Authors: David Crompton; Peter Kohleis; Jane Shakespeare-Finch; Gerard FitzGerald; Ross Young · Research
Can Opportunistic Mental Health Screening Help After Natural Disasters?
Evaluating the effectiveness of mental health screening through a general health helpline after major floods and cyclones in Queensland, Australia
Source: Crompton, D., Kohleis, P., Shakespeare-Finch, J., FitzGerald, G., & Young, R. (2023). Opportunistic Mental Health Screening: Is there a Role Following a Disaster? Lessons from the 2010-2011 Queensland (Australia) Floods and Cyclones. Prehospital and Disaster Medicine, 38(2), 223-231. https://doi.org/10.1017/S1049023X23000092
What you need to know
- Opportunistic mental health screening through a general health helpline can effectively identify people at risk for psychological distress after natural disasters.
- Regions more severely affected by disasters had more callers reporting personal impacts and higher rates of mental health risk.
- While the screening identified many at-risk individuals, over 20% declined referral to specialized mental health services.
Background
Natural disasters like floods and cyclones can have significant psychological impacts on affected communities. However, many people may not seek mental health support directly after a disaster, leading to unmet needs. This study examined the effectiveness of incorporating mental health screening into calls to a general health helpline in Queensland, Australia following major floods and cyclones in 2010-2011.
The Screening Program
After the disasters affected 78% of Queensland, the state government established a mental health response plan that included a 24-hour health helpline called 13HEALTH. In 2012, the helpline began screening callers to assess the impact of the disasters, even if they were calling about unrelated health concerns.
The screening process worked like this:
- Callers were asked if they lived in a flood or cyclone-affected area.
- If yes, they were asked if they were personally affected.
- Adults who were personally affected were offered a brief mental health screening using the Primary Care-PTSD (PC-PTSD) scale.
- For calls about children, parents were asked if they noticed any behavioral or emotional changes in the child since the disasters.
Those identified as at-risk through the screening were offered referral to specialized mental health services.
Key Findings
Many Callers Affected
Out of 205,064 total calls to 13HEALTH in 2012:
- 19,708 callers lived in disaster-affected areas
- 7,315 adults reported being personally affected
- 907 adults scored as at-risk on the PC-PTSD screening
- 290 children were assessed as at-risk
Regional Differences
Areas more severely impacted by the floods and cyclones had 1.3-2.3 times more callers reporting being personally affected compared to less impacted regions. These areas also had higher rates of callers screening positive for mental health risk.
Referral Acceptance
Of those identified as at-risk:
- 77% of adults agreed to referral for mental health services
- 71% of parents agreed to referral for their at-risk child
This means over 20% declined referral despite screening positive.
Cost-Effective Approach
The total cost of the screening program in 2012 was $53,284 AUD (about $65,000 AUD in 2022). This works out to just $5.66 AUD per mental health screen conducted.
Why This Matters
This study demonstrates that incorporating brief mental health screening into general health services can be an effective way to identify people struggling with psychological impacts after disasters. Many callers were found to be at risk for mental health issues even though they called about physical health concerns.
The regional differences highlight how screening can help target resources to the most affected areas. The high rates of people declining referrals also show the ongoing challenge of connecting at-risk individuals to mental health care.
Limitations to Consider
The screening focused mainly on post-traumatic stress symptoms rather than other mental health issues like depression or anxiety that can also occur after disasters. Additionally, the study did not collect data on why people declined referrals, which could provide valuable insights for improving mental health outreach.
Implications for Disaster Response
This research suggests that integrating mental health screening into general health services could be a valuable part of disaster response plans. Some key takeaways:
- General health services like helplines can serve as an access point for mental health support.
- Brief screening tools can effectively identify those at risk.
- Outreach efforts may need to target the most severely affected regions.
- More work is needed to understand and address barriers to accepting mental health referrals.
Future Directions
The authors suggest that future disaster response could benefit from:
- Establishing mental health screening programs early in the disaster response
- Using disaster severity modeling to target high-risk areas
- Incorporating screening for a wider range of mental health issues beyond just PTSD
- Exploring ways to improve acceptance of mental health referrals
While technology has advanced since this study, with more options for digital and mobile app-based support, the core finding remains relevant: providing accessible entry points for mental health assessment and care is crucial after disasters.
Conclusions
- Opportunistic mental health screening through general health services can effectively identify at-risk individuals after disasters.
- Areas more severely affected by disasters show higher rates of personal impact and mental health risk.
- While screening can identify those in need, connecting people to mental health care remains challenging, with over 20% declining referrals.
- Integrating mental health screening into disaster response plans could help address unmet mental health needs in affected communities.