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Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico

Published online by Cambridge University Press:  20 August 2019

Julio C. Jiménez Chávez*
Affiliation:
Ponce Health Sciences University and Ponce Research Institute, Ponce, Puerto Rico
Esteban Viruet Sánchez
Affiliation:
Ponce Health Sciences University and Ponce Research Institute, Ponce, Puerto Rico
Fernando J. Rosario Maldonado
Affiliation:
Ponce Health Sciences University and Ponce Research Institute, Ponce, Puerto Rico
Axel J. Ramos Lucca
Affiliation:
Ponce Health Sciences University and Ponce Research Institute, Ponce, Puerto Rico
Barbara Barros Cartagena
Affiliation:
Ponce Health Sciences University and Ponce Research Institute, Ponce, Puerto Rico
*
Correspondence and reprint requests to Julio C. Jiménez, PO Box 7004, Ponce, PR, 00732-7004 (e-mail: [email protected]).

Abstract

Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.

Type
Concepts in Disaster Medicine
Copyright
© 2019 Society for Disaster Medicine and Public Health, Inc.

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References

REFERENCES

Aitsi-Selmi, A, Egawa, S, Sasaki, H, et al. The Sendai Framework for Disaster Risk Reduction: renewing the global commitment to people’s resilience, health, and well-being. Int J Disaster Risk Sci. 2015;6(2):164176. doi: 10.1007/s13753-015-0050-9CrossRefGoogle Scholar
Goldmann, E, Galea, S. Mental health consequences of disasters. Annu Rev Public Health. 2014;35(1):169183. doi: 10.1146/annurev-publhealth-032013-182435CrossRefGoogle ScholarPubMed
Brown, P, Daigneault, A, Tjernstrom, E, et al. Natural disasters, social protection, and risk perceptions. World Dev. 2018;104:310325. doi: 10.1016/j.worlddev.2017.12.002CrossRefGoogle ScholarPubMed
Kishore, N, Marqués, D, Mahmud, A, et al. Mortality in Puerto Rico after Hurricane Maria. N Engl J Med. 2018;379(2):162170. doi:10.1056/nejmsa1803972CrossRefGoogle ScholarPubMed
Fink, G. Stress: definition and history. In: Squire, LR, ed. Encyclopedia of Neuroscience. Vol. 9. Oxford, England: Academic Press; 2009:549555. doi: 10.1016/b978-008045046-9.00076-0CrossRefGoogle Scholar
Davis, JR, Wilson, S, Brock-Martin, A, et al. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;4(01):3038. doi: 10.1017/s1935789300002391CrossRefGoogle ScholarPubMed
Joseph, NT, Matthews, KA, Myers, HF. Conceptualizing health consequences of Hurricane Katrina from the perspective of socioeconomic status decline. Health Psychol. 2014;33(2):139146. doi: 10.1037/a0031661CrossRefGoogle ScholarPubMed
Osofsky, HJ, Hansel, TC, Osofsky, JD, et al. Factors contributing to mental and physical health care in a disaster-prone environment. Behav Med. 2015;41(3):131137. doi: 10.1080/08964289.2015.1032201CrossRefGoogle Scholar
Martin, U. Health after disaster: a perspective of psychological/health reactions to disaster. Cogent Psychol. 2015;2(1). doi: 10.1080/23311908.2015.1053741CrossRefGoogle Scholar
Lowe, D, Ebi, K, Forsberg, B. Factors increasing vulnerability to health effects before, during and after floods. Int J Environ Res Public Health. 2013;10(12):70157067. doi: 10.3390/ijerph10127015CrossRefGoogle ScholarPubMed
Rhodes, J, Chan, C, Paxson, C, et al. The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans. Am J Orthopsychiatry. 2010;80(2):237247. doi: 10.1111/j.1939-0025.2010.01027.xCrossRefGoogle ScholarPubMed
Ford, ES, Mokdad, AH, Link, MW, et al. Chronic disease in health emergencies: in the eye of the hurricane. Prev Chronic Dis. 2006;3(2):A46. http://www.cdc.gov/pcd/issues/2006/apr/05_0235.htm. Accessed July 23, 2018Google ScholarPubMed
Lowe, SR, Kwok, RK, Payne, J, et al. Why does disaster recovery work influence mental health?: pathways through physical health and household income. Am J Community Psychol. 2016;58(3-4):354364. doi: 10.1002/ajcp.12091CrossRefGoogle ScholarPubMed
