Early Mental Health Intervention Reduces Mass Violence Trauma

Early psychological intervention guided by qualified mental health caregivers can reduce the harmful psychological and emotional effects of exposure to mass violence in survivors, according to a national conference report released today. Experts emphasized that although more research is needed, existing data, including studies of other kinds of traumatic events, as well as clinical experience, provide useful guidance to the mental health community in responding to mass violence.

"School violence, shootings in the workplace, and terrorist acts have increased Americans' exposure to mass violence during the past decade, and psychological interventions are increasingly among the first responses to it. It is vital to the health and well-being of the American people that effective interventions reach the people who need them in a timely and efficient manner," said LTC (Dr.) Elspeth C. Ritchie, U.S. Army, chairperson of the planning committee for the conference.

The report calls on the scientific community to develop a national research program to examine the relative effectiveness of early mental health interventions following exposure to mass violence. Early intervention is defined as any form of psychological intervention delivered within the first four weeks following mass violence or disasters. Examples of early interventions include brief, focused psychotherapeutic intervention and selected cognitive behavioral approaches.

The report says that some interventions—including mass education via media outlets—although beneficial, have the potential for unintended harm. The report recommends that the leadership select professionals who have the training, expertise, accountability, and responsibility required to provide these interventions. Also, the report cites some evidence that early intervention in the form of a single one-to-one recital of events and discussion of emotions evoked by a traumatic event does not consistently reduce risk and may even put some survivors at heightened risk for later developing mental health problems.

The report is targeted to those who deliver these interventions to emotionally distressed persons following mass violence, to those who research these issues, and to employers who want to help workers who have experienced this type of emotional trauma. It is also intended to aid officials who must decide what mental health help to include in the local, state, and national responses to survivors of mass violence and terrorism. Prepared by 58 mental health researchers and clinicians from the U.S. and five other countries, the report details what is effective, what is not, and what questions require further research.

The report provides guidance on screening for mass violence trauma-related mental health problems, on follow-up with trauma-exposed persons, and on the expertise, skills, and training for providers of early intervention services. The report also addresses what is known about timing for various types of early interventions.

Participants agreed that it is sensible to expect persons to recover from the trauma of mass violence, although some groups may be more vulnerable, such as those with preexisting mental disorders. They also agreed that most survivors who show no clinically significant symptoms for approximately two months generally do not require follow-up and that participation of survivors in early intervention sessions should be voluntary.

The report includes an outline of a sample training program for an early intervention workforce. Recognizing that persons who arrive first at a scene of mass violence may not be trained to provide early mental health interventions, participants recommended that early response personnel be trained to make appropriate referrals when additional expertise is needed. MFT CEUs
Entitled “Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices," the report was developed by the National Institute of Mental Health (NIMH) at the National Institutes of Health in the U.S. Department of Health and Human Services, the U.S. Departments of Defense, Justice, and Veterans Affairs, and the American Red Cross.

Developing A Recovery And Wellness Lifestyle, A Self-Help Guide: Sleep

Developing A Recovery And Wellness Lifestyle
A Self-Help Guide
Sleep
You will feel better if you sleep well. Your body needs time every day to rest and heal. If you often have trouble sleeping–either falling asleep, or waking during the night and being unable to get back to sleep–one or several of the following ideas might be helpful to you —

Go to bed at the same time every night and get up at the same time every morning. Avoid "sleeping in" (sleeping much later than your usual time for getting up). It will make you feel worse.

Establish a bedtime "ritual" by doing the same things every night for an hour or two before bedtime so your body knows when it is time to go to sleep.

Avoid caffeine, nicotine, and alcohol.

Eat on a regular schedule and avoid a heavy meal prior to going to bed. Don't skip any meals.

Eat plenty of dairy foods and dark green leafy vegetables.

Exercise daily, but avoid strenuous or invigorating activity before going to bed.

Play soothing music on a tape or CD that shuts off automatically after you are in bed.

Try a turkey sandwich and a glass of milk before bedtime to make you feel drowsy.

Try having a small snack before you go to bed, something like a piece of fruit and a piece of cheese or some cottage cheese so you don't wake up hungry in the middle of the night. Have a similar small snack if you awaken in the middle of the night.

Take a warm bath or shower before going to bed.

Place a drop of lavender oil on your pillow.

