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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
Post-Hurricane Data
2 months – 167 participants
8 months – 160 participants
14 months – 153 participants
23 months – 140 participants*
(*anticipated)
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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?
Florida Older Adult Hurricane Study
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?
Florida Older Adult Hurricane Study
98% reported damage to home or property
51% reported major structural damage
88% lost electricity
43% lost furniture or furnishings
12% lost keepsakes
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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
Florida Older Adult Hurricane Study
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.
Disaster Mental Health Disaster Mental Health Outreach and ServiceOutreach and Service
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
Disaster Mental Health Disaster Mental Health Outreach and ServiceOutreach and Service
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%
12.5% reported 20% to 39%
11.3% reported 40% to 59%
1% reported 60% to 79%
1% reported 80% - 100%
LTC and Disaster Mental Health Services
Residents were depressed
26.2 % Reported none
40% reported 1% to 19%
12.5% reported 20% to 39%
11.2% reported 40% to 59%
1% reported 60% to 79%
1% reported 80% - 100%
LTC and Disaster Mental Health Services
Residents were anxious
21.2 % reported none
38.7 % reported 1% to 19%
20 % reported 20% to 39%
1% reported 40% to 59%
1% reported 60% to 79%
1% reported 80% - 100%
LTC and Disaster Mental Health Services
Residents anxious about upcoming hurricane season32.5 % reported none
32.5 % reported 1% to 19%
11.2 % reported 20% to 39%
1% reported 40% to 59%
1% reported 60% to 79%
1% reported 80% - 100%
LTC and Disaster Mental Health Services
•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%)
LTC and Disaster Mental Health Services
•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