A video of a presentation by Toni Gutschlag, General Manager of Mental Health Services at the CDHB, at the 2016 Seismics in the City Conference. The presentation is titled, "Shaping Young Minds: Mental health issues and solutions".
The number of emergency psychiatric assessments in Christchurch has more than doubled since the earthquakes struck.
This paper identifies and analyses the networks of support for tangata whaiora (mental health clients) utilising a kaupapa Mäori health service following the Ötautahi/Christchurch earthquakes in Aotearoa New Zealand from 2010 to 2012. Semi- structured interviews were undertaken with 39 participants, comprising clients (Mäori and Päkehä), staff, managers and board members of a kaupapa Mäori provider in the city. Selected quotes are presented alongside a social network analysis of the support accessed by all participants. Results show the signifi cant isolation of both Mäori and Päkehä mental health clients post- disaster and the complexity of individuals and collectives dealing with temporally and spatially overlapping hazards and disasters at personal, whänau and community level.
Natural hazard disasters often have large area-wide impacts, which can cause adverse stress-related mental health outcomes in exposed populations. As a result, increased treatment-seeking may be observed, which puts a strain on the limited public health care resources particularly in the aftermath of a disaster. It is therefore important for public health care planners to know whom to target, but also where and when to initiate intervention programs that promote emotional wellbeing and prevent the development of mental disorders after catastrophic events. A large body of literature assesses factors that predict and mitigate disaster-related mental disorders at various time periods, but the spatial component has rarely been investigated in disaster mental health research. This thesis uses spatial and spatio-temporal analysis techniques to examine when and where higher and lower than expected mood and anxiety symptom treatments occurred in the severely affected Christchurch urban area (New Zealand) after the 2010/11 Canterbury earthquakes. High-risk groups are identified and a possible relationship between exposure to the earthquakes and their physical impacts and mood and anxiety symptom treatments is assessed. The main research aim is to test the hypothesis that more severely affected Christchurch residents were more likely to show mood and anxiety symptoms when seeking treatment than less affected ones, in essence, testing for a dose-response relationship. The data consisted of mood and anxiety symptom treatment information from the New Zealand Ministry of Health’s administrative databases and demographic information from the National Health Index (NHI) register, when combined built a unique and rich source for identifying publically funded stress-related treatments for mood and anxiety symptoms in almost the whole population of the study area. The Christchurch urban area within the Christchurch City Council (CCC) boundary was the area of interest in which spatial variations in these treatments were assessed. Spatial and spatio-temporal analyses were done by applying retrospective space-time and spatial variation in temporal trends analysis using SaTScan™ software, and Bayesian hierarchical modelling techniques for disease mapping using WinBUGS software. The thesis identified an overall earthquake-exposure effect on mood and anxiety symptom treatments among Christchurch residents in the context of the earthquakes as they experienced stronger increases in the risk of being treated especially shortly after the catastrophic 2011 Christchurch earthquake compared to the rest of New Zealand. High-risk groups included females, elderly, children and those with a pre-existing mental illness with elderly and children especially at-risk in the context of the earthquakes. Looking at the spatio-temporal distribution of mood and anxiety symptom treatments in the Christchurch urban area, a high rates cluster ranging from the severely affected central city to the southeast was found post-disaster. Analysing residential exposure to various earthquake impacts found that living in closer proximity to more affected areas was identified as a risk factor for mood and anxiety symptom treatments, which largely confirms a dose-response relationship between level of affectedness and mood and anxiety symptom treatments. However, little changes in the spatial distribution of mood and anxiety symptom treatments occurred in the Christchurch urban area over time indicating that these results may have been biased by pre-existing spatial disparities. Additionally, the post-disaster mobility activity from severely affected eastern to the generally less affected western and northern parts of the city seemed to have played an important role as the strongest increases in treatment rates occurred in less affected northern areas of the city, whereas the severely affected eastern areas tended to show the lowest increases. An investigation into the different effects of mobility confirmed that within-city movers and temporary relocatees were generally more likely to receive care or treatment for mood or anxiety symptoms, but moving within the city was identified as a protective factor over time. In contrast, moving out of the city from minor, moderately or severely damaged plain areas of the city, which are generally less affluent than Port Hills areas, was identified as a risk factor in the second year post-disaster. Moreover, residents from less damaged plain areas of the city showed a decrease in the likelihood of receiving care or treatment for mood or anxiety symptoms compared to those from undamaged plain areas over time, which also contradicts a possible dose-response relationship. Finally, the effects of the social and physical environment, as well as community resilience on mood and anxiety symptom treatments among long-term stayers from Christchurch communities indicate an exacerbation of pre-existing mood and anxiety symptom treatment disparities in the city, whereas exposure to ‘felt’ earthquake intensities did not show a statistically significant effect. The findings of this thesis highlight the complex relationship between different levels of exposure to a severe natural disaster and adverse mental health outcomes in a severely affected region. It is one of the few studies that have access to area-wide health and impact information, are able to do a pre-disaster / post-disaster comparison and track their sample population to apply spatial and spatio-temporal analysis techniques for exposure assessment. Thus, this thesis enhances knowledge about the spatio-temporal distribution of adverse mental health outcomes in the context of a severe natural disaster and informs public health care planners, not only about high-risk groups, but also where and when to target health interventions. The results indicate that such programs should broadly target residents living in more affected areas as they are likely to face daily hardship by living in a disrupted environment and may have already been the most vulnerable ones before the disaster. Special attention should be focussed on women, elderly, children and people with pre-existing mental illnesses as they are most likely to receive care or treatment for stress-related mental health symptoms. Moreover, permanent relocatees from affected areas and temporarily relocatees shortly after the disaster may need special attention as they face additional stressors due to the relocation that may lead to the development of adverse mental health outcomes needing treatment.