Mokdad, AH, Mensah, GA, Posner, SF, et al. When chronic conditions become acute: prevention and control of chronic diseases and adverse health outcomes during natural disasters. Prev Chronic Dis. 2005; 2 Spec no:A04. https://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm. Accessed July 2018.Google Scholar
Acierno, R, Ruggiero, KJ, Galea, S, et al. Psychological sequelae resulting from the 2004 Florida hurricanes: implications for postdisaster intervention. Am J Public Health. 2007;97(Suppl 1):S103S108. doi: 10.2105/ajph.2006.087007CrossRefGoogle ScholarPubMed
Math, S, Nirmala, M, Moirangthem, S, et al. Disaster management: mental health perspective. Indian J Psychol Med. 2015;37(3):261271. doi: 10.4103/0253-7176.162915CrossRefGoogle ScholarPubMed
Shultz, JM. Perspectives on disaster public health and disaster behavioral health integration. Disaster Health. 2014;2(2):6974. doi: 10.4161/dish.24861CrossRefGoogle ScholarPubMed
Evans, S, Banerjee, S, Leese, M, et al. The impact of mental illness on quality of life: a comparison of severe mental illness, common mental disorder and healthy population samples. Qual Life Res. 2007;16(1):1729. doi: 10.1007/s11136-006-9002-6CrossRefGoogle ScholarPubMed
Brenes, GA. Anxiety, depression, and quality of life in primary care patients. Prim Care Companion J Clin Psychiatry. 2007;9(6):437443. doi: 10.4088/pcc.v09n0606CrossRefGoogle ScholarPubMed
Walker, HK, Hall, HD, Hurst, JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition, Chapter 201. Boston, MA: Butterworth Publishers; 1990.Google ScholarPubMed
Dixon, LB, Holoshitz, Y, Nossel, I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry. 2016;15(1):1320. doi: 10.1002/wps.20306CrossRefGoogle ScholarPubMed
Kar, N. Disaster management: mental health perspective. In: Chavan, BS, Nitin, G, Priti, A, Ajeet, S, Sushrut, J. Community Mental Health in India. New Delhi, India: JayPeeDigital; 2012:257266. doi: 10.5005/jp/books/11688_24CrossRefGoogle Scholar
Frahm, KA, Barnett, SD, Brown, LM, et al. Posttraumatic stress disorder and use of psychiatric and alcohol related services: the effect of the 2004-2005 Florida hurricane seasons on veterans. Community Ment Health J. 2012;49(6):636642. doi: 10.1007/s10597-012-9558-2CrossRefGoogle ScholarPubMed
Ali, JS, Farrell, AS, Alexander, AC, et al. Race differences in depression vulnerability following Hurricane Katrina. Psychol Trauma. 2017;9(3):317324. doi: 10.1037/tra0000217CrossRefGoogle ScholarPubMed
Nazumber, AH. Disaster mental health and crisis interventions. International J Emerg Mental Health Hum Resil. 2015;17(1):368.Google Scholar
James, LE, Noel, JR, Favorite, TK, et al. Challenges of postdisaster intervention in cultural context: the implementation of a lay mental health worker project in postearthquake Haiti. Int Perspect Psychol. 2012;1(2):110126. doi: 10.1037/a0028321Google Scholar
World Health Organization. Disasters and mental health. World Health Organization web site. July 13, 2017. http://www.searo.who.int/bangladesh/disastersandmentalhealth/en/. Accessed December 9, 2018.Google Scholar
Mattei, J, Tamez, M, Ríos-Bedoya, CF, et al. Health conditions and lifestyle risk factors of adults living in Puerto Rico: a cross-sectional study. BMC Public Health. 2018;18(1):491. doi: 10.1186/s12889-018-5359-zCrossRefGoogle ScholarPubMed
Administración de Servicios de Salud Mental y Contra la Adicción. Need Assessment Study of Mental Health and Substance Use Disorders and Services Utilization among Adult Population of Puerto Rico. San Juan, PR: Administración de Servicios de Salud Mental y Contra la Adicción, Puerto Rico Department of Health; 2016. http://www.assmca.pr.gov/BibliotecaVirtual/Estudios/Need%20Assessment%20Study%20of%20Mental%20Health%20and%20Substance%20of%20Puerto%20Rico%202016.pdf. Accessed September 2018.Google Scholar
