Treatment of Healthcare Professionals and Legal Professionals
Psychological Impact of the 2005 Disaster on Gulf Coast Attorneys & Healthcare Workers
The disastrous events of September, 2005 affected our country as a whole, the South Central United States as a region, the citizens of Mississippi and Louisiana in profound ways, and the residents of the Gulf Coast areas of those states in devastating ways. From August 30 through September 26, the top headline was about hurricanes Katrina or Rita all but five days in the New York Times and all but five days in the Los Angeles Times.
Mental health professionals have been called on to deliver services to the masses and professional assistance programs are working overtime to triage cases. Most professionals have been expected to function at higher levels despite the impact on their personal lives because community infrastructure is being rebuilt and/or redesigned. The theme of ‘injustice’ has prevailed in numerous situations and often attorneys have shouldered the responsibility of leading communities and maintaining civil equilibrium.
James Griffith, MD provided a workshop in November of 2005 on PTSD following Katrina and offered these observations. There is an acutely traumatized population, an over-burdened group of professionals, and a gross disruption of social and economic infrastructure. He identified some family dysfunction presently, a migration and displacement of families, a loss of a tax base and social services, and shifting of focus beyond the crisis.
A review of the published data concerning effects of disasters on mental health through 2004 showed the most common post-disaster condition to be posttraumatic stress, followed by depression, physiological stress responses including poor sleep, and sometimes an increase in alcohol or drug consumption, though this consumption may increase most in people who already had problematic use or developed other psychological syndromes. The more severe the disaster, the less the characteristics of individuals matter. In very severe disasters, virtually everyone shows adverse emotional responses.
Most studies that look at the effects of disasters on involved professionals assess samples of rescue and recovery workers. Our work is devoted to the evaluation and treatment of healthcare professionals (primarily physicians) and legal professionals (primarily lawyers and judges). We decided to undertake an evaluation of this population in Louisiana and Mississippi. We have used a successive cohort design, in which sub-samples were surveyed at various post-Katrina/Rita intervals throughout the Gulf Coast. The subjects were (N=185) voluntary attendees at 5 different educational presentations given during the year following the hurricanes on recovery topics.
We chose the Self-Report Questionnaire (SQR) because it is a robust instrument that measures psychological functioning and has numerous sub scales for analysis. This instrument was developed by the Division of Mental Health of the World Health Organization in 1994 and is utilized when assessing different natural and man-made disasters. In addition to English, the questionnaire is available in seventeen different languages. There are over thirty publications on the psychometric properties of the instrument. We have adopted the cutoff for items 1-20 as 7/8 which yielded an intra-class correlation of 0.963 (x²=198.32, df=26). If an individual scores above this cutoff, then there is an indication of the presence of significant psychological symptoms.
- 27% of the sample scored above the cutoff, therefore indicating the presence of significant psychological symptoms
- lawyers in the direct strike zone had statistically higher scores than those lawyers farther away from the direct strike zone
- 60% reported feeling worried, tense, or nervous while 54% reported having sleep disturbance
- 50% reported suffering daily at work while 44% reported having difficulties making decisions
- 40% reported feeling unhappy and having trouble thinking clearly
- 43% reported feeling tired all the time and 32% report having loss interest in daily activities
- 21% reported using Alcohol more than usual
- 20% reported having somatic symptoms
- 10% explained having thoughts of ending their life while 9% reported feeling like a worthless person
These results indicate a need for continued vigilance by CO-LAP members and all professional assistance programs as individuals have been displaced throughout the United States. Although the total score categorized 27% of the sample, individual items and sub scales revealed the need to address and explore specific struggles and coping strategies. Ehrenreich's model of the phases of disaster explains that individuals and communities are experiencing disillusionment, working through, and/or reconstruction. We believe as anticipated aid is offered in the region some will be seen as less fortunate than others, attorneys will have an increased level of stress in navigating the system, and deep rooted depression may follow. Individual's will be required to accept that they must depend on themselves if they are going to move on and rebuild their lives as failure to do this can lead to bitterness and unresolved animosity. Finally, the resilience literature describes the process of emerging from adversity with stronger and more capable skills. Traumatic events are frequently a source of energy for new ideas, discoveries, and growth.
Kimball, Miles; Levy, Helen; Ohtake, Fumio; and Yoshiro, Tsutsui, “Unhappiness after Hurricane Katrina,” National Bureau of Economic Research Working Papers, March 2006, Number 12062.
Norris, Fran H., “Range, Magnitude, and Duration of the Effects of Disasters on Mental Health: Review Update 2005, Research Education Disaster Mental Health, Dartmouth Medical School and National Center for PTSD.
Iacoponi, E. and Mari, J.J. (1989). Reliability and factor structure of the Portuguese version of Self-Report Questionnaire. The International Journal of
Social Psychiatry, 35 (3), 213-222.
Lima, B. R., Chavez, H., Samaniego, N., and Pai, S. (1992) Psychiatric Disorders among emotionally distressed disaster victims attending primary mental health clinics in Equador. Bulletin of PAHO, 26 (1), 60-66.
Ehrenreich, J. (2001). Coping with Disaster.
Dr. Philip Hemphill has been the Program Director of the Professional Enhancement Program at Pine Grove Behavioral Health & Addiction Services in Hattiesburg, Mississippi since 2002. He is responsible for the management and supervision of the clinical services of the Professional Enhancement Program, an intensive outpatient/residential treatment program for professionals who are struggling with addictive and personality disorders. In addition to administrative management of the program, he assists with evaluation, treatment planning, direct clinical care, fitness for duty issues, staff training, vocational and professional reintegration, and workplace monitoring. Prior to coming to Pine Grove, Dr. Hemphill worked at the Masters and Johnson Sexual Trauma and Compulsivity programs in New Orleans, Louisiana for 14 years where he was Director of Extended Care, Director of Research, and Director of Behavioral Therapy. He has been a consultant to Missouri, Kentucky, and Louisiana social service agencies in developing treatment for juvenile offenders. Between 1993 and 2005, he developed and supervised an outpatient program for juvenile offenders and their families at New Orleans Adolescent Hospital.
Alexis Polles, MD is a fellow of the American Psychiatric Association and has sub-specialty certifications in Addiction Psychiatry and Forensic Psychiatry. She is residency trained in Emergency Medicine. Dr. Polles has certification from the American Society of Addiction Medicine, is a Certified Sexual Addiction Therapist, and Eye Movement Desensitization and Reprocessing, Level II therapist. She has over 20 years experience in addiction evaluation and treatment of dually diagnosed professionals.