Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT May 30, 2003 "Newspapers are unable, seemingly to discriminate between a bicycle accident and the collapse of civilization." - George Bernard Shaw
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CONFERENCES AND WORKSHOPS:
CONFERENCE ON PTSD/COMPLEX PTSD
June 11-14, 2003
Vancouver, B.C., Canada
Contact: Anne Dietrich (604) 889-3787
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
Location: Carlton Crest Hotel
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers:
Summer Intensive Program
Graduate Certificate in
Disaster Mental Health
Disaster Mental Health Institute (University of South Dakota)
Location: Union Building
University of South Dakota Campus Vermillion, SD
Contact: Disaster Mental Health Institute
University of South Dakota
SDU 114 414 East Clark St
Vermillion, SD 57069-2390
Phone: 605-677-6575 or 800-522-9684
6th Annual Conference
The University of South Dakota
Disaster Mental Health Institute
"Innovations in Disaster Psychology:
Time for a New Paradigm?
Reflecting on the Past:
Looking to the Future"
Rapid City, SD
September 18-20, 2003
SMART MARRIAGES SEVENTH
JUNE 26-29, 2003
72 Hours CE
Materials included. Markman,
Stanley, Doherty, Hendrix,
Olson, Weiner-Davis, Covey,
Bray, Love, Pittman, Glenn,
Epstein, Glass, Carlson, Gray
- 200 top experts.
Hotel from $65
Disaster Response Network
PRESENTS A 2 DAY COURSE
IN TRAUMATIC MEMORY RESTRUCTURING (TMR)
DR. RONY BERGER
Director of Community Services for Natal
the Israel Trauma Center
for Victims of Terror and War located in Tel Aviv
Dates: Jun 7 - 8, 2003
Time: 9 AM - 5 PM
New England Baptist Hospital
Potter Conference Room
To Register, Call:
SAFE ROOM SUCCESSES IN OKLAHOMA
Imagine hearing the howling sounds of devastation and knowing that all your possessions are being lost to a force of nature. Then imagine emerging from the rubble safe and sound thanks to your safe room or storm shelter. For the full story, go to: http://www.fema.gov/nwz03/fnf_03_01.shtm
OUTPOURING OF AID
After a tornado devastated the community of South Pekin, Ill., nearby residents came forward with donations to help the storm victims. Their generosity overwhelmed a local church which volunteered to store donated items. For the full story, go to: http://www.fema.gov/nwz03/fnf_03_03.shtm
ISLAMIC CONFERENCE HAS KEY ROLE IN ENSURING PEACE, FIGHTING TERRORISM - ANNAN
28 May The Organization of the Islamic Conference (OIC) had "key contributions" to make in safeguarding the interests of the Iraqi people, bringing peace to the Middle East, rebuilding Afghanistan and healing the breach between faiths opened by terrorism, United Nations Secretary-General Kofi Annan said in a message issued today to a meeting of the 56-member body. For the complete story, go to: http://www.un.org/apps/news/story.asp?NewsID=7228&Cr=islamic&Cr1=conference
ROAD MAP MAY BE LAST CHANCE AT MIDDLE EAST PEACE FOR 'LONG TIME' - UN ENVOY
19 May The Road Map peace plan may be the last chance to achieve a two-state solution to the Middle East conflict for a very long time, since ongoing Palestinian terror radicalizes both communities while Israeli settlement expansion makes creation of a viable Palestinian state ever more difficult, the senior United Nations envoy to the region, Terje Roed-Larsen, told the Security Council today. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=7116&Cr=palestin&Cr1=
VALUE OF UNs OIL-FOR-FOOD RELIEF ITEMS FPR IRAQ EXCEEDS $1 BILLION
28 May The total value of priority items from the United Nations Oil-for-Food humanitarian pipeline that can be shipped to Iraq for emergency needs continues to climb, reaching $1.1 billion, the UN Office of the Iraq Programme (OIP) announced today. For the Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=7221&Cr=iraq&Cr1=oil
WHO PUTS TORONTO BACK ON SARS TRANSMISSION LIST
27 May The United Nations health agency has put Toronto, Canada, back on the list of areas with recent local transmission of Severe Acute Respiratory Syndrome (SARS) following new reported clusters of 26 suspect and eight probable cases of the deadly disease linked to four area hospitals. For Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=7197&Cr=sars&Cr1=
UN SURVEY SHOWS STABLE COCA PRODUCTION IN PERU, NO MAJOR SHIFT FROM COLOMBIA