Payne, RA, Abel, GA, Guthrie, B, et al. The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ. 2013;185(5):E221228. doi: 10.1503/cmaj.121349CrossRefGoogle ScholarPubMed
Leventhal, H, Weinman, J, Leventhal, EA, et al. Health psychology: the search for pathways between behavior and health. Annu Rev Psychol. 2008;59(1):477505. doi: 10.1146/annurev.psych.59.103006.093643CrossRefGoogle ScholarPubMed
Brannon, L, Feist, J, Updegraff, JA. Health Psychology: An Introduction to Behavior and Health. 9th edition. Boston, MA: Cengage Learning; 2018.Google Scholar
Michaud, J, Kates, J. Public health in Puerto Rico after Hurricane Maria. November 20, 2017. The Henry J. Kaiser Family Foundation. https://www.kff.org/other/issue-brief/public-health-in-puerto-rico-after-hurricane-maria/. Accessed September 28, 2018.Google Scholar
World Health Organization. Global Strategy on People-centered and Integrated Health Services. Geneva, Switzerland: World Health Organization; 2014.Google Scholar
Carameli, KA, Eisenman, DP, Blevins, J, et al. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers. Disaster Med Public Health Prep. 2013;7(03):257265. doi: 10.1001/dmp.2010.46CrossRefGoogle ScholarPubMed
Winfield, L. In the wake of hurricanes, hospitals should revisit their emergency preparedness plans. Healthc Financ Manage. 2017;26.Google Scholar
Department of Homeland Security. National Response Framework. Washington, DC: Federal Emergency Management Agency, Department of Homeland Security; 2008. FEMA Publication P-682. https://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf. Accessed September 2018.Google Scholar
Kessler, RC; Hurricane Katrina Community Advisory Group. Hurricane Katrina’s impact on the care of survivors with chronic medical conditions. J Gen Intern Med. 2007;22(9):12251230. doi: 10.1007/s11606-007-0294-1Google ScholarPubMed
Reiss-Brennan, B, Brunisholz, KD, Dredge, C, et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA. 2016;316(8):826. doi: 10.1001/jama.2016.11232CrossRefGoogle ScholarPubMed
Ruskin, J, Rasul, R, Scheinder, S, et al. Researchers report on Hurricane Sandy’s mental health impact on older adults. [ScienceDaily Web site]. June 18, 2015. https://www.sciencedaily.com/releases/2015/08/150818112735.htm. Accessed September 3, 2018.Google Scholar
Pietrzak, RH, Southwick, SM, Tracy, M, et al. Posttraumatic stress disorder, depression, and perceived needs for psychological care in older persons affected by Hurricane Ike. J Affect Disord. 2012;138(1-2):96103. doi: 10.1016/j.jad.2011.12.018CrossRefGoogle ScholarPubMed
Jiménez, J, Rivera, D, Benítez, P, et al. Integrating mental health services into a general hospital in Puerto Rico. J Clin Psychol Med Settings. 2013;20(3):294301. doi: 10.1007/s10880-012-9352-xCrossRefGoogle ScholarPubMed
Rodríguez-Gómez, JR, Davila-Martínez, MG, Collazo-Rodríguez, LC. Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly. P R Health Sci J. 2006;25(2):127132. https://www.ncbi.nlm.nih.gov/pubmed/17203709. Accessed September 26, 2018.Google ScholarPubMed
Contreras, S, Fernandez, S, Malcarne, VL, et al. Reliability and validity of the Beck Depression and Anxiety Inventories in Caucasian Americans and Latinos. Hisp J Behav Sci. 2004;26(4):446462. doi: 10.1177/0739986304269164CrossRefGoogle Scholar
Nomura, S, Parsons, AJ, Hirabayashi, M, et al. Social determinants of mid- to long-term disaster impacts on health: a systematic review. Int J Disaster Risk Reduct. 2016;16:5367. doi: 10.1016/j.ijdrr.2016.01.013CrossRefGoogle Scholar
Substance Abuse and Mental Health Services Administration. Disaster Technical Assistance Center Supplemental Research Bulletin - Greater impact: how disasters affect people of low socioeconomic status. Rockville, MD: Substance Abuse and Mental Health Services Administration, US Department of Health & Human Services; 2017. https://www.samhsa.gov/sites/default/files/programs_campaigns/dtac/srb-low-ses.pdf. Accessed August 2018.Google Scholar
