Disaster Mental Health Nursing: Implications for Disaster Preparedness and Practice in New Zealand
Disaster mental health care is now a recognised nursing specialty in many countries, including Australia, Sweden and the United States of America (Raphael & Meldrum 1993). Despite compelling international literature on the benefits of disaster mental health response, (Myers 1993, Speier 1995),New Zealand has not followed these trends recognising the importance of such health care. Disaster mental health care is conspicuously absent in any meaningful form within our current health system. The majority of Crown Health Enterprise (CHEs), including Capital Coast Health Ltd and Midcentral Health Ltd preparedness plans imply only that mental health services will respond. Unfortunately, the plans say little of how these services are to be met or what is required in terms of knowledge, skills and resources to meet these objectives. The focus of disaster management in New Zealand is trauma orientated, directed towards the surgical, physical and medical needs of casualties. In his experience (Burkle, 1996) argues that triage and disaster management plans, for the most part, fail 3 to include in their classifications the primary casualty who also suffers acute psychological consequences of the physical trauma. New Zealand has experienced many memorable disasters that would seem to have been forgotten in the planning of health care, especially in relation to mental health care needs, both at the national and local service level of planning. The aim of this literature review is to inform the reader regarding knowledge of disaster health care issues such as understanding the impact, public health effects,clinical implications, interventions and the issues, problems and challenges that nurses in New Zealand can learn about mental health disaster preparedness and response. The ultimate goal of this review is to contribute towards the development and implementation of national health care standards and guidelines, focusing on the mental health aspects of disaster care in New Zealand. The framework chosen for this literature review is a combination of epidemiologic public health and service issues, rather than focusing on a singular nursing framework. This is intentional because in New Zealand, mental health nursing is hugely undeveloped or in the main, absent in this area. The frameworks used are expected to inform nursing in the professional provision of disaster mental health care. The rationale for the combination of frameworks used is that disasters affect a community in numerous ways and are considered a public health problem (WHO 1980). Noji (1991) points out that surveys have shown that each kind of disaster has its own common epidemiologic profile and pathologic characteristics. This is crucial in planning and in designing and implementing prevention activities. Within an epidemiologic framework, follow-up studies can assist in identifying risk factors for nurses that would serve as the basis for planning strategies in preventing or reducing impact related morbidity in future disasters. Practical applied and operational research can be useful for nurses in planning public health responses to future disasters. Within this framework it also provides nurses with information useful for client care and developing appropriate mental health relief response.Ideally, the disaster mental health team should be inter-disciplinary and multi-skilled - professionals. Disaster mental health nursing within inter-disciplinary teams is now a well recognised, but still developing specialty in overseas literature, (Myers 1993; Raphael & Meldrum 1993). This literature review supports an interdisciplinary approach as the preferred way of how nursing would fit within disaster mental health care. It is envisaged that the resulting discussion and recommendations form the background for further clinical research and/or background towards formulating health care policies and standards in regards to all aspects of service and professional provision of disaster mental health care in New Zealand, including nursing. It is imperative that both readers and health policy plamers alike are challenged into assisting with frameworks in the areas of preparedness planning, recruitment, training and other local and national relief efforts of various professional groups and disaster service organisations. There is an expectation that all services will respond in a disaster, including mental health. The current reality is that when the next disaster does strike, the public of New Zealand could be failed.