Global & Disaster Medicine

Archive for the ‘Mental health’ Category

WHO: Psychological first aid: Guide for field workers



This guide (2011) covers psychological first aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities.

Endorsed by many international agencies, the guide reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.


Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies.

World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.

The target group for WHO work on mental health and psychosocial support in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors and terrorism-, war- or genocide-exposed populations.

The WHO Department of Mental Health and Substance Abuse emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.


Management of physical health conditions in adults with severe mental disorders

Preventable physical health conditions lead to premature mortality in people with severe mental disorders, reducing their life span by 10-20 years. The majority of these premature deaths are due to physical health conditions.

The physical health of people with severe mental disorders is commonly overlooked, not only by themselves and people around them, but also by health systems, resulting in crucial physical health disparities and limited access to health services. Many lives can be saved by ensuring that people with severe mental disorders receive treatment.

WHO’s “Guidelines on management of physical health conditions in adults with severe mental disorders” provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health conditions.


WHO: Mental Health of Refugees and Migrants


Being a refugee or a migrant does not, in itself, make individuals significantly more vulnerable to mental disorders, but refugees and migrants can be exposed to various stress factors that influence their mental well-being.

Refugees and migrants have often faced war, persecution and hardship in their country of origin. Many will have experienced displacement and difficulties in transit countries and embarked on dangerous travels. Lack of information, uncertainty about immigration status, potential hostility, changing policies, and undignified and protracted detention all contribute to additional stress.

Furthermore, forced migration requires multiple adaptations in short periods of time, making them more vulnerable to abuse and neglect. Pre-existing social and mental health problems can thus be exacerbated.

Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies

The world is ignoring millions of suffering people.


“……Only one in 27 people with depression in developing countries receives adequate treatment, according to the report. Developed countries do a bit better – one in five people with depression get treatment. But overall, wealthier countries have a poor enough record of providing adequate services…..”


Afghanistan: Nearly 40 years of violent conflict & a growing mental health crisis


“…..the World Health Organization estimates more than a million Afghans suffer from depressive disorders and over 1.2 million suffer from anxiety disorders. The WHO says the actual numbers are likely much higher…….”


“…..According to latest WHO estimates, more than 300 million people are living with depression globally, an increase of more than 18% between 2005 and 2015. …..”

Human Rights Abuse: People with severe mental disorders endure abuse around the world, caged, warehoused in institutions, and imprisoned.

NY Times

“….Drug treatment, mostly for psychosis, blunted day-to-day symptoms of hallucinations and delusional thinking. But it did not reduce the length of time people were held in chains at the camp.…”

British Journal of Psychiatry

“Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers.

To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical identifier NCT02593734).

Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff.

Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size –0.48). There was no significant difference in days in chains…..”

Mental health and disasters

Mental health nurses and disaster response in Sierra Leone

Harris, Dawn et al.
The Lancet Global Health , Volume 6 , Issue 2 , e146 – e147



“….public health officials say that, in the aftermath of an extreme weather event like a hurricane, the toll of long-term psychological injuries builds in the months and years that follow, outpacing more immediate injuries and swamping the health care system long after emergency workers go home and shelters shut down. ….”


“….. As flood waters recede from Hurricanes Harvey, Irma, Maria and Nate, and survivors work to rebuild communities in Texas, Florida and the Caribbean, mental health experts warn that the hidden psychological toll will mount over time, expressed in * *

  • heightened rates of depression,
  • anxiety,
  • post-traumatic stress disorder,
  • substance abuse,
  • domestic violence,
  • divorce,
  • murder and
  • suicide. …..”

Mosul: Bombs, bullets, and mental trauma



Examining the impact of Hurricane Sandy on the mental health and substance use of residents of the Rockaways

The lasting mental health effects of Hurricane Sandy on residents of the Rockaways

Rebecca M. Schwartz, PhD;
Patricia Rothenberg, BA;

Samantha M. Kerath, MS;

Bian Liu, PhD;

Emanuela Taioli, MD, PhD
July/August 2016; pages 269-279
Image result for fema hurricane sandy
Objective: To examine the impact of Hurricane Sandy on the mental health and substance use of residents of the Rockaways, which is a lower income, ethnically diverse region of NYC that was devastated by the hurricane. Design: Prospective, cross sectional.
Setting: Rockaways, Queens, NYC community residents.
Participants: From October 2013 to April 2015, 407 adult residents of the Rockaways completed self-report, validated measures of depression, anxiety, and post-traumatic stress symptoms as well as indicators of substance use (alcohol, illicit substance, and tobacco use) and exposure to Hurricane Sandy.
Main Outcome Measures: Depression, anxiety, post-traumatic stress, alcohol use, illicit substance use, and tobacco use.
Results: Differences in exposure scores on outcomes were compared using Wilcoxon tests. Associations between hurricane exposure (categorized into “personal” and “property” exposure) and outcomes were investigated using logistic regression, adjusting for demographic covariates, mental health history, and time since hurricane. The study participants were predominately female (57.5 percent) and black (63.9 percent) and average age was 44.7 years. Multivariable results showed that property exposure scores were positively associated with increased risks of mental health difficulties across all three mental health symptom outcomes, but not substance use. Increased personal and total exposures were also significantly associated with increased Posttraumatic Stress Disorder symptoms. Substance use variables were not significantly associated with any of the hurricane exposure indicators.
Conclusions: The present study quantifies the lasting impact that Hurricane Sandy has had on the mental health of Rockaways residents indicating the need for continued recovery efforts and increased mental health service provision in this vulnerable region.
Key words: Rockaways, mental health, substance use, Hurricane Sandy


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