Adini, B, Ohana, A, Furman, E, et al. Learning lessons in emergency management: the 4th International Conference on Healthcare System Preparedness and Response to Emergencies and Disasters. Disaster Mil Med. 2016;2(1):16. doi: 10.1186/s40696-016-0026-3CrossRefGoogle ScholarPubMed
Pourhosseini, S, Ardalan, A, Mehrolhassani, M. Key aspects of providing healthcare services in disaster response stage. Iran J Public Health. 2015;44(1):111118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449997/. Accessed August 2018.Google ScholarPubMed
Gray, L. Social determinants of health, disaster vulnerability, severe and morbid obesity in adults: triple jeopardy? Int J Environ Res Public Health. 2017;14(12):1452. doi: 10.3390/ijerph14121452CrossRefGoogle Scholar
World Health Organization. Environmental health in emergencies: vulnerable groups. World Health Organization web site. August 24, 2012. http://www.who.int/environmental_health_emergencies/vulnerable_groups/en/. Accessed September 28, 2018.Google Scholar
Davis, JR, Wilson, S, Brock-Martin, A, et al. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;4(1):3038. doi: 10.1017/s1935789300002391CrossRefGoogle ScholarPubMed
Bethel, JW, Burke, SC, Britt, AF. Disparity in disaster preparedness between racial/ethnic groups. Disaster Health. 2013;1(2):110116. doi: 10.4161/dish.27085CrossRefGoogle ScholarPubMed
Census Bureau, US. US Census Bureau QuickFacts: Puerto Rico, 2017. https://www.census.gov/quickfacts/pr. Accessed September 2018.Google Scholar
American Community Survey Office. 5-year data profiles 2017. November 19, 2018. Census Bureau QuickFacts. https://www.census.gov/acs/www/data/data-tables-and-tools/data-profiles/2017/. Accessed December 8, 2018.Google Scholar
Ranabir Singh, S, Reza Eghdami, M, Singh, S. The concept of social vulnerability: a review from disasters perspectives. International Journal of Interdisciplinary and Multidisciplinary Studies. 2014;1(6):7182.Google Scholar
Bara, C. Factsheet Social Vulnerability to Disasters. Zurich, Switzerland: Center for Security Studies, Federal Office for Civil Protection; 2010.Google Scholar
Department of Health. Report of Chronic Diseases, Puerto Rico 2013-2015. San Juan, Puerto Rico: Department of Health; 2017.Google Scholar
Miller, AC, Arquilla, B. Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients. Prehosp Disaster Med. 2008;23(02):185194. doi: 10.1017/s1049023x00005835CrossRefGoogle ScholarPubMed
Bethel, JW, Foreman, AN, Burke, SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011;40(2):139143. doi: doi: 10.1016/j.amepre.2010.10.020CrossRefGoogle ScholarPubMed
United Nations Office for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction. UNISDR Web site. https://www.unisdr.org/we/coordinate/sendai-framework. Accessed January 8, 2019.Google Scholar
United Nations Office for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030. United Nations Office for Disaster Risk Reduction UNISDR Web site; 2015. https://www.unisdr.org/we/inform/publications/43291. Accessed July 2018.Google Scholar
Sartorius, N. Comorbidity of mental and physical disorders: a central challenge for medicine of the 21st century. Shanghai Arch Psychiatry. 2013;25(2):6869. doi: 10.1016/s0924-9338(12)74058-0Google Scholar
López-Ibor, J, Christodoulou, G, Maj, M, et al. Disasters and Mental Health. Hoboken, NJ: John Wiley & Sons; 2005.Google Scholar
Veenema, TG, Rains, AB, Casey-Lockyer, M, et al. Quality of healthcare services provided in disaster shelters: an integrative literature review. Int Emerg Nurs. 2015;23(3):225231.10.1016/j.ienj.2015.01.004CrossRefGoogle ScholarPubMed