Showing papers by "Beverley Raphael published in 2011"

Mass catastrophe and disaster psychiatry

Abstract: This paper discusses the vital role of disaster psychiatry in the evolving structures for preparedness and response in the fields of disaster management. The authors address the role of science and experience in addressing the tragedies of mass catastrophe, the need for systems and the challenges of integrating mental health contributions into the practical requirements for survival, aid, emergency management and ultimately recovery. The human face of disaster and the understanding of human strengths and resilience alongside the protection of, and care for, those suffering profound trauma and grief are central issues.

Neither the internist nor the Internet : use of and trust in health information sources by people with schizophrenia

Abstract: Objective: The aim of this study was to explore health information sources accessed by people with schizophrenia and the level of trust invested in themMethod: A cross-sectional survey was performed comparing the responses of 71 adults with schizophrenia (recruited from both community and inpatient settings) with 238 general practice attendees on their use of television, radio, the Internet, newspapers, magazines, family and friends, and doctor to obtain information on health matters, and their levels of trust in these sourcesResults: People with schizophrenia most commonly reported using a doctor, family and friends, and television to obtain information on health matters However, compared with general practice attendees, they gained less health information from doctors and the Internet, and had less trust in doctors Within-group analysis revealed that in people with schizophrenia: living alone increased the likelihood of obtaining health information from television; a higher level of education increa

Alert but less alarmed: a pooled analysis of terrorism threat perception in Australia

Abstract: Previous Australian research has highlighted disparities in community perceptions of the threat posed by terrorism. A study with a large sample size is needed to examine reported concerns and anticipated responses of community sub-groups and to determine their consistency with existing Australian and international findings. Representative samples of New South Wales (NSW) adults completed terrorism perception questions as part of computer assisted telephone interviews (CATI) in 2007 (N = 2081) and 2010 (N = 2038). Responses were weighted against the NSW population. Data sets from the two surveys were pooled and multivariate multilevel analyses conducted to identify health and socio-demographic factors associated with higher perceived risk of terrorism and evacuation response intentions, and to examine changes over time. In comparison with 2007, Australians in 2010 were significantly more likely to believe that a terrorist attack would occur in Australia (Adjusted Odd Ratios (AOR) = 1.24, 95%CI:1.06-1.45) but felt less concerned that they would be directly affected by such an incident (AOR = 0.65, 95%CI:0.55-0.75). Higher perceived risk of terrorism and related changes in living were associated with middle age, female gender, lower education and higher reported psychological distress. Australians of migrant background reported significantly lower likelihood of terrorism (AOR = 0.52, 95%CI:0.39-0.70) but significantly higher concern that they would be personally affected by such an incident (AOR = 1.57, 95%CI:1.21-2.04) and having made changes in the way they live due to this threat (AOR = 2.47, 95%CI:1.88-3.25). Willingness to evacuate homes and public places in response to potential incidents increased significantly between 2007 and 2010 (AOR = 1.53, 95%CI:1.33-1.76). While an increased proportion of Australians believe that the national threat of terrorism remains high, concern about being personally affected has moderated and may reflect habituation to this threat. Key sub-groups remain disproportionately concerned, notably those with lower education and migrant groups. The dissonance observed in findings relating to Australians of migrant background appears to reflect wider socio-cultural concerns associated with this issue. Disparities in community concerns regarding terrorism-related threat require active policy consideration and specific initiatives to reduce the vulnerabilities of known risk groups, particularly in the aftermath of future incidents.

The public and a radiological or nuclear emergency event: threat perception, preparedness, and anticipated response - findings from a preliminary study in Sydney, Australia

Abstract: This paper presents selected findings from a preliminary study that sought to assess the impacts of a radiological or nuclear emergency event on an Australian population, and their anticipated responses to such an event. The questionnaire was wide-ranging and included sections on threat perception, preparedness, use of media sources and trusted organisations, as well as socio-demographic, personal resilience and health-related data. Survey data were collected from samples of the general public living in Sydney, Australia during the period May-June 2008 using a mixed convenience sample approach (n=324). In general, data suggest that the public is not highly concerned about terrorism involving radiological or nuclear materials and is unprepared for such an event. First Responders (Fire, Police, Ambulance) and the Australian Nuclear Science and Technology Organisation (ANSTO) were the authorities the public had most confidence in to respond to such incidents and these were also the agencies the public was most likely to trust for credible information. When respondents were prompted with a series of possible behaviours they might elicit in the event of a radiological or nuclear emergency incident, their immediate most likely responses included calling family members to check they are OK, washing off radioactive material, seeking shelter indoors, calling emergency services, covering their mouth to prevent inhalation of dust, and trying to get back home. Longer-term behaviours included having more frequent health checks. These findings suggest that there would be high demand on telecommunication services soon after such an event, and the general lack of preparedness of the public suggests that there would be a high degree of confusion and uncertainty in their responses. This emphasises the importance of timely communication and direction following such an event, preferably delivered by one of the authorities most trusted by the public.

