Toward a Public Mental Health Approach for Survivors of Terrorism

Abstract

Although most people exposed to bioterrorism or mass casualties will be extremely distressed during the immediate aftermath, only a minority (approximately 30%) will develop clinically significant psychiatric disorders. From a public mental health perspective, the challenge is to provide both preventive programs for the entire population and early detection and intervention for those at greatest risk for PTSD or other post-traumatic psychiatric disorders. Both individual and soci-etal preventive and early intervention approaches are reviewed. Utilization of the media, especially television, is presented as an example of one of many potential community/societal public mental health approaches.     

The Primary Care Health System as a Core Resource in Response to Terrorism

Abstract

Living through a terrorist event or under threat of attack affects both mental and physical health. A nation's primary care system plays a critical role under such circumstances. This article reviews the American experience after September 11, 2001 and advocates for integration of mental and physical health services in primary care settings as a key counter-terrorism strategy. Americans put their trust in primary care providers. The nation's healthcare system must develop and implement a strategy that informs and supports primary care providers in meeting the mental health needs of a nation confronted by terrorism.     

Community Mental Health in Emergencies and Mass Disasters

Summary

Mass disasters are widespread and intensive, affecting individuals, families, communities, society, and culture. Mental health services must play a crucial role in order to meet non-routine challenges that put basic professional issues to the test both in theory and in practice. In the Tel Aviv Model, responsible planning is based on a broad system of mediators and activities during normal times, supplemented by intervention personnel and techniques set in motion during emergencies. This operation is coordinated with municipal and governmental support systems, which must be aware of the importance of comprehensive and flexible emergency systems for treating the population.     

Mandated Reporting Among School Personnel

Summary

An empirical review and critique of existing state standards for batterer programs in the domestic violence field appeared timely, given the current debate about their status and utility. Although there has been a considerable amount of polemic discussion of the topic, relatively limited data have been reported. The present article surveyed the content of standards developed in 30 states within the United States. Five categories of interest were examined including: (1) the minimum length of treatment specified; (2) specification of treatment orientation, methods, and content; (3) preferred or allowable modalities of treatment; (4) whether research findings were mentioned or endorsed as a basis for development of treatment standards; and (5) methods for developing and revising standards. A related area, the minimum education required for providers, was also included as an area of interest to further describe the current pool of practitioners targeted for regulation. An analysis of the content of these standards was then performed with regard to existing peer-reviewed research in the field. The results are discussed in terms of the strengths and weaknesses of current standards, the areas in which further research is needed, and specific recommendations regarding steps that might be taken to improve existing efforts.     

Impact of Workplace Bullying on Emotional and Physical Well-Being: A Longitudinal Collective Case Study

Bullying and mobbing are occupational safety hazards pervasive in developed and developing countries. Our study aim was to determine whether bullying and mobbing caused poor health for a victim and a witness from the same workplace in western Canada. Longitudinal semistructured interviews were conducted in 2007 and 2008 with both parties. The interviews were transcribed, analyzed, and arranged into arrays using chronological ordering and time sequencing. The victim felt targeted because she represented a threat to the bully, with victim and witness experiencing negative health outcomes. The authors suggest that wellness programs should place greater emphasis on mental health promotion to discourage workplace bullying.     

Social Responsibility and the Mental Health Professions

Summary

While mental health professionals tend to primarily focus on their professional responsibilities toward the specific members of the public whom they serve, many are also concerned about positively impacting the broader society or culture in which they live and work. This notion of social responsibility is addressed in the ethics codes of both psychologists and social workers. This article reviews how this notion is addressed for these two mental health professions and also examines the changes that have occurred for psychologists between the 1992 and 2002 ethics codes. Finally, some general issues regarding the role of mental health professionals in changing society are considered.     

Exploring Gender Differences in the Association Between Childhood Physical Abuse and Thyroid Disorders

This study used a regional subsample (n = 13,070) from the 2005 Canadian Community Health Survey to explore the independent contribution of childhood physical abuse to thyroid conditions in adulthood. Gender-specific logistic regression analyses controlled for age and race, in addition to 5 clusters of variables: childhood stressors, health behaviors, general stress levels, mental health, and socioeconomic status. No significant relationship between childhood abuse and thyroid conditions was found in men; however, childhood physical abuse was associated with higher odds of thyroid conditions among women, independent of a wide range of factors. In a fully adjusted model, abused women had 40% higher odds of thyroid conditions compared to their non abused peers, 95% CI [1.05, 1.87]. Future research on gender differences in the abuse–thyroid relationship is warranted.     

How a Mental Health Professional Handles Referrals and Fees

Summary

The choice of referral and the relationship between referral sources can pose clinical and ethical dilemmas, due to the potential that the relationship between the psychologist and the referral source will interfere with the treatment relationship. Once the referral has been made, the referring psychologist must be sensitive to a second, and often a more problematic level of risk: conflicts that occur between the patient and the referral recipient. The situation becomes even more problematic when a psychologist is giving or receiving any form of compensation in connection with the referral. In addition to clouding the clinical relationship, the giving or receiving of such compensation, whether it is characterized as “referral fees” or otherwise, has important legal consequences, and may well result in license revocation proceedings or even criminal liability.     

The role of Christian commitment in predicting drug use amongst church affiliated young people

This research set out to establish which of four statements reflecting Christian commitment ('usually go to church on Sunday', 'have given my life to Jesus', 'read the Bible every week' and 'pray most days') were the most important predictors of never having smoked, drunk alcohol or tried drugs amongst a group of church affiliated young people. A self-report questionnaire was completed by 7661 participants aged 12-30. Agreement with the Christian commitment statements was generally associated with a lesser likelihood of having smoked, drunk alcohol or tried drugs, though different factors were found to be important in predicting lifetime substance use in the two age groups surveyed (12-16 years and age 17-30). Church attendance was the only factor which predicted each behaviour for the younger age group (12-16 years), but for older participants (age 17-30), statements suggesting a greater level of commitment were most important ('have given my life to Jesus', 'read the Bible every week'). The findings suggest that for church affiliated young people it is initially the socialization of religion that acts as a prohibitor against substance use, though, as age increases, a greater internalization of Christian commitment becomes more important.     

Representation of mental illness in Christian self-help bestsellers

The present study examined messages about mental illness in 14 contemporary Christian self-help bestsellers. Content analysis revealed that most texts focused upon depression. Categories of textual units included Underlying Assumptions Regarding Depression, Representations of Depression, Roots/Causes/Reasons for Depression, and Christian Responses to Depression. Demonic influence was the most frequently cited reason for depression. Other reasons included negative cognitions, failure as a Christian, and negative emotions. Christian responses to depression included trusting God, religious activity, and individual willpower. Discussion of these results focused upon the problematic impact of these messages upon individuals with depression, and upon suggestions for reducing mental illness stigma in religious communities.