Sức khoẻ tâm thần trong thảm họa chương trình tâm lý

Mục này sẽ không Giúp bạn trở thành những chuyên giatư vấn viên về sức khỏe tâm thần trong tình huống khẩn cấp Nhưng sẽ giúp bạn Giúp đỡ Đánh giá được những yếu tố quan trọng trong phất triển dịch vụ sức khỏe tâm thần và chính sách đối với trong và sau Thảm Họa Đánh giá được những hỗ trợ về tâm lý trong một tình huống khẩn cấp

Sức khoẻ tâm thần trong thảm họa

Hoạt động : bài tập sau khi làm (3 minutes)

viết lên giấy nhu sau: từ thứ nhất, thứ hai, thứ ba

nghĩa ra trong đầu khi đề cập đến chương trình

tâm lý hay dịch dụ chăm sóc tâm thần

 Đánh giá được những hỗ trợ về tâm lý trong một

tình huống khẩn cấp

Chăm Sóc Tâm Lý Trong Khủng Hoảng Và Thảm Hoạ

 Tầm quan trọng của sinh kế ….chuyển khái niệm từ việc

cung cấp những cách giảm nhẹ ttkc thành:

 giảm sự cảm nhiễm

 quản lý nguy cơ

 Quy trình phụ hồi và tái kiến thiết sẽ ngày càng nhấn

mạnh đến khía cạnh tâm lý

CHĂM SÓC TÂM LÝ TRONG KHỦNG HOẢNG VÀ THẢM HỌA

Người sống sót

 Không: chỉ không chết

 Chất lượng cuộc sống:

 « kinh qua » kinh nghiệm mất mát

 cảm giác quan trọng nhất: vô vọng

CHĂM SÓC TÂM LÝ TRONG KHỦNG HOẢNG VÀ THẢM HỌA

Cuộc sống = có thể dự đoán

gia đình trường

học công việc xã hội

bạn bè mong đợi bản thân

dài kéo dài tuyến tính trải nghiệm

CHĂM SÓC TÂM LÝ TRONG KHỦNG HOẢNG VÀ THẢM HỌA

vô vọng

không có khả

năng tiên đoán hiện tại

đối mặt cái chết Trải nghiệm

cùng cực mất tích

đề cập đến động lực, tự liên hệ bên trong,

liên quan giữa suy nghĩ một người, cảm

giác, phản ứng cơ thể, và hành vi, và

những kinh nghiệm xả hội và văn hoá của h

ọ

tâm lý-xã hội (định nghĩa)

Can thiệp tâm lý được định nghĩa là

những can thiệp không sinh học nhằm thay thế

những rối loạn tâm thần và cải thiện sức khoẻ

cũng như thể chất

Yếu tố gây stress

biến cố hay sự kiện đưa đến những phẩn ứng

tâm lý hay thể chất của một các nhân cụ thể

dưới một điều kiện cụ thể

có thể đưa đến “tổn thương »

biến cố gây thương tích: một biến cố

liên quan đến những cái chết bị đe dọa và thật sự hay chấn thương nghiêm trọng, ha một mốt đa

dọa đối với sự tòan vẹn thể chất hay của bản

thân hay người khác Đáp ứng của một người

bao gồm sợ hãi mãnh liệt, vô vọng hay hỏang

loạn

Các yếu tố căng thẳng trong thảm hoạ

 yếu tố căng thẳng ban đầu

 diễn ra trong suốt tác động

 kinh nghiệm bản thân

 sẽ quyết định kết quả : chủ yếu là PTSD

 2 nhân tố chính:

 vô vọng & vô ích

 to counteract: EMPOWER - provide a holding environment

yếu tố stress ban đầu

 mức độ trầm trọng của yếu tố stress ban đầu:

 the amount of mastery possible

 tốc độ khởi phát

 the level of mastery possible/warning

 numerical scope of impact

will determine: helplessness / anxiety/ emotional storm/

hopelessness / inhibition / conflicts…….

SECONDARY STRESSORS important to consider to better managing the response and recovery phases

 destruction/ loss of home, property

 loss of job/ unemployment…

disruption of families, disruption of social network….

 breakdown of traditional network for of social support….

 disabilities…

 displacement of people, housing in camps….

 much grief

 disruption of community life

 destruction of sense of community (refugee)

 hardship stress, human negligence, violence, little support

They contribute to NEW MORBIDITY ……….

