The Mental Health System Response to Avian and Pandemic Influenza

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The Mental Health System Response to Avian and
Pandemic Influenza

• Presented by Division of Mental Health Services,
• NJ Department of Human Services

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A Novel ThreatNo Existing Models for Mental
Health

• A comprehensive review of the literature yields
  no empirical studies addressing the behavioral or
  emotional consequences of avian or pandemic
  influenza.
• The concepts used today to discuss mental health
  and behavior were not in existence during the
  last great pandemic.
• The concepts discussed in this program are
  considered evidence-informed assumptions about
  the risk of a major avian influenza outbreak or
  pandemic, and the likely emotional and behavioral
  responses to such events.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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New Findings

• Recent research (Redefining Readiness other
  studies) suggest that the general population may
  not react to a public health crisis in the manner
  anticipated by emergency management
  professionals.
• This unanticipated behavior can
• Complicate pubic health and emergency medical
  responses
• Lead to greater physical harm for greater numbers
  of people
• Lead to higher rates of long-term mental health
  problems.
• You can find the Redefining Readiness study at
  http//www.cacsh.org/eptpp.html

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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Emotional Challenges

• There are many emotional challenges that may
  face individuals and families during avian or
  pandemic influenza. These challenges are not
  limited to the medical impact of a disease
  outbreak, but include reactions to
• Organizational and governmental response.
• The impact on society.
• Personal and global economic disruption.
• Pre-existing medical or mental health issues.
• Separation from natural sources of support.
• Loss of and grief for friends and/or family
  members.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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An Important Distinction

• It is important to make a clear distinction
  between
• Behavioral implications,
• and
• Emotional implications.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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Behavioral Responses

• Foreseeable behavioral responses may include
• Non-compliance with vaccination or medication
  orders.
• Resisting travel restrictions.
• Avoiding an area evacuating a community.
• Breaking quarantine and isolation.
• Civil unrest or rioting.
• Looting, theft and violence.
• Increasing alcohol, tobacco and drug use.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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Emotional Responses

• Foreseeable emotional responses to a
  devastating pandemic would likely involve serious
  mental health problems such as
• Fear and anxiety.
• Sadness and depression.
• Increased rates of suicide.
• Traumatic stress reactions.
• Complicated grief and bereavement.
• Any and all of these mental health problems
  may occur in both the diagnostic and
  sub-diagnostic range.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
8
Beyond Traumatic Stress Reactions

• Public Health crises (i.e., SARS, pandemic
  influenza, etc.) also result in different
  responses that are not seen in natural or
  technological disasters. Those include
• Multiple Unexplained Physical Symptom (MUPS)
• Misattribution of normal arousal
• Sociogenic illness
• Panic
• Surge in healthcare seeking behavior
• Greater mistrust of public officials
• These reactions further complicate and confuse
  the public health and medical response to the
  situation.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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Panic is related to the perception that there is
a limited opportunity for escape, a high-risk of
being injured or killed, or that help will only
be available to the very first people who seek
it.

• Panic is not typically seen in most disaster
  scenarios.
• Panic turns neighbor against neighbor.
• Panic is likely in a pandemic.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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Pandemic Timeline and Planning Framework
Disruption
Initial Panic
Second Wave?
Pandemic Alert
Pre-Pandemic
Maximum Disruption
Prolonged Recovery
Onset
Today
6-12 months
Time
Unknown
1-3 mos
6-12 months
Adapted from Connell, P., Banks and Avian Flu
Planning for a Possible Pandemic, 2006.
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Grief and Loss

• Several aspects of a pandemic and public
  health response may complicate grief and loss
  reactions. These include the
• Inability to see loved ones or say good-bye to
  those who may die in the hospital or while
  separated from family.
• Inability to retrieve the body for timely burial
  or funeral rituals.
• Shortage of caskets, burial sites or
  crematoriums.
• Mass stockpiling of corpses until burial or
  cremation can be facilitated.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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The Mental Health Response System

• The Disaster Terrorism Branch of the NJ
  Division of Mental Health Services has worked in
  concert with the Department of Health and Senior
  Services to develop an integrated mental
  health/public health response to a pandemic.
• A section of the New Jersey Pandemic Influenza
  (pages 56-66) describes anticipated mental health
  activities by pandemic phase.
• There are articulated roles for mental health
  services in all phases of a pandemic.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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The Mental Health Response System

• Efforts have begun to train disaster mental
  health responders in
• Psychological First Aid skills to address
  emotional and behavioral responses during a
  crisis.
• Hostility and Rage Management (HARM) to help
  deescalated angry and agitated individuals.
• Pandemic-specific Issues to better prepare them
  for responding to such a crisis.

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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NJs Disaster Mental Health System

• NJ has a long history of disaster mental health
  response, formally beginning in the late-80s
• Responses have included declared disasters
• 9/11
• Anthrax Postal System Attacks
• Hurricane Floyd
• 2004 Floods in Burlington and Camden Counties
• Hurricane Ivan along the Delaware River
• Also including non-declared disasters
• Seton Hall Dormitory Fire
• Edison Gas Line Explosion

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch
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For More Information

• Please contact the
• NJ Division of Mental Health Services
• Disaster Terrorism Branch
• Training Technical Assistance Group
• [phone]
• mhsttag_at_dhs.state.nj.us
• or
• www.disastermentalhealthnj.com

New Jersey Division of Mental Health Services
Disaster
Terrorism Branch