Community in Crisis:

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Community in Crisis
Relieving the Burden of Depression and Disaster
Bowen Chung MD, MSHS UCLA Semel
InstituteUCLA/RAND NIMH Center for Health
Services Research and Media and Medicine for
CommunitiesUCLA DARNet Information
Exchange March 4, 2006
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Background

• Mental disorders affect the health and well-being
  of all
• Underserved communities face disparities in
  access to and quality of mental health care
• These communities have little voice in programs
  that affect their own health
• This situation is worsened by disasters

• What can we do?

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What we will share

• How improving quality of care can reduce
  depression burden and disparities
• What the nation can do to relieve mental health
  suffering of Katrina survivors
• Partnership approach to reduce depression burden
  in communities of color
• Witness for Wellness
• Supporting Wellness for Katrina survivors
• The role the entertainment industry can play in
  public understanding of the issues

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Clinical Depression Has Major Societal Effects

• Leading cause of disability worldwide --Early
  onset disrupts work and family
• --51 billion yearly in U.S.

• Affects 1 in 20 Americans
• --All age and cultural groups
• 80 respond to treatment
• Most do not get needed care, especially
  underserved minorities

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The Many Faces of Clinical Depression
I could no longer function at my job and had to
take a sick leave.
You feel so worthless and youre in so much pain
you just want the pain to be over.
No one under-stood why I couldnt be Super Mom
and Super Wife anymore.
I just wanted to end it all.
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Older individuals with mental health problems are
less likely to have any savings
Source Gresenz and Sturm (2000)
100
Healthy
Physical Health Condition Only
75
ANY MENTAL HEALTH DISORDER
50
lt 35
35 - 54
55 years old
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• Supported by
• the National Institute of Mental Health and the
• Agency for Healthcare Research and Quality

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Programs Increased Appropriate Care for All
QI programs
African American
Usual care
Latino
White
receiving appropriate care at 1 year
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Intervention Effects Over Two Years

• Compared to usual care
• 1 - 2 additional months free of symptoms of
  depression
• 450 more in health care costs
• 1 additional month of employment

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Interventions Reduced Long-Term Outcome
Disparities
African American
QI programs
Usual care
Latino
White
recovered at 5 years
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Mental Health Responses for Storm Survivors

• People are resilient, but psychological reactions
  and mental disorders are common responses that
  eat at the fabric of community life and slow
  recovery
• Depression
• Post-traumatic stress disorder
• Grief reactions
• Substance abuse

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What are the challenges?

• Public servicessevere mental illness
• Private servicesfew poor clients
• Many survivors History of discrimination and
  distrust of services
• Geographic scatter and scope 1/300 Americans
  displaced from their homes

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What is needed?

• Widespread education about common symptoms and
  giving reassurance for recovery
• Emergency assistance for those cut off from
  treatment
• Clinic-plan-community agency partnerships for
  education, outreach, prevention, and linkage to
  treatment in the long-run
• Minority providers, community agencies, programs
  responsive to underserved groups

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What is Needed? (2)

• Training for assessment, referral, and treatment
  of common mental health reactions
• Health professionals of all kinds
• Community agencies, paraprofessionals
• Consistent and generous insurance for at least 3
  years with full parity for mental health care
• Public education to reduce stigma
• Support for survivors to participate as
  co-leaders
• Federal allocation of about 1 billion to achieve
  goals

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How Can We Achieve the Promise?

• My sense of desperation is gone. I do not feel
  so alone and helpless in combating my day-to-day
  problems. My anger has subsided to the point
  that people see me differently (because I am
  different!) and my relationships with people have
  improved dramatically.

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Context for ImprovingHealth Communications

• Half of all American adults, or 90 million
• Americans, have difficulty understanding
• or acting upon health information.

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Health Literacy

• Institute of Medicine defines as
• The degree to which individuals have the
  capacity to obtain, process, and understand basic
  health information an services needed to make
  appropriate health decisions.

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Challenges of Public Health Communicationfor
Depression

• Cultural Appropriateness
• Literacy Level
• Addressing Stigma

One approach is partner with consumers and
communities to determine what they want!
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Hurricane Katrina and Mental Health

• Psychological Consequences
• Grief and Bereavement
• Post Traumatic Stress Disorder
• Depression

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Supporting Wellness for Katrina Survivors

• How do we talk to Survivors of Katrina about
  Mental Health?
• Low Literacy Levels (lt6th Grade)
• Predominantly African American
• Avoid Stigma around Mental Health

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• Current Partnerships to develop materials
• UCLA / RAND NIMH Health Services Research Center
• UCLA / RAND Center for Media, Medicine for
  Communities
• Ecumenical Congress of Black Churches
• Healthy African American Families
• Catholic Charities
• L.A. County Department of Mental Health
• UCLA Department of Media Arts Design
• Pacificare
• Partners in Louisiana and Mississippi

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