Lisa M. Brown, Ph.D.

Challenges in Developing and Implementing Disaster Behavioral Health Care

Programs for Older Adults– Outreach, Assessment, and

Intervention

Lisa M. Brown, Ph.D.Department of Aging and Mental Health Florida Mental Health InstituteUniversity of South Florida

Florida Older Adult Hurricane Study

Use of Disaster Mental Health Service in Long-Term Care Facilities

Research Program

Hurricane season is June 1 through November 30

Florida was impacted by 5 major storm systems during a 44 day periodBonnie, Charlie, Frances, Ivan, Jeanne

2004 Hurricane Season

2004 was the most intense hurricane season in Florida’s history

$60 billion damage

117 deaths

Affected all 67 counties

2004 Hurricane Season

National Hurricane Center predicted that Hurricane Charley would make landfall in Tampa as a category 2 hurricane early afternoon on August 13

Less than two hours later, the storm strengthened in intensity and veered 70 miles south, arriving unexpectedly in Charlotte County as a category 4 storm

Sustained winds of 145 miles per hour

Wind gusts that exceeded 180 miles per hour

Killed 34 people (2 older adults died by suicide)

$6.8 billion in damage


Pre-Hurricane Data 1997 – 466 participants

2002 - 236 participants

60 to 84 years

Comprehensive battery of measures:Cognition Medical & Physical

Mood

Personality Social support Mastery

Religion Demographics QoL


Post-Hurricane Data

2 months – 167 participants



23 months – 140 participants*

(*anticipated)


Few studies have pre-disaster data (only 11 studies have pre-disaster data) – single measure of mood

Majority of disaster studies start 12 to 14 months after the event

How people recovery after a disaster is unclear

Why people don’t use disaster mental health services is unknown


Compare pre-disaster levels of mood and well-being to post-disaster levels

Examine posttraumatic stress disorder (PTSD) and posttraumatic growth

Study mental health service use

Evaluate use of social marketing to improve outreach efforts


Disaster questionnaire assessed:

Damage to home and community

Physical injuries to self or family members

Feelings of safety, panic, danger, ability to cope, confidence, fear of future hurricanes

Experience with previous disastersAttitudes toward media, government,

and recovery services


Would you describe yourself as a victim of Hurricane Charley? (friends and relatives description?)

Were you well prepared to deal with Hurricane Charley? (general public, federal, state, local government?)

If you evacuated, why, where, how long, what did you take?

Did you apply for assistance? Received? Pending? Adequate?


Did you receive help from a counselor or mental health professional to help you deal with your reaction to the hurricane or for an emotional or mood problem?

Who provided these services?

How many times did you received mental health services?

If you received mental health services, were they helpful?


98% reported damage to home or property

51% reported major structural damage

88% lost electricity

43% lost furniture or furnishings

12% lost keepsakes


31% feel less safe now than before Hurricane Charley

28% felt a sense of panic during the hurricane

20% felt their life was in danger during the hurricane


2 months -14% reported significant levels of depression (5% in 1997)

8 months -16% reported significant levels of depression

30% were out of the area when the hurricane struck but reported levels of depression that was equal to the group that experienced the hurricane


2 months - 2% over cutoff on PTSD Checklist

8 months - 11% over cutoff on PTSD Checklist

2 months – 27% rated their mental health as worse or much worse since the hurricane

8 months -28% rated their mental health as worse or much worse since the hurricane


2 months – 1% were using disaster mental health services

8 months – 4% were using mental health services

Use of disaster mental health services was not commensurate with disaster related mental health distress


Disaster Mental Health Disaster Mental Health Outreach and ServiceOutreach and Service

Empirical evidence from our study, along with reports from community and state agencies (AAA and DCF) who provided disaster mental health services, reveals that a substantial gap exists between those who are psychologically distressed and use of mental health services.


It is not well understood why few older adults used disaster mental health services despite:

Aggressive outreach efforts

In-home services

Groups held in community centers

Free or low-cost programs

Psychological distress


Older adults are less likely to use mental health services in traditional mental health settings due to a complex set of help-seeking factors:

Problem recognition

Symptom misattribution

Readiness to change

Knowledge about services

Preferences for services

Barriers to treatment

However, none of these studies were conducted with older adults who had survived a disaster and were contending with disrupted social networks, destroyed communities, and damaged homes.

LTC and Disaster Mental Health Services

Survey of 168 Nursing homes

88% LTC facilities were affected by the 2004 or 2005 hurricanes

Residents were mentally or emotionally distressed

17.5% reported none

43.7% reported 1% to 19%



1% reported 60% to 79%

1% reported 80% - 100%


Residents were depressed

26.2 % Reported none





1% reported 80% - 100%


Residents were anxious

21.2 % reported none

38.7 % reported 1% to 19%

20 % reported 20% to 39%



1% reported 80% - 100%


Residents anxious about upcoming hurricane season32.5 % reported none

32.5 % reported 1% to 19%

11.2 % reported 20% to 39%



1% reported 80% - 100%


•6% facilities would have used, but did not have available disaster mental health services

•27% used disaster mental health services

•Services were provided by social workers (23.3%) and psychologists (12.4%) nurses (5.4%) psychiatrists (1%)


•What percentage of residents found disaster mental health services helpful?

•35% reported none •31% reported 1% to 19%•17.3% reported 20% to 39%•1% reported 40% to 59% •1% reported 60% to 79%•1% reported 80% - 100%

Implications

Research is needed to evaluate existing outreach efforts

More effective marketing of disaster mental health services

Many elders don’t want to be known as needing mental health services

Many elders don’t consider themselves as special needs

Responders who provide care to elders should have training specific to older adults

Implications

Cooperative planning should occur at local, state, and federal levels

Special needs shelters

Education about disaster planning – advance directive format

Programs to enhance resilience and disaster preparedness of community dwelling elders

Training or protocols for home health aids

Programs for institutionalized adults

Lisa M. Brown, Ph.D.

Department of Aging and mental Health

Florida Mental Health Institute, MHC 1441

University of South Florida

13301 Bruce B. Downs Blvd.

Tampa, Florida 33612

813 – 974 – 0098

[email protected]

Lisa M. Brown, Ph.D.

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