Distress vs Disorder Mental Health and Psychosocial support

Distress vs. Disorder Mental Health and Psycho-social support in Disasters in the Caribbean Dr Nelson Clarke 24 th April 2012

The Caribbean � A conglomerate of island states � Share many similarities, similar histories, development problems, reliant on tourism � Many differences between and within states, ethnicity, language, religion, culture � Colourful, musical, laidback, fun-loving, (Carnival, Junkanoo, Fete) � Deficiencies in infra-structure � Significant poverty, pockets of wealth within countries � Widespread belief in the occult, mystical beliefs � Mystical beliefs about mental illness is widely prevalent � Many myths exist regarding the causes, treatment and possibility of recovery

Only 10% of people experience significant symptoms �Although disasters have been associated with the development of psychological symptoms, few people end up with mental illness as a direct consequence �Psychological Reactions to the disaster, on the other hand are common and should be expected.

Anxiety is common �Most people experience anxiety during and after a disaster �It usually resolves over time �No specific treatment is required �In some individuals somatic complaints may be predominant

Common reactions of adults during the impact and immediate post disaster period • • • Feeling dazed or numb Feeling shocked Shaking and trembling Feeling anxious and fearful Feeling vulnerable and unsafe Feeling easily upset Being emotional, crying, Irritability Anger Feeling detached/its unreal/ it’s a dream Recklessness and unnecessary risk taking

The Acute Reactions to Stress � These are very common � Usually recede over a few weeks � After a month there is appreciable improvement � They may serve an adaptive function � They do not need “treatment” � Support by family, friends, others in the community is sufficient to help � Not good to medicalize these reactions

Most severe Psychological Reactions eventually improve over time � Disasters may result in widespread psychological distress � Severity of reactions may relate to perceived losses or possibility of further risk � Avoid premature labeling of persons � Support within the community is very important in assisting people in handling their reactions to a disaster � People still experiencing severe reactions after a month with no appreciable improvement need to be carefully evaluated

Stigma against those with mental health problems is still an issue �People experiencing significant mental health problems may experience ridicule, persecution, exclusion �It might be difficult for them to accept that they need help, given the risk of ridicule and stigma �Stigma against the mentally ill is widespread

Clues to Identifying severe mental disorders �Inability to self care �Inability to look after one’s children or dependents �Presence of delusions �Hallucinations �Threats to harm self �Attempts to harm self �Compulsive use of mind altering drugs �Expressions of violent intent, threats made to others �Actual violent behaviour

Individuals of all ages are likely to experience psychological reactions to a disaster or traumatic event �The emphasis most often is on the adult population �Some groups are forgotten, the elderly, the young, those with physical and sensory impairments, �People with pre-disaster mental illness are often forgotten in the confusion that occurs after a disaster

Mental Disorders should be diagnosed using specific diagnostic criteria �Depressive Illness �Bipolar Illness �Anxiety Disorders (Phobias, Panic Disorder, Generalized Anxiety Disorder, OCD, PTSD) �Post Traumatic Stress Disorder �Substance Dependence Disorders ( Alcohol, Cannabis, Benzodiazepines e. g. Ativan, Valium) �Psychotic Illness (Psychosis)

When Disorder is suspected �Evaluation should be carried out in the primary care setting �Strongly recommended that specific criteria are used to diagnose disorders/illnesses �WHO-mh. GAP strategies are helpful and can be utilized by primary care health personnel in managing persons diagnosed with mental health disorders

Mental Distress or Mental Disorders? The 2 D’s Distress Disorders Common � A response to environmental challenges � May be adaptive – drives personal and community responses � Usually short term and– does not significantly impair functioning for long � Should not be “diagnosed” � Usually does not require professional intervention – no therapy, no medications � Usually responds well to “usual” personal and community supports and positive lifestyle activities � Encouragement to rapidly return to “usual” activities Less common � Frequently onsets without environmental challenges � Frequently long term (may be chronic and episodic) – significant functional impairment � Must meet recognized diagnostic criteria (ICD; DSM) � Frequently requires professional intervention – many different types � Usually responds well to evidence based treatments � Usually helped by appropriate supports and positive lifestyle activities

Summary �Disasters often result in widespread reactions of anxiety, depressed mood and hightened vigilence �Most people recover without developing a mental illness. Most people are helped by friends/ family support �Psychological First Aid should be available for everyone �Care should be taken not to overdiagnose/estimate mental illness developing after a disaster �After a month most persons are very aware of their progress

Summary �Forgotten people, the homeless, elderly, children, immigrant populations, persons who have preexisting mental illness (those in the community and in mental hospital) are often overlooked �When mental illness is suspected specific criteria need to be utilized in diagnosing the disorder �Treatment in the primary care setting is best, and health care personnel may use the strategies in mh. GAP to assist in managing identified disorders.