Haiti Earthquake: Mental Health Needs Are Emerging

In the face of 200,000 or more dead and millions injured or  homeless in Haiti following the January 12 earthquake, mental health and medical organizations, along with US government agencies, are offering aid both to those suffering and to those helping.

The catastrophic earthquake measuring 7.0 on the Richter scale, followed by periodic aftershocks, has devastated the capital city of Port-au-Prince and severely damaged such coastal cities as Logne and Jacmel, according to the Association of Haitian Physicians Abroad (Association des Mdecins Hatiens l’Etranger or AMHE) and the Haitian American Psychiatric Association (HAPA).

Major health problems include dehydration, bleeding, crush injuries, eye injuries, fractures and dislocations, respiratory ailments, risks for infection (diarrheas), and acute depression, as described on AMHE’s Web site.

Marc Vital-Herne, MD, HAPA president, told Psychiatric Times that his organization is working in tandem with AMHE to arrange for volunteer teams of physicians to go to Haiti.

“We met on January 13 and are pulling together 50 physicians-10 from each discipline,-to volunteer,” Vital-Herne said. “My viewpoint is that it is too early for psychiatrists to go to Haiti. Right now, the pressing needs are to rescue people and to treat the injured. But in the upcoming weeks, psychiatrists and other mental health professionals will be needed to help those traumatized by the tragedy.”

The Haitian Consulate in New York has been helping to facilitate the process of physicians going to Haiti, according to Vital-Herne, an assistant professor of psychiatry at the New York College of Osteopathic Medicine. Some medical personnel of Haitian descent have flown to the Dominican Republic and then taken a bus to Port-au-Prince.

We plan to send some 200 physicians and nurses in Haiti by January 24, Christian Lauriston, MD, AMHE president, said in a letter.

In the US, Vital-Herne said there are large concentrations of Haitians in New York, Connecticut, New Jersey, Massachusetts, Florida and other states.

“Many are experiencing emotional turmoil. Some feel impotent and overwhelmed. They want to be there in person, but it is impossible. Their family members in Haiti may be missing or dead and their family homes destroyed,” he said. “My brother-in-law lost 4 family members. My cousin who was unaccounted for, was finally found alive from the rumbles [sic] of her house.”

Vital-Herne, attending psychiatrist at St. Barnabas Hospital’s HIV Clinic and at the methadone maintenance treatment program and substance abuse outpatient clinic, said HAPA is asking psychiatrists in private practice or working in clinics to provide psychological help to those Haitians in the U.S. in need of a Creole- or French-speaking psychiatrist. Names and telephone numbers of such clinicians are being posted on the HAPA Web site.

The APA also plans to offer assistance through its district branches, according to Darrel Regier, MD, MPH, executive director of the American Psychiatric Institute for Research and Education and director of the Division of Research.

We have disaster psychiatry contacts in all of our district branches to coordinate the efforts in their areas. Regier said. We have to wait and see what they propose as most appropriate for their given area.

“There are a lot of cultural considerations with the Haitian community, so we are being very careful to listen to the community to determine how we can best be of help. We don’t want to do things that might be culturally inappropriate,” said William Narrow, MD, MPH, associate director of APA’s Division of Research.

Some guidance might come from the 83 members of APA who were born in Haiti.

Regier pointed out that the district branches where there are large Haitian populations-such as New York, Boston, Miami, Philadelphia-are eligible to apply to the APA for the Erich Lindemann Disaster Grants. A small grant of up to $10,000 can be provided to assist district branches that are responding to disasters.

On a state level, the New Jersey Association of Mental Health Agencies, Inc. (NJAMA), a statewide trade association representing some 150 hospital-based and freestanding mental health and addiction agencies throughout New Jersey, and the New Jersey Mental Health Institute, Inc. (NJMHI), a private nonprofit charitable organization, offered to coordinate assistance to family members affected by the Haitian tragedy.

