1. 1 The Mental Health System Response to Avian and Pandemic Influenza Presented by: Division of Mental Health Services, NJ Department of Human Services

2. 2 A Novel Threat: No Existing Models for Mental Health A comprehensive review of the literature yields no empirical studies addressing the behavioral or emotional consequences of avian or pandemic influenza. The concepts used today to discuss mental health and behavior were not in existence during the last great pandemic. The concepts discussed in this program are considered evidence-informed assumptions about the risk of a major avian influenza outbreak or pandemic, and the likely emotional and behavioral responses to such events. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

3. 3 New Findings Recent research (Redefining Readiness & other studies) suggest that the general population may not react to a public health crisis in the manner anticipated by emergency management professionals. This unanticipated behavior can: Complicate pubic health and emergency medical responses; Lead to greater physical harm for greater numbers of people; Lead to higher rates of long-term mental health problems. You can find the Redefining Readiness study at: http://www.cacsh.org/eptpp.html New Jersey Division of Mental Health Services Disaster & Terrorism Branch

4. 4 Emotional Challenges There are many emotional challenges that may face individuals and families during avian or pandemic influenza. These challenges are not limited to the medical impact of a disease outbreak, but include reactions to: Organizational and governmental response. The impact on society. Personal and global economic disruption. Pre-existing medical or mental health issues. Separation from natural sources of support. Loss of and grief for friends and/or family members. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

5. 5 An Important Distinction It is important to make a clear distinction between: Behavioral implications, and Emotional implications. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

6. 6 Behavioral Responses Foreseeable behavioral responses may include: Non-compliance with vaccination or medication orders. Resisting travel restrictions. Avoiding an area; evacuating a community. Breaking quarantine and isolation. Civil unrest or rioting. Looting, theft and violence. Increasing alcohol, tobacco and drug use. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

7. 7 Emotional Responses Foreseeable emotional responses to a devastating pandemic would likely involve serious mental health problems such as: o Fear and anxiety. o Sadness and depression. o Increased rates of suicide. o Traumatic stress reactions. o Complicated grief and bereavement. Any and all of these mental health problems may occur in both the diagnostic and sub-diagnostic range. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

8. 8 Beyond Traumatic Stress Reactions Public Health crises (i.e., SARS, pandemic influenza, etc.) also result in different responses that are not seen in natural or technological disasters. Those include: o Multiple Unexplained Physical Symptom (MUPS) o Misattribution of normal arousal o Sociogenic illness o Panic o Surge in healthcare seeking behavior o Greater mistrust of public officials These reactions further complicate and confuse the public health and medical response to the situation. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

9. 9 Panic is related to the perception that there is a limited opportunity for escape, a high-risk of being injured or killed, or that help will only be available to the very first people who seek it. o Panic is not typically seen in most disaster scenarios. o Panic turns neighbor against neighbor. o Panic is likely in a pandemic. Panic in a Pandemic New Jersey Division of Mental Health Services Disaster & Terrorism Branch

10. 10 Pandemic Timeline and Planning Framework Disruption Time Pandemic Alert Today Pre- Pandemic OnsetMaximum Disruption Prolonged Recovery Initial Panic Second Wave? Unknown 1-3 mos 6-12 months Adapted from Connell, P., Banks and Avian Flu: Planning for a Possible Pandemic, 2006.

11. 11 Grief and Loss Several aspects of a pandemic and public health response may complicate grief and loss reactions. These include the: Inability to see loved ones or say good-bye to those who may die in the hospital or while separated from family. Inability to retrieve the body for timely burial or funeral rituals. Shortage of caskets, burial sites or crematoriums. Mass stockpiling of corpses until burial or cremation can be facilitated. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

12. 12 The Mental Health Response System The Disaster & Terrorism Branch of the NJ Division of Mental Health Services has worked in concert with the Department of Health and Senior Services to develop an integrated mental health/public health response to a pandemic. A section of the New Jersey Pandemic Influenza (pages 56-66) describes anticipated mental health activities by pandemic phase. There are articulated roles for mental health services in all phases of a pandemic. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

13. 13 The Mental Health Response System Efforts have begun to train disaster mental health responders in: Psychological First Aid skills to address emotional and behavioral responses during a crisis. Hostility and Rage Management (HARM) to help deescalated angry and agitated individuals. Pandemic-specific Issues to better prepare them for responding to such a crisis. New Jersey Division of Mental Health Services Disaster & Terrorism Branch

14. 14 NJs Disaster Mental Health System NJ has a long history of disaster mental health response, formally beginning in the late-80s Responses have included declared disasters: 9/11 Anthrax Postal System Attacks Hurricane Floyd 2004 Floods in Burlington and Camden Counties Hurricane Ivan along the Delaware River Also including non-declared disasters: Seton Hall Dormitory Fire Edison Gas Line Explosion New Jersey Division of Mental Health Services Disaster & Terrorism Branch

15. 15 For More Information Please contact the NJ Division of Mental Health Services Disaster & Terrorism Branch Training & Technical Assistance Group (609) 984-2767 mhsttag@dhs.state.nj.us or www.disastermentalhealthnj.com New Jersey Division of Mental Health Services Disaster & Terrorism Branch