Liability of professional and volunteer mental health practitioners in the wake of disasters: a framework for further considerations

Qualified immunity from civil liability exists for acts of disaster mental health (DMH) practitioners responding to disasters or acts of terrorism. This article reviews current legal regimens dictating civil liability for potentially wrongful acts of DMH professionals and volunteers responding to disasters. Criteria are proposed to inform determinations of civil liability for DMH workers in disaster response, given current legal parameters and established tort law in relevant areas. Specific considerations are examined that potentially implicate direct liability of DMH professionals and volunteers, and vicarious liability of DMH supervisors for actions of volunteer subordinates. The relevance of pre-event DMH planning and operationalization of the plan post-event is linked to considerations of liability. This article concludes with recommendations to minimize liability exposure for DMH workers in response efforts.     

Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence

Findings from research on psychiatric epidemiology, disaster effects, discrepancies in service use, and cross-cultural psychology are reviewed to generate guidelines for culturally responsive postdisaster interventions. Ethnicity and culture influence mental health care at various points: on need for help; on availability and accessibility of help; on help-seeking comfort (stigma, mistrust), and on the probability that help is provided appropriately. There are aspects of disaster mental health practice that may ameliorate many of barriers that contribute to ethnic disparities in service use. It is proposed that interventions should give greater attention to socially engaged emotions and functioning. To promote disaster recovery, practitioners are advised to: assess community needs early and often; provide easily accessible services; work collaboratively and proactively to reduce stigma and mistrust and engage minorities in care; validate and normalize distress and help-seeking; value interdependence as well as independence as an appropriate developmental goal; promote community action; and advocate for, facilitate, or conduct treatment and evaluation research. Notwithstanding the pain and stress they cause, disasters create opportunities to de-stigmatize mental health needs and build trust between providers and minority communities.     

Children in war and its aftermath: mental health issues in the development of international law

Children now experience war as they never have in the past. This article presents clinical impressions of children from war zones and suggests interventions that might ameliorate the horrors of war for some of these children. It also describes the evolving framework in international law (i.e., the United Nations) that provides a context for implementing some of these interventions and for insulating children from some of the devastating effects of war.     

Migrant mental health: a model for indicators of mental health and health care consumption.

OBJECTIVE: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. DESIGN: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. MAIN OUTCOME MEASURES: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" RESULTS: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. CONCLUSIONS: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.     

Reliability of proxy response on mental health indices for aged, community-dwelling women

The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent-proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed.     

Mental health literacy: empowering the community to take action for better mental health

For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.     

Crisis intervention from the viewpoint of the mental health professional

Pastoral Psychology -     

Prevention and public health. Psychology's response to the nation's health care crisis

Psychology as a scientific and applied discipline has a unique responsibility to participate in the pursuit of strategies that reduce the nation's health care needs. As a social and behavioral science, psychology can contribute to unraveling the processes underlying conditions of health and disorder. As an applied discipline, psychology can work to design effective interventions to promote human health and to avoid disease and dysfunction. Insofar as these endeavors are unsuccessful, psychology can help reduce significant contributors to the nation's morbidity and mortality. Achieving such success, however, challenges psychologists to collaborate effectively, to combine science with practice and policy, and to address complex philosophical and ethical issues concerned with individual freedom and public responsibility.     

The prevalence of mental retardation: Cross-cultural considerations from Sweden and the United States

