Bioterrorism, stress, and pain: the importance of an anticipatory community preparedness intervention

This article reviews the accumulating scientific evidence demonstrating the negative impact caused by a cataclysmic event, such as bioterrorism, on the mental health of a community. Moreover, the potential mental health problems created by the continuing threat of possible future events are discussed. This close link among disaster events, stress, pain, and psychopathology is presented from a biopsychosocial perspective. Although there are now efforts being systematically developed to prepare for possible future biological or chemical terrorism events, there is currently also a critical need for early mental health intervention in response to future attacks to decrease psychiatric sequelae, especially workforce illness and morbidity. In this article, examples of such emergency bioterrorism preparedness, incorporating a major focus on mental health issues, are reviewed. Although these are now recognized needs, there is still not a concerted effort to prepare the population for the mental health sequelae that would be produced by such events.     

An integrated approach to workplace mental health: an Australian feasibility study

We developed and implemented an integrated workplace mental health promotion intervention combining job stress reduction with a workplace mental health literacy program. The intervention was evaluated using an uncontrolled design, with organizationorganisation-wide census employee surveys of working conditions and mental health literacy pre-intervention, followed by a 1-year action planning and intervention period, then a post-intervention survey. All employees were invited to be surveyed, and all respondents were included in analysis, independent of participation in intervention activities or employment status (44% response rate at baseline, 37% at final). No significant changes were observed in the targeted psychosocial working conditions – job control, job demands, and social support at work. In contrast, significant improvements in some aspects of mental health literacy were observed, particularly in helping behaviours. Acknowledging the limitations of this being an uncontrolled pilot study, our results suggest that it is feasible to integrate job stress and mental health literacy intervention, as well as evidence of sustained improvements in mental health literacy and the need for more intensive and sustained efforts to improve psychosocial working conditions.     

Bioterrorism Preparedness Survey of Hawaii Mental Health Professionals

The purpose of this study is to assess the objective knowledge of mental health professionals in Hawaii related to evidence-based early psychological interventions for victims of mass trauma as well as their perceived response readiness to a bioterrorism associated event. During June and July 2004 an anonymous survey was mailed as many as three times to a random sample of licensed psychologists and social workers residing in Hawaii (n = 273). The response rate for deliverable surveys was 68 percent (176 of 257). Only 10 percent of respondents reported prior bioterrorism preparedness training. Less than 50 percent felt able to identify and manage populations exhibiting the normal range of stress reactions to a bioterrorist event, and only 19 percent felt able     

Incorporating Community Mental Health into Local Bioterrorism Response Planning: Experiences from the DeKalb County Board of Health

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.     

Family burdens, Chinese health beliefs, and the mental health of Chinese caregivers in Hong Kong

This study explored the types of family burdens, mental health and Chinese health beliefs of Chinese caregivers with relatives suffering from a serious mental illness. It also examined the impacts of these beliefs on caregivers' burdens and mental health. A structured questionnaire was administered to 125 Chinese caregivers in out-patient clinics in Hong Kong. Measures included distress (General Health Questionnaire), family burdens and belief in traditional Chinese medicine. Family burdens exerted a significant impact on the mental health of caregivers. Significant differences were found between believers and non-believers of traditional Chinese medical beliefs in terms of financial burdens, disruptions to family interactions and decline in physical health. No [corrected] moderating effect of Chinese health beliefs on family burdens and mental health was found. The lack of a moderating effect of health belief on family burdens may be related to caregivers' changes in perspectives from a traditional Chinese cultural perspective to a psychosocial and personality perspective. Implications for research and service development are discussed.     

Participation in planning and evaluating mental health services: building capacity

The participation of people who use mental health services in service planning and evaluation has become increasingly important in recent years. Health planners and people who use services are seeking information about how to enable participation that is meaningful and impacts positively on service delivery. This qualitative study explored the perspectives of people who use mental health services on participation in mental health service planning and evaluation. Sixty-three people from diverse backgrounds participated in either a focus group or interview. Themes were extracted from the data and resulted in a conceptual framework that can be used to guide the development and evaluation of participation.     

