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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. A Novel Threat: No Existing Models for Mental Health.

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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 Threat: InfluenzaNo 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 Influenza

  • 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 Influenza

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 Influenza

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 Influenza

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 Influenza

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


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Beyond Traumatic Stress Reactions Influenza

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 in a Pandemic Influenza

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 Influenza

Disruption

Initial Panic

Second Wave?

Pandemic Alert

Pre-Pandemic

Maximum Disruption

Prolonged Recovery

Onset

Today

6-12 months

Unknown

1-3 mos

6-12 months

Time

Adapted from Connell, P., “Banks and Avian Flu: Planning for a Possible Pandemic, 2006.


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Grief and Loss Influenza

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 Influenza

  • 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 Influenza

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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NJ’s Disaster Mental Health System Influenza

  • NJ has a long history of disaster mental health response, formally beginning in the late-80’s

  • 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 Influenza

Please contact the

NJ Division of Mental Health Services

Disaster & Terrorism Branch

Training & Technical Assistance Group

(609) 984-2767

mhsttag@dhs.state.nj.us

or

www.disastermentalhealthnj.com

New Jersey Division of Mental Health Services Disaster & Terrorism Branch