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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 ,
Esteban Viruet Sánchez ,
Fernando J. Rosario Maldonado ,
Axel J. Ramos Lucca  and
Barbara Barros Cartagena
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]).
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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.

Keywords

mental health servicesdisaster response programsintegrated healthcare servicesdisaster situationsmental health services program
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 14 , Issue 1 , February 2020 , pp. 130 - 138
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):164–176. doi: 10.1007/s13753-015-0050-9CrossRefGoogle Scholar
Goldmann, E, Galea, S. Mental health consequences of disasters. Annu Rev Public Health. 2014;35(1):169–183. 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;104:310–325. 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):162–170. doi:10.1056/nejmsa1803972CrossRefGoogle ScholarPubMed
Fink, G. Stress: definition and history. In: Squire, LR, ed. Encyclopedia of Neuroscience. Vol. 9. Oxford, England: Academic Press; 2009:549–555. 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):30–38. 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):139–146. 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):131–137. 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):7015–7067. 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):237–247. 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):354–364. 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):S103–S108. 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):261–271. doi: 10.4103/0253-7176.162915CrossRefGoogle ScholarPubMed
Shultz, JM. Perspectives on disaster public health and disaster behavioral health integration. Disaster Health. 2014;2(2):69–74. 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):17–29. 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):437–443. 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):13–20. 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; 2012:257–266. 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):636–642. 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):317–324. 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):110–126. 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):E221–228. 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):477–505. 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):257–265. 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):1225–1230. 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):96–103. 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):294–301. 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):127–132. 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):446–462. 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;16:53–67. 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):111–118. 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):30–38. doi: 10.1017/s1935789300002391CrossRefGoogle ScholarPubMed
Bethel, JW, Burke, SC, Britt, AF. Disparity in disaster preparedness between racial/ethnic groups. Disaster Health. 2013;1(2):110–116. 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):71–82.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):185–194. doi: 10.1017/s1049023x00005835CrossRefGoogle ScholarPubMed
Bethel, JW, Foreman, AN, Burke, SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011;40(2):139–143. 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):68–69. 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):225–231.10.1016/j.ienj.2015.01.004CrossRefGoogle ScholarPubMed