Integration of psychological and social strategies in the acute, mid- and long-term phase

Prof.dr. Berthold P.R. Gersons

Bijlmer aircrash1992 memorial 39 people died 260 lost there homes Approximately 2000

eyewitnesses and rescue workers

10.000 in memorial march

67 nationalities involved

Bijlmer aircrash 4 October 1992

Example of reception centre for the survivorswith a market of organizations

Direct help after disasters,

Should this be debriefing?

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0,5 years 1,5 years

PTSD

PART PTSD

no PTSD

other

‘early mental health care’

Conclusions from Bijlmer disaster

1. Fragmentation in stead of integration;

2. Traditional psychotherapy approach without diagnoses in stead of evidence based care;

3. Loss of trust of the community;

4. No effective monitoring;

5. No effective leadership

Enschede Firework Disaster 13 May 2000

Information and Advice Center 3 – 5 yearsFor everyone who has questions regarding the disaster

Information and Advise Center (IAC)

Only one organization responsible for everything after the Only one organization responsible for everything after the disaster;disaster;

This organization cannot go over to ‘business as usual’;This organization cannot go over to ‘business as usual’; One address of front-office with back-offices;One address of front-office with back-offices; Is finding all questions and answers;Is finding all questions and answers; Public information: media, news, leafletts, handouts;Public information: media, news, leafletts, handouts; Monitoring of recovery (material and health);Monitoring of recovery (material and health); Open for 3-5 years; Open for 3-5 years; Key-aim: regaining control;Key-aim: regaining control; 13.000 registered;13.000 registered;

Course per month for 3 years for PTSD and ASD

P02

General practitioner monitoring

Mental health survivors 2-3 weeks and 1,5 years after the Enschede Firework disaster

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2-3 weeks

1,5 year

Control

Multidisciplinary Guideline DevelopmentMental Health Care

MULTIDISCIPLINARY GUIDELINEEarly psychosocial interventions after disasters,

terrorism and other shocking events2007

Promote natural recovery and the use of natural sources of help;

Identify those affected who need acute psychological help;

As necessary, refer and as necessary treat those affected who need acute psychological help.

Outcome of questionaire EUTOPA

High percentage of agreement on the IMPACT guideline;

There is now a standard for immediate intervention;

Standard for longterm care should also be developed;

Call, J.A., Pfefferbaum, B., Lessons from the first two years of project Heartland, Oklahoma’s mental health response to the 1995 bombing, Psychiatric Services 50: 953-955, 1999

The goal of Project Heartland was—and continues to be—to provide crisis counseling, support groups, outreach, and education for individuals affected by the bombing. Several concerns became evident in the first days after the bombing. ODMHSAS, the state agency selected to organize, coordinate, and conduct the mental health response, had no disaster plan in place. Furthermore, the Oklahoma Office of Civil Emergency Management had little previous interaction with ODMHSAS, and no interagency service agreement existed. Despite the lack of a formal agreement, work commenced, and by April 24 planning began.

The American Red Cross provides only immediate postimpact crisis services. The Compassion Center, the support and death-notification program established by the Red Cross in downtown Oklahoma City, closed within ten days. Unfortunately, tension among individuals and organizations involved in disaster response is not unusual. After the bombing, staff of the local Red Cross did not wish to transfer responsibility to Project Heartland as directed, and they resisted training ODMHSAS staff.

To decrease the likelihood of such conflicts over leadership during transitions and to provide consistency in leadership, it is prudent that the postimpact counseling and death-notification center be directed by specially trained staff from the state agency responsible for developing and maintaining the postdisaster plan. This staff should work closely with other agencies in predisaster planning and disaster response and should be knowledgeable about the various organizations involved in the response. This staff needs clear governmental authority to direct service delivery.

In May 1995 ODMHSAS sponsored a statewide forum in Oklahoma City to obtain community input in the development of service goals for the mental health recovery plan. This use of a quasipublic disaster relief planning workshop appears unique in the disaster literature. One-hundred stakeholders were invited to participate in one of five half-day facilitated workshops to develop specific mental health goals for disaster recovery.

The stakeholders made 15 primary recommendations to help ensure that the agencies involved in Project Heartland would enlist qualified providers and use a multidisciplinary team approach to deliver accessible, high-quality, culturally sensitive services to a variety of special populations affected by the bombing. The recommendations also focused on ensuring that the media would be educated about responses to trauma and that the needs of rescue workers, those already affected by mental illness, the homeless, and civilian workers in the area would not be overlooked. The needs of children were a special concern, and a companion paper addresses Project Heartland's services for children (7).

Key-problems are organizational ones

The mental health care column lacks a clearcut commanding structure like police, firebigade, hospitals;

The mental health compartment in the restructuring process after disasters is not well developed and clear;

Risk of selling false expectations by too many organizations at the high moment of chaos after disasters;

Destructive competition of NGO’s etc. which give decision makers much doubt about the quality of MHC;

This is what the children of Enschede expect from us