Incorporating Mental Health into Bioterrorism Response Planning

Abstract

Despite some recent improvements in public health preparedness in many communities, efforts to incorporate mental health plans and services into bioterrorism response planning remain in their infancy. A recent report from the Institute of Medicine recommended that "to address the prevention, health care, and promotion needs related to psychological consequences of terrorism, this area must be integrated into national, state, and local planning." 1 Bioterrorism events may produce unique consequences compared to other manmade or natural disasters. 2 Fear-inducing threats of contamination, the likelihood of covert release of poisonous agents, and the possibility of contagion may result in large numbers of adverse emotional/psychological reactions. These "psychological casualties" of a bioterrorism event will likely far outnumber the medical casualties; nevertheless, response planners have been relatively slow to incorporate mental health considerations into terrorism response plans. Psychological consequences 1,3-7 can be classified as distress responses (e.g., insomnia, fear, sense of vulnerability), behavioral changes (e.g., acting out, social withdrawal, increased consumption of nicotine, alcohol, or other drugs), 4,5 psychosomatic symptoms and outbreaks of medically unexplained symptoms, 8 psychiatric/psychological symptoms (e.g., sadness, irritability, dissociation), and psychiatric illnesses such as depression and posttraumatic stress disorder. 6,7 The protection and promotion of mental health in the community is a critical component of pre-event planning for bioterrorism events. Mental health elements should be included in all disaster response plans, and should be regarded with equal weight and immediacy as other elements of the plans. These mental health functions should include: 9-14 • Assessing and providing appropriate services; • Preparing content for and advising on the process of risk communication; • Creatively using assets belonging to the public trust (such as mental health facilities); • Consulting with community mental health leaders on the psychology of epidemics, managing fear and uncertainty, and managing responder and leadership distress; • Training local community thought leaders in group coping methods; and

Health-Related Quality of Life Domains and Household Preparedness for Public Health Emergencies: Behavioral Risk Factor Surveillance System, 2006-2010

“…Previous studies have shown that individuals with physical and mental limitations have increased vulnerability during a disaster. 18,19 This study indicates that perception of one's physical and mental health is also associated with vulnerability. As several researchers have suggested, public health entities should partner with community organizations and service providers to improve preparedness among individuals with physical and mental limitations.…”

“…Given that people reporting FMD, FPD, FAL, fair or/poor general health, lack of social and emotional support, and dissatisfaction with life already experience impaired quality of life, they are a particularly vulnerable population. While emergency planning and response efforts have consistently focused on physical well-being, 17 only recent attention has been given to incorporating mental illness into disaster preparedness and response 14 , 15 , 17 , 18 . The need for inclusion of mental health in these efforts is evidenced in this report by the difference in preparedness between those who did and did not report impairments in the mental health quality of life domain.…”

Addressing the Mental Health Needs of Victims and Responders to the Boston Marathon Bombings

“…Many articles have documented that mental health disaster planning and services need to be a high priority in the mental health and health fields [4,6,7,8,9,10,11,12,13,14]. Mental health must be linked with primary care, physical health, and the medical response.…”

Bioterrorism—Types of epidemics, new epidemiological paradigm and levels of prevention

“…The psychological casualties of a bioterrorism event will likely far outnumber all other medical casualties. 25 Anticipated psychological consequences include distress responses, such as insomnia, phobias, fear, and the feeling of vulnerability. [26][27][28][29][30][31] Furthermore, behavioural changes-social withdrawal, acting out, and increased consumption of nicotine, alcohol or drugs-can be one of the responses to the attack.…”