Promoting youth mental health through early intervention

Abstract: The mental health and wellbeing of young people is at the forefront of mental health policy in Australia, with significant recent investment in initiatives for those aged 12-25 years. This is a welcome outcome from over 15 years of sustained advocacy. Mental health was recognised as a health priority area in 1996 and, since then, increasing awareness of the burden of mental disorder in adolescence and young adulthood has sharpened the focus on this stage of the lifespan. The most recent Australian data from the National Survey of Mental Health and Wellbeing revealed that one in four young people will experience an affective, anxiety or substance use disorder in a 12-month period. This parallels data from the large US comorbidity study, which showed that three-quarters of mental disorders emerge before the age of 25 years and half before the age of 14.The National Action Plan for Promotion, Prevention and Early Intervention for Mental Health in 2000 emphasised the need to focus on the teenage and early adult years, and many of its directions were taken up and have significantly advanced. The Plan provided strong conceptual support to intervene early in the developmental trajectory of mental disorder, aiming to prevent the development of disorder where possible and, where this was not possible, to mitigate the impact of disorder on the individual, their family and the community. It is particularly important to reduce the impact of mental health problems on adolescents and young adults as they are in the process of accomplishing essential developmental tasks that if not achieved, interfere with their transition to adulthood and can have a lifelong negative impact. All young people need support to develop their identity and independence, belong and connect with relevant social groups including family, and to attain educational and vocational goals. Young people experiencing mental health problems need even greater support to achieve these outcomes.This special issue of Advances in Mental Health (ISSN 1837-4905), 'Promoting Youth Mental Health through Early Intervention' also released as a reader (ISBN 978-1-921729-30-0), presents a range of original research, conceptual and descriptive articles that consider some recent initiatives in promoting youth mental health through early intervention. The first paper (Catania, Hetrick, Newman & Purcell, 2011) sets the groundwork by examining whether there are evidence-based models of care for prevention and early intervention for mental health problems for those aged up to 25 years. Importantly, evidence for childhood interventions is covered as well as that relevant in adolescence and early adulthood. This acknowledges that the childhood and preteen years are also vital for early intervention for mental health. Catania et al. (2011) argue that there is a pressing need to develop better models of care to ensure greater access to appropriate early intervention services, and that evidence for the value of collaborative and integrated service systems is growing.The next three papers (Collin et al., 2011; Howe, Batchelor, & Bochynska, 2011; Wilson, Rickwood, Bushnell, Caputi, & Thomas, 2011) consider different aspects of promoting effective help-seeking and service use by young people. The strong current focus on youth help-seeking is in response to the low rate of professional service use evident at this stage of life - a clear mismatch with the high level of need. Effective youth participation is essential to developing services that young people are prepared to use, and the paper entitled 'Finding our way' (Howe et al., 2011) describes how youth participation was incorporated within the development and promotion of youth mental health services in the Central Coast. The next article considers two factors that have been argued to signifi- cantly impact on young people's reluctance to use professional services - need for autonomy and preference for seeking help from informal sources - and their infl uence is shown to be not quite as expected (Wilson et al. …

Disaster mental health preparedness and response: Asia‐Pacific perspectives

Abstract: With the increasing severity and frequency of natural disasters across the world, the Asia-Pacific region has been particularly vulnerable. Multiple earthquakes, tsunami, cyclones, hurricanes, floods and fires have affected the region in the past decade. These disasters have been so severe that they can be considered mass catastrophes in terms of the deaths, community devastation and high levels of destruction over enormous areas associated with their impacts. Other “humancaused” disasters have also been severe, including technological hazards, such as transport and airline crashes, building collapses, toxic chemical spills and contamination. Terrorist incidents are disasters for those affected, both in the acute phase and in the long-term, through the malevolent intent of the deaths and destruction, and through the dread and uncertainty resulting from the potential for further attacks. The Asia-Pacific region has also known the threat of major complex health disasters, such as severe acute respiratory syndrome (SARS) and radioactive contamination. There are many initiatives that aim to mitigate such hazards and their impacts, such as the Institute for Disaster Risk Reduction (IDRR). Reducing impact requires the knowledge of threats and what might prevent them from occurring where possible. It also requires preparedness strategies to help people in their communities by building resilience, providing knowledge and education to assist with an emergency should it occur and to manage disaster consequences. Aid agencies, donors, the United Nations, government and non-government organizations, including health agencies, support agencies (e.g. Red Cross and Red Crescent Societies) and many other agencies offer assistance during the emergency and afterwards. In recent decades, particularly in the last 20–30 years, there has been increased recognition of the significant mental health consequences associated with these disasters, as well as the resulting profound social disruption and damage. These consequences may greatly hinder opportunities for recovery and development, and add to difficulty in the long aftermath. It is thus important that potential disasterrelated mental health problems are effectively addressed, with early and subsequent interventions. It is often more difficult for lowand middle-income countries to prepare and respond to such needs, as they may have very limited existing infrastructure for mental health services, and few such resources, especially in the community. Indeed, the provision of such care is also a challenge for high-income countries in many circumstances. Mental health effects of disaster have been studied extensively, for instance by Galea et al. (2005) in a comprehensive review of the epidemiology of Post Traumatic Stress Disorder (PTSD), reviewing 40 years of studies to that time. The authors found that there was a very significant burden of PTSD among people who experienced a disaster. Neria et al. (2009) have also provided reviews. There is considerable consistency in the findings. First, while PTSD has been considered to be the “signature diagnosis” for disaster, other disorders are frequent, including anxiety disorders and major depression. Grief-related problems have also been a significant issue related to the extent of death and destruction (Norris and Wind, 2009). Patterns of pathology have been shown to relate to the types of stressor experienced. Personal life threat, “I thought I would die”, threat to lives of loved ones or exposure to the gruesome, multiple deaths of others, are likely to increase the risk of PTSD. Such experiences are more prevalent among people closest to the epicenter of the disaster, most directly and severely affected. Studies in many settings have demonstrated that people closest to the epicenters are most likely to have higher rates of PTSD than those more distal, even Offi cial journal of the Pacifi c Rim College of Psychiatrists

Factors associated with high psychological distress in horse industry participants during the 2007 Australian equine influenza outbreak and evidence of recovery after 1 year.

Abstract: This short report summarises data on the prevalence of high psychological distress in horse industry participants during the 2007 Australian equine influenza (EI) outbreak and the statistical analysis undertaken to identify the factors associated with this high psychological distress. In addition, follow-up data collected 1 year later are reported briefly.