PSYCHOLOGICAL RESPONSE

 depends on 3 main factors :

 type of disaster: characteristics of the disaster….

 the community/ family/ network of the person:

 characteristics of the post-disaster response

 characteristics of the recovery process

 the victims’/ survivors’ characteristics:

 vulnerable groups : elderly, children, bereaved

families…

 previous life events

Factors which affect the outcome of a stressful

– interpretation of the situation

– types of support systems in the community

Behavior that protects the individual from internal

and external stresses; coping behavior implies

adaptation, defense, mastery

Coping mechanisms : avoidance, alteration,

management, prevention, and control of undue

emotional expression

Crisis

A crucial period or turning point in a person’s life that

has both physical and emotional consequences A crisis

is a time-limited period of psychological

disequilibrium, precipitated by a sudden and

significant change in an individual’s life situation This

change results in demand for internal adjustments and

the use of external adaptation mechanisms that are

temporarily beyond the individual’s capacity

Its meanings vary according to individuals and

societies

Culture has a very big influence in

defining the way people cope with

stressors and emergencies

Social Support System

The group of individuals who influence each

other’s lives by fulfilling specific human

needs For the individual the social network

provides respect approval and self-definition

The linkages in a social network of supports

depend upon the type and quality of

communication among members of the

community

SEVERE TRAUMATIC EVENTS

 In the specific situation of refugee add one more concern =

important to ask carefully about severe traumatic events such

as:

 torture

 sexual assault , rape

 other physical violence

 any serious event the refugee has gone through

Specific rehabilitation programs CONSIDER

STRESS DIFFERENTIAL DIAGNOSIS

important to make the differential diagnosis between

1. stress related problems

2. somatization (chronic complaints)

3. anxiety disorders

4. depression and risk of suicide

5. physical illness

6. people who use drugs

7. Severe psychiatric disorders

support programs should be designed to

deal with all these aspects

support programs should be designed to

deal with all these aspects

activities of immediate support :

 to give comfort and support

 to make psychological triage

 to identify those involved

 to care for the vulnerable ones:

 elderly

 disabled people

 ……….



activities of immediate support :

to respond to practical needs :

 accommodation / food / clothing / transport / child care /

funerals….

 contact with relatives

 to give support to relatives

 to collect and give information

Outreach programs

 3 major components

 identification of the affected (individuals / community)

 communication (more than just information of the

availability of resources)

 willingness of the survivors to follow-through

 methods for outreach activities implementation :

 immediate post-impact

 first month / long term

 methods to promote outreach activities

Pre-Incident Phase What should we do ?

Preparedness

Detailed preparedness plans for social and mental health

response system of coordination with focal points from various agencies and NGOs

training of relevant personnel as mental health workers

integration of plan to PHC system accessible to all in the

community not just to sub-populations exposed to certain

stressors include medium and long term perspectives

monitoring indicators – integrated to health information system

Risk Communication Program for a particular natural hazard

or emergency

Post-Incident Phase What should we do ?

Valuable Early Social Interventions include :

establish and disseminate ongoing reliable flow of

information on the emergency

efforts to establish physical safety for the population

information on relief efforts including what each organization

is doing

location of relatives to enhance family reunions

information should be distributed according to the principles

of risk communication understandable to the young

population and empathic

Valuable Early Social Interventions include :

• Organize family tracing – particularly for children, elderly and

vulnerable groups

• Organize shelter

• Consult community on all issues like location of important

places (e.g., school, religious places) in the camp

• If realistic discourage unceremonious disposal of dead bodies

• Encourage the conduct of religious and cultural events related

to grieving

• Encourage activities that facilitate the inclusion of orphans

widows, widowers , or those without their families into social

networks

Post-Incident Phase What should we do ?

Valuable Early Social Interventions include :

For children

return to school, recreational activities- do not hand out

recreational items that were considered luxury items

pre-disaster involve adolescents and children in community

activities

Communicate widely the normal stress reactions to the

community at large and emphasize natural recovery

Post-Incident Phase What should we do ?

Valuable Early Psychological Interventions include :

• establish contact with PHC and emergency care in the local

area manage urgent psychiatric complaints

• ensure availability of essential psychotropic medications

particularly for people with pre-existing psychiatric

conditions

• however most acute mental health conditions during the

acute emergency phase are best managed without

medications

• listening, convey compassion, assess needs, ensure basic

physical needs, do not force talking

• organize non-intrusive emotional support- no forced

one-on-one interviews and discussion

• if acute phase is protracted start training and supervising HC

workers

Rebuilding or Reconsolidation Phase : What should we do ?