Drink a cup of herbal chamomile tea or take several chamomile capsules before going to bed.
You need to see your doctor if —

you often have difficulty sleeping and the solutions listed above are not working for you.

you awaken during the night gasping for breath

your partner reports that your breathing is interrupted when you are sleeping

you snore loudly

you wake up feeling like you haven't been asleep

you fall asleep often during the day
Do you have a hard time getting to sleep or staying asleep?

If so, what are you going to do to help yourself get a good night's sleep?

After an Earthquake: Mental Health

After an Earthquake: Mental Health
Following a natural disaster, when many people have suffered great losses, it is normal to feel sad, angry, or nervous.

Some who have experienced a disaster may have bad feelings right away. Others may not notice a change until much later, after the crisis is over. It can take time to feel better and for things to return to normal, especially with so much loss. Many people find support and comfort by talking to surviving family members, close friends, doctors, nurses, and religious leaders. Sometimes, help from mental health professionals may be needed.

Medical follow up will be important for the health and wellbeing of many survivors. Survivors should be encouraged to share questions and concerns about their health with their doctors.

Links to CDC resources and those of other organizations are below. Survivor experiences and needs may differ, so some sites may be more helpful to some than others.

Information available in French, Haitian-Creole, and English:

•Mental Health Information for the Public
•Mental Health Information for Professionals
•Mental Health Advisory for Health Professionals Providing Care for Survivors of the 2010 Haitian Earthquake
•General Mental Health Resources
How to find mental health services in the U.S. by state and information for developing cultural competence in disaster mental health programs.
Care Tips for Survivors of a Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life
Things to Remember When Trying to Understand Disaster Events

Signs that Adults Need Stress Management Assistance

Ways to Ease the Stress

Things to Remember When Trying to Understand Disaster Events

No one who sees a disaster is untouched by it.
It is normal to feel anxious about you and your family's safety.
Profound sadness, grief, and anger are normal reactions to an abnormal event.
Acknowledging our feelings helps us recover.
Focusing on our strengths and abilities will help you to heal.
Accepting help from community programs and resources is healthy.
We each have different needs and different ways of coping.
It is common to want to strike back at people who have caused great pain. However, nothing good is accomplished by hateful language or actions.
Signs that Adults Need Stress Management Assistance

Difficulty communicating thoughts
Difficulty sleeping
Difficulty maintaining balance
Easily frustrated
Increased use of drugs/alcohol
Limited attention span
Poor work performance
Headaches/stomach problems
Tunnel vision/muffled hearing
Colds or flu-like symptoms.
Disorientation or confusion
Difficulty concentrating
Reluctance to leave home
Depression, sadness
Feelings of hopelessness
Mood-swings
Crying easily
Overwhelming guilt and self-doubt
Fear of crowds, strangers, or being alone
Ways to Ease the Stress

Talk with someone about your feelings– anger, sorrow, and other emotions-- even though it may be difficult.
Don't hold yourself responsible for the disastrous event or be frustrated because you feel that you cannot help directly in the rescue work.
Take steps to promote your own physical and emotional healing by staying active in your daily life patterns or by adjusting them. This healthy outlook will help yourself and your family. (i.e. healthy eating, rest, exercise, relaxation, meditation.)
Maintain a normal household and daily routine, limiting demanding responsibilities of yourself and your family.
Spend time with family and friends.
Participate in memorials, rituals, and use of symbols as a way to express feelings.
Use existing supports groups of family, friends, and church.
Establish a family emergency plan. Feeling that there is something that you can do can be very comforting.
* When to Seek Help: If self help strategies are not helping or you find that you are using drugs/alcohol in order to cope, you may wish to seek outside or professional assistance with your stress symptoms.

Mental health advisory for health professionals providing care for survivors of the 2010 Haitian earthquake
Updated February 24, 2010

In the aftermath of disasters, many survivors will show acute reactions to stress. Reactions to stress may appear immediately after traumatic events or days and even weeks later. Although many reactions to stress may also be symptoms of psychiatric disorders if they persist, reactions to stress are expected responses to traumatic events in the context of disasters. Reactions to stress may be confusing and frightening, and some may view their reactions as signs of weakness or mental illness. Providing reassurance that it is very natural to have physical and emotional responses after a disaster can help to reduce distress and promote better functioning. Common reactions include:

