Calls for help after September 11: a community mental health hot line.
Although unprepared for a disaster of the magnitude of September 11th, New York City's mental health system responded immediately. Within weeks, Project Liberty, a recovery program funded by the Federal Emergency Management Agency (FEMA), was in operation. The program provides free education, outreach, and crisis counseling services for those affected by the disaster and its aftermath. LifeNet, a 24-hour, 7-day-a-week mental health information and referral hotline, is a key component of Project Liberty. In this article, we describe the operation of LifeNet and examine the volume of calls to the hotline during the 6 months following the terrorist attacks on the World Trade Center. We describe the demographics of the callers and the kinds of disaster-related mental health problems that callers presented. The data indicate a clear pattern of increasing calls from October through March for all demographic subgroups except seniors. Callers complaining of symptoms of posttraumatic stress and symptoms of anxiety, panic, and phobia increased over time. Bereavement-related calls increased as well. The number of callers who reported symptoms of depression and substance abuse/dependence did not show as clear-cut an increase over time. We looked at the volume of LifeNet calls in relation to the Project Liberty media campaign and suggest that the campaign has had a positive effect on call volume and that its impact is likely to continue over time. (+info)
Project Liberty: a public health response to New Yorkers' mental health needs arising from the World Trade Center terrorist attacks.
The September 11th terrorist attacks had a dramatic impact on the mental health of millions of Americans. The impact was particularly severe in New York City and surrounding areas within commuting distance of the World Trade Center. With support from the federal government, state and local mental health authorities rapidly mounted a large-scale public health intervention aimed at ameliorating the traumatic stress experienced by residents of the disaster area. The resulting program, named Project Liberty, has provided free public educational and crisis counseling services to tens of thousands of New Yorkers in its initial months of operation. Individuals served vary widely in the severity of experienced trauma and associated traumatic reactions. Data from logs kept by Project Liberty workers suggest that individuals with the most severe reactions are being referred to longer-term mental health treatment services. (+info)
Repeat use of contraceptive crisis services among adolescent women.
"They don't get pregnant twice unless they are hopeless." This was one Doctor's reported assessment of women who had more than one abortion. There is some evidence that the repeated use of pregnancy testing 'scares', emergency contraception and abortion is increasing across all women. However, there may also be an interaction between this general trend and the difficulties faced by particularly vulnerable groups of teenagers who also have higher rates of teenage parenthood. This paper aims to provide an overview of the research and international statistics in this sparsely researched area. It will draw on the author's own qualitative work with 'high risking' teenage girls, and that of other researchers, in order to attempt to reach an understanding of the mechanisms behind this increasingly common phenomenon. The indications from this work refutes the notion that these women form a special or 'hopeless' group, but point towards general problems with contraception and services common to all women that may become compounded through structural vulnerability such as deprivation. (+info)
Dual Diagnosis Motivational Interviewing: a modification of Motivational Interviewing for substance-abusing patients with psychotic disorders.
Motivational Interviewing (MI) is a brief treatment approach for helping patients develop intrinsic motivation to change addictive behaviors. While initially developed to target primary substance using populations, professionals are increasingly recognizing the promise this approach has for addressing the motivational dilemmas faced by patients who have co-occurring psychiatric and psychoactive substance use disorders. Unfortunately, this recognition has not lead to a clear explication of how MI might be adopted for specific diagnostic populations of dually diagnosed patients. In this article we describe how we have applied the principles and practices of MI to patients who have psychotic disorders and co-occurring drug or alcohol use problems. Specifically, we provide two supplemental guidelines to augment basic MI principles (adopting an integrated dual diagnosis approach, accommodating cognitive impairments and disordered thinking). We present recommended modifications to primary MI skill sets (simplifying open-ended questions, refining reflective listening skills, heightening emphasis on affirmation, integrating psychiatric issues into personalized feedback and decisional balance matrices). Finally, we highlight other clinical considerations (handling psychotic exacerbation and crisis events, recommended professional qualifications) when using MI with psychotic disordered dually diagnosed patients. (+info)
Interventions for post-traumatic stress disorder and psychological distress in emergency ambulance personnel: a review of the literature.
A literature review was carried out to establish the extent of the literature on interventions for psychological distress and post-traumatic stress disorder in emergency ambulance personnel. A total of 292 articles were identified. Of these, 10 were relevant to this review. The primary intervention used with this population was critical incident stress debriefing, although there was some debate in the literature about the effectiveness of this intervention and the quality of the research conducted. More high quality research is needed on critical incident stress debriefing before being confident of its effectiveness. (+info)
Approaching the suicidal patient.
The suicide of a patient can be devastating to the family and to the family physician. The patient's death may shake the physician's confidence, undermine any willingness to work with patients with a mental illness, and provoke professional and legal review. In an attempt to help the family physician prevent suicide, this article reviews known risk factors and offers a strategy for assessing these factors in individual patients. The authors outline interventions that fit the existing level of risk and provide suggestions for the physician in the event of a completed suicide. (+info)
Managing crisis: the role of primary care for people with serious mental illness.
BACKGROUND AND OBJECTIVES: More than 30% of patients with serious mental illness in the United Kingdom now receive all their health care solely from primary care. This study explored the process of managing acute mental health crises from the dual perspective of patients and primary care health professionals. METHODS: Eighteen focus groups involving 45 patients, 39 general practitioners, and eight practice nurses were held between May and November 2002 in six Primary Care Trusts across the British West Midlands. The topic guide explored perceptions of gold standard care, current issues and critical incidents in receiving/providing care, and ideas on improving services. RESULTS: Themes relevant to the management of acute crisis included issues of process, such as access, advocacy, communication, continuity, and coordination of care; the development of more structured care that might reduce the need for crisis responses; and issues raised by the development of a more structured approach to care. CONCLUSIONS: Access to services is a complicated yet crucial feature of managing care in a crisis, with patients identifying barriers at the level of primary care and health professionals at the interface with secondary care. The development of more structured systems as a solution may generate its own ethical and pragmatic challenges. (+info)
What physicians can do to prevent suicide.
Many people who attempt suicide or succeed at it visit their physicians shortly before the act; thus, primary care physicians have a key role in preventing suicide. The first step is to suspect that the patient might be at risk, and the second step is to ask about it. Nevertheless, one cannot predict whether any particular person will or will not attempt suicide. (+info)