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The care of the mentally ill in Taiwan
Published in Dinesh Bhugra, Samson Tse, Roger Ng, Nori Takei, Routledge Handbook of Psychiatry in Asia, 2015
Kai-Da Cheng, Yu-Chen Lin, Cheng-Chung Chen, Winston W. Shen
The psychiatrist is the leader of the mental health team and is responsible for coordination of the team. The training program was set up by the Taiwanese Society of Psychiatry (TSOP) in 1988 and revised in 2012. Before becoming a psychiatrist, the candidate physician needs one year of postgraduate training and then a three-year psychiatric residency training course in an approved psychiatric residency training program. The training program includes clinical and lecture courses. The clinical courses include interview training, psychiatric emergencies, psychiatric consultation, forensic psychiatry, disaster psychiatry, and psychotherapy as well as practicum experience in acute wards and chronic wards, and day-ward practicum experience in the three-year residency training. During the clinical courses, they also need to receive training in psychiatric subspecialties such as geriatric psychiatry and addiction psychiatry, as well as child and adolescent psychiatry. Each psychiatric resident has at least one supervisor in the different courses, and is responsible for 15 patients in the acute ward and 50 patients in the chronic ward and day hospital. The lecture courses include psychopathology, psychopharmacology, and other psychiatry-related fields.
Fourteen Years Later: Hobfoll and Colleagues Five Principles of Psychological First Aid through the Lens of the COVID-19 Global Pandemic
Published in Psychiatry, 2021
James C. West, Joshua C. Morganstein, David M. Benedek
Fourteen years ago, Hobfoll and colleagues published a seminal article in the disaster psychiatry literature, “Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence” (Hobfoll et al., 2007). This expert consensus’ five essential elements, which came to be known as the principles of Psychological First Aid (PFA) include promoting a sense of safety, calming, self- and community efficacy, connectedness, and hope. The elements of PFA were conceived at a time when the world was recovering from major disaster events including the 9–11 attacks, the South Asian tsunami of 2004, and Hurricane Katrina. Since its publication, the pace of disaster response has only increased. Mass shootings in Paris and Las Vegas, the Haiti and Great Japan Earthquakes, and the COVID-19 pandemic are extreme examples that illustrate the need for a coherent framework for disaster responders to approach the distress and illness that inevitably follow. As an evidence-informed framework of intervention, PFA has been a component of the disaster response to all these events. PFA frameworks are the standard of acute mental health intervention following disaster for the American and International Red Cross, the World Health Organization, and countless non-governmental and municipal organizations around the world. PFA has been incorporated into education curricula for medical and nursing students, other healthcare workers, and first responders. It is an easily teachable skill, and the five essential elements have utility for assisting distressed individuals beyond the disaster setting.
President’s message: The COVID-19 pandemic through the lens of disaster psychiatry
Published in Journal of Addictive Diseases, 2020
I wanted to take this moment to look through the lens of disaster psychiatry and see what lessons can be learned to inform us during the COVID-19 pandemic. First, how are disasters are defined in the literature? Disasters are community-wide events that result in collective trauma and substantial losses for many people at one time. Commonly we think about natural disasters, technological disasters, and mass violence. With climate change, we have seen a rise in devastating hurricanes, wildfires, and floods. We have lived through technological disasters, including failures of levees and nuclear reactor accidents. Sadly, we have become accustomed to mass shootings and lived through terrorist attacks. Until this year, pandemics were not at the forefront of most of our minds when we thought about disasters, as the other types of disasters are much more common than a pandemic. COVID-19 is the fourth pandemic since the Spanish Flu of 1918, so there is little to no research on how pandemics affect substance use in a population. There are several studies, however, on how other types of disasters (e.g., hurricanes, tornados, mass shootings) affect substance use. We know that post-disaster mental health and substance use affect each other. Disasters have been prospectively linked to depression and anxiety as well as increases in tobacco, alcohol, and cannabis use. People with post-disaster mental illnesses smoke more tobacco and cannabis and drink more alcohol than those without. Furthermore, people who engage in smoking and drinking following a disaster are more likely to develop mental illness.1
Lessons for psychiatrists from the COVID pandemic: the need for expanded roles and additional competencies
Published in International Review of Psychiatry, 2021
Vinay K. Parekh, Karen L. Swartz
The literature on disaster psychiatry stresses the importance of focussed evaluation with careful monitoring for the emergence of serious psychiatric syndromes and practical support (Everly et al., 2012; Everly et al., 2016). Psychological First Aid (PFA) is an evidence-based approach to crisis response that has demonstrated excellent efficacy for the evaluation and initial triage of individuals following a variety of disasters (Ng & Kantor, 2009; Fox et al., 2012; Everly et al., 2012; Everly & Lating, 2017; Despeaux et al., 2019). PFA is a subset of psychological crisis intervention that emphasises stabilisation and mitigation goals. One central principle of PFA is to monitor those who are distressed in response to a disaster and have specific interventions for those with dysfunction. This approach is complementary to the traditional role of psychiatrists which emphasises the evaluation and treatment of those with psychiatric conditions. Psychiatrists often collaborate as members of multidisciplinary teams, but they often fulfil traditional consultative roles. The COVID-19 pandemic presents multiple challenges for psychiatrists: a greater community need for mental health services, adaptation to remote service delivery, and necessary changes in practice methods. These changes go beyond the usual response to a natural disaster such as a flood, fire, or hurricane. With multiple waves of infection, each hitting before the community has had a chance to return to a healthy level of functioning, there is the potential for progressively worsening psychological functioning in the community lasting far after the pandemic recedes. This creates even greater demands on psychiatrists and other mental health providers.