“New Jersey has the fourth largest Haitian population in the United States,” said Debra Wentz, PhD, NJAMA’s chief executive officer. “Some are in limbo waiting for news about their loved ones, while others have received the horrible news that they didn’t survive.”

Within NJAMA’s membership are behavioral health providers and clinics already working with the Haitian community that can help provide grief counseling, help with PTSD and other kinds of psychological support.

Wentz, who was in Sri Lanka when the deadly tsunami hit in 2004, said she and Henry Acosta, MSW, LSW, NJMHI’s deputy director, are coordinating assistance in English, French, Haitian Creole, and Spanish for family members who may need mental health services.

At APA’s headquarters, Robert J. Ursano, MD, chair of the Disaster Psychiatry Work Group, a component of the Council on Research and Quality Care, and an international expert on disaster psychiatry, sent an e-mail letter to APA members and staff that describes the APA resources supportive of disaster responders. The letter also refers to the Inter-Agency Standing Committee (IASC), which offers recommended qualifications for foreign mental health professionals wishing to travel to disaster-affected regions.

Regier explained that rescuers in Haiti are excavating individuals from the rubble, moving bodies, and dealing with the horror of the situation on the ground.

“The impact of these experiences on the rescuers is a major mental health issue from the get-go,” he said.

Extensive information exists on APA’s Disaster Web site on how to approach disaster response issues, including how first responders need to take care of their own mental health needs in such a situation, as well as some guidance on how one would do psychological first aid when people are deployed as part of a response team, said Regier.

In major disasters, such as Hurricane Katrina, Regier said APA works very closely with the Red Cross and with the Substance Abuse, Mental Health Services Administration (SAMHSA), which usually has the mental health responsibility for Federal Emergency Management Agency  (FEMA) in arranging for mental health volunteers to go to disaster areas.

“Regarding Haiti, we have not as yet heard anything from SAMHSA or the Red Cross,” Regier said.

The APA’s Council on Research and Quality Care and the Office of International Activities is monitoring the situation in Haiti and maintaining coordination with other mental health organizations.

U.S. Government
Last Thursday, the US Department of Health and Human Services (HHS) activated the National Disaster Medical System and the U.S. Public Health Service Commissioned Corps. More than 12,000 personnel could possibly assist in the coming days, according to HHS. On Friday more than 200 HHS medical personnel, including physicians, nurses, paramedics, and emergency medical technicians, arrived in Haiti, with an additional 50 en route. They are providing basic and acute medical care.

“HHS personnel also may assist the Haitian government with mental health services, disaster and public health assessments, environmental health and safety testing, and the critical reconstruction of health care infrastructure,” according to an HHS press statement issued Saturday.

The US Agency for International Development (USAID) Bureau for Global Health is sending additional specialists to Haiti to help assist with the rising medical needs.

Global Health Bureau’s Clydette Powell, MD, MPH, who specializes in pediatrics, pediatric neurology and public health, and Robert E. Ferris, MD, who is trained in both internal medicine and pediatrics, are on their way to Haiti. Both have lived and worked in Haiti, and are experienced in responding to disasters. They are assigned to the USNS Comfort, a naval hospital ship commanded by Captain James Ware. The USNS Comfort, which has 250 hospital beds and a 550-person medical team, departed Baltimore, MD, last Saturday and is expected to arrive in Haiti by Jan. 21.

Donations
For individuals who want to help financially, the APA has organized a list of charitable organizations on its Web site that are accepting financial donations to support recovery efforts in Haiti. Among them are the Pan American Health and Education Foundation; the Haiti Emergency Relief Fund; Doctors Without Borders/Mdecins Sans Frontires (MSF); and International Medical Corps.

AMHE is collecting financial donations to give to the Haitian Red Cross. Checks made payable to AMHE-NY-Disaster Relief Fund can be sent to AMHE, 1166 Eastern Parkway, 2nd floor, Brooklyn, NY 11213.