飞行员心理健康状况及相关心理社会因素的调查研究

目的探讨心理社会应激因素与飞行员心理健康的关系,为开展心理健康教育和提高军事训练的效率提供科学依据。方法对421名健康疗养飞行员进行问卷调查,包括症状自评量表（SymptomChecklist90,SCL-90）、卡特尔16种人格问卷（Cattell’S16PersonalityFactors,16PF）、社会支持评定量表（SocialsupportRatingScale,SSRS）、紧张性生活事件评定量表（StrainedLifeEventRat—ingScale,SLERS）,并采用SPSS11．0作相关／回归分析。结果飞行员自身的多项性格特点、获得的社会支持、经历的多项紧张性生活事件与其心理健康水平均有相关性;多元回归分析显示,负性的人际关系问题、负性的工作经济问题、负性的学习问题、负性生活事件年心理紧张度,性格特点中紧张性、稳定性、忧虑性、敢为性以及其自身健康等级是影响军事飞行员心理健康的主要因素。结论心理应激有关因素对飞行员心理健康有重要影响。     

Supporting Mental Health and Wellness among Private School Students: A Survey of Catholic Elementary and Secondary Schools

Little systematic inquiry has focused on school-based mental health services in the Catholic education sector, which educates more than two million children annually in the United States. More than 400 Catholic elementary and secondary schools were surveyed to inform a baseline environmental scan measuring how Catholic schools nationally are serving children's mental health needs. The article sheds light on patterns of mental health staffing and resource provision, student psychosocial and mental health issues, mental health service provision, and barriers to and challenges of mental health service provision. The findings are contextualized by comparison with estimates of public school mental health service provision, consideration of funding issues pertinent to the private school sector, and the continuing need for strategic assessment and action planning to support student mental health.     

Needs and utilization of mental health services in schizophrenia

The planning of mental health treatment for people with severe mental disorders constitutes a major public health problem and an important social challenge. This study aims to identify the needs and to describe the utilisation of 20 services or modalities of mental health treatment among a schizophrenic population living in the Estrie region of Quebec. The results confirm that the needs are great and show that the most important deficiencies are in the psychosocial and readaptation services. The implications of these results with regard to the organisation of mental health services for schizophrenics are briefly discussed.     

Cultural diversity in the integration of disaster mental health and public health: a case study in response to bioterrorism

Disaster leads to severe disruptions of the coping capacities of the community. Terrorism, and in particular bioterrorism, has tremendous impact on the community that is affected Cultural groups present unique issues that need to be appreciated for the effective integration of disaster mental health services with public health. The following paper identifies unique issues and challenges of cultural groups in disaster. It highlights issues such as language, cultural interpretation and expression of grief, and help-seeking behavior, as well as inherent cultural resources that can promote resilience. The implications of these cultural issues are illustrated in a potential bioterrorist event, addressing the areas of surge capacity, mass quarantine, and risk communication. Next steps are identified in promoting greater cultural competency in the integration of disaster mental health and public health, thus building greater community resilience.     

Mental health response in Haiti in the aftermath of the 2010 earthquake: a case study for building long-term solutions

Significant challenges exist in providing safe, effective, and culturally sound mental health and psychosocial services when an unforeseen disaster strikes in a low-resource setting. We present here a case study describing the experience of a transnational team in expanding mental health and psychosocial services delivered by two health care organizations, one local (Zanmi Lasante) and one international (Partners in Health), acting collaboratively as part of the emergency response to the 2010 Haiti earthquake. In the year and a half following the earthquake, Zanmi Lasante and Partners in Health provided 20,000 documented individual and group appointments for mental health and psychosocial needs. During the delivery of disaster response services, the collaboration led to the development of a model to guide the expansion and scaling up of community-based mental health services in the Zanmi Lasante health care system over the long-term, with potential for broader scale-up in Haiti. This model identifies key skill packages and implementation rules for developing evidence-based pathways and algorithms for treating common mental disorders. Throughout the collaboration, efforts were made to coordinate planning with multiple organizations interested in supporting the development of mental health programs following the disaster, including national governmental bodies, nongovernmental organizations, universities, foreign academic medical centers, and corporations. The collaborative interventions are framed here in terms of four overarching categories of action: direct service delivery, research, training, and advocacy. This case study exemplifies the role of psychiatrists working in low-resource settings as public health program implementers and as members of multidisciplinary teams.     