A video of a presentation by Bridget Tehan and Sharon Tortonson during the Community and Social Recovery Stream of the 2016 People in Disasters Conference. The presentation is titled, "Community and Social Service Organisations in Emergencies and Disasters in Australia and New Zealand".The abstract for this presentation reads as follows: What happens when support services for issues such as mental health, foster care or homelessness are impacted by a disaster? What happens to their staff? What happens to their clients? The community sector is a unique, valuable and diverse component of Australasian economy and society. Through its significant numbers of employees and volunteers, its diversity, the range of service and advocacy programs it delivers, and the wide range of people it supports, it delivers value to communities and strengthens society. The community and social services sector builds resilience daily through services to aged care, child welfare and disability, domestic violence, housing and homelessness, and mental health care. The sector's role is particularly vital in assisting disadvantaged people and communities. For many, community sector organisations are their primary connection to the broader community and form the basis of their resilience to everyday adversity, as well as in times of crisis. However, community sector organisations are particularly vulnerable in a major emergency or disaster. Australian research shows that the most community sector organisations are highly vulnerable and unprepared for emergencies. This lack of preparedness can have impacts on service delivery, business continuity, and the wellbeing of clients. The consequences of major disruptions to the provision of social services to vulnerable people are serious and could be life-threatening in a disaster. This presentation will review the Victorian Council of Social Service (Australia) and Social Equity and Wellbeing Network (formerly the Christchurch Council of Social Services) records on the impacts of emergencies on community sector organisations, staff, and clients. From the discussion of records, recommendations will be presented that could improve the resilience of this crucial sector.
A video of the keynote presentation by Alexander C. McFarlane during the third plenary of the 2016 People in Disasters Conference. McFarlane is a Professor of Psychiatry at the University of Adelaide and the Heady of the Centre for Traumatic Stress Studies. The presentation is titled, "Holding onto the Lessons Disasters Teach".The abstract for this presentation reads as follows: Disasters are sentinel points in the life of the communities affected. They bring an unusual focus to community mental health. In so doing, they provide unique opportunities for better understanding and caring for communities. However, one of the difficulties in the disaster field is that many of the lessons from previous disasters are frequently lost. If anything, Norris (in 2006) identified that the quality of disaster research had declined over the previous 25 years. What is critical is that a longitudinal perspective is taken of representative cohorts. Equally, the impact of a disaster should always be judged against the background mental health of the communities affected, including emergency service personnel. Understandably, many of those who are particularly distressed in the aftermath of a disaster are people who have previously experienced a psychiatric disorder. It is important that disaster services are framed against knowledge of this background morbidity and have a broad range of expertise to deal with the emerging symptoms. Equally, it is critical that a long-term perspective is considered rather than short-term support that attempts to ameliorate distress. Future improvement of disaster management depends upon sustaining a body of expertise dealing with the consequences of other forms of traumatic stress such as accidents. This expertise can be redirected to co-ordinate and manage the impact of larger scale events when disasters strike communities. This presentation will highlight the relevance of these issues to the disaster planning in a country such as New Zealand that is prone to earthquakes.
A video of a presentation by David Meates, Chief Executive of the Christchurch District Health Board and the West Coast District Health Board, during the first plenary of the 2016 People in Disasters Conference. The presentation is titled, "Local System Perspective".The abstract for this presentation reads as follows: The devastating Canterbury earthquakes of 2010 and 2011 have resulted in challenges for the people of Canterbury and have altered the population's health needs. In the wake of New Zealand's largest natural disaster, the health system needed to respond rapidly to changing needs and damaged infrastructure in the short-term in the context of developing sustainable long-term solutions. Canterbury was undergoing system transformation prior to the quakes, however the horizon of transformation was brought forward post-quake: 'Vision 2020' became the vision for now. Innovation was enabled as people working across the system addressed new constraints such as the loss of 106 acute hospital beds, 635 aged residential care beds, the loss of general practices and pharmacies as well as damaged non-government organisation sector. A number of new integration initiatives (e.g. a shared electronic health record system, community rehabilitation for older people, community falls prevention) and expansion of existing programs (e.g. acute demand management) were focused on supporting people to stay well in their homes and communities. The system working together in an integrated way has resulted in significant reductions in acute health service utilisation in Canterbury. Acute admission rates have not increased and remain significantly below national rates and the number of acute and rehabilitation bed days have fallen since the quakes, with these trends most evident among older people. However, health needs frequently reported in post-disaster literature have created greater pressures on the system. In particular, an escalating number of people facing mental health problems and coping with acute needs of the migrant rebuild population provide new challenges for a workforce also affected by the quakes. The recovery journey for Canterbury is not over.