15 May A new United Nations survey shows that that coca cultivation in Peru has remained stable over the past year - dispelling fears of a possible shift in coca growing from neighbouring Colombia, where a considerable decline had been recently registered. For Full Story, go to: http://www.un.org/apps/news/story.asp?NewsID=7083&Cr=drug&Cr1=control
CHURCHES' ADOPTION OF INFORMATION TECH MAY SPARK SOCIAL CHANGE
Black churches' slow adoption of information technologies has hampered their access to federally funded programs and ability to provide members with additional needed social services, according to a Penn State study. Roderick Lee, a doctoral student in the School of Information Sciences and Technology, said churches need to "catch up to the information society" in order to broaden their traditional role as agents of social change for the African-American community. "Faith-based organizations can provide the digital literacy that is needed by many residents of urban areas to participate in the information society," Lee said at an Information Resources Management Association conference in Philadelphia earlier this week. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=3110
ADOLESCENCE AND ADHD
Adolescence, in general, creates its own set of challenges, and this is certainly true in the treatment of ADHD. There are both diagnostic and treatment issues that require special attention in this developmental phase of life. For the complete article, go to: http://www.medscape.com/viewarticle/451241
MEDICAID PROPOSAL CREATING CONCERNS AMONG MH ADVOCATES
The Bush administration's proposal to change the Medicaid program is creating both white-hot concern and cool detachment among mental health and other advocates. Mental Health Weekly 13(10) 2003 For the complete article, go to: http://www.medscape.com/viewarticle/450883?mpid=11622
SUICIDAL BEHAVIOR IN SCHIZOPHRENIA: DIAGNOSIS, NEUROBIOLOGY, AND TREATMENT IMPLICATIONS
It is well known that schizophrenia is a chronic, generally life-long, mental illness that significantly debilitates afflicted individuals and severely compromises their function and quality of life. A less-appreciated fact is the twofold increase in age-standardized mortality among patients suffering from schizophrenia, whose lifespan is abbreviated by an average of 15 years in comparison with the general population. The precise etiology of this excess mortality in schizophrenia is not clearly understood. In five studies reported over the past year, causes contributing to this increased mortality in schizophrenia were assessed in different settings, thereby elucidating the factors associated with higher death rates in patients afflicted with schizophrenia. Factors observed to contribute to increased mortality in schizophrenia included both natural (cardiovascular diseases, respiratory diseases, etc.) and unnatural (principally suicide) causes. What is particularly disturbing is the observation that standardized mortality ratios in schizophrenia increased 1.3-1.7-fold over the past two decades. On a hopeful note, several studies commented on how this excess mortality in schizophrenia could potentially be lessened by effective treatment, close monitoring, and reduction in high-risk behaviors. For the Full Article, go to: http://www.medscape.com/viewarticle/449550
STRESS, ANXIETY AND CROSS-CULTURAL VARIABLES IN RURAL AREAS OF THE WESTERN UNITED STATES: MENTAL HEALTH
There has been increasing interest in recent years in the development of comprehensive mental health programs. This interest has been world-wide. In a pluralistic society like the United States, successful intervention will quite often depend on how well the therapist knows and understands the client's cultural or ethnic group. Rural areas of the western United States add still another dimension, with sometimes large geographical areas populated with diverse ethnic and cultural groups.
The American west has been portrayed in song, story, speech, myth, legend and films. From the classic tales of Mark Twain to the legends of Butch Cassidy to Native Americans to films about western women, schoolmarms and prostitutes to the major epic dramas of United States history, the American west has held a fascination for people from many cultures. The west, though, has a reality of its own. The myths and legends were created, but the reality doesn't always fit the myth or legend - or even the general concept of what the west may be like. The modern west is changing as man seeks to use and/or change the environment.
