Liaison Inpatient admissions Primary Health Care Mental health clinics located within health centers Community services Drop-in center Community treatment Mobile clinics Mobile clinics to rural communities and offshore cayes conducted once or twice a month Mental health promotion Media Schools Community groups Teaching and Training Nursing students (practicum) Psychological First Aid Mental health training for police officers

9 Belize - Disaster Statistics 9

10 Mental Health in Multi-Sector Health Response In the past the Ministry of Health organized and dispatched multi-sector post disaster response teams to affected communities Teams included: Medical Officers Public Health Inspectors Psychiatric Nurse Practitioner Public Health Nurse Others 10

11 Role of PNP on Disaster Response Teams Example of Hurricane Iris in 2001 Alleviate unpleasant feelings, psychological suffering Provided emotional support and comforting Identify survivors that may need psychiatric intervention Referrals received from Red Cross, Human Development, public health and community persons Collaborate with multi-sector team to help meet the immediate needs of survivors Referred survivors who needed shelter, food, water, clothing and medicines to the Red Cross, human development, public health 11

12 Difficulty with this approach Reduction in mainstream access to psychiatric care due to disruption of services Persons requiring mainstream mental health services could not access them because clinic was closed Inappropriate us of resources Specialized nurses (PNP) were providing basic/non-specialist psychological care 12

13 Difficulty with this approach PNPs performed a formed of psychological debriefing called critical incident stress debriefing Recent evidence does not support the use of this technique for large populations and further suggests that it may be potentially associated with more adverse outcomes Duplication of services Several entities were providing similar services e.g. Red Cross, Human Services, etc. 13

14 The Project PAHO with support of the Canadian International Development Agency (CIDA) providing funding and technical cooperation to Caribbean countries aimed at strengthening the capacity of countries and professionals to deal with mental health issues in disasters 14

15 Recommendations for inclusion MH Plans Update national mental health policies, plans and legislation, as appropriate, promoting investments and initiatives that consider the medium- to long term vision; Provide mental health care to emergency-related and pre-existing mental disorders through general health care and community-based services; Ensure sustainability of newly established mental health services; Promote the inclusion of mental health services/units in newly built facilities community health centers, general hospitals; Facilitate community-based care for people in psychiatric institutions; Training and development of skills to work in community settings to existing mental health staff; Ensure a mental health component in training programs for PHC practitioners. 15

16 The Project Pilot application started in Belize and Suriname in 2008 Development of MHPSS component of national health disaster plan Training of health sector staff and stakeholders in topics related to MHPSS in disasters Participation in preparation of book and training materials on Mental Health and Psycho-social Support in Disasters in the Caribbean Montserrat, British Virgin Islands, St. Vincent and the Grenadines and Trinidad and Tobago were supported to develop similar plans during 2011 and Anguilla, Antigua and Barbuda, Jamaica and Barbados have started the process in (PAHO) 16

17 Elements of the National Mental health Disaster Plan Objectives To organize and coordinate support services, and establish the roles of the different actors in mental health in disaster preparedness and response within the national emergency framework To ensure training for all responders on how to provide psychological and psychosocial support to affected communities. To avoid disruption of mental health services. 17

18 Strategies 1. Integrate and promote the use of primary health care (PHC) in the delivery of mental health services in emergencies and disaster response 1. A two-day training for 55 primary health care providers and a one day training for 20 mental health first responders staff were held (Montreal WHO-PAHO Collaborating Centre ). 2. A 13-week mental health training which included disaster mental health for community nurses was done by the UWI satellite campus in Belize 18

19 Strategies 1. Develop awareness training and educate responders about disaster preparedness and response. Six one day training sessions with 60 community health workers from all district; A one day training with 48 first responders from the district emergency management organization (DEMO) in Corozal 19

20 Strategies Facilitate community self-care and social support Two different brochures explaining main concepts of mental health in emergencies were also printed and distributed to health and community workers. Two educational videos on mental health and disaster were developed for radio and television

21 Strategies Train first responders in Psychological First Aid (PFA) Belize has recently (September/November) trained143 Community Health Workers on Psychological First Aid (PFA). PFA- intervention that is considered appropriate for this emergency phase and its immediate aftermath (Rafael, 1977; NIMH 2001) The evaluation of the experience is being considered as a final step in the context of this project. 21

22 Some Other Positive Impacts A trigger to strengthen the mental health system in the country: Suriname - national mental health policy/plan almost complete Trinidad plans for national trauma center Improved disaster response greater awareness better coordination and better informed/trained: Belize hurricane season 2010 Greater efficiency in use of limited MH resources in disasters The mental health professionals focused on those cases that need specialized care 22

23 Thanks to PAHO and Canadian International Development Agency (CIDA ) for financial and technical contribution to this program. 23

24 References Mental Health and Psychosocial Support in Disaster Situations in the Caribbean core knowledge for emergency preparedness and response (PAHO 2012) NATIONAL MENTAL HEALTH and PSYCHOSOCIAL DISASTER PREPAREDNESS AND RESPONSE PLAN (Ministry of Health, Belize) 24