Continue relevant social interventions

Conduct outreach mainly public health education on available

mental health services and on normal psychological distress

avoiding suggestions of wide scale presence of

psychopathology and avoiding jargon and idioms that carry

stigma; emphasize positive ways of coping

Encourage development and livelihood initiatives of which the

community are engaged

Rebuilding or Reconsolidation Phase : What should we do ?

Psychological Interventions Educate humanitarian workers and community leaders in

psychological care skills

Train and supervise PHC workers in basic mental health

knowledge and skills

Ensure continuation of psychotropic medication for

psychiatric patients

Rebuilding or Reconsolidation Phase : What should we do ?

Psychological Interventions

Train and supervise community workers to assist Health workers

in the following skills:

assessments of individuals, families and groups

psychological first aid

providing emotional support

stress management

problem solving counseling

referral

Development phase

All these are suggested for implementation in synergy with

ongoing mental health system development priorities

Work towards developing or strengthening feasible strategic

workplans

strengthen PHC and general hospital psychiatric care

strengthen family care of persons with chronic and severe

mental health disorders

Work towards proper and relevant national mental health

legislation and policy – the long term goal is a public health

system with mental health as a core element

Issues to think about in developing a mental health

intervention/program in emergency situations

Basic Program Management Issues

staff organizational structure funding

PSYCHOLOGICAL CARE IN CRISIS AND DISASTERSKEY MANAGERIAL ISSUES

 early intervention is needed :

 pro-active do not wait survivors asking support

 include elements of:

crisis counseling social support psychological support linked with recovery programs CISD

 culturally adapted

 community based

integration of mental health within the framework of primary

care reasons for that :

 many potential users do not come to a facility which is

openly labeled as « mental health » service

 a large majority of « cases » of psychological distress

among attendees of health centers :

 go unrecognized

 do not receive proper care

 represent an important burden for the health services

 better prompt recognition and management of these disorders, including PTSD, can improve their

outcome and reduce the burden on the health services

integration of mental health within the framework of

primary care:

 The primary health care network = central position in the

community – can guarantee proper follow-up of victims and

their families for as long as they need

community based work

 it is especially important to work at community

level when a disaster involves a community or

big sections of the community directly

 to achieve this goal involves:

 facilitating the participation of the

community in :

 planning

 reconstruction projects

 memorials

 responding to media enquiries

 a traumatic event tend to reinforce whatever

existing divisions there are in the community

Vulnerable groups

 people with sensory impairment

 those with learning difficulties

 children

 old people

 the physically handicapped

 those with psychiatric disorders

 those who have been multiply bereaved

 those who see themselves as responsible for the disaster

 those facing tremendous loss (secondary stressors ++)

Plan for them

Groups at risk : CHILDREN

children may experience other psychological problems

such as:

 anxiety : especially separation anxiety

 intense distress when absent from a parent

 anxiety at the threat of even short separations previously well tolerated

Groups at risk : CHILDREN children –especially the adolescents- may not let their parents

know their suffering in order to avoid upsetting a person they

perceive vulnerable In consequence :

 protect children / avoid separating children

 allocate a helper specially for children

 screening for signs of psychological problems

 bereaved counseling

 group counseling for children should be available If that is

impractical, individual and family counseling

 help parents to help children

MANAGEMENT - AGENCIES

 managers should be aware of potential problems and should

anticipate : need for organized organizational coordination

 defining a « core » preparedness for agencies

 plan for development of agencies

 education and training

MANAGEMENT - AGENCIES

Network requirements

 the network of :

– social services

– psychosocial services, psychological services

– other community services

requires:

regular revision training

exercising of plans regular revision of the composition, roles and functions

 the network requires the development of :

 a social and a psychosocial plan dealing with :

 initial response

 longer term response

 recovery and sustainable development

 this plan should be fully compatible with the emergency plan

 consider cross boundaries issues such as :

 liaisons with other authorities

 facilitate the setting up of joint and complementary support services

 disasters are not confined to organizationally convenient boundaries

MANAGEMENT - AGENCIES crucial point

 in organizing the support = consideration of :

– the different ethnics

– the local cultural or religious specificity

– the community bounds

 it is important to identify workers :

– from different ethnic backgrounds

– who are sensitive to different customs and beliefs

Agencies must know what they are before entering the

network

 central questions to be answered :

 potential risks / crisis / hazards

 who will be affected - how

 what organization are appropriately involved in social care following a disaster?

psycho- what are the « agency’s responsibilities »?

 what would be the effect of inaction (for community /

agency)

 how will the crisis affect the normal work load

 what strategies will be effective and when

 are the resources available and is the will to act present

 what will be the cost : financial – resources - personnel…