Recent reports from Sweden and other European countries have shown a sharp disparity between their incidence and prevalence figures on mild mental retardation and similar figures in the U.S. (Grunewald, 1979; Martin, Blodgett, Edwards, Geer, & Melcher, 1974; Robinson & Robinson, 1976).The purpose of this paper is to provide a model of intellectual performance that might explain such disparities and predict future levels of occurrence of mild mental retardation. Such explanations should have relevance for our views on the development of intellectual ability as well as, on a practical level, planning the allocation of treatment resources. Such planning clearly depends upon the number of children having the condition in question.Over the past few decades we have progressed substantially in our ability to describe mental retardation and to differentiate it from conditions that superficially resemble it; such as, autism, learning disabilities, schizophrenia, etc., (Baroff, 1974; Robinson & Robinson, 1976). Our ability to identify variables that relate to mild mental retardation also has developed substantially, but correlation does not necessarily lead to understanding. One of the large set of variables that often is associated with mild mental retardation in the U.S. is poverty. But “poverty” is too broad a variable to be explanatory. Such a dimension is a surrogate factor standing in the place of other variables, not yet understood, that control, in part, the actual process, by which the child develops the condition of mild mental retardation (Kirk & Gallagher, 1983). A series of papers has been presented by psychologists in Sweden that allow us to address this issue.The ability to observe two cultures, Sweden and the U.S., that have both substantial similarities and differences provides a natural comparison of the prevalence of mental retardation that would be impossible to achieve through experimental manipulation. Prevalence is used here as the total number of cases present in a population group during a specific interval of time (Kramer, 1975).     

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.     

Ethical and methodological issues in academic mental health research in populations affected by disasters: the Oklahoma City experience relevant to September 11, 2001

Empirical data from research studies are vital to guiding mental health interventions following disasters. However, few data are available for this purpose. Important advances in policy and procedures for the conduct of organized research emerged from the Oklahoma City bombing, yielding cooperative working relationships among researchers and culminating in the ethical attainment of informative research data. However, the academic community was again caught off guard after the September 11, 2001, terrorist attacks. Suggestions to surmount these obstacles include incorporating research infrastructures into disaster preparedness plans in advance; organizing the community of researchers; and working closely with major funding organizations. Methodological issues pertaining to measurement of psychopathology include the importance of obtaining diagnostic data; interpreting the meaning of symptoms in the absence of a psychiatric disorder; differentiating preexisting symptoms from those that emerged after the disaster, and optimal timing of postdisaster assessment.     

U.S. involuntary mental health commitment statutes: requirements for persons perceived to be a potential harm to self

The civil commitment statutes of all 50 states and the District of Columbia were reviewed to determine: (1) What is required for a person who is believed to be at serious and imminent risk of self-harm to be eligible for involuntary hospitalization; and (2) Whether an attempt to involuntarily hospitalize was required or was merely an option when the requirements found in number 1 were met. The analysis revealed that nearly 85% of the jurisdictions require dangerousness to self to be the result of a mental illness, and only two jurisdictions mandate attempts at involuntary commitment if a person is deemed to be an imminent harm to self. These results have implications for practice with individuals who are suicidal.     

The aftermath of heresy: a response to Pendery et al.'s (1982) critique of "Individualized Behavior Therapy for Alcoholics"

A point-by-point response is presented to Pendery et al.'s (1982) critique of the study “Individualized Behavior Therapy for Alcoholics (IBTA)”. Two independent, external investigations have critically examined the original records from the IBTA study. The IBTA study compared two different techniques for treating poor-prognosis, chronic alcoholic state hospital patients. It was found that a broad-spectrum behavioral treatment oriented to controlled drinking was a more effective treatment than was the standard hospital treatment program based on conventional wisdom. The Pendery et al. critique gave the appearance of being a refutation by presenting findings for only one group of Ss in a comparative study. In this response, it is shown that the experimental and control Ss were justifiably classified as gamma alcoholics, that Ss were randomly assigned to groups, and that the two groups were comparable in terms of pretreatment characteristics. Moreover, as regards the originally reported 2-yr treatment outcome findings, it is shown that Pendery et al, reported no specific events which were not already documented in the original study records which formed the basis for publications about the IBTA study. Finally, even in terms of long-term outcomes, i.e. mortality rates 10–11 yr after treatment, the experimentally-treated group (20% mortality) continued to fare better than the traditionally-treated group (30% mortality). Ironically, rather than Pendery et al.'s report being a refutation of the original published accounts of the IBTA study, it is concluded that the data reported by Pendery el al. actually strengthen the validity of the original publications. The attack on the IBTA study can be meaningfully viewed as a reflection of the scientific revolution presently underway in the alcohol field. The central impetus for conceptual change in the alcohol field, however, derives less from controlled-drinking research than from the lack of empirical support for conventional wisdom. Ideas are changing because the traditional view no longer inspires progress.