Mental Health: Meeting Needs for an Older Population
Commitment by International Medical Corps
In 2019, International Medical Corps (IMC) committed to train healthcare partners in Puerto Rico and the U.S. Virgin Islands (USVI) to provide mental health care to older adults. Hurricanes Irma and Maria not only had a significant impact on affected populations' daily lives, but also exposed pre-existing weaknesses within vital infrastructure and social services. When collaborating with health centers in Puerto Rico and the USVI, IMC found that local staff maintained limited training on how to provide mental health and psychosocial support to distressed populations, and that older adults were disproportionately affected by the storms. To address this gap, IMC will train 255 staff at partner organizations to provide mental health care to older adults. In addition, they will work with healthcare partners to offer mental health promotion activities to community members, focused on topics such as stress and positive coping mechanisms. Through this commitment, 15 community health centers across 15 different communities will increase their capacity to provide psychosocial support for this population.
PUERTO RICO; VIRGIN ISLANDS
International Medical Corps
Asociación de Salud Primaria de PR; Frederiksted Health Care, Inc.; National Association of Community Health Centers
To address the mental health service gap for older adults in Puerto Rico and the USVI, International Medical Corps will collaborate with the Asociación de Salud Primaria de Puerto Rico (ASPPR), a network of community health centers serving low-income populations on the island, Frederiksted Health Care in the U.S. Virgin Islands, and with the National Association of Community Health Centers, to deliver trainings for approximately 255 health staff on mental health care for older adults. The organization will conduct initial assessments of health facilities and available services in Puerto Rico and the U.S. Virgin Islands, develop and implement a training package, and provide ongoing supervision, mentorship, and consultation to healthcare staff to ensure they can apply new skills. Trainings will be developed in line with evidence-based World Health Organization materials, Inter-agency Standing Committee guidelines, and the Government of Puerto Rico's Economic and Disaster Recovery Plan, with topics including Psychological First Aid, recognizing signs of distress and disorder, providing appropriate referral to other services as needed, and principles of mental health and psychosocial support in emergency settings.
International Medical Corps' selection of training locations will take into account the population density of older adults, the number of Medicare recipients in each geographical location, and the Centers for Disease Control's Social Vulnerability Index, as well as the capacity of healthcare staff in the areas. The training sessions will reach 15 health centers across 15 communities, spreading the impact of support in Hurricane Maria-affected areas.
Following the trainings, International Medical Corps will work with health center staff and community members to organize community-based mental health promotion activities and events for an estimated 1,500 people. The activities will target vulnerable populations, especially older adults, and contain discussions about stress and positive coping mechanisms. Mental health and psychosocial support information dissemination and group sessions will promote exercise, health lifestyles, and social support networks. Ultimately, teams will enhance the capacity of healthcare staff to provide mental health and psychosocial support services, build community awareness of such services, and strengthen the referral system between mental health actors.
January – February 2019: Collaborate with local partners and government to map existing mental health and psychosocial support services in Puerto Rico and U.S. Virgin Islands
Actions to be taken:
Complete mental health and psychosocial support needs assessment and mapping of such existing services in Puerto Rico and U.S. Virgin Islands and identify 15 health centers to be served
February 2019 – August 2019: Enhance capacity of healthcare staff to provide mental health and psychosocial support services
Develop and adopt mental health training package for healthcare staff, in line with internationally-accepted standards
Conduct training of at least 255 healthcare staff from clinics on mental health issues affecting vulnerable populations post disaster
August 2019 – October 2019: Improve community awareness of mental health and psychosocial support and strengthen referral pathways between existing local, regional and national mental health actors
Conduct community-based mental health promotion activities
Provide technical guidance and supportive supervision to local partners on mental health and psychosocial support protocols to ensure news practices are integrated and adopted
In 2017, the United States and Caribbean endured a catastrophic hurricane season with Hurricanes Irma and Maria causing unprecedented destruction. The impact of the hurricanes on the Caribbean and southeastern United States was disastrous. Record wind speeds and storm surge caused massive damage to infrastructure and widespread flooding, breaking supply chains and leaving communities across the region without access to necessities such as clean water, healthcare, and shelter.
The hurricanes not only had a significant impact on affected populations' daily lives, but also exposed pre-existing weaknesses within vital infrastructure and social services. When collaborating with health centers in Puerto Rico and the U.S. Virgin Islands, specifically, International Medical Corps found that local staff maintained limited training on how to provide mental health and psychosocial support to distressed populations, especially post-disaster. Meanwhile, months after the hurricanes, many individuals endured rises in depression, anxiety, panic attacks, and post-traumatic stress disorder (Artiga, Hall, Rudowitz, and Lyons, 2018).
As the Guardian reported in September 2018, mental healthcare was an issue in Puerto Rico before Hurricane Maria, due to the ongoing recession and significantly stressed health care system on the island. As younger populations have left, the population of elderly adults in Puerto Rico has grown to now nearly 20%; many of whom still faces challenges accessing the services that are available due to road closures, a lack of infrastructure and unreliable access to ongoing care. In addition, with the World Health Organization noting that approximately 15% of older adults (60+) suffer from a mental disorder (WHO, 2017), International Medical Corps is specifically emphasizing care for older populations.
While the organization has enough funding to meet the initial training goal, with additional resources International Medical Corps can expand training efforts to reach even more health workers. Based on expertise, partners will be able to: 1) contribute to a mental health training package; 2) have the opportunity to deploy with International Medical Corps to see the impact of their support; and 3) tell the story of lifesaving disaster preparedness and response through social media campaigns and additional media outlets.
International Medical Corps (IMC) developed and facilitated mental health activities for 1,108 hurricane-affected people in Puerto Rico, including the training of 553 local health providers and community members to strengthen the number of people who can assist with psychosocial care during future emergency responses – exceeding its target of 225 health workers trained. Additionally, IMC's teams promoted awareness of emotional regulation, suicide prevention, and crisis coping skills through 13 sessions for 555 community members, and supported referrals to higher levels of care as necessary. Over the last year, IMC also reached approximately 2.8 million regular media consumers and school children through the use of culturally preferred arts activities, such as radio shows, to promote awareness of mental health, in partnership with local radio stations and schools.
International Medical Corps' work was guided by initial assessments of 25 communities across all regions of Puerto Rico and the USVI to determine psychosocial needs after Hurricanes Maria and Irma. The assessment not only helped develop International Medical Corps' existing services, but also informed their future responses – such as with our emergency response to Hurricane Dorian in the Bahamas and more recently, the earthquakes in Puerto Rico. IMC also leveraged previous mental health trainings from Hurricanes Maria and Irma to deploy teams of trained local health providers and community members to help meet psychosocial needs after the recent earthquakes that started in December 2019, further expanding the reach and scope of this commitment and investment in training.
As part of the initial assessments, International Medical Corps found an urgent need for suicide prevention in Puerto Rico. The Department of Health in Puerto Rico that reported there was a 29% increase in suicides from 2016 to 2017 – this is compared to a nearly negligible global increase of only a 0.73%. Consequently, International Medical Corps, in coordination with the GlobalGiving Foundation, is expanding their reach and focus beyond older adults to increase access to mental health and psychosocial support, with a specific focus on suicide prevention, for the broader population. Over the next year, International Medical Corps aims to provide 500 community members from seven communities in Puerto Rico with culturally-inclusive and arts-based 1) training and psychoeducation for health personnel and community members with a focus on signs and symptoms related to suicide prevention, and mitigation strategies and 2) emotional regulation and positive coping skills sessions with mental health patients to help cope with distress symptoms and suicidal ideation.