Paula A. Madrid

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need.

Population Psychiatric Medication Prescription Rates following a Terrorist Attack

INTRODUCTION While several population-based studies have documented behavioral health disturbances following terrorist attacks, a number of mental health service utilization analyses present conflicting conclusions. PURPOSE The purpose of this study was to determine if mental health service utilization increased following a terrorist attack by assessing changes in psychoactive drug prescription rates. METHODS The rate of selective serotonin reuptake inhibitor (SSRI) prescriptions was measured among New York State Medicaid enrollees before and after the terrorist attacks of 11 September 2001. The association between geographic proximity to the events and changes in the rate of SSRI prescriptions around 11 September 2001 was assessed. RESULTS From September to December 2001, among individuals residing within three miles of the World Trade Center site, there was an 18.2% increase in the SSRI prescription rate compared to the previous eight-month period (p = 0.0011). While there was a 9.3% increase for non-New York City residents, this change was not statistically significant (p = 0.74). CONCLUSIONS There was a quantifiable increase in the dispensing of psychoactive drugs following the terrorist attacks of 11 September 2001, and this effect varied by geographic proximity to the events. These findings build on the growing body of knowledge on the pervasive effects of disasters and terrorist events for population health, and demonstrate the need to include mental and behavioral health as key components of surge capacity and public health response to mass traumas.

Development of Functional Symptoms in Children Exposed to Traumatic Events

This chapter will review the typical symptoms occurring in children after stressful traumatic exposures. Unlike other chapters in this book, no specific organ system is the most likely focus of functional symptoms in this setting. Psychological distress may exacerbate symptoms of physical illness and injury associated with the traumatic events, may be expressed as almost any seemingly unrelated symptom, may intensify the age appropriate fears typical of any child, or may predominantly be exhibited behaviorally. In most nonsevere cases, the impact is self-limited and the individual’s functioning will be back to normal within days or weeks. We will suggest simple behavioral and environmental interventions intended to help relieve children’s distress. However, when large populations are affected and individuals suffer severe loss such as in a mass casualty disaster, the scale of events requires community-wide efforts to meet the needs of children and their families. The fact that some children are more psychosocially vulnerable than others will be discussed. The chapter will conclude by highlighting warning signs warranting professional mental health care.

Resilience Challenged: Thoughts on Children's Mental Health in the Gulf Coast 5 Years After Katrina

Geographic circumstances: Soon after Hurricane Katrina, I tended to the mental health needs of children and families and to the need for developing programs to take care of the most affected populations; I revisited the Gulf Coast area of impact about twice per month for days at a time for ∼3 years. About the author: I am a fellow at the Harvard Program in Refugee Trauma and adjunct faculty at the National Center for Disaster Preparedness at Columbia University, and I privately practice psychology in New York City. A few days after Katrinas landfall I participated in a needs assessment with the National Center for Disaster Preparedness. While at the George R. Brown center in Houston, Texas, I interacted with many evacuees and helped them connect with relatives and offered them psychological first aid and support. This shelter was housing literally tens of thousands of people, which allowed us to both help many people and obtain information that later helped to shape our programs. My life and that of my colleagues at Columbias National Center for Disaster Preparedness and the Childrens Health Fund changed dramatically as it became our mission to develop permanent medical and mental health programs and training that would provide assistance not only immediately but also in the long-term aftermath of this horrible disaster. Although my home remained in New York City, I spent a great deal of time in Louisiana and Mississippi over the next 3½ years. I feel honored to … Address correspondence to Paula A. Madrid, PsyD, Harvard Program in Refugee Trauma, 22 Putnam Ave, Cambridge, MA 02139. E-mail: questions{at}paulamadrid.com