Community in Crisis: Bowen Chung MD, MSHS UCLA Semel Institute UCLA/RAND NIMH Center for Health Services Research and Media and Medicine for Communities UCLA DARNet Information Exchange March 4, 2006 Relieving the Burden of Depression and Disaster

Background  Mental disorders affect the health and well-being of all  Underserved communities face disparities in access to and quality of mental health care  These communities have little voice in programs that affect their own health  This situation is worsened by disasters 2 What can we do?

What we will share:  How improving quality of care can reduce depression burden and disparities  What the nation can do to relieve mental health suffering of Katrina survivors  Partnership approach to reduce depression burden in communities of color  Witness for Wellness  Supporting Wellness for Katrina survivors  The role the entertainment industry can play in public understanding of the issues 3

Clinical Depression Has Major Societal Effects  Leading cause of disability worldwide --Early onset disrupts work and family --$51 billion yearly in U.S.  Affects 1 in 20 Americans --All age and cultural groups --All age and cultural groups  80% respond to treatment  Most do not get needed care, especially underserved minorities 4

The Many Faces of Clinical Depression “You feel so worthless and you’re in so much pain you just want the pain to be over.” “I could no longer function at my job and had to take a sick leave.” “I just wanted to end it all.” “No one under- stood why I couldn’t be ‘Super Mom’ and ‘Super Wife’ anymore.” 5

Source: Gresenz and Sturm (2000) Healthy Physical Health Condition Only ANY MENTAL HEALTH DISORDER 50% 75% 100% < years old Older individuals with mental health problems are less likely to have any savings 6

Supported by the National Institute of Mental Health and the Agency for Healthcare Research and Quality 7

% receiving appropriate care at 1 year Programs Increased Appropriate Care for All programs QI programs Usual care African American Latino White 8

Intervention Effects Over Two Years Compared to usual care:  additional months free of symptoms of depression  $450 more in health care costs  1 additional month of employment 9

% recovered at 5 years Interventions Reduced Long-Term Outcome Disparities QI programs White African American Usual care Latino 10

Mental Health Responses for Storm Survivors  People are resilient, but psychological reactions and mental disorders are common responses that eat at the fabric of community life and slow recovery –Depression –Post-traumatic stress disorder –Grief reactions –Substance abuse 11

What are the challenges?  Public services–severe mental illness  Private services–few poor clients  Many survivors: History of discrimination and distrust of services  Geographic scatter and scope; 1/300 Americans displaced from their homes 12

What is needed?  Widespread education about common symptoms and giving reassurance for recovery  Emergency assistance for those cut off from treatment  Clinic-plan-community agency partnerships for education, outreach, prevention, and linkage to treatment in the long-run  Minority providers, community agencies, programs responsive to underserved groups 13

What is Needed? (2)  Training for assessment, referral, and treatment of common mental health reactions: –Health professionals of all kinds –Community agencies, paraprofessionals  Consistent and generous insurance for at least 3 years with full parity for mental health care  Public education to reduce stigma  Support for survivors to participate as co- leaders  Federal allocation of about $1 billion to achieve goals 14

How Can We Achieve the Promise? “My sense of desperation is gone. I do not feel so alone and helpless in combating my day-to-day problems. My anger has subsided to the point that people see me differently (because I am different!) and my relationships with people have improved dramatically.” 15

16 Context for Improving Health Communications Half of all American adults, or 90 million Americans, have difficulty understanding or acting upon health information.

17 Health Literacy  Institute of Medicine defines as: “The degree to which individuals have the capacity to obtain, process, and understand basic health information an services needed to make appropriate health decisions.”

18 Challenges of Public Health Communication for Depression  Cultural Appropriateness  Literacy Level  Addressing Stigma 18 One approach is partner with consumers and communities to determine what they want!

19 Hurricane Katrina and Mental Health  Psychological Consequences –Grief and Bereavement –Post Traumatic Stress Disorder –Depression

20 Supporting Wellness for Katrina Survivors  How do we talk to Survivors of Katrina about Mental Health? Low Literacy Levels (<6 th Grade) Low Literacy Levels (<6 th Grade) Predominantly African American Predominantly African American Avoid Stigma around Mental Health Avoid Stigma around Mental Health

21  Current Partnerships to develop materials –UCLA / RAND NIMH Health Services Research Center –UCLA / RAND Center for Media, Medicine for Communities –Ecumenical Congress of Black Churches –Healthy African American Families –Catholic Charities –L.A. County Department of Mental Health –UCLA Department of Media Arts | Design –Pacificare –Partners in Louisiana and Mississippi

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