Download Chapter 8 - Distress vs Disorder

Distress vs. Disorder
Mental Health and Psycho-social support
in Disasters
in the Caribbean
Dr Nelson Clarke
24th 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-mhGAP 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
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
Disorders
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
If people are not improving then, an evaluation by a
competent primary healthcare worker is needed
Summary
 Forgotten people, the homeless, elderly, children, immigrant
populations, persons who have pre-existing 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 mhGAP to assist in
managing identified disorders.