The physical aspects of our environment are a large part of an individual's experience. They have an impact on the individual and the amount of stress and anxiety experienced. One aspect of the physical environment, population density, appears to have negative effects on feelings of personal security and on affiliative and other social responses to individuals or groups.
There has been relatively little research on crowding which has focused on individual and cross-cultural differences. Evans (1978) found evidence that young children may be more adversely affected by crowding than older persons. However, this may only be indicative of western cultures. Children in Kung society (Draper, 1974) apparently do not suffer any ill effects from crowding. Studies of crowding in Chicago (Galle, Gove and MacPherson, 1972) support the hypothesis that pathology tends to increase as the population density increases. This relationship appears to work the other way in the Netherlands (Levy and Herzog, 1974). In a study done in Hong Kong no adverse effects were found as the result of high population density (Mitchell, 1971).
The environment is the source of many stressors which can initiate a variety of reactions. These reactions may range from endocrine secretions to such things as complicated appraisals and evaluations of the sources. These reactions to stressors may be physiological (Selye, 1956) and/or psychological (Lazarus, Opton & Tomita, 1966). Few investigators have attempted to study all aspects of the stress process simultaneously.
Stressful responses can be evoked by the changes and challenges one experiences in daily life. They can be caused by the disruption of one's habits (e.g. unpredictable noise or crowding). Malfunctioning of social systems which place obstacles in one's path, deprivation, losses and culturally-governed mores may also contribute to stressful responses. Stressors may be intrusive, physical and universally threatening (e.g. natural disasters). Others may be more culturally determined, less universal and more psychosocial in nature. Aiello and Thompson (1980) found that varying intensities of crowding and proximities in spatial invasion are specific to cultural norms and meanings.
The obvious lack of relative crowding and the presence of generous open space in western rural areas would seem to offer escape from the stressors generally associated with urban areas. The lessening of noise factors, crowding and other variables associated with stress production would seem to enhance the quality of life. In fact, these have been some of the traditional reasons why people have sought out rural areas for rest, relaxation and vacations.
Ranchers and farmers have tended to form small close communities which have supported their way of life and provided for mutual support. Depending on their cultural heritage, they have developed and maintained values and attitudes congruent with their way of life. Other groups (e.g. Mexican Americans) have been generally successful in preserving their cultural heritages while attempting to adapt and adjust to changes in United States society. Others (e.g. Native American groups) have maintained their culture in varying degrees and, in many cases, in relative isolation from the mainstream of U.S. society.
Much of the history of the United States is concerned with the westward expansion of a civilization that had its beginnings on the eastern shores of the North American continent. The Spaniards were the first men of European origins to penetrate the vast regions between the Rocky Mountains and the Pacific Ocean. As late as the 1820's, very little exploring had been done in the far west. In many cases, the terrain was found to be rough and rugged and resources were scarce in the beginning. Communities were separated by great distances and travel was difficult, at best, by today's standards (Hulse, 1990).
Today, in many areas of the western United States, rural towns and communities may be separated by as much as 100 miles or more. Many of these towns are farm and ranch centers or mining towns. There is often a shortage of physicians, psychiatrists and psychologists as well as other mental health related services and trained personnel. An increase in population in a number of areas within the past 15-20 years has placed a tremendous strain on many local resources. The need for effective community counseling programs in rural areas of the western United States has been increasing. This is at least partially due to stressors placed on old timers and newcomers alike. The rapid growth in some areas is exacerbated by rapidly fluctuating economic changes. As more people enter an area, they tend to overwhelm old timers who quite often are left bewildered and lost in a community which once was theirs. Newcomers have difficulties dealing with scarce or non-existent services and resources as well as a lack of adequate housing. Tensions develop over these areas as well as from a clash of values. There is a need for adequate and effective community counseling centers to address these problem areas.
Human services in any community cover a broad area. In addition to mental health services, such services may include law enforcement, legal services, social services, public health, recreation, youth services, local government, educational services, and services for senior citizens. These services have generally been provided informally or through institutions. When rapid community growth occurs, the size of the local population may increase at a rate which causes people problems to increase tremendously with a resultant strain on existing community resources.