The prediction of mental health service use in residential care

The purpose of this study was to characterize the clinical and psychosocial factors of residents living in psychiatric nursing homes, assess residents' levels of mental health service utilization, and examine the factors that predict the utilization of mental health services. Data were collected from 200 randomly selected residents with schizophrenia living in four intermediate care facilities. Fewer than 60% of residents received mental health services beyond medication and nearly one-half of the residents were readmitted to the hospital in the course of a year. Family contact and involvement in activities were associated with mental health service utilization. Hospital readmission was predicted, not by substance use, but rather by not using substances. There is a growing need among service providers to better identify relevant factors that are important in treatment planning and service delivery. Attention to these issues may impact treatment provision and outcomes for persons with schizophrenia and their families.     

The psychobiology of PTSD: coping with trauma

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.     

Combining evidence-based practice with stakeholder consensus to enhance psychosocial rehabilitation services in the Texas benefit design initiative

This article describes the use of evidence-based practice along with a multi-stakeholder consensus process to design the psychosocial rehabilitation components in a benefit package of publicly funded mental health services in Texas. The Texas Benefit Design initiative demonstrates how the combination of science and consensus can be used as a powerful tool for change. It applies the findings of rigorous research regarding psychosocial rehabilitation service delivery approaches that achieve positive outcomes in real world, community settings. At the same time, it makes use of the unique knowledge and experience that mental health service consumers, providers and other advocates can bring to service system design and planning.     

Comparisons between schizophrenia patients recruited from Australian general practices and public mental health services

OBJECTIVE: To examine differences between samples of schizophrenia patients recruited from general practice and public mental health services. METHOD: Demographic, psychosocial, disability and 12-month service utilization data are reported from a multicentered survey of psychotic disorders and an associated study of schizophrenia in general practice. Patients with schizophrenia from three recruitment sources (in-patient, community services, general practice) were compared. RESULTS: General practice patients had fewer symptoms, better functioning, lower service use, but comparable substance abuse, to patients from mental health services. They were generally similar to community mental health patients, with the exception of family support, premorbid work adjustment, negative symptoms and disability. Service contact models are also reported which demonstrate that general practitioners deal with schizophrenia patients across the range of illness severity and acuity. CONCLUSION: Recruitment source impacts in schizophrenia research need to be more carefully considered during sample selection and better accounted for in the interpretation of results.     

Measuring consumer participation in mental health services: are attitudes related to professional orientation?

This study describes the development of the Consumer Participation Questionnaire to measure consumer involvement in the planning, management and evaluation of mental health services, and the attitudes of mental health workers towards consumer participation. Results indicate that while most professionals view the concept positively, progress may be occurring faster at the level of individual treatment than at the organisational level. Professionals with a more biological (as opposed to psychosocial) orientation were less likely to predict that services would improve if consumers were involved in the planning of services or were employed therein. Recommendations to facilitate more effective consumer participation are made, including the need for the value of a collaborative approach to be emphasised in professional training programmes.     

Mental health and psychosocial support after the tsunami in Thailand

This article presents an overview of the psychosocial and mental health response after the Asian Tsunami hit Thailand in 2004. The organization and deployment of service modalities that used pre-existing community and school advisory programmes for rapid emergency response were seen as key elements of the response. Mental health programmes were provided to mitigate and ameliorate the effects of the catastrophic event. We describe these strategies and report on lessons learnt.     

Mental health and psychosocial support after the tsunami in Thailand

This article presents an overview of the psychosocial and mental health response after the Asian Tsunami hit Thailand in 2004. The organization and deployment of service modalities that used pre-existing community and school advisory programmes for rapid emergency response were seen as key elements of the response. Mental health programmes were provided to mitigate and ameliorate the effects of the catastrophic event. We describe these strategies and report on lessons learnt.