•Physical Reactions: rapid heart rate, trembling hands, unexplained somatic symptoms (e.g., headaches, backaches, chest or abdominal pain), dizziness, blurry vision, sweating/trembling/shaking for no reason, sleep problems, loss of appetite, feeling choked or smothered
•Cognitive Reactions: problems concentrating or remembering things, confusion, disorientation
•Emotional Reactions: feeling tense and nervous, excessive fatigue, crying often or easily, feeling numb, being angry or irritable, feeling nervous or anxious around reminders of the earthquake, and nightmares/intrusive memories/mental images related to the earthquake
•Interpersonal Reactions: problems in relationships with family or friends, conflict, withdrawal, isolation
In evaluating patients, clinicians should keep in mind that some patients may present with signs and symptoms that appear to be reactions to stress but may also be manifestations of medical illness. Adverse reactions to medications or having recently stopped taking medications are other potential causes of physical or mental status changes that should be considered as part of a clinical evaluation.

Grief – Grief is normal and to be expected given the extensive loss of life that occurred after the earthquake; however sometimes grief can become so severe or persistent as to interfere with daily function to a degree that warrants clinical attention.

Long-Term Psychological Responses: The majority of people who experience reactions to stress after disasters and emergencies show resilience and do not go on to develop long-term psychopathology. However, in some survivors, the symptoms do not resolve. Posttraumatic Stress Disorder (PTSD), anxiety disorders, major depression, or other psychiatric disorders may develop. Such illnesses may be serious, even fatal, and warrant prompt follow up.

Depending on the severity of symptoms, level of function, potential risks, clinical questions, and/or other factors, referral to a mental health professional (and/or another health professional) may be warranted even in the absence of a psychiatric disorder.

Suicidal or homicidal ideation may occur in a variety of psychiatric disorders, and warrant immediate attention.

Alcohol and substance use may also increase suicide risk, as well as the risk of motor vehicle crashes and violence. Alcohol and substance use may increase following natural disasters.

Some examples of symptoms that may be indicative of PTSD include: dissociation (e.g., feeling unreal or outside oneself, having "blank" periods of time that one cannot remember); intrusive re-experiencing (e.g., disturbing memories, nightmares, or flashbacks); avoidance of reminders of the disaster (e.g., avoiding activities that remind one of the earthquake, withdrawing from other people); emotional numbing (e.g., unable to feel emotion, as if empty); hyper-arousal (e.g., startle responses, rage, extreme irritability, intense agitation). Diagnostic criteria for PTSD and other psychiatric disorders are included in the most recent edition of the DSM IV (American Psychiatric Association, 2000).

Risk Factors: People who have experienced any of the following are more likely to experience long-term difficulties and may be at higher risk for developing psychopathology:

•Direct and indirect exposure to the earthquake and its impact, e.g., being injured in the earthquake, seeing injured or dead people, hearing people screaming
•Loss of loved ones or friends
•Exposure to prior traumas (e.g., disasters, sexual abuse, motor vehicle crashes, combat)
•Pre-existing mental health issues such as depression or anxiety disorders
•Social isolation
•Multiple relocations and displacements
•Loss of home, valued possessions, neighborhood, or community
•Recent or subsequent major life stressors or emotional strain (e.g., intense emotional demands, searching for survivors, interacting with bereaved family members)
•Extreme fatigue, weather exposure, hunger, or sleep deprivation
Cross-Cultural Issues: Clinicians should be aware that in Haitian culture, there is stigma associated with experiencing or disclosing behaviors associated with mental illness, and there are different culturally appropriate ways of expressing grief, pain, and loss. Haitian patients may be reluctant to discuss or admit to mental health problems, or may refer to stress and psychiatric symptoms in culturally-specific ways, e.g., referring to saisissement (rapid heartbeat and cool blood, due to trauma), and supernatural causes of symptoms, e.g., voudou and hexes. Any discussions of mental health or reactions to stress should be explained in culturally sensitive, supportive, and non-stigmatizing ways.

Children: Children’s immature abilities to understand and process the immediate and long-term effects of emergencies make them among the most vulnerable members of affected communities. Because of stigma in Haitian culture around mental illness, many children may be reluctant to discuss or admit to mental health problems. Likewise, prior caregivers in Haiti may not have fully explored such issues, even prior to the earthquake. Clinicians should consider potential mental health and developmental issues. Reactions to stress differ depending on developmental level and are generally marked by changes in typical behavior for the specific child or adolescent. Some children will warrant referral to a mental health professional.