In areas of rapid development, there tends to be a rapidly developing shortage of adequate and reasonably-priced housing. Rentals become high and crowding develops (Uhlmann, Doherty and Hill, 1977). Recreation presents other problems. Citizens of rural communities in the west have traditionally engaged in recreational activities such as camping, fishing and hunting. Newcomers tend to have a different set of interests ( e.g. bowling alleys, theaters, swimming pools, and handball courts). Communities which can't provide these types of activities may find newcomers taking advantage of more easily available diversions such as drinking, gambling and prostitution (Uhlmann, 1977).
Uhlmann (1977) pointed out a number of significant problem areas in her analysis of the delivery of human services in Wyoming boom towns. A review of her report points out the potential sources of stress and other mental health related problems encountered in western rural communities experiencing rapid growth. She found that mental health problems in rapidly developing communities include an increased incidence of depressed women and a rising rate of alcoholism among males. She also found an increase in family crises and that children and adolescents are at risk for an increased incidence of behavior disorders and social maladjustments. Newly arrived young adults (18-26) were found to face problems as a result of few, if any, solid interpersonal relationships. They frequently became involved in drug and alcohol abuse. Uhlmann found that public assistance through social services was drastically reduced and that there was frequently a lack of adequate medical personnel available. She found that schools experienced difficulties as a result of a rapid growth in student population. At the high school level, the drop-out rate tended to increase as young people were attracted and drawn off by employment opportunities in the area.
Uhlmann suggested that law enforcement personnel in rapidly developing communities may have to deal with problems they have not encountered before and may be hampered by inadequate training, low salaries and a high turnover of personnel. Poor and/or inadequate facilities (e.g. jails, juvenile detention, and foster homes) were seen as making the job of law enforcement more difficult.
Uhlmann suggested that local governments in small rural communities may not have the administrative structure necessary to deal with the new and critical demands placed on them by a rapidly growing population.
In the past, rural communities in the western United States were frequently characterized by a large population of senior citizens. Uhlmann suggests this occurred because young people left the community to seek better employment elsewhere. However, it seems that when a rapid increase in population due to development occurs, this process is partially reversed. Senior citizens may be forced to leave the community due to a rising cost of living. Such a process of demographic change was observed in three Wyoming communities (Uhlmann, Kimble and Throgmorton, 1976; Uhlmann, Doherty and Hill, 1977).
Other problems associated with rapid population growth include a sense of a decreasing "quality of life". Rapid growth brings rapid change. Many impacted communities have stressed decline and loss. The negative effects such accounts point out usually include: a speeded-up pace of life; congestion and overcrowding; inflation in prices; fear of change in life style for present residents; lack of activities and sense of belonging for newcomer families; alcoholism and mental health problems (HUD Program Guide, 1976). Increased incidents of severe depressions and alienation of both oldtimers and newcomers may result in "we-they" conflicts.
Traditional agencies and persons who have dealt with the above problem areas may not even exist in such communities. Many of these small rural communities have long been used to everyone taking care of themselves. Existing agencies may find their caseloads overwhelming. Communities which are impacted need help in defining future problems, predicting the magnitude of such problems and designing and implementing programs and mechanisms to alleviate the problems.
Uhlmann (1977) suggested that most of these problems develop because communities don't have the time to develop financial resource bases and local attitudinal support for needed services. She also suggested that problems occur due to the changing composition of local populations. She pointed out that all of the factors reviewed above bring about increased demands for human services in impacted communities.
STRESS AND RURAL AREAS
Nevada has a history of boom and bust dating back to the middle of the nineteenth century (Hulse, 1990). As a state, it has managed to grow and expand its interests. Although geographically rugged and sparsely populated, it has maintained a rich culture and a pluralistic society. Basque sheepherders in the north, cattle ranchers, miners, Mexican Americans, Chinese Americans, Japanese Americans, Shoshone, Washo and Paiute Indians, and many other groups add to the color and richness of Nevada culture.
Over the years, an expanded effort has been made to develop and maintain mental health services in rural areas (Doherty, 1984). Fluctuations in the economy have stressful effects on the small rural communities. Growth and decline of communities have a psychological impact on those directly affected. People experience this stress and anxiety differently, depending on a number of factors.
One method of studying perceived stress and anxiety is to use a self-report indicator such as Speilberger's (1970) State-Trait Anxiety Inventory (STAI). Speilberger (1970) states that Trait anxiety tends to be relatively stable and indicates a tendency to respond to situations perceived as threatening with elevations on the State scale. McClelland & Atkinson (2000) suggest that trait anxiety has the characteristics of a class of constructs which they term "motives". They define these as dispositions which remain latent until they are activated by cues in different situations. Campbell (See Speilberger & Bale, 1970) calls these "acquired behavioral dispositions". According to him, they involve residues of past experiences which tend to predispose individuals to view the world in a particular way. They also tend to predispose an individual to manifest what he calls "object consistent" response tendencies.
In other words, trait anxiety is like potential energy. It suggests differences between people in the disposition to respond to stressful situations with varying amounts of state anxiety (Speilberger & Bale, 1970). Persons with high levels of trait anxiety tend to be more likely to respond with an increase in state anxiety intensity in situations that hold a threat to their self-esteem (Speilberger & Bale, 1970). Whether persons who differ in trait anxiety differ in a similar way for state anxiety depends on the extent they perceive a specific situation as being threatening or dangerous. This is strongly influenced by their past experience.
Attitudes toward the sources of stress tend to mediate the responses. If an individual or a group believe that a stressor will cause no permanent harm, the response will probably be less extreme than if the danger poses the threat of lasting harm. Psychologically, the perceptions of control, social support and other characteristics of individuals exposed to stressors will affect their evaluation of different stressors. Perceived control can be a powerful mediator of stress. That is, it can provide the individual, or group, with a sense of being able to cope more effectively.
Adequate needs assessments, community planning and allocation of available human resources can help prevent and alleviate potential problems and stressors associated with rapidly growing rural communities. Such activities can give communities perceived and actual control over their futures and can contribute to the well-being and mental health of the whole community.
Doherty, George W. (Fal 1984). Mental health in a rural area: A program description. Journal of Rural Community Psychology, Vol 5(2), pp. 55-63.
Hulse, James W. (June 1990). Nevada adventure: A history Univ of Nevada Pr; 6th edition.
Lazarus, Arnold (1976). Multimodal Behavior Therapy. Springer Publishing Co.
Lazarus, Arnold A. (1989). The practice of multimodal therapy: Systematic, comprehensive, and effective psychotherapy. Johns Hopkins University Press.
Lazarus, Arnold A. (2000). Multimodal replenishment. Professional Psychology Research and Practice, Vol 31(1) 93-94.
Lazarus, Richard S., Opton, Edward Jr., Tomita, Masatoshi (1966). A cross-cultural study of stress-reaction patterns in Japan. Journal of Personality & Social Psychology, 4(6), pp. 622-633. Journal URL: http://www.apa.org/journals/psp.html
McClelland, David C. & Atkinson, J.W. (2000). Achievement Motive Irvington Pub.
Selye, Hans (1956). The stress of life. 324 pp.
Speilberger, Charles D.; Bale, Ronald M. (Dec 1970). State and trait anxiety in student naval aviators. Bucky, Steven F. USN AMRL, No. 1125.
Uhlmann, Kimble and Throgmorton (1976). Wyoming Human Services Project Report.
Uhlmann, Doherty, R. and Hill, R. (1977). Wyoming Human Services Project Report.
Uhlmann (1977). Wyoming Human Services Project Report.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
From Book News, Inc. The social behavior of the 55 million rural residents of the United States differs from urban residents and necessitates a different approach to federal and state policies promoting health care in these communities, argues Stamm (Institute of Rural Health, Idaho State U.). He presents 18 papers that are organized into three sections dealing with the assessment of behavioral needs, public health service delivery concerns, and issues related to special populations. The majority of the contributors come from the fields of social work and psychology.Book News, Inc.®, Portland, OR
Discusses the needs of individuals living in rural and frontier areas. Presents a comprehensive analysis of the public and federal policy, clinical trends, and empirical literature relevant to the provision of healthcare services in these areas. For those in public health, psychology, nursing, and family medicine.
Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Laramie, WY 82073-0786
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