Acknowledging Psychological Distress: Clinicians should be aware that many patients may be reluctant to acknowledge psychiatric symptoms or distress. Earthquake survivors may fear being stigmatized within their community or denied entrance to the United States, and aid workers and military personnel may fear being penalized professionally if they have psychiatric diagnoses noted on their medical records. Whenever mental health referrals are warranted, added care should be taken to explain and arrange such referrals to the patient and his/her caregivers in a culturally sensitive, supportive, and non-stigmatizing way.

Potential for Misattribution of Symptoms of Non-Psychiatric Medical Conditions to Psychological Distress – In the aftermath of the earthquake, some patients may experience symptoms of head injury, cardiovascular disease, infection, or other undiagnosed medical conditions which may present themselves through mental status changes. Health care providers examining patients who have survived the earthquake need to be alert to that possibility.

Women's Mental Health

Since the publication of Mental Health: A Report of the Surgeon General in 1999, an increasing body of evidence from the research base, public policy analysis, consumer advocacy, and health care practice has underscored the critical importance of mental health to the overall health of women—and to our Nation as a whole. Many advances have been made in our understanding of mental illnesses, effective treatments, and promising approaches for promoting mental health, resilience, and fulfilling lives for those living with mental illnesses. A key component of this progress has been the increased understanding of the critical role of gender in the risks, course, and treatment of mental illnesses. New research findings also have pointed to the effectiveness of a growing array of treatment options for mental illnesses and of a new model of treatment that is recovery-oriented, strengths-based, and includes the active participation of individuals in their treatment. The recent advances in the science and practice of women’s mental health provide an unprecedented opportunity to address the burden of mental illnesses on women’s lives and increase the capacity for recovery. However, for this knowledge to be effective, it must be translated into tangible actions that can promote change and support progress to improve the mental and overall health of our Nation’s women and girls. Thus, this report proposes the following actions:

Promote the widespread understanding that women’s mental health is an essential part of their overall health.
Improve the interface of primary care and mental health services for women.
Accelerate research to increase the knowledge base of the role of gender in mental health and to reduce the burden of mental illnesses in both women and men.
Increase gender and cultural diversity in academic research and medicine.
Support efforts to track the mental health, distress, and well-being of women and girls in national, State, and large community-based surveillance systems.
Decrease the amount of time it requires to translate research findings on women’s mental health into practice.
Recognize the unique prevalence of trauma, violence, and abuse in the lives and mental health of girls, women, and female veterans. Address their effects and support promising new approaches that enhance recovery.
Address the cultural and social disparities that place women at greater risk for certain mental illnesses by including considerations of these disparities in diagnosis and intervention and by investigating ways to increase cultural competence in treatment approaches.
Promote a recovery-oriented, strengths-based approach to treatment for women promulgated by the recommendations of the President’s New Freedom Commission.
Build resilience and protective factors to promote the mental health of girls and women and aid recovery.
Meet the mental health needs of girls and young women as part of overall health care.
for more on this topic visit link below
mft ceussit link below
Incorporate gender issues and considerations in emergency preparedness and disaster planning, including mental health issues.
The Action Steps for Improving Women’s Mental Health represent a collaborative effort of women’s health experts across multiple agencies and offices of the U.S. Department of Health and Human Services (HHS) including the HHS Office on Women’s Health, Office of the Surgeon General, Substance Abuse and Mental Health Services Administration, Office of Minority Health, National Institute of Mental Health, National Institute on Drug Abuse, Indian Health Service, and Office of the Assistant Secretary for Policy and Evaluation. Its purpose is to spur positive changes. The hope is that policy planners, healthcare providers, researchers, and others will take up its suggested actions and help translate them into reality. In this way, we can promote improved mental health and a healthier future for the women and girls of America.

mft ceu online

mft ceu online

The Board of Behavioral Sciences for California has determined that all ceus may be earned by homestudy.

What is the difference between an Online Interactive CE Course and a Homestudy Course?
If you submit a completed course/exam to the CE provider via regular mail, then you have taken a homestudy course. If the course/exam is completed and submitted online, then the hours are approved as regular continuing education. Many state boards, such as the California Board of Behavioral Services, allow all required continuing education to be earned from online interactive continuing education courses. Check with your respective board to determine the amount of hours/units are permitted online.